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A sexual problem is something that keeps sex from being satisfying or positive.
Most women have symptoms of a sexual problem at one time or another.
For some women, the symptoms are ongoing. But your symptoms are only a sexual
problem if they bother you or cause problems in your relationship.
There is no "normal" level of
sexual response because it's different for every
woman. You may also find that what is normal at one stage of your life changes
at another stage. For example, it's common for an exhausted mother of a
baby to have little interest in sex. And it's common for both women and men to
have lower sex drives as they age.
Female sexuality is complicated. At its core is a need for closeness and
intimacy. Women also have physical needs. When there is a problem in either the
emotional or physical part of your life, you can have sexual problems.
Some common causes include:
Symptoms of sexual problems can
You may notice a change in desire or sexual
satisfaction. When this happens, it helps to look at what is and isn't working
in your body and in your life. For example:
Your doctor can help you decide what to do. He or she
will ask questions, do a physical exam, and talk to you about possible causes.
It can be hard or embarrassing to talk to your doctor about this. Sometimes it helps to write out what you want to say
before you go. For example, you could say something like, "For the past few months,
I haven't enjoyed sex as much as I used to." Or you could say, "Ever since I
started taking that medicine, I haven't felt like having sex."
Treatment for a sexual problem depends on the cause. It may include treating a health
problem, learning how to talk openly with your partner, and learning about things you can
do at home. For example, you might take a warm bath to relax, have plenty
of foreplay before sex, or try different positions during sex.
It's important to feel comfortable talking with your doctor. The more you can tell your doctor, the more he or she will be able to help you.
Learning about sexual problems in women:
Your sexuality is a mixture of mental,
emotional, and physical signals. A problem in one area can grow to involve
Mental and emotional causes: These include stress, depression, relationship problems, fear, a history of sexual abuse or rape, and being unhappy about your body.
Physical causes: These include natural hormonal changes, such as those related to your
menstrual cycle, birth control pills, or pregnancy. Physical causes also include injuries, pain during sex, and certain health problems, such as diabetes, endometriosis, or arthritis.
Medical treatments: Sometimes treatments for other illnesses or conditions—such as past surgeries or cancer treatments—cause changes that result in pain during sex or other problems. For example, it's common for a woman who has had her
breast removed or has had her uterus and
ovaries removed to have less sexual desire.
Medicines: Some medicines may lower sexual desire and arousal. These include certain medicines for high blood pressure, diabetes, depression, and allergies.
Getting older: As a woman ages, she may have a decrease in sexual desire. She may need more time to feel sexually aroused. And aging can cause physical changes. Vaginal walls may grow thinner. The vagina itself may narrow or shorten. There may be less lubrication. These changes can cause pain during sex.
Alcohol and drug abuse: Drinking too much or continually using illegal drugs like cocaine or amphetamines will eventually cause problems with orgasm and sexual desire.
sexual problems can include:
These symptoms are problems only if they bother you or cause problems in your relationship with a
Many things in a woman's life can lead to a sexual problem. Over time, an untreated sexual problem can have a growing impact on your quality of life. If the problem makes you feel uncomfortable and/or unsatisfied, sex can become a tense and unwelcome experience.
Women normally experience a physical change
during sexual arousal, as blood swells areas of the
vulva. If those areas aren't stimulated enough, a woman may not feel as much sexual pleasure.
Chronic (ongoing) illnesses, such as
arthritis, can affect sexual desire, enjoyment, and
Medicines for many medical conditions also affect
desire and arousal.
Any history of pain during sex may cause a
woman to avoid sex or find it unpleasant.
Pain during sex may result from:
Living situations that give
couples very little privacy can interfere with feelings of
Your partner's level of sexual skill and attention
can play a big part in your sexual enjoyment. A positive,
respectful connection between partners sets the stage for sexual interest and
Positive sexual experiences help build a healthy
sexuality. On the other hand, a woman who has had a forced sexual experience is
likely to have mixed feelings about sex. In one study, 1 out of 5 women reported
having been forced to do something sexual. This was most often done by someone
they were close to.2
Some women feel guilty, embarrassed, ashamed, or self-conscious during sex.
A woman may avoid sex because she's afraid that an illness (such as cancer) or surgery (such as mastectomy or hysterectomy) will make sexual activity unpleasant for one or both partners.
Or she may be afraid of spreading a sexually transmitted infection, such as genital herpes.
As a woman ages, she may have sex less often because she no longer has a partner or her partner has lost interest in or is no longer able to have sex. Many older women also report problems with lubrication.
Women may notice less desire for sex after menopause.
It may take longer to feel
sexually aroused, and
orgasms may be briefer. But orgasms still will offer
mental and physical pleasure to most women.
Women can feel sexual pleasure throughout their lives. But those
who stop having sex after menopause have more shrinking and drying of the
vagina than women who continue to have sex.2
A risk factor is anything that increases your chances of having a problem. The main risk factors for sexual problems are:
Other risk factors include:
Most women have a sexual problem at one time or
another. For some women, the problem is long-term.
Surveys of the general
population in the United States found that many women occasionally have sexual
problems and worries. These may include:2
Call a doctor for immediate care if you have sudden, severe
doctor for an appointment if you feel pain or discomfort in your vaginal area. You may have a
vaginal infection or a
sexually transmitted infection.
Watchful waiting is a wait-and-see approach. If
you improve on your own, you won't need treatment. If you don't improve, you
and your doctor will decide what to do next.
If you are having pain with sex, you need to see a doctor. For other sexual problems, it may help to talk with your doctor before trying watchful waiting.
During watchful waiting, you might try home treatment, such as lubrication and
exercises to stimulate sexual desire.
Maintaining honest and frequent
communications with your doctor will help you decide whether medical treatment
Health professionals who
can help you evaluate your symptoms and treat a
sexual problem include:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Your doctor will work with you to identify your symptoms. He or she will:
It can be embarrassing to talk about sexual problems. It may help to remember that a sexual problem is no different than any other health problem. There is usually a treatment that will help.
Treatment will depend on the type of sexual problem you're having. Treatment may
Treatment for physical causes
of this problem can include:
counseling as a couple can help strengthen your emotional connection with your
partner. Improving a stressed relationship is likely to improve your sexual
There are also steps you can take at home that may raise your sexual desire. To learn more, see Home Treatment.
Having a partner you feel comfortable and
nonstressed with plays a big part in your desire level. It's normal to lack desire for a partner who forces
sex or is verbally abusive or physically violent.
Treatment for decreased sexual excitement may
include learning about the role emotions play and about how a woman's arousal sometimes depends on stimulating other parts of her body, especially her breasts.
Treatment may also include:
Treatment usually begins with
changing any medicine that is known to affect orgasm. But don't stop taking your medicine without talking to your doctor first.
If you're having trouble with orgasm or it takes much longer than it used to, you can try a number of things at home, such as self-stimulation and fantasy.
It may also help to find out more about sexual response. For example, most women find it easier to have an orgasm from direct clitoral stimulation. And most couples do not have orgasms at the same time.
If pain is caused by a physical problem, treating that problem may get rid of the pain. But pain during intercourse may have
more than one cause, including psychological causes such as anxiety or the
memory of sexual assault.2
Pain that occurs when the penis first enters the vagina may be caused by involuntary contractions of the vagina
(vaginismus). This is sometimes related to a lack of experience with sex.1
Treatment may include a program of
progressive muscle relaxation and gradual vaginal dilation, possibly including
But pain during initial penetration also may be caused by
vaginal irritation or another physical problem. If so, getting rid of the pain
will require treating the physical reason.
If the pain is caused by the deep thrusting of the
penis, the cause may be a pelvic disease. But it may also be caused by not being able to relax. Being able to talk openly with your doctor will help you explore the cause of the pain and decide on treatment.
Vaginal dryness after menopause can sometimes be treated at home with lubrication.
home treatment doesn't work as well as you need it to, talk to your doctor about
using estrogen. This hormone can be used in several forms to help menopause-related problems. To learn more, see Medications.
You can take
the following steps to help prevent sexual problems.
Being sexually active with a partner or through masturbation helps maintain vaginal health. And having regular sexual intercourse helps preserve vaginal elasticity and keeps vaginal tissues from shrinking.
You can try a number of things at home that may help your sexual problems.
You may be able to increase your sexual desire and arousal with:
Lack of lubrication in the vagina is the most common cause of pain with sex.
Nonprescription water-based products that
provide vaginal lubrication can help. You can typically find these
products, such as Astroglide and K-Y Jelly, at pharmacies, usually near the
Vaginal moisturizers, such as Replens, are not for use right before sexual intercourse. But when used regularly, they can help with vaginal dryness.
Exercises can help you develop muscular control of contraction and relaxation of the pelvic muscles.
This can increase sexual arousal and improve orgasm. You can improve pelvic floor muscle strength using
Kegel exercises or vaginal weights.
Vaginal weights usually come in five sizes. You start with the smallest weight, and work up to the largest over time. Insert a weight into your vagina, then hold it in place while standing upright for 15 minutes. Your muscles will feel the urge to tighten and hold it in.
After a few days, the vaginal muscles become strong enough that they no longer feel an urge to hold the weight. This is when you use the next larger weight. When you've used all five weights, keep your muscles toned by using the largest weight for 5 to 7 days in a row each month.
Medicines may be used in treating certain conditions that contribute to
For women who have pain in the area around the opening of the vagina (vulvodynia), putting on lidocaine gel shortly before sex may be helpful. Talk to your doctor about how to use the gel safely.
If you only have
vaginal dryness and irritation (and not other symptoms such as hot flashes),
you can use a limited amount of
estrogen in a cream, tablet, or ring in the vagina.
The daily estrogen makes your vaginal lining thicker.
Many women find that using a cream or tablet twice a week is enough. This may
increase vaginal tone and lubrication, which will decrease
vulvar dryness, irritation, and shrinkage (atrophy).
If you also have other
menopausal symptoms that affect physical and mental
well-being, talk to your doctor about taking daily estrogen.
Estrogen can increase the blood flow in the
vagina and reduce hot flashes and other
Estrogen therapy or
estrogen-progestin therapy can be oral (pills),
vaginal, or transdermal (with a patch). In a small number of women, hormone
therapy can cause heart disease, breast cancer, ovarian cancer, dangerous blood
clots, stroke, and dementia. Talk to your doctor about whether this therapy is
right for you.
may play a part in a woman's sex drive and satisfaction. Your ovaries make
testosterone throughout your life. Women have
the most testosterone in early adulthood. Testosterone levels drop by half
between the early 20s and the early 40s.
A woman who has had surgery to remove her uterus (hysterectomy) and ovaries (oophorectomy) will suddenly be in menopause. She will have an immediate drop in both estrogen and testosterone. She may then have a problem with sexual desire. If so, her doctor may suggest hormone therapy.
Ospemifene (Osphena) is used to reduce vaginal changes that can make sex painful.
Sildenafil (Viagra), which is used to treat
erectile dysfunction in men, is being studied for use in women who have arousal problems but has not been shown to work.3
Surgery isn't used to treat sexual problems unless pain is caused by endometriosis or another medical condition.
There are advertised procedures, such as "vaginal rejuvenation" surgeries, that promise to increase sexual pleasure. But such surgeries may not provide any benefit. And they may cause harm. They also may be costly and painful.
Researchers continue to look for
treatments for raising sexual desire, arousal, and satisfaction. The research includes both devices and herbal supplements.
such as different vitamins and herbs, are promoted as natural treatments for
sexual problems. But most of these products have not been subject to the same
kind of testing for safety and effectiveness that standard
medical treatments must go through before they are approved in the United
If you decide to use an alternative medicine or supplement, follow
Like testosterone, DHEA (dehydroepiandrosterone) is an
androgen made in the body. Over-the-counter
This is a small
battery-operated device used to stimulate engorgement of the clitoris. It was cleared by the U.S. Food and Drug Administration (FDA) for sale in the U.S. in 2000.
Using this device is said to increase lubrication and clitoral sensation, to help with achieving orgasm, and to improve women's sexual satisfaction.
Initial studies have shown good results in women reporting sexual problems and also in women recovering from cervical cancer treatment.4
The North American Menopause Society (NAMS) is a nonprofit
organization that promotes the understanding of menopause and thereby improves
the health of women as they approach menopause and beyond. NAMS members include
experts from medicine, nursing, sociology, psychology, nutrition, anthropology,
epidemiology, pharmacy, and education. The NAMS website has information on
perimenopause, early menopause, menopause symptoms and long-term health effects
of estrogen loss, and a variety of therapies.
Haessler A, Rosenthal MB (2007). Psychological aspects
of obstetrics and gynecology. In AH DeCherney, L Nathan, eds., Current Diagnosis and Treatment Obstetrics and Gynecologic,
10th ed., pp. 1003–1024. New York: McGraw-Hill.
Baram DA (2007). Sexuality, sexual dysfunction, and
sexual assault. In JS Berek, ed., Berek and Novak's Gynecology,
14th ed., pp. 313–349. Philadelphia: Lippincott Williams and
Drugs for female sexual dysfunction (2010). Medical Letter on Drugs and Therapeutics, 52(1353/1354): 100–102.
American College of Obstetricians and Gynecologists (2011). Female sexual dysfunction. ACOG Practice Bulletin No. 119. Obstetrics and Gynecology, 117(4): 996–1007.
Other Works Consulted
Potter J (2009). Female sexuality: Assessing satisfaction and addressing problems. In EG Nabel, ed., ACP Medicine, section 16, chap. 22. Hamilton, ON: BC Decker.
Agronin ME (2009). Sexual disorders. In DG Blazer et al., eds., American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th ed., pp. 357–373. Washington, DC: American Psychiatric Publishing.
Basson R (2006). Sexual desire and arousal disorders in women. New England Journal of Medicine, 354(14): 1497–1506.
Becker JV, Stinson JD (2008). Human sexuality and sexual dysfunctions. In
RE Hales, SC Yudofsky, eds., American Psychiatric Publishing Textbook of Psychiatry, 5th ed., pp. 711–728. Washington, DC: American Psychiatric
Goldstein I (2007). Urological management of women
with sexual health concerns. In AJ Wein et al., eds., Campbell-Walsh Urology, 9th ed., vol. 1, pp. 863–889.
Philadelphia: Saunders Elsevier.
Gretchen ML (2007). Emotional aspects of gynecology.
In MA Stenchever et al., eds., Comprehensive Gynecology,
5th ed., pp. 177–194. St. Louis: Mosby.
Sadock VA (2009). Normal human sexuality and sexual and gender identity disorders. In BJ Sadock et al., eds., Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, 9th ed., vol. 1, pp. 2027–2060. Philadelphia: Lippincott Williams and Wilkins.
April 30, 2013
Sarah Marshall, MD - Family Medicine & Kirtly Jones, MD - Obstetrics and Gynecology
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