What is female sexual dysfunction, and what can I do about it?

Prepared in consultation with Timothy P. Canavan, MD

In the past few years, men’s sexual problems have received a great deal of attention, but women’s sexual problems are still not as openly or as often discussed. In reality, it is reported that female sexual dysfunction is very common and affects between 25% and 63% of all women in the United States. Many women find it embarrassing to discuss their sexual problems, but it is important that your physician be aware of any sexual difficulties you have, as such problems may signal the presence of a medical condition or the effects of any medication you are taking. Medical conditions, such as diabetes or hypertension, are known to affect women’s sexuality.

What is female sexual dysfunction?

Sexual dysfunction is the general name used for a variety of conditions interfering with a woman’s sexual function, such as pain during or after sex, lack of desire, inability to get aroused or to reach orgasm, or fear of sex. Many women experience some change in their sexual function just before, during, or after menopause. However, these difficulties can affect you at any age and can cause stress or bother for you or for your partner.

What causes sexual dysfunction?

In addition to emotional or relationship issues that may interfere with your interest in or ability to enjoy sex, many medical conditions—such as cancer, depression, fatigue, headache, low hormone levels, being overweight, urinary incontinence—can all cause serious problems with sex. Many medications used to treat any of these conditions may affect your desire level, ability to reach orgasm, or cause pain with sex. Even herbal supplements or nonprescription products can affect your sex life. Smoking is another common cause of sexual problems.

What are the characteristics of female sexual dysfunction?

The following conditions explain what type of problem you may be experiencing. If you think you may be affected by any of these conditions, you should make an appointment with your primary care physician. Many sexual problems can be effectively treated, even lack of interest in sex.

If you are often or persistently lacking in sexual desire or feel heightened sexual desire that distresses you, there may be a medical reason for this. Many people associate decreased sexual desire with aging, but this is not necessarily the case. Decreased desire can sometimes be a sign of decreased hormone levels, which often affect women in menopause but can also affect younger women. Certain medications can cause low sexual desire, as can certain medical conditions (for example, heart disease), smoking, or surgery.

Difficulty in becoming aroused, staying aroused, or maintaining vaginal lubrication even though you feel you are getting enough sexual stimulation are usually symptoms of a medical condition. If you have noticed less feeling in your clitoris and labia than you used to, this could also be a signal of an arousal disorder, which can be caused by diminished blood flow to the vagina and clitoris, menopause, diabetes mellitus, or radiation therapy to the pelvis.

Many things can cause pain during sex. The cause may sometimes be psychological, but often it is the result of decreased vaginal lubrication, vaginal or urinary tract infection, vaginal scar tissue, endometriosis, or a condition called vaginismus, in which the vaginal muscles involuntarily tighten, sometimes to the point where penetration of the vagina is impossible. If you usually experience pain with intercourse or with other forms of sexual stimulation, you should consult your physician.

If reaching orgasm is difficult for you, or if you do not orgasm at all, you should ask your physician for help. Medical conditions, such as poor blood flow, can cause orgasmic problems but relationship problems are also a very common cause of a delay or difficulty in reaching orgasm.

This condition is characterized by a persistent, phobic aversion to sexual activity. The aversion can be to anything sexual, or it may just be specific to one kind of sexual act or one partner. These disorders usually have a psychological cause.

Will menopause change my sex life?

It is possible that after menopause you may experience body changes that can affect your sex life. You may notice a decrease in vaginal lubrication, less sensitivity of your clitoris, painful contractions of the uterus during orgasm, less interest in sex, or less intense orgasms. However, research shows that women who remain sexually active during menopause, with a partner or by self-stimulation, usually experience fewer body changes that could potentially interfere with sex. If you notice less vaginal lubrication, water-soluble lubricant can be used to ease discomfort, or you may ask your physician about estrogen cream. It might also help to increase the length of foreplay; after menopause it usually takes longer for the vagina to become naturally lubricated.

What about my partner?

It is always important to involve your partner. Talk openly about your sexual likes and dislikes and any sexual problems that you may be having. If you feel confident that your sexual difficulties are not a result of relationship problems and decide to consult your physician, bring your partner with you to the appointment. If you are in a sexually abusive relationship, talk to someone you trust. Taking about sexual abuse is difficult, but staying in an abusive relationship only gets worse with time.

What can I do about it?

If you are having a problem related to your sex life that bothers you or your partner, the first step should be to see your physician so that you can be properly diagnosed and treated. If you feel your sexual problem may stem from problems within your relationship with your partner, you may wish to address those problems with your partner first, or consult with a sex therapist. If your partner is not providing enough stimulation, it may be helpful to self-stimulate or encourage your partner to provide extra stimulation. Sometimes women feel more comfortable watching an erotic video or reading a “sexy” book with their partner to see if this may help before consulting a physician.

Kegel exercises have been suggested as a way to help retain the muscle tone and elasticity of your vagina, or even to enhance sexual pleasure. By rhythmically contracting your pelvic muscles as though you are stopping a stream of urine for 5 to 10 seconds, about 50 times a day, you can learn to increase your control of your sexual organs. Remember, treatments are available. Ask your physician for help, even if you are embarrassed.

What about my partner?

The questions your physician asks may be quite extensive: this is the only way that he or she can be sure to completely understand your problem and determine the best treatment for you. It is important for you to be as open and honest as you can when providing the answers to such questions:

  • Are you sexually active?
  • Is your sexual activity satisfying for you? For your partner?
  • Do you have any concerns about your sex life?
  • How long has this been a problem? Did it begin gradually or suddenly?
  • Is this a problem every time that you attempt sex? For example, is it a problem when you masturbate? When you are with your partner?
  • Do you experience desire, mental excitement, and orgasm?
  • How have you reacted to this problem? How has your partner reacted?
  • Have you tried treatment previously?
  • What medications are you currently using, including any supplements?

Note: To locate a recommended sex therapist in your area, call AASECT, at 804-644-3288.