Understanding Sexual Dysfunction in Women

Sexual dysfunction is the medical term for ongoing issues with desire (aka libido), arousal, orgasm, or pain during intercourse that cause distress to you or your partner and impact overall wellbeing.

It’s important to remember that it’s normal to experience problems with sex at some point in your life. It can occur to anyone at any stage of life regardless of age, gender, or health status.

Sexual response is a complex process, and it can be influenced by many different issues, including physical factors, psychological factors, lifestyle factors, social factors, hormonal factors, and relationship factors.

It’s also important to remember that sexual dysfunction is, for the most part, a subjective finding. If you and your partner are satisfied with your sex life, that’s great. If you and your partner are happy with your desire, arousal, and orgasms, then keep doing what you’re doing.

The one exception is painful sex (dyspareunia). It’s not normal to experience pain with sex, and this condition should be evaluated by a gynecologist or health care provider who is well-versed in diagnosing and treating women’s reproductive health issues.

It’s one thing to bite your lip when having great sex, but it’s another thing altogether to bite your lip/grin and bear it when feeling discomfort or pain during sex.

If you’ve been experiencing problems with sex, keep reading to gain a better understanding of sexual dysfunction in women – including the different types, causes, and symptoms of sexual dysfunction as well as the various diagnostic techniques and treatment options that are available.

Types of Sexual Dysfunction in Women

Broadly, female sexual dysfunction can be broken down into four categories:

Desire Disorders

The most common type of sexual dysfunction in women involves a low or absent interest or desire for sex. You might also hear the term: Hypoactive Sexual Desire Disorder (HSDD).

Arousal Disorders

This occurs when a person has a problem achieving or maintaining arousal despite having a desire for sexual activity.

Orgasm Disorders

This disorder may be diagnosed when someone has difficulty achieving orgasm even with enough sexual arousal or starts experiencing orgasms with reduced intensity.

Pain Disorders

This disorder happens if someone feels pain during or after sex. This can also lead to avoidance of sex or intimacy due to fear of feeling discomfort or pain during sex.

Common Causes of Female Sexual Dysfunction

Getting sex ‘right’ can be a challenge for many people. So, figuring things out when sex is going ‘wrong’ can often feel insurmountable. But it’s not. Even if sex is complicated by a confluence of factors, when it comes to sexual dysfunction, there are certain factors that seem to be in play more often than others.

Physical Factors

Hormonal Changes

Perimenopause, menopause, and pregnancy can lower estrogen levels (or cause them to fluctuate), which can reduce the desire to want sex. Lower estrogen after menopause can lead to changes in vaginal tissues (thinner, less stretchy) and reduce vaginal lubrication, which can make sex painful. Hormonal changes can also reduce blood flow to the pelvic region and make it more difficult to become aroused and achieve orgasm.

Medical Conditions

Cancer, diabetes, heart disease, neurological disorders, chronic pain, genital surgery, and pelvic floor dysfunction (among others) can decrease blood flow, make sex uncomfortable, lower libido, and lead to sexual health problems.

Medications

Certain medicines can decrease sexual desire and make it harder to have an orgasm. These include medicines to treat depression (like SSRIs), high blood pressure, and cancer.

Psychological Factors

Stress

Stress is a killer. It can cause a slew of health problems, including high blood pressure and sexual dysfunction.

Anxiety and Depression

Both conditions can reduce interest in pleasurable activities, interfere with enjoyment of those activities, cause low self-esteem, and lead to problems with sex.

Past Sexual Trauma

Experiences with sexual assault or abuse can create emotional barriers that make it hard to want sex or be present in the bedroom.

Lifestyle Factors

Smoking, Alcohol and Recreational Drug Use, Sleep Problems, and Lack of Physical Activity

All of these issues can impair sexual function in profound ways.

Relationship Factors

Communication Issues

Misunderstandings and unresolved conflicts can wreak havoc on sexual desire.

Lack of Emotional Connection

Feeling disconnected from your partner can make sex seem like a chore.

Trust Issues

Resentment and trust issues can dimmish desire and disrupt every step in the sexual response cycle, including desire, arousal, orgasm, and resolution.

How Doctors Diagnose Sexual Dysfunction in Women

In order to diagnose sexual dysfunction, your health care provider will likely ask some personal questions about your sex life. This can be awkward and uncomfortable for many people, but it’s important to be open and honest during this q and a.

Sexuality is a key part of your overall wellbeing and being forthright about your body, your partner, your sexual function, and your feelings increase the chance of finding a treatment.

Typically, your doctor will begin by reviewing your sexual history, including the current state of your sex life and past sexual experiences, and any relationship factors that may be contributing to your issues. Your provider will also ask about your medical history to check for underlying health conditions and medications.

She may perform a physical exam to assess causes related to infections or anatomical issues and conduct a pelvic exam to check for changes that could be contributing to your sexual dysfunction, like vaginal thinning or vulvar pain. If warranted, your provider may also draw blood to rule out common health issues, like hypothyroidism, that can cause sexual problems in many people.

Treatment Options for Female Sexual Dysfunction

Remember, sexual dysfunction is only a problem only if it bothers you and your partner. So, treatment usually begins with a healthy dose of self-reflection and open communication with your partner. Most often, treatment for sexual dysfunction involves a mix of treatments, and thankfully, there are many medications and lifestyle modifications that have been shown to help with sexual problems.

Medication

Estrogen Therapy

Vaginal estrogen cream can be applied to the vagina to relieve dryness and improve thinning, which can help with pain during sex. This topical treatment delivers a small amount of estrogen to the vagina and doesn’t enter the bloodstream or impact other areas of the body. Systemic estrogen (pills, patches) is also an option to consider.

Ospemifene (Osphena)

Taken by mouth, this selective estrogen receptor modulator (SERM) medicine treats painful intercourse linked to the thinning of vaginal tissue.

Testosterone therapy

Testosterone plays a role in healthy sexual function in women as well as men. Many providers prescribe testosterone ‘off label’ to improve desire in women.

Flibanserin (Addyi)

This medication, which is taken once daily, is approved for use before menopause to treat low sexual desire.

Bremelanotide (Vyleesi)

This is another FDA-approved treatment for low sexual desire in premenopausal people. This medicine is a shot you give yourself just under the skin in the belly or thigh before having sex.

Prasterone (Intrarosa)

You put this insert or suppository of human-made hormone dehydroepiandrosterone (DHEA) into the vagina. It helps ease vaginal dryness and pain with intercourse.

Lifestyle Modifications

• Manage stress
• Get regular exercise
• Limit alcohol
• Eat a healthy diet
• Avoid smoking
• Stay sexually active
• Improve communication with partner
• Use lubricant and a vaginal moisturizer
• Try a device, such as a vibrator

Therapy

Pelvic floor therapy

These exercises strengthen pelvic muscles, improve blood flow, and can reduce pain and discomfort with sex.

Talk and listen

Good sex requires good communication. Talk openly and honestly with your partner about needs and concerns in the bedroom and relationship issues outside of it.

Seek counseling

A good sex therapist or couples’ counselor can help address psychological and relationship barriers, improve communication and emotional intimacy, and offer tools for managing stress, anxiety, and past traumas.

Conclusion

Sexual dysfunction in women is a common, treatable issue that many people face. If you’re experiencing persistent problems in the bedroom, talk to your partner and don’t be ashamed to seek medical advice. There are many commonsense methods for improving intimacy and the joy of sex, including medications, lifestyle changes, and talk therapy. Sexual health is health and an important component of wellbeing.