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What Are the Types of Female Sexual Problems?
Types of female sexual problems include low desire, lack of arousal, difficulty reaching orgasm, pain during sex, and drug-related sexual dysfunction
Female sexual dysfunction is a broad term for sexual problems in women, which fall into five categories that often overlap with each other:
1. Low desire
Some women have little or no interest in sex until they engage in sexual activity, at which point they become aroused. Sexual dysfunction occurs when a woman:
- Lacks interest in any sexual behavior, including masturbation
- Has few or no sexual fantasies, ideas, or dreams
- Is worried about her lack of sex drive
- Does not want to initiate sexual intercourse with her partner
- Does not experience pleasure during sexual intercourse
2. Lack of arousal
Women may have difficulty becoming or being physically aroused, even if they are interested in sex. Some women who have this porblem don’t produce enough vaginal lubricant for sexual activity. This could be attributed to various causes, both physical and psychological.
3. Difficulty reaching orgasm
Some women never have orgasms or reach climax during sexual intercourse. Other women may want to have orgasms but have never had orgasms before and are unable to reach climax. In some cases, women may find that their orgasms are not as intense as they used to be.
4. Pain during sex
Some women experience pain when they have vaginal intercourse. This may be due to lack of lubrication, cervical erosion, or anxiety issues.
5. Drug-related sexual dysfunction
Some women experience sexual problems shortly after taking or stopping certain drugs. The following drugs have the potential to causesex problems:
- Anticholinergic medications
- Birth control pills
- Blood pressure medications such as beta blockers
- Selective serotonin reuptake inhibitors
- Opioids
- Chemotherapy
- Alcohol
- Marijuana
Sexual behavior is a uniqe combination of physiological, anatomical, and psychosocial factors that vary from person to person. The first step toward understanding sexual dysfunction is to establish a baseline of expected anatomic and physiologic responses to sexual stimulation in healthy people.
Factors that can lead to female sexual dysfunction include:
- Physical: Sexual dysfunction can be caused by medical conditions such as cancer, kidney failure, multiple sclerosis, heart disease, and bladder problems.
- Hormonal: After menopause, lower estrogen levels may cause changes in your genital tissues and sexual responsiveness. A decrease in estrogen causes a decrease in blood flow to the pelvic region, which can result in less genital sensation, making it more difficult to build arousal and reach orgasm. With age, the vaginal lining thins and loses elasticity, especially if you are not sexually active. These factors can result in dyspareunia (painful intercourse). Hormone levels in your body change after giving birth and during breastfeeding, which can cause vaginal dryness and affect your desire to have sex.
- Psychological and social: Untreated anxiety or depression, as well as long-term stress and a history of sexual abuse, can cause or contribute to sexual dysfunction. Pregnancy worries and the demands of being a new mother may have similar effects. Long-standing disagreements with your partner about sex or other aspects of your relationship can reduce your sexual responsiveness. Cultural and religious issues, as well as body image issues, can also play a role.
Risk factors of female sexual problems include:
- Depression or anxiety
- Heart and blood vessel disease
- Neurological conditions, such as spinal cord injury or multiple sclerosis
- Gynecological conditions, such as vulvovaginal atrophy, infections, or lichen sclerosis
- Certain medications, such as antidepressants or high blood pressure medications
- Emotional or psychological stress, especially about your relationship with your partner
- History of sexual abuse
How are female sexual problems diagnosed?
Individuals or their partners may become aware of sexual problems before talking to a doctor. Your doctor may confirm a diagnosis by:
- Taking your medical history followed by a thorough physical examination
- Determining whether there are any predisposing illnesses or physical conditions
- Determining whether there are any fears, anxieties, or guilt associated with sexual behaviors or performance
- Determining whether there is a history of prior sexual trauma
- Performing a pelvic exam if you are in pain
- Examining you for signs of infection through urine tests or cervical or vaginal fluid tests
What are the treatment options for female sexual problems?
Treatment of female sexual problems varies greatly due to the wide range of possible symptoms and causes. Women with sexual concerns often benefit from a multifaceted treatment approach.
Nonmedical treatment of female sexual dysfunction
- Communication: Open communication with your partner can make a huge difference in your sexual satisfaction. Even if you’re not used to discussing your likes and dislikes, learning to do so and providing feedback in a nonthreatening manner sets the stage for greater intimacy.
- Lifestyle habits: Consume alcohol in moderation, as too much alcohol can reduce your sexual responsiveness. Regular physical activity can boost your stamina and elevate your mood, which can help enhance sexual desire. Practice stress-reduction techniques to help you enjoy your sexual experiences.
- Counseling: Consult a therapist or counselor who specializes in sexual issues. They may help you learn ways to optimize your body’s sexual responses and improve intimacy with your partner through reading materials or couples exercises.
- Lubricants: If you experience vaginal dryness or pain during sex, a vaginal lubricant may help.
- Devices: Arousal can be increased by stimulating the clitoris. To provide clitoral stimulation, try using a vibrator or other sex toys.
Medical treatment for female sexual dysfunction
- Estrogen therapy: Localized estrogen therapy comes in the form of vaginal rings, creams, or tablets. This therapy improves sexual function by increasing vaginal blood flow and lubrication, as well as improving vaginal tone and elasticity. Risks of hormone therapy vary depending on your age, risk of other health problems such as heart and blood vessel disease, and the dose and type of hormone used.
- Osphena (ospemifene): This medication works by selectively modulating estrogen receptors. It alleviates pain during sex for women suffering from pain during sex.
- Androgen therapy: Androgens include testosterone. Although testosterone levels in women are much lower than those in men, testosterone plays a role in healthy sexual function in both men and women. Androgen therapy for sexual dysfunction is divisive, however. Some studies show benefits for women who have low testosterone levels and develop sexual dysfunction, whereas others show little or no benefit.
- Addyi (flibanserin): Originally developed as an antidepressant, flibanserin is now approved by the FDA as a treatment option for premenopausal women with low sexual desire. Addyi, a daily pill, may aso increase sex drive in women who have low sexual desire. Low blood pressure, sleepiness, nausea, fatigue, dizziness. and fainting are potential side effects, especially if the drug is combined with alcohol. If you haven’t noticed an improvement in your sex drive after 8 weeks, experts advise discontinuing use.
- Vyleesi (bremelanotide): Another FDA-approved treatment for low sexual desire in premenopausal women is bremelanotide. This medication is injected just under the skin in the abdomen or thigh prior to sexual activity. Some women experience nausea, which is more common after the first injection but usually goes away after the second. Other side effects include nausea, flushing, headache, and a skin reaction at the injection site.
Potential treatments that need more research
Phosphodiesterase inhibitors: This class of drugs is effective in treating erectile dysfunction in men, but it does not work nearly as well in treating female sexual dysfunction. Studies on the efficacy of these drugs in women have yielded inconclusive results.
- Revatio and Viagra (sildenafil): This drug is helpful for some women with sexual dysfunction because of taking selective serotonin reuptake inhibitors, a class of drugs used to treat depression. If you take nitroglycerin for angina (chest pain caused by reduced blood flow to the heart), do not take sildenafil.
- Herbal supplements: Herbal supplements and topical oils that claim to boost libido and sexual pleasure have not been thoroughly researched. Before using any herbal or topical oil formulations, consult your doctor.
Female Sexual Dysfunction
Sexual Dysfunction is Common
What’s sexual dysfunction? Sexual dysfunction is a common concern shared by many women. Problems may occur during any phase of the sexual response cycle (excitement, plateau, orgasm, and resolution) that prevent a woman from experiencing sexual satisfaction. Many women are reluctant or embarrassed to discuss their sexual problems, but it’s important to tell your doctor what you are experiencing since most cases of female sexual dysfunction can be treated. Female sexual dysfunction may encompass problems with desire, arousal, orgasm, hormones, or pain.
What Causes Female Sexual Problems?
Female sexual dysfunction can have physical or psychological causes. Physical causes include diabetes, heart disease, neurological diseases, hormonal imbalances, menopause, chronic diseases such as kidney disease or liver failure, urinary tract infection, alcoholism, drug abuse, and side effects of medications, including antidepressant drugs. Hormone fluctuations that occur during pregnancy, after childbirth, and menopause may play a role in sexual disorders, too. Psychological causes of sexual dysfunction can include stress, anxiety, concerns about sexual performance, relationship problems, depression, feelings of guilt, and effects of a past sexual trauma.
Both men and women can suffer from sexual dysfunction and sex problems. Seniors may be affected more often, possibly due to health-related declines associated with aging. Males may experience premature ejaculation or delayed ejaculation, problems getting or maintaining an erection, or problems due to low testosterone. Like women, men may also experience problems with desire.
How Do Sexual Problems Affect Women?
Common types of sexual dysfunction in women include:
- Inhibited sexual desire
- Inability to become aroused
- Lack of orgasm (anorgasmia)
- Painful intercourse
Hormone fluctuations may play a role in female sexual dysfunction. These will be discussed on the following slides.
Lack of sexual desire or lack of interest in sex is inhibited sexual desire. This can have many causes, including hormonal changes, certain medical conditions and treatments, depression, pregnancy, stress, fatigue, lifestyle influences such as work stress or child care, and even boredom with regular sexual routines. Speak with your doctor if you believe medication side effects are contributing to your lack of desire and problems with sexual arousal. Changing your routine may help if lack of desire is a problem. Having sex in new places, at different times of the day, or trying different sexual positions may help reignite desire.
Inability to Become Aroused
Insufficient vaginal lubrication in women may trigger the inability to become physically aroused during sexual activity. Problems with blood flow to the vagina and clitoris may also affect lubrication and sexual arousal in women. Lubricants may help women become aroused more easily. If a woman is postmenopausal, estrogen cream may help as well.
The absence of sexual climax (orgasm) is called anorgasmia, and it is a common sex issue. Many factors can contribute to anorgasmia, including sexual inhibition, inexperience, or lack of knowledge. Psychological contributors to anorgasmia may include guilt, anxiety, or a past sexual trauma or abuse. Insufficient stimulation, drugs or medications, and chronic diseases can also result in lack of orgasm. Kegel exercises are one potential treatment for lack of orgasm.
Painful Intercourse
Painful intercourse can be a result of a number of conditions such as endometriosis, a pelvic mass, ovarian cysts, vaginitis, poor lubrication, vaginal dryness, the presence of scar tissue from surgery, or a sexually transmitted disease. A painful, involuntary spasm of the muscles that surround the vaginal entrance is a condition called vaginismus that may occur in women who fear penetration will be painful, have sexual phobias, or previous traumatic or painful sexual experiences. Dyspareunia is pain during intercourse or other sexual activity involving penetration or attempted penetration. Pain may be superficial or deep.
Sexual dysfunction in women is diagnosed by a physical exam and symptom history. The doctor will probably perform a pelvic exam with a Pap smear to check for cancer or precancerous changes in the cervix. Other tests may be ordered to rule out medical conditions that may cause female sexual dysfunction. You may also be asked about attitudes toward sex, past sexual trauma or abuse, problems in your relationship, or alcohol and drug abuse to help determine if these psychological factors contribute to the dysfunction. A woman’s age will factor into the possible diagnosis of female sexual dysfunction. The doctor may order lab tests to look for potential physical issues contributing to sexual dysfunction.
How Are Female Sexual Problems Treated?
Many types of sexual problems can be treated by addressing the underlying physical or psychological problems. Usually it involves cooperation between the woman, her doctors, and therapists. Treatment strategies for sexual dysfunction in women are discussed on the following slides. Involvement of a woman’s sexual partner may be part of the treatment process.
Patient education is important to help women overcome anxiety about sexual function and performance. Learning about sexual behaviors and normal responses may ease anxiety. Knowing about normal anatomy, sexual function, changes that occur during aging, and changes that occur in pregnancy and menopause may help ease a woman’s fears. Women should know they have permission to enjoy sex and sexual experimentation.
Enhancing Sexual Stimulation
It may be necessary to enhance sexual stimulation to help a woman overcome some sexual dysfunction. Masturbation, changing your sexual routine, or use of erotic videos or books may help. Get to know your body and what feels good to you. Tell your partner. Try different sexual positions, have sex at different times of the day, and have sex in new places to discover how to make sex feel better. Schedule sex and make time and energy for the date so you won’t feel rushed or tired.
Anxiety may be alleviated with distraction. Erotic or non-erotic fantasies can be useful. Music, videos, or television can also distract and help women relax. Contracting and relaxing pelvic muscles, similar to the movements one makes during Kegel exercises, can also be a distraction technique.
Encouraging Non-Coital Behaviors
Other behaviors that do not involve intercourse such as sensual massage may help a woman feel more comfortable with her sexuality and with intercourse and feel less pressure and anxiety surrounding sexual activity. Sensual massage can help a woman feel more comfortable and communicate better with her partner.
If sexual dysfunction is due to pain, sometimes changing sexual positions may help minimize or eliminate the pain. Vaginal lubricants may relieve pain caused by friction, and relaxation before intercourse (warm bath, meditation) may decrease pain responses. Avoiding deep thrusting may help. A doctor may recommend that a woman takes nonsteroidal anti-inflammatory drugs (NSAIDs) prior to having intercourse to minimize pain.
Can Sexual Problems Be Cured?
The prognosis for treating sexual dysfunction in women depends on whether the underlying cause can be treated. If sexual dysfunction is related to a treatable physical condition, the outcome is often positive. When dysfunction is due to psychological causes, it can often be treated successfully with counseling, education, and improved communication between partners. If a combination of factors contributes to female sexual dysfunction, all of them need to be addressed to improve the chance of a good outcome.
Hormones play a large role in sexual function in women. As women age, the hormone estrogen decreases, which can lead to poor vaginal lubrication and decreased genital sensation. Low levels of the male hormone testosterone in women may also contribute to reduced sexual arousal, genital sensation, and orgasm. As long as it is not contraindicated, hormone therapy may help women enjoy improved sexual function. Estrogen combats urogenital atrophy, menopausal mood disorders, and vasomotor symptoms, like flushing, which can negatively impact female sexual function.
What Effect Does a Hysterectomy Have on Sexual Function?
A hysterectomy (surgical removal of the uterus) may cause sexual dysfunction in many women. Women who have their uterus removed for a benign condition may experience a decrease in sexual responsiveness of up to 30 percent. Hormonal changes associated with removal of the ovaries may result in loss of desire, decreased vaginal lubrication, and genital sensation. Nerves and blood vessels integral to sexual functioning may also be damaged during the surgery. Finally, some women may become depressed or feel a loss of self-esteem from their uterus being removed that may make it hard for them to engage sexually following the procedure.
Menopause and the associated loss of estrogen can affect women’s sexual function such as a loss of vaginal lubrication and genital sensation. Other emotional aspects of menopause may contribute to a loss of interest in sex or an inability to become aroused. Loss of estrogen causes thinning and loss of elasticity of the vagina. Estrogen suppositories may help this problem.
However, many postmenopausal women have increased sexual satisfaction. This is thought to be due to less anxiety about getting pregnant, or having the time to relax and enjoy being intimate with their partners.
When Should I Call my Doctor About Sexual Problems?
Sexual problems in women are common, and nearly every woman will experience them on occasion. If the problems persist, they can be very upsetting for a woman and can affect her relationship with her partner. If you experience any sexual problems on a regular basis, talk to your doctor. Help is available! You don’t have to suffer in silence and forgo the pleasure of sex.
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