Sexual Problems in Women

Sexual problem, or sexual dysfunction, refers to a problem during any phase of the sexual response cycle that prevents the individual or couple from experiencing satisfaction from the sexual activity. The sexual response cycle has four phases: excitement, plateau, orgasm, and resolution.

While research suggests that sexual dysfunction is common (43% of women and 31% of men report some degree of difficulty), it is a topic that many people are hesitant to discuss. Fortunately, most cases of sexual dysfunction are treatable, so it is important to share your concerns with your partner and doctor.

What Causes Sexual Problems?

Sexual dysfunction can be a result of a physical or psychological problem.

• Physical causes: Many physical and/or medical conditions can cause problems with sexual function. These conditions include diabetes, heart disease, neurological diseases, hormonal imbalances, menopause, chronic diseases such as kidney disease or liver failure, and alcoholism and drug abuse. In addition, the side effects of certain medications, including some antidepressant drugs, can affect sexual desire and function.
• Psychological causes: These include work-related stress and anxiety, concern about sexual performance, marital or relationship problems, depression, feelings of guilt, and the effects of a past sexual trauma.

Who Is Affected by Sexual Problems?

Both men and women are affected by sexual problems. It is more common in the early adult years, with the majority of people seeking help during their late 20s and early 30s. Sexual dysfunction also is common in the geriatric population, which may be related to a decline in health associated with aging.

How Do Sexual Problems Affect Women?

The most common problems related to sexual dysfunction in women include:

Inhibited sexual desire: This involves a lack of sexual desire or interest in sex. Many factors can contribute to a lack of desire, including hormonal changes, medical conditions and treatments (for example cancer and chemotherapy), depression, pregnancy, stress and fatigue. Boredom with regular sexual routines also may contribute to a lack of enthusiasm for sex, as can lifestyle factors, such as careers and the care of children.

Inability to become aroused: For women, the inability to become physically aroused during sexual activity often involves insufficient vaginal lubrication. The inability to become aroused also may be related to anxiety or inadequate stimulation. In addition, researchers are investigating how blood flow problems affecting the vagina and clitoris may contribute to arousal problems.

Lack of orgasm (anorgasmia): This is the delay or absence of sexual climax (orgasm). It can be caused by sexual inhibition, inexperience, lack of knowledge and psychological factors such as guilt, anxiety, or a past sexual trauma or abuse. Other factors contributing to anorgasmia include insufficient stimulation, certain medications, and chronic diseases.

Painful intercourse: Pain during intercourse can be caused by a number of problems, including endometriosis, a pelvic mass, ovarian cysts, vaginitis, poor lubrication, the presence of scar tissue from surgery, and a sexually transmitted disease. A condition called vaginismus is a painful, involuntary spasm of the muscles that surround the vaginal entrance. It may occur in women who fear that penetration will be painful and also may stem from a sexual phobia or from a previous traumatic or painful experience.

How Is a Female Sexual Problem Diagnosed?

The doctor likely will begin with a physical exam and a thorough evaluation of symptoms. The doctor may perform a pelvic examination to evaluate the health of the reproductive organs and a Pap smear to detect changes in the cells of the cervix (to check for cancer or a pre-cancerous condition). He or she may order other tests to rule out any medical problems that may be contributing to the problem.

An evaluation of your attitude regarding sex, as well as other possible contributing factors (fear, anxiety, past sexual trauma/abuse, relationship problems, alcohol or drug abuse, etc.) will help the doctor understand the underlying cause of the problem and make appropriate recommendations for treatment.

How Are Female Sexual Problems Treated?

The ideal approach to treating sexual problems in women involves a team effort between the woman, doctors, and trained therapists. Most types of sexual problems can be corrected by treating the underlying physical or psychological problems. Other treatment strategies focus on the following:

• Providing education -- Education about human anatomy, sexual function and the normal changes associated with aging, as well as sexual behaviors and responses, may help a woman overcome her anxieties about sexual function and performance.
• Enhancing stimulation -- This may include the use of erotic materials (videos or books), masturbation, and changes to sexual routines.
• Providing distraction techniques -- Erotic or non-erotic fantasies; exercises with intercourse; music, videos or television can be used to increase relaxation and eliminate anxiety.
• Encouraging non-coital behaviors -- Non-coital behaviors (physically stimulating activity that does not include intercourse), such as sensual massage, can be used to promote comfort and increase communication between partners.
• Minimizing pain -- Using sexual positions that allow the woman to control the depth of penetration may help relieve some pain. The use of vaginal lubricants can help reduce pain caused by friction, and a warm bath before intercourse can help increase relaxation.

Can Sexual Problems Be Cured?

The success of treatment for sexual dysfunction depends on the underlying cause of the problem. The outlook is good for dysfunction that is related to a treatable or reversible physical condition. Mild dysfunction that is related to stress, fear, or anxiety often can be successfully treated with counseling, education, and improved communication between partners.

How Do Hormones Affect Sexual Function?

Hormones play an important role in regulating sexual function in women. With the decrease in the female hormone estrogen that is related to aging and menopause, many women experience some changes in sexual function as they age, including poor vaginal lubrication and decreased genital sensation. Further, research suggests that low levels of the male hormone testosterone also contribute to a decline in sexual arousal, genital sensation, and orgasm. Researchers still are investigating the benefits of hormones and other medications, including the male drug Viagra, to treat sexual problems in women.

What Effect Does a Hysterectomy Have on Sexual Function?

Many women experience changes in sexual function after a hysterectomy (surgical removal of the uterus). These changes may include a loss of desire, and decreased vaginal lubrication and genital sensation. These problems may be associated with the hormonal changes that occur with the loss of the uterus. Furthermore, nerves and blood vessels critical to sexual function can be damaged during the hysterectomy procedure.

How Does Menopause Affect a Woman's Sexual Function?

The loss of estrogen following menopause can lead to changes in a woman's sexual functioning. Emotional changes that often accompany menopause can add to a woman's loss of interest in sex and/or ability to become aroused. Hormone replacement therapy may improve certain conditions, such as loss of vaginal lubrication and genital sensation, that can create problems with sexual function.

It should be noted that some post-menopausal women report an increase in sexual satisfaction. This may be due to decreased anxiety over getting pregnant. In addition, post-menopausal woman often have fewer child-rearing responsibilities, allowing them to relax and enjoy intimacy with their partners.

When Should I Call my Doctor?

Many women experience a problem with sexual function from time to time. However, when the problems are persistent, they can cause distress for the women and her partner, and have a negative impact on their relationship. If you consistently experience these problems -- especially pain during intercourse -- for more than a few months, see your doctor for evaluation and treatment.

Reviewed by the doctors at The Cleveland Clinic Department of Obstetrics and Gynecology.
Edited by Charlotte E. Grayson, MD, Oct. 2003.