Expert Talk: Top Sexual Problems In Women And How To Deal With Them

Sexual problems or dysfunctions are fairly common amongst women, but often underreported and not openly discussed with friends and family. These issues can range from recurring problems with sexual response, desire, orgasm, or pain that causes distress in a woman.

Usually, the typical response cycle consists of four stages: desire (excitement stage), arousal (plateau phase), orgasm (climax), and resolution. Inability to achieve any one of these stages will disrupt sexual satisfaction and create issues down the line.

How Common Is Sexual Dysfunction In Women?

Many women have problems with sexual function at some time in their lives, and some have problems their entire lives. Female sexual dysfunction can strike at any age. It can happen exclusively in some sexual scenarios, or it can happen in all sexual situations.

A recent survey study of Singaporean women reports that 38.3% have experienced sexual problems and 22% have reported sexual pain in the genitalia.

Sex problems tend to worsen as women become older, although they can strike at any age. Sexual dysfunction can be acute or persistent (long-lasting).

A complex interaction of physiology, emotions, experiences, beliefs, lifestyle, and relationships is involved in sexual response. Any component disruption can influence sexual desire, arousal, or satisfaction, and treatment frequently takes more than one way.

Types of Sexual Dysfunction

The four types of sexual dysfunction also correspond with the stages of the response cycle. Commonly reported symptoms of sexual dysfunction can be categorised under the following:

1. Low Libido/Sexual Desire – This condition refers to a lack of interest in sex or low willingness to participate in sexual activity.
2. Sexual Arousal Disorder – Though sexual desire remains intact, a woman may find difficulty in becoming aroused or there is an apparent inability to maintain the necessary level of arousal throughout the sexual process.
3. Orgasmic Disorder – In some women, orgasms may be delayed or may not even occur at all (anorgasmia) even after sufficient sexual arousal and stimulation. This can potentially create a vicious cycle that results in a woman losing interest in sex due to the inability to achieve an orgasm. Further studies have determined that an estimated 7% – 10% of women have experienced some sort of anorgasmia.
4. Sexual Pain Disorder – As the name suggests, this refers to any pain experienced during any stage of intercourse (dyspareunia), which could potentially lead to frustration for both parties due to unsuccessful and unpleasurable intercourse experiences.

Symptoms of Sexual Dysfunction in Women

Symptoms differ based on the type of sexual dysfunction you have.

1. Vaginal Dryness

Vaginal dryness can be caused by hormonal changes during breastfeeding or menopause. In reality, a study of 1,000 postmenopausal women published in the journal Menopause in January 2010 discovered that 50% of postmenopausal women report vaginal dryness.

2. Low Desire

As your hormone levels drop in the years leading up to menopause, your libido may suffer as well. However, low desire isn’t just a problem for older women: according to a national survey of 1,000 women, half of females aged 30 to 50 have experienced a lack of lust.

Low libido can be caused by a variety of factors, including physical disorders such as diabetes and low blood pressure, as well as psychological difficulties such as depression or simply being dissatisfied in your relationship. According to a study published in The Journal of Sexual Medicine in June 2010, certain drugs, such as antidepressants, as well as hormonal contraceptives, can be libido killers.

3. Painful Sex

According to research published in The Journal of Sexual Medicine in April 2015, up to 30% of women suffer pain during sex. According to The American Congress of Obstetricians and Gynecologists, pain can be caused by vaginal dryness or be an indicator of a medical problem such as ovarian cysts or endometriosis. Vaginismus, a disorder in which the vagina tightens reflexively when penetrated, can also be linked to painful sex.

4. Arousal Problems

Inability to become aroused can be caused by a variety of factors, including worry or a lack of stimulation (aka, you need more foreplay). It may be more difficult to become turned on if you endure dryness or soreness during sex.

Hormonal changes caused by menopause or a partner’s sexual troubles (such as erectile dysfunction or premature ejaculation) can also make it harder to get into a good mood.

5. Trouble Reaching Orgasm

“Approximately 5% of perimenopausal women have orgasm problems,” adds Worly. In addition to hormonal shifts, failure to achieve orgasm may be caused by worry, insufficient foreplay, certain drugs, and chronic conditions.

Risk factors

Some factors may raise your chances of developing sexual dysfunction:

• Anxiety or depression
• Heart and vascular disease
• Neurological disorders such as spinal cord damage and multiple sclerosis
• Gynaecological issues such as vulvovaginal atrophy, infections, and lichen sclerosus
• Certain drugs, such as antidepressants or hypertension meds
• Emotional or psychological stress, particularly in your connection with your partner
• A history of sexual abuse

Causes of Female Sexual Dysfunction

When your hormones are in flux, such as after having a baby or during menopause, sexual issues are more likely to arise. While there are many causes of sexual dysfunction, they can be divided into 3 major categories.

Medical Causes

• Chronic medical causes such as cancer, diabetes, or heart diseases may contribute to the way one’s body responds to sexual stimulation.
• Previous history of surgery or radiation therapy can contribute to vaginal dryness and painful intercourse due to scar tissues present at the surgical site.
• Consumption of long term medications such as antidepressants or blood pressure medication.
• Underlying gynaecological conditions, such as vaginismus or Sexually Transmitted Diseases (STD).

Hormonal Causes

Certain stages of life such as pregnancy, breastfeeding, and menopause can also contribute to a woman’s sexual dysfunction due to an imbalance in hormones. For example, hormonal shifts during pregnancy or breastfeeding can potentially contribute to vaginal dryness which could result in painful intercourse.

After menopause, lower estrogen levels may cause changes in your vaginal tissues and sexual receptivity. A decrease in estrogen causes a decrease in blood flow to the pelvic region, which can result in reduced genital sensation as well as taking longer to build arousal and achieve orgasm.

The vaginal lining also thins and loses elasticity, especially if you are not sexually active. These elements can result in painful intercourse (dyspareunia). When hormone levels drop, so does sexual desire.

Hormone levels in your body change after giving birth and during breastfeeding, which can cause vaginal dryness and alter your desire to have intercourse.

Emotional, Psychological, and Social Causes

Sexual dysfunction can also occur due to mood disorders such as anxiety or depression or body image issues, which can affect one’s confidence level and ability to have a fulfilling sexual experience.

Untreated anxiety or melancholy, as well as long-term stress and a history of sexual abuse, can cause or contribute to sexual dysfunction. Pregnancy fears and the duties of becoming a new mother may have similar consequences.

Apart from that, long-standing conflict or relationship issues with one’s partner can also affect sexual responsiveness and willingness to participate in sexual activity.

Some women may be dissatisfied with their spouses or bored during sex. Other relational stressors may result in sexual dysfunction.

Stress at home or at work can make it difficult to concentrate on having fun with your partner. According to research, stress can raise cortisol levels. This rise may reduce the sexual urge.

Anxiety and dread of intimacy may result from trauma or abuse. These emotions might make having sex difficult.

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Can sexual dysfunction be prevented?

While there is no single technique to prevent sexual dysfunction, you can lower your risk by doing the following:

• Avoiding narcotics and excessive alcohol consumption.

• Consuming a well-balanced diet.

• Regular exercise.

• Keeping a healthy body weight.

• Seeking support from a health care provider if you are having difficulties with your mood or communication with your partner.

Also, before beginning new medications or performing certain medical procedures, consult with your healthcare professional about the possibility of sexual dysfunction.

How is sexual dysfunction diagnosed?

In most circumstances, you understand that something is interfering with your enjoyment (or the enjoyment of your partner) of a sexual connection.

A comprehensive history of symptoms and a physical examination are usually the first steps taken by your provider. They may arrange diagnostic testing to rule out any medical issues that could be causing the malfunction. In most cases, lab testing has only a minor role in the diagnosis of sexual dysfunction.

An assessment of sexual attitudes, as well as other potential contributing factors such as fear, anxiety, past sexual trauma/abuse, relationship concerns, medications, alcohol or drug abuse, and so on, assists a clinician in understanding the underlying cause of the problem and recommending the best treatment.

Managing and treating sexual dysfunction in women

Women can engage with their healthcare team to develop a treatment strategy for sexual dysfunction. Before selecting therapy, it is critical to understand the physical or psychological causes.

Treatments include:

• Arousal techniques

Discuss with your spouse how you might increase desire and arousal. Consider modifying your sexual regimen. Erotic materials (sexual stimulation gadgets, films, or books), massage, or masturbation are also options.

• Counselling

Speaking with a mental health professional may be beneficial. You can overcome emotional or psychological impediments to having pleasurable sex. You can pick between one-on-one and couples counselling.

Mood disorders can be alleviated by counselling sessions, while long-standing issues with one’s partner may require a couple of counselling sessions with a clinical sexologist. Most importantly, however, is to ensure constant communication and support is had with your partner in order to understand each other’s wants and needs.

• Hormone therapy

Your clinician may offer topical creams, vaginally given drugs, or hormones taken orally or applied to your skin based on your symptoms.

• Medication

The only drugs licenced to treat hypoactive sexual desire disorder (low sex drive) in women are flibanserin and bremelanotide. This form of treatment is only available to premenopausal women. Other drugs used ‘off-label’ to treat sexual dysfunction may be discussed with your clinician.

If the dysfunction is caused by medication, then a switch to a different class of medications may alleviate the issues.

If there is a risk of underlying undetected vaginal infections, it is important to get yourself tested and treated immediately at the clinic.

In most cases, maintaining a healthy lifestyle which includes no smoking and alcohol as well as regular exercise will be able to boost sexual health.

• Pain management

There are various methods for minimising pain during intercourse. Before intercourse, you can experiment with different sexual positions, vaginal lubricants, or relaxation techniques.

Vaginal dryness can be resolved with topical lubricants, while Pelvic Floor Physiotherapy sessions can help to strengthen the pelvic floor muscles, especially after undergoing a major bodily change such as postpartum or postmenopausal.

Additionally, devices such as a vaginal dilator may help to gradually train pelvic floor muscles and alleviate painful intercourse, especially for women suffering from vaginismus.

When should I call the doctor about female sexual dysfunction?

Many ladies have the occasional sexual problem. But if it bothers you or it becomes a recurring issue, it’s time to seek professional assistance.

To summarise, sexual dysfunction amongst women is commonplace, but most cases are reversible with the correct approach, so do not wait or suffer in silence. Talk to your doctor today and get on the right track to incredible sexual wellbeing!

This article has been written by Dr Goh Lit Ching, a doctor of DTAP Clinic (Dr. Tan & Partners) for theAsianparent. 

Updates by Matt Doctor

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