Concerns and sexual problems - Women's Health Matters

Many women have problems with sex at some stage in their lives. Just over 60% of Australian women have reported that they have had a sexual problem in the past year. Half of women reported a lack of interest in sex, and about a quarter report pain or lack of pleasure with sex.

Sexual concerns (or dysfunctions) refer to a situation when you are not able to experience sex as you would like and is problematic to you and/or your partner.

Different types of problems often relate to the different areas of sexual functioning: libido, arousal, orgasm and frequency of sexual activity. Here are some examples of female sexual dysfunction:

Libido

A reduced sex drive (loss of libido), affects some women at certain times of life, including:

during pregnancy,
after having a baby and breastfeeding,
menopause,
relationship problems,
depression, stress or anxiety,
previous mental or physical trauma,
fatigue,
diabetes,
hormone disorders,
excessive alcohol consumption or drug use,
certain medicines, such as SSRI type of antidepressants.

But some women experience it all the time with fluctuations of a woman’s natural testosterone levels to drop.

Arousal

Arousal may be reduced due to:

painful sex
anticipation of sex to be painful, uncomfortable or unpleasurable

Orgasm

Orgasm problems can be due two problems:

Primary – when a woman has never had an orgasm
Secondary – when a woman has had an orgasm in the past, but can’t now

It is not necessary to experience orgasm to enjoy sex, but the inability to reach orgasm in an acceptable time can be a concern for some women and their partners. Reaching orgasm is dependent on libido, arousal and all three are interconnected and the time difference to achieve orgasm between partners may be an issue.

Reasons why a woman cannot have an orgasm may include:

fear or lack of knowledge about sex
being unable to “let go”
not enough effective stimulation
relationship problems
feeling depressed or stressed
previous traumatic sexual experience

Psychosexual therapy may help a woman overcome orgasm problems. It involves exploring her feelings about herself, sex, and her relationship.

Painful sex

Vaginismus

Vaginismus is when muscles in or around the vagina go into spasm, making sexual intercourse painful or impossible. It can be very upsetting and distressing.

Reasons why a woman may have vaginismus can include:

fear of sex as being wrong or as painful
past vaginal trauma, such as an episiotomy during childbirth
relationship problems
fear of pregnancy

Depending on the cause, vaginismus may be treated by focusing on sex education, counselling and using vaginal trainers (dilators).

Sex after menopause

Pain during sex is common after menopause as oestrogen levels fall causing the vagina to feel dry and may affect a woman’s desire for sex. Lubrication creams can help.

Female genital mutilation

Female genital mutilation (FGM) is where female genitals are deliberately cut, injured or changed without a medical reason. Women who have experienced FGM can find sex difficult and painful as well as have a reduced sexual desire and a lack of pleasurable sensation.

Talking to a GP, health professional or therapist may help with sexual problems that may be the result of FGM.

Other factors that may increase sexual concerns

Age

With increasing age sexual problems may rise too.

Menopause

Premature or early menopause at 40-45 years
The transition to menopause during your mid-40s and early 50s
Surgical menopause leading to a very sudden drop in hormone levels

Medical conditions

Cancer or a pelvic/neurologic/vascular disease, other chronic medical issues.

Treatment or medications

Medications to block hormone production such as aromatase inhibitors, tamoxifen and GnRH agonists can cause vaginal atrophy and superficial dyspareunia
Pelvic chemotherapy can cause bladder and bowel irritation and vaginal mucositis (inflammatory changes)
Some antidepressants, antipsychotics and anticonvulsants
Some anti-hypertensive medication (in particular those from the beta-blocker class)
Decreased nipple sensation following breast surgery

Psychological function

Depression, anxiety, stress, low self-esteem, negative body image.

Sexual experiences

Previous sexual abuse, sexual assault or problems with sexual function.

Partner

Decrease in the quality or harmony of the relationship.

Lifestyle

Substance abuse, excess alcohol, lack of physical exercise, poor work-life balance.

Management and treatment of sexual problems

Solutions are dependent on the cause of the sexual problems and there is no one-size-fits-all approach. It is important to at first acknowledge there is a problem to seek an appropriate health professional and discuss a course of action tailored to you to manage and treat the root of the problem.