Sex is a normal, healthy part of life. But many women have problems with sex at some point in their lives. If you are having a problem with sex, and it is worrying or upsetting you, you may want to find a solution. Some sexual problems can be solved by you alone or with your partner. For others, you may want to see a health care provider.
Many people think that sex starts with desire, which leads to arousal and then orgasm. Although this may be true for men, some research suggests that women’s sexual responses are more complex. For many women, physical desire is not always the starting point. A woman may be motivated to have sex to feel close to her partner or to show her feelings. The physical desire to have sex may not occur until after sexual activity has started. A woman may not be motivated to have sex if the situation does not feel right, or if she feels unsafe. Not responding sexually may be her body’s way of telling her to stop the activity.
Also, many women say that they are satisfied even if they do not have an orgasm during sex. The physical and emotional aspects of sex are pleasurable even if orgasm does not occur.
Lack of orgasm is a concern, however, for some women. Orgasm may be difficult to achieve from intercourse alone. Many women need more stimulation than intercourse provides, including kissing and caressing as well as stroking and touching sensitive areas, such as the breasts and clitoris, to have an orgasm. It is important for both partners to understand that sex can include other activities besides sexual intercourse.
Causes of Sexual Problems
Sexual problems are common. One estimate suggests that 40% of women in the United States have a sexual problem. Problems with sex can have many causes.
A woman’s libido (another term for interest in and desire for sex) and sexual activity sometimes decrease with age. This decrease is normal and usually is not a cause for concern. However, problems can arise if one partner in a relationship desires sex more often than the other. Both partners should talk openly about these normal changes and how each partner can please the other.
The normal stages and events in a woman’s life can affect her interest in and response to sex. During pregnancy or menopause, a woman’s interest in sex can increase, decrease, or fluctuate. Many women note changes in their interest throughout the menstrual cycle. Research suggests that some of these changes are due to changes in a woman’s hormone levels.
Androgens and estrogen are hormones that are thought to play key roles in female sexual responses. When androgen levels decrease, desire and arousal may be reduced. Decreases in androgen levels may be caused by surgical removal of the ovaries, use of birth control pills and certain medications, and the effects of some diseases. Decreased estrogen levels (such as during perimenopause and menopause) may cause vaginal dryness and lead to pain during intercourse.
Some illnesses and many drugs can interfere with sex. Stress can be a major factor. Relationship problems with your partner may affect sex. Past negative experiences often contribute to sexual problems. Sexual problems also can be caused by depression and anxiety.
Types of Sexual Problems
“Female sexual dysfunction” is a general term for a problem with interest in or response to sex. Knowing the types of common sexual problems may be useful. Sexual problems fall into four groups, which often overlap:
- Desire problems
- Arousal problems
- Orgasmic problems
- Sexual pain disorder
Lack of desire is the most common sexual concern reported by women. Desire is often present in new relationships but tends to decrease as time goes on. A lack of desire before having sex is normal for some women. They may not feel that they want to have sex until they begin to engage in sexual activity and become aroused. A lack of desire is considered a disorder when a woman
- does not want to engage in any type of sexual activity, including masturbation
- does not have (or has very few) sexual thoughts or fantasies
- is worried or concerned about these issues
Arousal is the name given to the physical and emotional changes that occur in the body as a result of sexual stimulation. For women, the following changes occur during arousal:
- Blood pressure goes up.
- Heart rate, breathing, and temperature increase.
- The nipples, labia, and clitoris fill with blood and become more sensitive.
- The vagina lubricates and expands.
Arousal can be affected by many things, including medications, alcohol, smoking, illegal drug use, and medical conditions. Anxiety, stress, problems with your partner, and past negative sexual experiences also can cause arousal difficulties.
There are different kinds of arousal disorders. Some women with arousal disorders may not feel mental or physical excitement from sex. Some may feel only mental excitement and do not have a physical response, or vice versa. Others may dislike the feelings of arousal or may be indifferent to them. Arousal disorders often overlap with desire disorders.
Women sometimes have a hard time reaching orgasm. Not having an orgasm during sexual activity may not be a problem. Sharing love and closeness without having an orgasm is satisfying for many women. However, other women may feel that not having an orgasm is a problem. They may want to find a solution.
Women with orgasmic disorders may never have had an orgasm from sexual encounters, or they may have had orgasms at one time but no longer have them, despite healthy arousal. The intensity of orgasm may have decreased, which can occur with age. A common issue is a woman who is able to have an orgasm during masturbation but cannot have an orgasm with her partner. Although not considered a disorder, communicating with her partner about the activities that lead to orgasm for her may be helpful.
Orgasmic disorder may be caused by a poor body image or a fear of losing control. It also may occur when a woman does not trust her partner. It is common for women who do not have orgasms to have arousal problems.
Sexual Pain Disorder
Painful sex may be a lifelong or short-term condition. Pain that occurs during sexual activities other than intercourse is called “noncoital sexual pain disorder.” Pain during intercourse is called dyspareunia. It includes pain that occurs during the following situations:
- During partial or complete entry into the vagina
- During thrusting
- During urination after sex
Most sexually active women have had pain during sex at some point in their lives. If it occurs often or is severe, a woman should see her health care provider.
A problem with sex is only a concern if it causes you distress or worry. A sexual problem may not affect your life in any way. However, if it is affecting your well-being and your relationship with your partner, and you are worried about these feelings, you may want to seek a solution.
There are many things that you can do alone or with a partner to address a sexual problem. Educate yourself. Check out the library or bookstore for books about sex. Learn about your body and how it works. Understand that sex for both partners can include activities other than intercourse, such as oral sex, manual stimulation with a partner, and masturbation with and without a partner. Try non-sexual, but sensual, activities like massage. Talk to your partner about your likes and dislikes. An open, honest talk can lead to greater understanding and help clear up conflicts. Learn to separate sex from stress. For example, couples with fertility issues may want to try having sex just for the sake of pleasure and intimacy rather than for achieving pregnancy.
Smoking, alcohol, and drugs can affect sexual response for both women and men. Smoking can slow down blood flow in the sexual organs and cause arousal problems. Alcohol and drugs affect how your body responds. A good first step in addressing sexual problems is to stop or limit smoking and the use of drugs or alcohol.
Before you see your health care provider about sexual concerns, you may want to try some of the following tips first.
For enhanced desire
Address and work toward resolving relationship concerns, stresses, and misunderstandings about sex as well as other issues that may be affecting you and your partner.
Focus less on intercourse and more on intimacy.
Improve your sex knowledge and skills.
Make time for sexual activity and focus on enjoyment and pleasuring each other.
For increased arousal
- Be well rested.
- Increase the time spent on foreplay.
- Try a vaginal lubricant for dryness.
- Do Kegel exercises (contract and relax pelvic muscles)
- Do not smoke.
To help you have an orgasm
- Increase sexual stimulation.
- Try sexual toys.
- Use mental imagery and fantasy.
To minimize pain
- Try different positions or sexual activities that do not involve intercourse.
- Allow plenty of time for arousal before penetration.
- Use a lubricant.
- Empty your bladder before sex.
- Take a warm bath.
Seeing Your Health Care Provider
If you have tried the self-help tips and still have a problem that is causing you distress, see your health care provider. If your health care provider does not ask you about sex, bring up the topic yourself. Some women find talking with their health care providers about sex to be difficult or embarrassing. Being open, however, makes it more likely that your health care provider will know how to help you. It helps to bring up the subject early in the visit. You could start off with a statement like:
“I am having some concerns about my sex life.”
“I do not enjoy sex like I used to.”
“I am feeling sad lately; my partner is complaining I never want sex.”
Keeping a journal of your symptoms may be helpful (see box “Keeping a Journal”). You can be more specific when you talk about your symptoms and any changes you have noticed if you keep a journal. Use your notes to tell your health care provider about your symptoms:
“It hurts when I have sex.”
“I am having problems with vaginal dryness.”
“Urinating after sex is painful.”
“I used to be able to have orgasms, but now I do not. Why is this happening?”
Here are some other questions you might ask:
“Lately, I have been having trouble with intimacy. What can I do?”
“I am just not interested in sex. Do you have any advice?”
“Getting older has affected my love life. Is there a fix?”
What to Expect at the Visit
Your health care provider may ask you a lot of questions about your physical and mental health. Be honest. Some of the questions may focus on your past sexual experiences. You may be asked about rape and sexual abuse. These questions may be difficult to answer. Being honest about your past, however, may provide important clues about the cause of your problem.
You may have a physical examination and a pelvic exam. If you have pain during intercourse, your health care provider may try to re-create this pain by touch. This will help to find the cause. Depending on your symptoms, you may have a blood test to measure hormone levels. Sometimes an imbalance in hormones can cause sexual problems.
Treatments That Can Help
Each type of female sexual dysfunction is treated differently. Sexual problems may overlap and, therefore, treatment can be complex. It might take a few tries. Be patient. Get treated early. The longer you wait, the harder it will be to treat the problem.
First, ask your health care provider to explain to you more about your body and sexuality. You might be asked to change the way you have sex. Some of your current medications may be the cause of your problem, and your health care provider may change your medication. If you have a hormone imbalance, there are medications you can take. Women with vaginal dryness caused by a decrease in estrogen may benefit from estrogen therapy. If a medical problem is suspected, you may need to see another type of doctor or specialist for treatment. Surgery may be an option in rare cases.
You may be referred to a sex therapist, even if you also are receiving medical treatment. Sex therapists help people work on the different aspects of sexual disorders, including the emotional, physical, and interpersonal aspects. Couples therapy may be suggested to help with interpersonal issues. Individual counseling may help build sexual confidence by helping you understand how past experiences may be affecting your current sexuality.
Sex can be a pleasurable part of your life. If you have sexual concerns, learn all you can about sex and try self-help approaches. If you still have problems, your health care provider may be able to help.
- Androgen: Any steroid hormone produced by the adrenal glands or by the ovaries that promotes male characteristics, such as facial hair and deepening voice.
- Blood Pressure: A measure of how hard blood is pressing against artery walls.
- Clitoris: An organ located near the opening to the vagina that is a source of female sexual excitement.
- Depression: Feeling of sadness for periods of at least 2 weeks.
- Dyspareunia: Pain with intercourse.
- Estrogen: A female hormone produced in the ovaries.
- Hormones: Substances produced by the body to control the functions of various organs.
- Kegel Exercises: Pelvic muscle exercises that assist in bladder and bowel control as well as sexual function.
- Labia: Folds of skin on either side of the opening of the vagina.
- Libido: The desire for or interest in sex; sex drive.
- Masturbation: Self-stimulation of the genitals, usually resulting in orgasm.
- Menopause: The time in a woman’s life when the ovaries have stopped functioning; defined as the absence of menstrual periods for 1 year.
- Orgasm: The climax of sexual excitement.
- Pelvic Exam: A physical examination of a woman’s reproductive organs.
- Perimenopause: The period around menopause that usually extends from age 45 to 55 years.
- Sexual Intercourse: The act of the penis of the male entering the vagina of the female (also called “having sex” or “making love”).