When a Woman Loses Desire: Sexual Dysfunction in Women
Dissatisfaction with sexual life is widespread in both men and women. According to a recent survey, up to 43% of women noted some sexual problem, while 31% of men did. The common sexual issues in women were a lack of interest in sex, inability to achieve orgasm, or pain during sex.
Unfortunately, pinpointing the underlying issues and conditions that cause sexual dissatisfaction can be complicated. There may be both medical and psychological issues involved. In fact, often several issues interrelate to affect a woman’s sexual life.
Sexual Dysfunction Disorders
In exploring women’s sexual problems , doctors realize that a woman’s sexual life is personal. For example, what may bother one woman may not bother another. And what may occur in one situation may not occur in every situation. Still, doctors use a general classification system to help sort out the basis of a women’s dissatisfaction with her sexual life. This classification system includes the following four disorders:
- Sexual desire disorder
- Sexual arousal disorder
- Orgasmic disorder
- Sexual pain disorder
Importantly, the underlying assumption of all these disorders is that the sexual problems are causing significant and ongoing personal distress to the woman, as well as to her partner.
Sexual Desire Disorder
Sexual desire disorder is a lack of interest in sex that causes persistent personal distress. The lack of interest may be not having sexual thoughts or fantasies, not desiring sexual activity, or not being receptive to a partner’s sexual activity. A similar but more rare condition is having a phobia to sex.
Sexual desire disorder is one of the most common sexual conditions that doctors see. Its causes can vary from low hormone levels to chronic medical illnesses to social or psychological issues. Often several factors interact to create a situation of low sexual desire.
Sexual Arousal Disorder
Sexual arousal disorder is the persistent inability to become sexually excited both physically and mentally, and its causes may be either physical or psychological. Physical causes include low blood flow to the genitals or inadequate lubrication. Psychological causes may include anxiety and stress.
Orgasmic disorder occurs when a woman cannot achieve orgasm. Some women do not achieve orgasm with intercourse or with their partners, but are otherwise satisfied with their sexual activity. This disorder is only considered if a woman is severely bothered by not achieving orgasm. Causes may include lack of experience, history of sexual abuse, medications, low hormone levels, or psychological and social issues.
Sexual Pain Disorders
Sexual pain disorders include persistent genital pain with intercourse, called dyspareunia , and involuntary spasms of the vaginal muscle, called vaginismus. Genital pain that occurs without intercourse also falls into this category.
Lack of lubrication is the most common cause of genital pain with intercourse. For example, up to 45% of women have dyspareunia for a period of time after giving birth to a baby. Postmenopausal women may also experience pain with intercourse due to lowered hormone levels, which reduce the natural lubrication of the vagina. Infections and inflammation of the vagina or bladder may also cause these painful conditions.
A Combination of Factors
Some women may have more than one sexual disorder condition. In these cases, there are often many underlying causes that interrelate. For example, a postpartum woman may have pain with her first intercourse after delivery because of lack of lubrication. She may also lose interest in sex because she is tired from taking care of an infant. If her partner desires sexual contact more than she does, she may then develop some anxiety or lack of excitement during sexual activity.
Dealing With Sexual Dissatisfaction
Although it is difficult to discuss, it’s important to talk to your doctor about your concerns. There may be some simple evaluations available, like checking hormone levels, reviewing medication lists, or just providing reassurance about what is normal.
Choosing the appropriate treatments will depend on what the main issue bothering a woman is and can range from hormone medications to counseling. For problems that stem from psychological or social issues, individual or couples counseling is often helpful. For a lack of lubrication, over-the-counter lubricants can be effective. For postmenopausal women, estrogen creams can also help reduce pain with intercourse.
Recently, investigators have looked at the use of sildenafil (Viagra) in women. In 2003, a study of postmenopausal women with sexual arousal disorder found that women who took sildenafil had higher satisfaction with sexual activity than women who took placebo. More research is underway to help determine whether sildenafil or similar medication will be as effective in women as they are in men. For example, in a small, eight-week trial, Viagra helped women on antidepressants reach orgasm.
In sum, a new interest in women’s sexual health has arrived. Currently, experts are encouraging more conversation, research, and the development of new treatments for women who are unhappy or unsatisfied with their sex lives.
American Association for Marriage and Family Therapy
The American College of Obstetricians and Gynecologists
The Canadian Women's Health Network
The Society of Obstetricians and Gynaecologists of Canada
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Last reviewed June 2008 by Ganson Purcell Jr., MD, FACOG, FACPE
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