Sometimes sex is not good for some women. In fact, they struggle with either repugnance, fear, or wondering why they don’t enjoy it more. There is a name for this problem, and this article explains what it is and what can be done.
Sarah* is 40 years old and the mother of three children ages nine, eleven, and thirteen. She laughs when she hears about studies that say that women reach their sexual peak at age 35. “If that’s true, then my ‘peak’ was an anthill,” she quips. She then grows serious.
“I know that sex is supposed to be great, but for me it’s an ordeal,” she confides. “I’ve tried lots of things, and nothing seems to help. Lately I’ve wondered if it’s just overrated media hype.”
If you are a woman, then according to recent research there is a 43% chance that you, like Sarah, will have a sexual problem at some point in your life (1). In fact, in the United States alone, 40 million women suffer with female sexual dysfunction.
What is Female Sexual Dysfunction?
Female sexual dysfunction (FSD) covers a variety of disorders of female sexuality, ranging from lack of interest in sex to the inability to have an orgasm. The categories include:
Hypoactive Sexual Desire disorder is a disorder of libido, or the desire to engage in or even think about sexual activity. The person may not fantasize about sex, and may avoid any sexual activity or contact. It occurs in roughly 20% of women, and causes can range from boredom or unhappiness in a relationship to sexual abuse in the woman’s past. Depression can play a part in this disorder, as well as exhaustion or debilitating diseases.
Sexual Arousal Disorder is the inability to swell vaginally or lubricate sufficiently during the excitement phase of sexual activity. This disorder is fairly common in women after menopause, when lowered hormone levels cause a decrease in the amount of vaginal lubrication. It can also occur in younger women who take birth control bills. Estrogen anatagonists such as Tamoxifen (used to treat breast cancer ) can also cause this side effect. Breastfeeding, which increases prolactin levels, may also cause vaginal dryness and discomfort during intercourse.
Psychological factors can also play an important part since anxiety, or the fear of feeling aroused will prevent a woman from allowing herself to respond. Interpersonal problems in a relationship may cause this disorder, especially if sexual arousal was normal before the relationship difficulties began. Diseases which can decrease blood flow (such as diabetes) may be a factor, as well as depression, which diminishes both desire and the arousal response.
Orgasmic Disorder is a delay in or the absence of orgasm with sexual stimulation and arousal. The woman feels extremely aroused, but can’t climax in spite of stimulation. While it is not unusual for a woman to not achieve orgasm at times (some surveys have shown that only 29% of women are orgasmic all the time), this disorder is considered a persistent inability over time. Depression and medications such as SSRIs (Selective Serotonin Reuptake Inhibitors) can contribute to this disorder. Lack of foreplay and sexual ignorance, or the fear of feeling pleasure can also play a role.
Pain With Intercourse
Dyspareunia is genital or vaginal pain during intercourse, with pain severe enough to prevent intercourse in some cases. It can be caused by poor vaginal lubrication or hormonal changes that occur after menopause, including thinning of the vaginal wall, or when irritation or infection are present. Trauma and surgery to the vagina (such as stitches after an episiotomy) may also be factors.
Vaginismus is involuntary spasms of the outer vaginal muscles with the insertion of any object, including a penis or a finger. This disorder is thought to be due to a fear of pain with intercourse, and may be related to a previous traumatic experience for the woman or other psychological disorders. The spasms are an unconscious attempt to prevent penetration.
Treatment:
Hormone Replacement Therapy: If the sexual dysfunction is caused by decreased hormone levels, such as menopause, in some cases the replacement of estrogen can increase desire and arousal and decrease pain during sexual intercourse.
Wellbutrin is a medication that works on norepinephrine and dopamine receptors in the brain. These are both neurotransmitters, and Wellbutrin has been shown recently to increase sexual satisfaction in women who took it(2).
Sexual Counseling:: There are specialists who work with sexual dysfunction and can help their clients with resolving factors that can influence sexual response (self image, depression, worries and responsibilities, family influences, religious influences, or a history of rape or sexual abuse to name a few). They may also help partners explore such techniques as the exercises developed by Masters and Johnson, which move the couple slowly from nongenital enjoyment (such as a gentle massage) to genital contact and finally sexual intercourse.
Medication Change: Some antidepressants such as SSRIs can cause delay of or inability to have an orgasm. In these cases, changing medications may help with the problem.
Other Interventions: If sexual intercourse is painful, trying different positions (such as the woman being on top, where she can control the depth of penetration) can help. Some women try a warm bath before intercourse to increase blood flow to the pelvic area, and different lubricants can also be tried.
In general, finding and treating the cause of the sexual dysfunction, along with gentleness and patience on the part of both partners, can help tremendously with resolving sexual disorders.
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