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Female Sexual Dysfunction - Part 2

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There are several types of sexual dysfunctions. They can be lifelong problems that have always been present, acquired problems that develop after a period of normal sexual function, or situational problems that develop only under certain circumstances or with certain partners. Causes of sexual dysfunctions can be psychological, physical or both.

Psychological causes can include:

  • stress or anxiety from work or family responsibilities

  • concern about sexual performance

  • conflicts in the relationship with your partner

  • depression

  • unresolved sexual orientation issues

  • previous traumatic sexual experience

  • body image and self-esteem problems

Physical causes can include:

  • diabetes

  • heart disease

  • liver disease

  • kidney disease

  • pelvic surgery

  • pelvic injury or trauma

  • neurological disorders

  • medication side effects

  • hormonal changes, including those related to pregnancy and menopause

  • thyroid disease

  • alcohol or drug abuse

Lack of sexual desire is the most common sexual problem in women. The American College of Obstetricians and Gynecologists reports survey data indicating up to 30 percent of women lacked interest in sex for at least one month in the previous year. About 15 percent of postmenopausal women have decreases in sexual desire, according to The Merck Manual of Diagnosis and Therapy.

Often, sexual desire is affected by a woman's relationship with her sexual partner. The more a woman enjoys the relationship, the greater the desire for sex. The stresses of daily living can affect desire, and feeling uninterested in sex occasionally is no cause for concern. But, when sexual fantasies or thoughts and desire for sexual activity are persistently or recurrently reduced or absent, and cause distress or interpersonal difficulties, the problem is known as hypoactive sexual desire disorder, or inhibited sexual desire disorder. The Merck Manual of Diagnosis and Therapy estimates hypoactive sexual desire disorder occurs in about 20 percent of women.

Avoiding all or almost all genital sexual contact with a sexual partner, to the point that it occasionally causes personal distress and relationship difficulties is a problem known as sexual aversion disorder. This condition may affect women who have experienced some type of sexual abuse, or who grew up in a rigid atmosphere in which sex was taboo. A recent study reported in the journal Archives of Sexual Behavior stated that among patients with panic disorder, 75 percent had sexual problems, and that sexual aversion disorder was the most common complaint, affecting 50 percent of women.

Sexual arousal disorder is the persistent or recurrent inability to reach or sustain the lubrication and swelling reaction in the arousal phase of the sexual response causing personal distress. It is the second most common sexual problem among women, affecting 15 to 20 percent, and most frequently occurs in postmenopausal women. Decreased estrogen levels that occur after menopause may make the vagina dry and thin, shrink vaginal tissue, and reduce blood flow to genital tissues. As a result, for menopausal and postmenopausal women, the arousal phase of the sexual response may take longer, and sensitivity of the vaginal area can decline. However, this can happen at any age.

Orgasms vary greatly in length and intensity, and often feel different at different times for women. Persistent absence or recurrent delay in orgasm after stimulation and arousal is known as female orgasmic disorder. About 10 percent of women have never had an orgasm, regardless of the stimulation or situation. About half of women regularly have an orgasm during intercourse, according to the Merck Manual of Diagnosis and Therapy.

Most women are biologically able to experience orgasm. Never having an orgasm, or not having one in certain situations, are problems that often can be corrected by learning how the female body responds, how to ensure adequate stimulation and/or how to overcome inhibitions or anxieties.

Some medications, including but not limited to those used to treat high blood pressure, depression and psychosis can decrease sexual desire and sexual arousal and interfere with orgasm. If you are taking such drugs and experiencing sexual functioning side effects, talk with your health care professional about changing your prescription.

Another type of sexual arousal disorder has the opposite effect. Some women may always feel sexually aroused, an experience that can be quite uncomfortable and upsetting.

Sexual Disorders Involving Pain
Pain during or after intercourse, called dyspareunia, occurs in nearly two out of three women at some time during their lives, according to the American College of Obstetricians and Gynecologists. Like other sexual disorders, it can have physical or emotional causes, or both. The most common cause of pain during sex is inadequate vaginal lubrication that can occur from a lack of arousal, medications or hormonal changes. Painful sex also can be a sign of illness, infection, cysts or tumors needing medical treatment or surgery, which is another reason why you should discuss the problem with your health care professional.

Another type of sexual pain disorder is vaginismus, which is the involuntary spasm of the muscles at the opening of the vagina, making anything entering the vagina painful. Vaginismus can have medical causes, including:

  • scars in the vagina from an injury, childbirth or surgery

  • irritations from douches, spermicides or latex in condoms

  • pelvic infections

Vaginismus also can have psychological causes. It can be a response to a fear, such as fear of losing control or fear of pregnancy. It can also stem from pain or trauma such as rape or sexual abuse. Another type of sexual pain disorder is vulvodynia. It is defined as any pain in the vulva. It could be outside on the labia, or an itching, burning or sharp pain.

According to the American College of Obstetricians and Gynecologists, a woman's sexual response tends to peak in her mid-30s to early 40s. That's not to say, however, that a woman can't have a full physical and emotional response to sex throughout her life. In fact, the 1999 JAMA study found that the prevalence of many sexual problems among women tends to decrease as they age. Most people will have a passing sexual problem at some point in their lives, and that is normal.

If your relationship or sexual problem is new, try having an open, honest talk with your partner to relieve concerns and clear up disagreements or conflicts. Women who learn to tell their partners about their sexual needs and concerns have a better chance at a more satisfying sex life. If the sexual problem persists, do discuss your concerns with your health care professional. Most sexual problems can be treated.

Reprinted from healthywomen.org