Sexual Difficulties in Women: Causes and Treatment

Women’s sexuality, long considered a taboo subject is now openly discussed and portrayed on television, in magazines, and on the Internet. Most importantly, women themselves are becoming increasingly aware of their sexuality and their sexual health.

Troubles with having sex or enjoying it are sometimes called female sexual dysfunction or female sexual difficulties (FSD). It can be life-long or can develop over time. FSD is defined as persistent problems with sexual response, desire, orgasm, or pain that causes you distress or strains your relationship with your partner.

There are four main types of FSD:

  • Low sexual desire. Lack of interest in sex and sexual activity.
  • Sexual arousal disorder. Difficulty in becoming aroused or lack of sexual response during sexual activity.
  • Orgasmic disorder. Consistent difficulty (or inability) to reach orgasm.
  • Sexual pain disorder. Pain during intercourse (called dyspareunia) or with vaginal stimulation.

Causes of sexual difficulties in women

The causes of sexual difficulties are as varied and complex as the human race. Any of the following can contribute to sexual problems:

  • Relationship problems: Discord in other aspects of the relationship, such as distribution of labor, childrearing, or money, can cause sexual problems. Issues of control or even abuse in the relationship are especially harmful to sexual harmony. Such problems can prevent a woman from communicating her sexual wants and needs to her partner.
  • Emotional problems: Depression, anxiety (about sex or other things), stress, resentment, and guilt can all affect a woman’s sexual function.
  • Insufficient stimulation: A woman’s (or her partner’s) lack of knowledge about sexual stimulation and response may prevent a woman from achieving a satisfactory experience. Poor communication between partners can also be a culprit here.
  • Gynecologic problems: A number of pelvic disorders can cause pain in intercourse and thus decrease satisfaction.
    • Vaginal dryness: The most common reason for this in younger women is insufficient stimulation. In older women, the decrease in estrogen that occurs in perimenopause or menopause is the cause of vaginal dryness. Poor lubrication can also be linked to hormone imbalances and other illnesses and to certain medications. It can inhibit arousal or make intercourse uncomfortable.
    • Vaginismus: This is a painful spasm of the muscles surrounding the vaginal opening that causes the vaginal opening to “tighten.” It can prevent penetration or make penetration extremely painful. Vaginismus can be caused by injuries or scars from surgery, abuse, or childbirth, by infection, or by irritation from douches, spermicides, or condoms. It can also be caused by fear.
    • Sexually transmitted diseases: Gonorrhea, herpes, genital warts, chlamydia, and syphilis are infectious diseases spread by sexual contact. They can cause changes in the genitals that make sex uncomfortable or even painful.
    • Vaginitis: Inflammation and irritation of vaginal tissues due to infection or other causes can make intercourse uncomfortable or painful.
    • Endometriosis, pelvic mass, ovarian cyst, surgical scars: Any of these can cause an obstruction or anatomical changes that prevent intercourse or make it difficult or painful.
    • Pelvic inflammatory disease: This is an infection of the vagina that moves up into the cervix, uterus, and ovaries. It can be very painful on its own and make intercourse extremely painful.
    • Nerve damage after surgery: Unavoidable cutting of small nerves during pelvic surgery (such as hysterectomy) may decrease sensation and response.
  • Physical conditions: Many physical or medical conditions can decrease a woman’s satisfaction with her sex life.
    • Tiredness (fatigue)
    • Chronic diseases such as diabetes, heart disease, liver disease, kidney disease
    • Cancer
    • Neurologic disorders
    • Vascular (blood flow) disorders
    • Hormonal imbalances
    • Menopause
    • Pregnancy
    • Alcohol or drug abuse
  • Medications: Certain medications can reduce desire or arousal. One well-known group of drugs that have this effect are the selective serotonin-reuptake inhibitor (SSRI) group of antidepressants, which includes drugs such as Prozac and Zoloft. Others include certain chemotherapy drugs, drugs for high blood pressure, and antipsychotic medications.
  • Other medical treatments: Treatments such as radiation therapy for certain types of cancer can reduce vaginal lubrication. They can also make skin and the membranes lining the genitals tender and sensitive.
  • History of abuse: A woman who has suffered sexual or other abuse may have trouble trusting her partner enough to relax and become aroused. She may have feelings of fear, guilt, or resentment that get in the way of a satisfactory experience, even if she cares deeply about her current partner.
  • Attitudes toward sex: Many people, either because of the way they were brought up or because of earlier bad experiences, don’t view sex as a normal and enjoyable part of a couple’s relationship. They may associate sex or sexual feelings with shame, guilt, fear, or anger. On the other hand are people who have unrealistic expectations about sex. Portrayals of sex in television and movies as always easy and fantastic mislead some people into believing that is how it is in real life. These people are disappointed or even distressed when sex is sometimes not earth-shattering or when a problem occurs.
  • Sexual problems of the partner: If a woman’s partner has sexual problems, such as impotence or lack of desire, this can inhibit her own satisfaction.

Treatment of sexual difficulties in women

The ideal approach to treating female sexual dysfunction involves a team effort between the woman, doctors, and trained therapists. Most types of sexual problems can be corrected by treating the underlying physical or psychological problems. Other treatment strategies focus on the following:

  • Providing education. Education about human anatomy, sexual function, and the normal changes associated with aging, as well as sexual behaviors and appropriate responses, may help a woman overcome her anxieties about sexual function and performance.
  • Enhancing stimulation. This may include the use of erotic materials (videos or books) and changes in sexual routines.
  • Providing distraction techniques. Erotic or non-erotic fantasies; exercises with intercourse; music, videos, or television can be used to increase relaxation and eliminate anxiety.
  • Encouraging non-coital behaviors. Non-coital behaviors (physically stimulating activity that does not include intercourse), such as sensual massage, can be used to promote comfort and increase communication between partners.
  • Minimizing pain. Using sexual positions that allow the woman to control the depth of penetration may help relieve some pain. Vaginal lubricants can help reduce pain caused by friction, and a warm bath before intercourse can help increase relaxation.
The success of treatment for female sexual dysfunction depends on the underlying cause of the problem. The outlook is good for dysfunction that is related to a treatable or reversible physical condition. Mild dysfunction that is related to stress, fear, or anxiety often can be successfully treated with counseling, education, and improved communication between partners.