Many women have problems with sex at some stage in their life. Here's a look at some forms of female sexual dysfunction (FSD) and advice on where to get help if FSD affects you.
According to the Sexual Advice Association, sexual problems affect around 50% of women and become more common as women get older.
Dysfunction can include loss of desire, loss of arousal, problems with orgasm, and pain during sex.
To identify the reasons behind sexual dysfunction, both physical and psychological factors have to be considered, including a woman's relationship with her partner.
Loss of desire
Loss of desire, or lack of sex drive, affects some women at certain times of life, such as during pregnancy or times of stress. But some women experience it all the time.
A lack of sex drive can have a range of physical or psychological causes, including diabetes, depression, relationship problems, hormone disorders, excessive alcohol and drug use, tiredness, and previous traumatic sexual experience.
Sex drive can also fall if a woman's natural testosterone levels drop. Testosterone is produced in the ovaries and adrenal glands, so levels can drop if these are removed or if they're not functioning properly.
These can be divided into two types: primary (when a woman has never had an orgasm) and secondary (when a woman has had an orgasm in the past but can't now).
Some women don't need to have an orgasm to enjoy sex, but an inability to reach orgasm can be a problem for some women and their partners.
Reasons why a woman can't have an orgasm can include fear or lack of knowledge about sex, being unable to "let go", not enough effective stimulation, relationship problems, mood disorders (such as depression), and previous traumatic sexual experience.
Research is being done into certain medical conditions that affect the blood and nerve supply to the clitoris to see whether this affects orgasm. Find out more in What is an orgasm?.
Psychosexual therapy can help a woman overcome orgasm problems. It involves exploring her feelings about sex, her relationship and herself.
Pain during sex (also called dyspareunia) is common after the menopause as oestrogen levels fall and the vagina feels dry. This can affect a woman's desire for sex, but there are creams that can help. Ask your GP or pharmacist.
Vaginismus is when muscles in or around the vagina go into spasm, making sexual intercourse painful or impossible. It can be very upsetting and distressing.
Vaginismus can occur if the woman associates sex with pain or being "wrong", if she's had vaginal trauma (such as childbirth or an episiotomy), relationship problems, fear of pregnancy, or painful conditions of the vagina and the surrounding area.
It can often be successfully treated by focusing on sex education, counselling and the use of vaginal trainers. Vaginal trainers are cylindrical shapes that are inserted into the vagina. A woman will gradually use larger sizes until the largest size can be inserted comfortably.
To establish the cause of sexual dysfunction, a doctor or therapist will need to ask you questions about your medical, sexual and social history. Your GP can carry out tests for underlying medical conditions.
If your problem is related to lack of hormones such as testosterone or oestrogen, hormone replacement therapy (HRT) can help.
Treating other conditions such as diabetes or depression might also alleviate symptoms of sexual dysfunction.
In many cases, sexual therapy can help. Talk with your partner about your problem and see a therapist together if you can. Don't be embarrassed. Many people experience sexual dysfunction and there are ways to get help.
Your GP can refer you to a therapist, or you can see one privately. Look for a therapist who is a member of the College of Sexual and Relationship Therapists. This means they'll be fully qualified and will make sure you get a proper check-up of physical and psychological factors.
The Sexual Advice Association offers sexual health factsheets on topics ranging from loss of sex drive to talking to your GP about sexual problems, and ageing and sex.
For more on sexual health, dysfunction and the menopause, read Sexual Health and the Menopause (RSM Press), edited by John Tomlinson, Margaret Rees and Tony Mander.