Many women experience problems with sex at some stage in their life. Here's a look at some forms of female sexual dysfunction (FSD) and where to go for help if FSD affects you.
According to The Sexual Dysfunction 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.
When it comes to identifying the reasons for sexual dysfunction, both physical and psychological factors are explored, 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 pregnancy or times of stress) but some experience it all the time.
A lack of sex drive can have a range of physical or psychological causes, including heart disease, diabetes, depression, relationship problems, hormone disorders, excessive alcohol and drug use, tiredness, and previous sexual experience that has been traumatic.
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 not functioning properly.
Orgasm problems
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 cannot now). Some women don’t have to have an orgasm to enjoy sex, but 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, relationships 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.
Psychosexual therapy can help a woman overcome orgasm problems, and involves exploring her feelings about sex, her relationship and herself.
Pain
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 available 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 has had vaginal trauma (childbirth, episiotomy), relationship problems, fear of pregnancy, or painful conditions of the vagina and surrounding area.
Vaginismus can often be successfully treated, focusing on sex education, counselling and the use of vaginal trainers. Vaginal trainers are cylindrical shapes inserted into the vagina. A woman will gradually use larger sizes until the largest size can be comfortably inserted.
Getting help
To find 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 can help.
Treating other conditions such as diabetes, depression or heart disease might also alleviate symptoms of sexual dysfunction.
In many cases of sexual dysfunction, sexual therapy can help. Talk with your partner about your problem, and go to see a therapist together if you can. Try not to feel embarrassed. Many people experience sexual dysfunction, and there are ways to get help.
Your GP can refer you to a therapist or you can go to one privately. Look for a therapist who is a member of the Institute of Psychosexual Medicine or the British Association for Sexual and Relationship Therapy (see Useful Links). This means they will be fully qualified, and will make sure you get a proper check-up of physical and psychological factors.
More information
To find out more about sexual health, dysfunction and the menopause, read Sexual Health and the Menopause (RSM Press), edited by John Tomlinson, Margaret Rees and Tony Mander.
