Understanding Female Sexual Problems — the Basics

Sexual behavior and response requires the complicated intertwining of environmental, physical (both anatomical and hormonal), and psychological factors. Research shows that about 66% of all women have sexual concerns, including lack of desire (33%), lack of pleasure in sexual contact (20%), pain with vaginal penetration (15%), problems with arousal (18% to 48%), problems attaining climax (46%), and complete lack of orgasm (15% to 24%).

Determining which factors are affecting your ability to enjoy your sexuality can be very difficult and will require great patience on the part of you, your partner, and your health care provider. Sexual dysfunction can afflict both sexes.

The major categories of sexual dysfunction in women include:

  • Inhibited or hypoactive sexual desire: a disinterest in sexual contact or complete lack of sexual desire.
  • Female sexual arousal disorder: the inability to become aroused, including lack of erotic feelings and physical signs of arousal, such as nipple erection, vaginal lubrication, and changes in blood flow to the labia, clitoris, and vagina.
  • Female orgasmic disorder: the inability to have an orgasm (sexual climax) despite the ability to become sexually aroused and despite adequate sexual stimulation.
  • Dyspareunia: pain with intercourse or attempted intercourse.
  • Vaginismus: a disorder in which the muscles around the entrance to the vagina spasm uncontrollably, making vaginal penetration and/or intercourse painful and extremely difficult or impossible.



What Causes Sexual Problems in Women?

Because the sexual response is so complex, there are many causes of sexual dysfunction.

Misinformation or poor techniques contribute to sexual problems. Only about one in three women reaches a climax regularly through intercourse alone, without additional stimulation of the clitoris. About 10% of women never achieve orgasm. But it is possible, and even common, to have a pleasurable sex life without orgasm.

Environmental factors may interfere with sexual functioning. You may find it difficult to perform sexually if there is no safe, private place to relax and allow yourself to become sexual or if fatigue due to an overly busy work and personal life robs you of the energy to participate sexually. Parents may find it difficult to find the time to be sexually intimate, given the demands and presence of their children. The difficulties of striving for “safer sex" and the psychological effects of discrimination are just a few of the factors that can give rise to anxieties for lesbian women.

Your sexual functioning may be affected by medical conditions such as:

  • High blood pressure
  • Diabetes
  • Kidney disease
  • Multiple sclerosis or spinal cord injury
  • Thyroid disease and other hormone disorders
  • Alcoholism
  • The consequences of radiation therapy for cancer
  • Any other condition that causes fatigue and debilitation
  • Premature menopause or removal of ovaries
  • Medications

Pain during intercourse (dyspareunia) may occur as a result of:

  • Painful ovarian cysts
  • Pain or spasm of the vaginal muscles
  • Chronic pain with no known cause (vulvodynia) that affects the vulva, which includes a woman’s external sex organs
  • Pelvic infections
  • Endometriosis
  • Uterine or bladder prolapse
  • Inadequate vaginal lubrication which can happen with menopause or with lack of foreplay
  • Skin conditions of the vulva and vagina called lichen sclerosis
  • An abnormally formed vagina (due to a birth defect, scarring from repair after childbirth, or radiation damage)
  • A poor-fitting contraceptive diaphragm
  • An allergic reaction to certain condoms or spermicidal jellies or foams
  • Fears or anxiety
  • A combination of one or more of the above conditions

A variety of medications and drugs can interfere with sexual functioning, including:

  • Alcohol
  • Drugs to treat high blood pressure
  • Pain medications
  • Sedatives
  • Certain antidepressants
  • Antipsychotic medications

Psychological factors may play a role, particularly if your problem is lack of desire or inability to get aroused. You may find it difficult to enjoy a sexual relationship if:

  • You are under a lot of stress.
  • Your relationship is troubled.
  • You have a history of traumatic sexual encounters.
  • You were raised in a family with strict sexual taboos.
  • You have poor body image.
  • You’re afraid of getting pregnant or of contracting a sexually-transmitted disease.
  • You have negative feelings (including guilt, anger, fear, and low self-esteem).
  • You have an anxiety disorder.
  • You are depressed.

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