Women need not suffer quietly

Sexual Wellness

Women need not suffer quietly

Many women are uncomfortable discussing sexual dysfunction with their primary care provider or gynecologist. They endure these issues silently, which can negatively affect their relationships and quality of life.

Women’s intimate activities include fondling, self-stimulation, oral sex, vaginal penetration and intercourse. Just as there are a range of sexual activity, there are many types of sexual health problems.

A woman's sexuality is a complex interplay of physical and emotional responses that affects the way she thinks and feels about herself. A sexual problem can hurt her personal relationships and her self-esteem. Yet, many women hesitate to talk about their sexuality with their health care professionals, and many health professionals are reluctant to begin a discussion about sexuality with their patients.

Instead, women needlessly suffer in silence when their problems could be treated.

Women can experience a variety of sexual problems, such as lack of desire, difficulty becoming aroused or having an orgasm or having pain during sex. When a physical or emotional problem persists, it's time to contact a health care professional.

Every woman differs in her sexual interest, response and expression. A woman's feelings about sexuality can change according to the circumstances and stages of her life.

Research on women’s sexuality in the mid-1960s by Masters and Johnson established what is known as the traditional linear sexual-response cycle: excitement/arousal, plateau, orgasm and resolution. The stages are defined as follows:

  1. Excitement/Arousal: The feeling that you want to have sex, followed by physical changes that occur in your body as you become sexually excited. These include moistening of the vagina; relaxation of the muscles of the vagina; and swelling of the labia (skin folds that are part of the vulva) and the clitoris (a small, sensitive organ above the vagina, where the inner labia, which surround the vagina, meet). The nipples also become erect.
  2. Plateau: The above changes in the genitals continue, there is an increase in blood flow to the labia, the vagina grows longer and glands in the labia produce secretions. There is an overall increase in muscle tension.
  3. Orgasm: Known as the peak of the sexual response, the muscles of the vagina and uterus contract leading to a strong, pleasurable feeling.
  4. Resolution: You return to your normal state.

More contemporary research suggests that a woman's sexual response is more complex, varied and less linear than this model suggests, particularly when the woman is involved in a long-term relationship.

Women’s sexual response does not always follow the order of desire then arousal. Many women may become aroused without much desire as a result of engaging in sexual stimulation. Once sexually aroused, desire is then kindled.

The variability among women and the multiple factors impacting a woman's sexual function are important to understanding their sexual health, as well as for accurately diagnosing and treating sexual dysfunction. Women’s sexual responses are connected as much to relationship and intimacy as to physical needs, and that variability does not always equate to being dysfunctional.

Sexual dysfunctions are disturbances in one or more of the sexual response cycle's phases or pain associated with sexual activity. An estimated 43% of women in the US experience a sexual problem, and 22% experience sexually related personal distress. Causes of sexual dysfunctions can be psychological, physical or related to interpersonal relationships or sociocultural influences.

A woman may be at greater risk for sexual problems if she is: experiencing emotional or stress-related problems, feeling unhappy, or physically and emotionally unsatisfied, a victim of sexual abuse or forced sexual contact, or has a medical condition.

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.

Lack of sexual desire is the most common sexual problem in women. Sexual response is very individual, and different women feel different degrees of it at different times in their lives. Women in their 50s have about half the testosterone they had in their 20s, causing reduced sexual response. That's not to say, however, that a woman can't have a full physical and emotional response to sex throughout her life.

Most women will have a passing sexual problem at some point in their lives, and that is normal. However, the highest prevalence of sexual problems with distress is in women aged 45 to 64.

Female sexual interest/arousal disorder occurs when sexual fantasies or thoughts and desire for sexual activity are persistently reduced or absent and/or a woman is unable to experience adequate sexual arousal causing distress or relationship difficulties. Often, a woman's sexual desire is affected by her relationship with her sexual partner. The more a woman enjoys the relationship, the greater her desire for sex. The stresses of daily living can affect desire, however, and occasionally feeling uninterested in sex is no cause for concern. But when disinterest persists and causes problems, it is classified as a disorder.

Female orgasmic disorder refers to the persistent absence or recurrent delay in orgasm after sufficient stimulation and arousal, causing personal distress. About one in three women have problems reaching orgasm.

Never having an orgasm, or not having one in certain situations, are problems that can sometimes be resolved 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 reduce your sexual desire and sexual arousal and interfere with orgasm. If you are taking such drugs and experiencing sexual side effects, talk with your health care professional about changing your dosage or prescription.

Genito-pelvic pain/penetration disorder refers to pain during or after intercourse. Also called dyspareunia, this disorder occurs in nearly two out of three women at some time during their lives. Like other sexual disorders, it can have physical and/or emotional causes. The most common cause of pain during sex is inadequate vaginal lubrication occurring from a lack of arousal, medications or hormonal changes. Painful sex also can be a sign of illness, infection, cysts or tumors requiring medical treatment or surgery, another reason why you should discuss the problem with your health care professional.

Persistent genital arousal disorder refers to persistent or recurrent distressing feelings of genital arousal or being on the verge of orgasm not associated with concomitant sexual interest, thoughts or fantasies for greater than six months. This disorder is extremely distressing and thoughts of suicide are common.

If you're having sexual problems, your health care professional will try to rule out medical causes, first by conducting a thorough medical history and exam, including a vulvar and/or pelvic exam and blood tests.

Treatment for sexual dysfunction depends on the cause of the problem. If the cause is physical, medical treatment is aimed at correcting the underlying disorder. If the cause is psychological, treatment consists of counseling. Treatment can include a combination of medical and psychological approaches.

Given the biopsychosocial nature of sexual problems, even if there is a biological cause, the psychological impact can still be significant, and you may be referred for psychological counseling. If you are not offered a referral, feel free to ask for a referral to a sex therapist. These specialists are trained to provide the type of therapy you need and, with your input, make a diagnosis and recommend treatment. When possible, your partner should be included in this therapy with you.

Sometimes, treatment may be behavioral. For example, with loss of desire, changes in the environment, timing, lovemaking techniques or foreplay can produce desire. With arousal disorder, the use of toys and vibrators can help with vaginal circulation. A warm bath and a massage from your partner can also help.

Vibrators are increasingly recommended by medical professionals and come in many types. They can be used independently or as part of partnered sex. They can be used to treat orgasmic disorders where orgasm is first achieved with a vibrator or masturbation and then bridged to a partner. The vibrator facilitates arousal, which improves genital blood flow leading to improved tissue elasticity and responsiveness.

If you are in a relationship, 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, discuss your concerns with your health care professional. Most sexual problems can be treated.

To find a certified, trained sex therapist contact the International Society for the Study of Women's Sexual Health, the Society for Sex Therapy and Research or the American Association of Sexuality Educators, Counselors and Therapists.

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