Sexual Dysfunction

A woman's sexuality is a complex interplay of physical and emotional responses that affects the way she thinks and feels about herself. When a woman has a sexual problem, it can impact many aspects of her life, including her personal relationships and her own self-esteem. Many women are hesitant 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 may needlessly suffer in silence when their problems could be treated.

Sexual activity includes a wide variety of intimate activities, such as fondling, self-stimulation, oral sex, vaginal penetration and intercourse. 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. Women also can experience a variety of sexual problems, such as lack of desire, difficulty becoming aroused, difficulty having an orgasm or pain during sex. When a physical or emotional problem associated with sex persists, it's time to contact a health care professional.

Research on the sexual response in the mid-1960s by Masters & Johnson established what is known as the traditional linear sexual-response cycle: desire-arousal-orgasm-resolution. The stages are defined as follows:

  • 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; 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 surrounds the vagina, meet that acts as a source of sexual excitement). The nipples also become erect.
  • 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.
  • Orgasm: Known as the peak of the sexual response, the muscles of the vagina and uterus contract leading to a strong, pleasurable feeling.
  • Resolution: You return to your normal state.

In a new sexual relationship, most women's sexual response can be described with this model. However, more contemporary research suggests that women's sexual response is both more complex and varied than this model suggests, particularly when involved in a long-term relationship. In 2001, the leader in this field, Rosemary Basson, PhD, introduced a new cycle for the female sexual response that focuses on women's need for intimacy.

These differences are important to understanding your sexual health as well as for accurately diagnosing and treating sexual dysfunction. The differences, in part, include recognizing that women's sexual responses are connected more to relationship and intimacy than to physical needs, and that the orgasm stage can be highly variable for women without actually being "dysfunctional."

Sexual dysfunctions are disturbances in one or more of the sexual response cycle's phases, or pain associated with arousal or intercourse. A study published in the Journal of the American Medical Association involving a national sample of 1,749 women estimated that sexual dysfunctions occur in 43 percent of women in the United States. According to this 1999 study, you may be at greater risk for sexual problems if you are:
  • single, divorced, widowed or separated
  • not a high school graduate
  • experiencing emotional or stress-related problems
  • experiencing a decline in your economic position
  • feeling unhappy, or physically and emotionally unsatisfied
  • a victim of sexual abuse or forced sexual contact

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. Causes of sexual dysfunctions can be psychological, physical or related to interpersonal relationships or sociocultural influences.

Psychological causes can include:
  • stress or anxiety from work or family responsibilities
  • concern about sexual performance
  • conflicts in the relationship with your partner
  • depression/anxiety
  • unresolved sexual orientation issues
  • previous traumatic sexual or physical experience
  • body image and self-esteem problems

Physical causes can include:
  • diabetes
  • heart disease
  • liver disease
  • kidney disease
  • pelvic surgery
  • pelvic injury or trauma
  • neurological disorders
  • medication side effects
  • hormonal changes, including those related to pregnancy and menopause
  • thyroid disease
  • alcohol or drug abuse
  • fatigue

Interpersonal relationship causes may include:
  • partner performance and technique
  • lack of a partner
  • relationship quality and conflict
  • lack of privacy

Sociocultural influence causes may include:
  • inadequate education
  • conflict with religious, personal, or family values
  • societal taboos

Lack of sexual desire is the most common sexual problem in women. The Association of Reproductive Health Professionals reports in the National Health and Social Life Survey that 33 percent of women lacked interest in sex for at least a few months in the previous year. Meanwhile, the Merck Manual of Diagnosis and Therapy estimates about 15 percent of postmenopausal women have declines in sexual desire.

The American College of Obstetricians and Gynecologists (ACOG) reports that a woman's sexual response tends to peak in her mid-30s to early 40s. That's not to say, however, that a woman can't have a full physical and emotional response to sex throughout her life. In fact, the 1999 JAMA study found that except for lubricating disorders, the prevalence of many sexual problems among women tends to decrease with age. Most women will have a passing sexual problem at some point in their lives, and that is normal.

If your relationship or sexual problem is new, 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, do discuss your concerns with your health care professional. Most sexual problems can be treated.

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