A sexual problem means that sex is not satisfying or positive for you. In women, common sexual problems include feeling little or no interest in sex, having problems getting aroused, or having trouble with orgasm. For some women, pain during intercourse is a problem.
Most women have a sexual problem at one time or another. For some women, the problem is ongoing. But your symptoms are only a sexual problem if they bother you or cause problems in your relationship.
There is no "normal" level of sexual response, because it is different for every woman. You may also find that what is normal at one stage of your life changes at another stage or age. For example, it's common for an exhausted mother of a baby to have little interest in sex. And it's common for both women and men to have less intense sex drives as they age. This is linked in part to hormone changes in the body.
Female sexuality is complex. At its core is a need for closeness and intimacy. Women also have physical needs. When there is a problem in either the emotional or physical part of your life, you can have sexual problems.
Some common causes include:
Sexual problems can include:
Women often recognize a sexual problem when they notice a change in desire or sexual satisfaction. When this happens, it helps to look at what is and isn't working in the body and in life. For example:
Your doctor can help you decide what to do. He or she will ask questions, do a physical exam, and talk to you about possible causes.
Some women find it hard to talk to their doctors about sexual problems at first. Sometimes it helps to write out what you want to say beforehand. For example, you could say something like "For the past few months, I haven't enjoyed sex as much as I used to." Or you could say "Ever since I started taking that medicine, I haven't felt like having sex."
If sexual problems are making you unhappy, you don't have to just live with them. Many sexual problems can be treated. Your treatment will depend on what is causing the problem.
Sex involves emotional, physical, and relationship issues. Successful treatment requires a high level of comfort between you and your doctor. Ideally, you and your partner will also be able to talk openly about sexual concerns. Treatment may include treating health problems, getting communication counseling, and learning about things you can practice at home. For example, you might take a warm bath to relax, have plenty of foreplay before sex, or try different positions during sex.
Learning about sexual problems in women:
A woman's sexuality is a complex mix of mental, emotional, and physical signals. A problem in one area can grow to involve others. For example, a physical problem can lead to fear of pain, and the fear can lead to guilt about its effect on your partner. So the causes of sexual problems in women are often interrelated.
Psychological causes may be related to past or current physical or emotional problems. These mental and emotional causes include:
Physical causes can be normal hormonal changes, injuries, medical procedures, or other medical problems. Physical causes include:
Aging may cause a decrease in sexual desire and changes in the vagina. These changes include:
Medicine use can sometimes decrease sexual desire and arousal. Such medicines include:
Losing a partner is a common life event that can lead a woman to be less sexually active and satisfied. This is not a "sexual problem." But it can leave you with unmet needs for intimacy.
Cultural and societal factors may play a role in a woman's sexual health. Inadequate health services and/or a lack of sex education may result in a woman's lack of knowledge about sexual behavior.
Drinking alcohol and using illegal recreational drugs in small amounts may reduce sexual inhibitions at first. But continually using drugs, such as cocaine or amphetamines, or drinking too much alcohol will cause problems with orgasm for a woman. Also, illegal drugs as well as many medicines may cause a woman to have less sexual desire.
Symptoms of sexual problems can include:
By definition, sexual problems are symptoms that are distressing for you and/or your relationship with a partner. If you have a symptom that you are not troubled by and that isn't causing a relationship problem, then it is not considered to be a sexual problem.
Most women have a sexual problem at one time or another. For some women, the problem is long-term. Surveys of the general population in the United States found that many women occasionally have sexual problems and worries, including:1
There are many reasons why a woman may have a sexual problem.
The main risk factors for sexual problems are also those that affect a woman's sexual function and satisfaction. These include:
A woman's physical well-being is also important. Being sexually active with a partner or through masturbation helps maintain vaginal health. And having regular sexual intercourse helps preserve vaginal elasticity and keeps vaginal tissues from shrinking.
Some physical risk factors include a current or long-term history of:
A common sexual problem is pain during intercourse. Call a doctor for immediate care if sudden, severe pelvic pain occurs with or without vaginal bleeding.
Watchful waiting is a wait-and-see approach. If you improve on your own, you won't need treatment. If you don't improve, you and your doctor will decide what to do next.
If you are having pain with sex, you need to see a doctor. For other sexual problems, it may help to talk with your doctor before trying watchful waiting. During this time, you may be using home treatment, such as using liberal lubrication to reduce fears of pain and using exercises to stimulate sexual desire. Maintaining honest and frequent communications with your doctor will help you decide whether medical treatment is needed.
Health professionals who can help you evaluate your symptoms, discuss treatment options, and treat a sexual problem include:
You may want to start with your regular doctor, because a sexual problem may be related to a physical condition or a medicine. It is important to identify any physical causes before entering therapy for sexual concerns.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Women often begin the process of diagnosing a sexual problem by noticing an absence of sexual desire or satisfaction.
Your doctor will work with you to identify your symptoms and the history of those symptoms. He or she will:
Your doctor will use the information from the history and exams to determine the cause of your sexual concerns.
Throughout the appointment and future treatment of a sexual problem, your doctor should establish an encouraging atmosphere for you to discuss your concerns. All of your communications about your sexual concerns should be done in a professional, confidential, and nonjudgmental manner. See a list of questions you might be asked by your doctor.
By definition, a sexual problem is a sex-related stressor for you and/or your relationship with a partner. If you have a symptom that you are not troubled by and that isn't causing a relationship problem, then it is not considered to be a problem.
Many sexual problems can be managed when you understand what is causing them. Effective management requires a high level of comfort between you and your doctor, possibly along with your partner.
Because a sexual problem often has multiple causes, treatments cannot be universally applied—what works for one woman may not work for another. An effective plan will address and manage the cause. And if you have a partner, your plan will also include ways to build and strengthen intimate communication between you and your partner. The best results will help you find methods of having more satisfying sex.
Treatment may include:
A decrease in your level of desire might be expressed by fewer sexual thoughts and/or a reluctance to engage in sexual activity. Treatment for physical causes can include:
Your doctor can treat physical or hormonal causes, and you can work on other aspects of sexual desire. For example:
It is normal to lack desire for a partner who forces sex or is verbally abusive or physically violent. For more information, see the topic Domestic Violence.
A decrease in the level of arousal might be noticed as an inability to feel or maintain sexual excitement. A woman's sexual arousal often is enhanced by, and is sometimes dependent on, stimulation in areas other than the genital area, especially the breasts. Treatment for a decrease in your sexual arousal may include:
A woman may seek treatment because she has never experienced an orgasm, is experiencing long delays in reaching orgasm, or has become unable to reach orgasm. Treatment usually begins with changing any medicine that is known to affect orgasm. (Talk to your doctor before you stop any medicine you are taking.)
It is also important to understand what a normal sexual stimulation phase would be for that woman. If a woman is experiencing a delay or absence of orgasm after adequate sexual stimulation, treatment may include:
Pain during intercourse often is caused by a physical reason, such as vaginal dryness or infection. This is why treatment must start with finding out the cause of a sexual problem. If a physical condition is the cause, treatment of that condition may eliminate the pain. But pain during intercourse may have more than one cause, including psychological causes such as anxiety or the memory of sexual assault.1
It is common for a woman's sexual desire to decrease gradually as she ages. In some cases this decrease is caused by the lack of a partner or, commonly, their partner's lack of interest or ability to have sex. But women continue to be sexually interested and to have the capability for sexual pleasure throughout their lives. Hormonal changes may be a cause of decreased sexual function in older women. During and after menopause, levels of the hormones estrogen, progesterone, and testosterone in a woman's body decline.
Nonprescription water-based products that provide vaginal lubrication are available. You can typically find these products, such as Astroglide and K-Y Jelly, at pharmacies, usually near the condoms. Vaginal moisturizers, such as Replens, are not for use right before sexual intercourse. But when used regularly, they can help with vaginal dryness and with keeping your vaginal pH normal.
Vaginal estrogen therapy can reduce vaginal dryness and irritation and increase the blood flow in the vagina. If you have only vaginal symptoms (and not hot flashes, for example), you can use a low-dose estrogen cream, ring, or tablet in your vagina. Many women find that using cream or a tablet twice a week is often enough.
Systemic estrogen therapy is a high enough dose that it affects your whole body and can help with several menopausal symptoms. If you have symptoms that affect your physical and mental well-being, talk to your doctor about the risks and benefits of taking daily estrogen. Estrogen therapy can be oral (pills), vaginal, or transdermal (with a patch). Estrogen therapy may affect sexual desire, arousal, and enjoyment, as well as the capability to reach an orgasm. But taking daily estrogen without progestin can cause cancer of the lining of the uterus (endometrial cancer). So a woman who has a uterus and wishes to take systemic hormones usually takes estrogen in combination with progestin to protect her uterus. This is called estrogen-progestin therapy, also known as hormone replacement therapy.
Testosterone therapy helps some postmenopausal women who have a low sex drive, especially those who have had their ovaries removed. Surgery to remove the ovaries (oophorectomy) causes sudden menopause—testosterone and estrogen, and sometimes sex drive, suddenly drop. (Normally, testosterone slowly declines with age.) Some postmenopausal women take testosterone to improve sexual desire and responsiveness and to increase the frequency of sexual fantasies and interest. Use of testosterone is not FDA-approved for treatment of low sexual desire, and there are concerns about long-term side effects. 2
If you are thinking about taking testosterone supplements, talk to your doctor about the potential side effects. Make sure that you are taking the lowest possible dose of testosterone and that you are carefully monitored for side effects.
Over time, an untreated sexual problem can increase its impact on your quality of life. As the cause of a sexual problem creates discomfort and dissatisfaction, sexual activity may become a tense and unwelcome experience.
Women have varied and interrelated reasons for desiring sexual activity and feeling sexually fulfilled. A woman's sexuality is influenced by her physical, psychological, and emotional states. Some causes of sexual problems, such as medical conditions, may not be within your control. But your emotional and psychological states are as important as your physical state in influencing your sexuality. You can take the following steps to help your sexual well-being.
Treatment of sexual problems is guided by you, your partner, and your health professional. You may find that it depends largely on changes you try at home. Techniques you can learn and practice at home include:
You can improve pelvic floor muscle strength using Kegel exercises or vaginal weights.
Because a woman's sexuality encompasses physical, emotional, and psychological factors, the causes of sexual problems are often complex and interrelated. Medicines may be used in treating certain conditions that contribute to sexual problems.
If you are taking medicine for another condition, such as depression, diabetes, or high blood pressure, and you notice that you are having sexual problems, talk to your doctor or pharmacist to see if there is other medicine you can take.
Lidocaine gel. For women who have pain in the area around the opening to the vagina (vulvodynia), putting on lidocaine gel shortly before sexual intercourse may be helpful. Talk to your doctor about how to use lidocaine safely.
Estrogen (for postmenopausal women). If you only have vaginal dryness and irritation (and not other symptoms such as hot flashes), you can use a limited amount of estrogen in a cream, tablet, or ring in the vagina. The daily estrogen makes your vaginal lining thicker. Many women find that using a cream or tablet twice a week is enough. This may increase vaginal tone and lubrication, which will decrease vulvar dryness, irritation, and shrinkage (atrophy).
If you also have other menopausal symptoms that affect physical and mental well-being, talk to your doctor about taking daily (systemic) estrogen therapy. Estrogen can increase the blood flow in the vagina and reduce hot flashes and other symptoms of menopause. Estrogen therapy or estrogen-progestin therapy can be oral (pills), vaginal, or transdermal (with a patch). In a small number of women, hormone therapy causes heart disease, breast cancer, ovarian cancer, dangerous blood clots, stroke, and dementia. Talk to your doctor about whether this therapy is right for you.
Testosterone. This hormone may play a part in a woman's sex drive and satisfaction. The ovaries make testosterone throughout a woman's lifetime. Women have the most testosterone in early adulthood. Testosterone levels drop by half between the early 20s and the early 40s.
A woman who has had surgery to remove her uterus (hysterectomy) and ovaries (oophorectomy) will suddenly be in menopause. She will have an immediate drop in both estrogen and testosterone. She may then have a problem with sexual desire. If so, her doctor may suggest hormone therapy.
Some medicines for treating depression may cause side effects related to sexual problems, such as decreased sexual desire. Other antidepressants like bupropion (Wellbutrin) or mirtazapine (Remeron) may be a better choice, as these are less likely to cause this kind of side effects.
Sildenafil (Viagra), which is used to treat erectile dysfunction in men, is being studied for use in women who have arousal problems, but it has not been shown to be effective.2
One type of sexual problem in women is pain during intercourse. Pain often is caused by a physical reason, such as injury or anatomical problems. If examinations and tests confirm that a physical condition is causing pain during intercourse, treatment of that condition may get rid of the pain. In some cases, such as with the medical condition endometriosis, surgery may be recommended.
There is no surgical treatment for sexual problems unless pain is caused by endometriosis or another medical condition.
Certain surgical procedures may cause sexual problems. For example, it is common for a woman who has had her breast or breasts removed (mastectomy) or has had her uterus and ovaries removed (hysterectomy and oophorectomy) to report reduced sexual desire. Sexual therapy may be recommended after surgery to assist you and your partner in finding methods to stimulate sexual arousal and achieve sexual satisfaction.
There are advertised procedures, such as "vaginal rejuvenation" surgeries, that promise to increase sexual pleasure. But such surgeries may not provide any benefit. And they may cause harm. They also may be costly and painful. Talk with your doctor about treatment for a sexual problem. If he or she is not able to help you find answers, ask for a referral to a doctor who is a specialist in this area of medicine.
Studies of alternative medicines for sexual problems are limited. But some of them show possible benefits. These include studies of devices and herbal supplements.
Vaginal weights can strengthen the pelvic floor and vaginal muscles. They usually come in five sizes. Start with the smallest weight, and work up to the largest over time. Insert a weight into your vagina, then hold it in place while standing upright for 15 minutes. Your muscles will feel the urge to tighten and hold it in. After a few days, the vaginal muscles become strong enough that they no longer feel an urge to hold the weight. This is when you use the next larger weight. When you've used all five weights, keep your muscles toned by using the largest weight for 5 to 7 days in a row each month.
Eros Therapy Device. This is a small battery-operated device used to stimulate engorgement of the clitoris. The Eros Therapy Device was cleared by the U.S. Food and Drug Administration (FDA) for sale in the U.S. in 2000. Using this device is said to increase lubrication and clitoral sensation and to help with achieving orgasm and improving women's sexual satisfaction. Initial studies have shown good results in women reporting sexual problems and also in women recovering from cervical cancer treatment.4
Researchers continue to look for treatments for raising sexual desire, arousal, and satisfaction. Some products, such as different vitamins and herbs, are promoted as natural treatments for sexual problems. But most of these products have not been subject to the same kind of rigorous scientific testing for safety and effectiveness that standard medical treatments must go through before they are approved in the United States. Be sure to talk with your doctor about which therapies might be best for you. If you decide to use an alternative medicine or supplement, follow these precautions.
|American Association of Sexuality Educators, Counselors, and Therapists (AASECT)|
|P.O. Box 1960|
|Ashland, VA 23005-1960|
The American Association of Sexuality Educators, Counselors, and Therapists (AASECT) is a nonprofit professional organization that promotes understanding of human sexuality and healthy sexual behavior. AASECT offers certification of sexual health practitioners.
|American Congress of Obstetricians and Gynecologists (ACOG)|
|409 12th Street SW|
|P.O. Box 96920|
|Washington, DC 20090-6920|
American Congress of Obstetricians and Gynecologists (ACOG) is a nonprofit organization of professionals who provide health care for women, including teens. The ACOG Resource Center publishes manuals and patient education materials. The Web publications section of the site has patient education pamphlets on many women's health topics, including reproductive health, breast-feeding, violence, and quitting smoking.
|Association of Reproductive Health Professionals (ARHP)|
|2401 Pennsylvania Avenue NW|
|Washington, DC 20037-1718|
This organization of health professionals provides education and information on reproductive health matters such as sexual health, sexually transmitted diseases (STDs), family planning, contraception, and infertility.
|National Institute on Aging|
|Building 31, Room 5C27|
|31 Center Drive, MSC 2292|
|Bethesda, MD 20892|
The National Institute on Aging (NIA), one of the centers of the U.S. National Institutes of Health, leads a broad scientific effort to understand the nature of aging and to extend the healthy, active years of life. The NIA funds research and provides information about health and research advances to the public and interested groups.
|National Women's Health Information Center|
|8270 Willow Oaks Corporate Drive|
|Fairfax, VA 22031|
The National Women's Health Information Center (NWHIC) is a service of the U.S. Department of Health and Human Services Office on Women's Health. NWHIC provides women's health information to a variety of audiences, including consumers, health professionals, and researchers.
|North American Menopause Society (NAMS)|
|5900 Landerbrook Drive|
|Mayfield Heights, OH 44124|
The North American Menopause Society (NAMS) is a nonprofit organization that promotes the understanding of menopause and thereby improves the health of women as they approach menopause and beyond. NAMS members include experts from medicine, nursing, sociology, psychology, nutrition, anthropology, epidemiology, pharmacy, and education. The NAMS website has information on perimenopause, early menopause, menopause symptoms and long-term health effects of estrogen loss, and a variety of therapies.
|UrologyHealth.org, American Urological Association|
|1000 Corporate Boulevard|
|Linthicum, MD 21090|
UrologyHealth.org is a website written by urologists for patients. Visitors can find specific topics by using the "search" option.
The website provides information about adult and pediatric urologic topics, including kidney, bladder, and prostate conditions. You can find a urologist, sign up for a free quarterly newsletter, or click on the Urology Resource Center to find materials about urologic problems.
- Baram DA (2007). Sexuality, sexual dysfunction, and sexual assault. In JS Berek, ed., Berek and Novak's Gynecology, 14th ed., pp. 313–349. Philadelphia: Lippincott Williams and Wilkins.
- Drugs for female sexual dysfunction (2010). Medical Letter on Drugs and Therapeutics, 52(1353/1354): 100–102.
- Haessler A, Rosenthal MB (2007). Psychological aspects of obstetrics and gynecology. In AH DeCherney, L Nathan, eds., Current Diagnosis and Treatment Obstetrics and Gynecologic, 10th ed., pp. 1003–1024. New York: McGraw-Hill.
- American College of Obstetricians and Gynecologists (2011). Female sexual dysfunction. ACOG Practice Bulletin No. 119. Obstetrics and Gynecology, 117(4): 996–1007.
Other Works Consulted
- Potter J (2009). Female sexuality: Assessing satisfaction and addressing problems. In EG Nabel, ed., ACP Medicine, section 16, chap. 22. Hamilton, ON: BC Decker.
- Agronin ME (2009). Sexual disorders. In DG Blazer et al., eds., American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th ed., pp. 357–373. Washington, DC: American Psychiatric Publishing.
- Basson R (2006). Sexual desire and arousal disorders in women. New England Journal of Medicine, 354(14): 1497–1506.
- Becker JV, Stinson JD (2008). Human sexuality and sexual dysfunctions. In RE Hales, SC Yudofsky, eds., American Psychiatric Publishing Textbook of Psychiatry, 5th ed., pp. 711–728. Washington, DC: American Psychiatric Publishing.
- Goldstein I (2007). Urological management of women with sexual health concerns. In AJ Wein et al., eds., Campbell-Walsh Urology, 9th ed., vol. 1, pp. 863–889. Philadelphia: Saunders Elsevier.
- Gretchen ML (2007). Emotional aspects of gynecology. In MA Stenchever et al., eds., Comprehensive Gynecology, 5th ed., pp. 177–194. St. Louis: Mosby.
- Sadock VA (2009). Normal human sexuality and sexual and gender identity disorders. In BJ Sadock et al., eds., Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, 9th ed., vol. 1, pp. 2027–2060. Philadelphia: Lippincott Williams and Wilkins.
|Primary Medical Reviewer||Sarah Marshall, MD - Family Medicine|
|Specialist Medical Reviewer||Kirtly Jones, MD - Obstetrics and Gynecology|
|Last Revised||February 22, 2012|
Last Revised: February 22, 2012
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