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Sexual Problems in Women

Topic Overview

What are sexual problems?

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.

What are some causes of sexual problems in women?

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:

  • Emotional causes, such as stress, relationship problems, depression or anxiety, a memory of sexual trauma, and unhappiness with your body.
  • Physical causes, such as hormone problems, pain from an injury or other problem, and certain conditions such as diabetes or arthritis.
  • Aging, which can cause changes in the vagina, such as dryness and stiffening.
  • Certain medicines that can cause sexual problems. These include medicines for depression, blood pressure, and diabetes.

What are the symptoms?

Sexual problems can include:

  • Having less desire for sex.
  • Having trouble feeling aroused.
  • Not being able to have an orgasm.
  • Having pain during intercourse.

How are sexual problems in women diagnosed?

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:

  • Are you ill, or do you take a medicine that can lower your sexual desire or response?
  • Are you stressed or often very tired?
  • Do you have a caring, respectful connection with a partner?
  • Do you and your partner have the time and privacy to relax together?
  • Do you have painful memories about sex or intimacy?

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."

How are they treated?

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.

Frequently Asked Questions

Learning about sexual problems in women:

Being diagnosed:

Getting treatment:

Cause

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:

  • Stress, depression, or anxiety.
  • Marital or relationship discord.
  • Fears that illnesses, such as cancer, or surgery, such as a mastectomy or hysterectomy, will make sexual activity unpleasant for the woman or her partner.
  • Being unhappy about your body.
  • Fear of spreading a sexually transmitted infection, such as genital herpes.

Physical causes can be normal hormonal changes, injuries, medical procedures, or other medical problems. Physical causes include:

  • Hormonal changes such as those related to the menstrual cycle, use of birth control pills or hormone therapy, pregnancy, recovery from pregnancy, perimenopause, and postmenopause.
  • Pain during intercourse. This may result from:
    • Vaginal dryness. Lack of lubrication in the vagina is the most common cause of pain with sex.
    • Vaginismus (say "vadj-uh-NIZ-mus"). This involves painful spasms of the vaginal muscles. Vaginismus may be linked to a fear that stems from losing control or from trauma such as rape or sexual abuse. But sometimes there is a medical cause, such as:
      • Scars in the vaginal opening from injury, surgery, or childbirth.
      • Pelvic infections, such as vaginitis or Bartholin's glands infections.
      • Chronic pain conditions, such as vulvodynia.
      • Skin conditions, such as lichen sclerosus or lichen planus.
      • Irritation from douches, spermicides, or latex condoms.
    • Dyspareunia (say "dis-puh-ROO-nee-uh"). This is physical pain that occurs during entry into the vagina, during deep thrusting, or after sexual intercourse.
  • A physical abnormality.
  • One or more of many medical conditions. This includes diseases that affect blood circulation, like diabetes, or problems with your thyroid, like hypothyroidism. Other medical problems, like endometriosis or arthritis, may cause pain during sex.
  • Medical treatments. Sometimes treatments cause changes that result in pain during intercourse or other sexual problems. These include previous surgeries, treatments for infertility, and cancer treatments.

Aging may cause a decrease in sexual desire and changes in the vagina. These changes include:

  • Thinner vaginal walls, so that the vagina may be easily bruised or chafed.
  • Narrowing, shortening, and/or stiffening of the vagina, causing pain during intercourse (dyspareunia).
  • A reduction in lubrication and a lengthening of the time needed to lubricate the vagina.
  • More time needed to feel sexually aroused.
  • Orgasms that do not last as long they did in the past.

Medicine use can sometimes decrease sexual desire and arousal. Such medicines include:

  • Blood pressure and diabetes medicines, such as diuretics, alpha-blockers, and calcium channel blockers.
  • Antidepressants. These include tricyclics and selective serotonin reuptake inhibitors (SSRIs).
  • Antihistamines, which are allergy medicines.

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

Symptoms of sexual problems can include:

  • A decrease in the level of desire, which might be expressed by fewer sexual fantasies or thoughts and a reluctance to engage in sexual activity.
  • A decrease in the level of arousal. A woman may notice that she feels unreceptive to sexual suggestions and is not able to feel or maintain sexual excitement.
  • An inability to reach orgasm after sexual stimulation. (For most women, the clitoris is the main site of orgasm. Many women do not have orgasms from vaginal intercourse alone.)
  • Pain during intercourse.

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

  • Concerns about sexuality (6 out of 10 women).
  • Lack of interest in sex (3 out of 10 women).
  • Sex not always being pleasurable (2 out of 10 women).
  • Pain with intercourse (1 to 2 out of 10 women).
  • Difficulty becoming aroused (5 out of 10 women).
  • Difficulty reaching orgasm (5 out of 10 women).
  • Not being able to have an orgasm (2 to 3 out of 10 women).

What Happens

There are many reasons why a woman may have a sexual problem.

Physical influences

  • Women normally experience a physical change during sexual arousal, as blood engorges the vulvar area. If a woman is aware of the exact places in her vulvar area where she feels increased sexual intensity (erectile tissue), her sexual pleasure may be increased by genital stimulation. It is possible for a woman not to be aware of this engorgement. It is also possible for a woman not to be aware of the spots that are most sensitive and responsive to stimulation.
  • Any history of pain during intercourse may cause a woman to avoid sexual activity.
  • Women who experience pain during intercourse may choose to continue to have intercourse, even though the experience is unpleasant and results in low sexual desire.
  • Ongoing (chronic) illnesses, such as diabetes and arthritis, can affect sexual desire, enjoyment, and performance. Medicines for many medical conditions also affect desire and arousal.

Partner and emotional influences

  • A partner's level of sexual skill and attention can play a big part in a woman's sexual enjoyment.
  • A positive, respectful connection between partners sets the stage for sexual interest and arousal. Relationship problems can lower sexual interest and response.
  • Living situations that give couples very little privacy can interfere with feelings of arousal.
  • The physical changes that signal sexual arousal may for some women be accompanied by feelings of guilt, embarrassment, shame, or self-consciousness. Any of these emotions can reduce or negate physical arousal.
  • Positive sexual experiences help build a healthy sexuality. On the other hand, a woman who has had a forced sexual experience is likely to have mixed feelings about sex. In one study, 1 out of 5 women reported having been forced to do something sexual. This was most often done by someone they were close to.1

Age-related influences

  • A decline in sexual activity as women age is most often caused by the lack of a partner or their partner's lack of interest or ability to have sex.
  • Many older women also report problems with lubrication.
  • Women may note a decrease in sexual desire after menopause. In mild cases, the change may be almost unnoticeable. In more severe cases, there may be a decrease in mental and physical responsiveness to sexual stimuli.
  • Many older women experience other changes in their sexuality. It may take longer to feel sexually aroused, and orgasms may be briefer. But orgasms still will offer mental and physical pleasure to most women.
  • Women can feel sexual pleasure throughout their lives. But those who stop sexual activity after menopause have more shrinking and drying of the vagina than women who continue sexual activity.1

What Increases Your Risk

The main risk factors for sexual problems are also those that affect a woman's sexual function and satisfaction. These include:

  • A woman's mental and emotional well-being.
  • Her sexual relationship.
  • Her partner's sexual function.

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:

  • Exhaustion, often from round-the-clock care of a baby or small children and/or parenting and having a job.
  • Normal hormonal changes linked to pregnancy, recovery from pregnancy, menopause, or aging.
  • Taking certain medicines that decrease a woman's desire for sex.
  • Health problems that cause pain during sex or decrease a woman's ability to engage in and enjoy sexual activity. Such health problems include:
    • Neurologic diseases such as stroke, spinal cord injury, and Parkinson's disease.
    • Surgery that affects a woman's pelvic organs or genitals.
    • Endocrine diseases such as diabetes or liver disease.
    • Peripheral arterial disease.

When To Call a Doctor

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.

Call a doctor if you experience pain or discomfort in your vaginal area. You may have a vaginal infection or a sexually transmitted infection.

Watchful waiting

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.

Who to see

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.

Exams and Tests

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:

  • Ask questions about your complete medical history, including a complete sexual history. This will include questions about any medicines you are taking.
  • Have you fill out questionnaires. These are special questions that can help your doctor find the cause of a sexual problem.
  • Do a physical exam, in some cases. For a sexual pain problem, this may include a pelvic exam.
  • Order laboratory tests, if they are needed. This includes blood tests to check hormone levels and thyroid function.

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.

What to think about

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.

Treatment Overview

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:

  • Medical treatment for any cause.
  • Education about your body, your sexual signals and receptors, and changes in sexuality as you get older.
  • Communication counseling for you and your partner.
  • Psychological therapy. Therapy for sexual problems often involves cognitive-behavioral therapy.
  • Sex therapy.

Treatment for decrease of sexual desire

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:

  • Changing from a medicine that has been curbing your interest in sex.
  • Relieving pain, illness, or sleep problems that are curbing your interest in sex.
  • Hormone therapy with estrogen. After menopause, low levels of estrogen in the body cause vaginal dryness. This can be painful during sex. Estrogen reverses this.
  • Testosterone. Normally, a woman's testosterone slowly declines with age. It drops suddenly when a woman has surgery to remove the ovaries (oophorectomy, causing surgical menopause). Testosterone is sometimes used after natural or surgical menopause to improve sex drive. When taken in too high a dose, testosterone causes male-type side effects, such as a deepening voice, thinning scalp hair, and growth of facial and body hair. Testosterone risks are not fully researched. Long-term use of testosterone has not been shown to be effective in increasing sexual desire.2
  • Exercise, to improve your mood and increase natural testosterone levels.

Your doctor can treat physical or hormonal causes, and you can work on other aspects of sexual desire. For example:

  • Changing your setting and routine can improve your time together. Do you have enough privacy and time? Are you interested in trying something new?
  • Having a partner you feel comfortable and nonstressed with plays a big part in your desire level.
  • Getting counseling as a couple can help strengthen your emotional connection with your partner. Improving a stressed relationship is likely to improve your sexual relationship.

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.

Treatment for decrease of sexual arousal

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:

  • Increasing the level of intimacy and sexual arousal with your partner before penetration.
  • Liberal use of vaginal lubricants.
  • Masturbation, possibly with the aid of a vibrator and/or with your partner.
  • Education about the role that emotions play in sexual arousal.
  • Counseling, to help adjust expectations of sexual activity. If too much pressure is put on partners to perform, arousal may be reduced.
  • Treatment changes for other conditions, if these are needed to stop the side effects that decrease arousal.

Treatment for an inability to reach orgasm

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:

  • Self-stimulation, along with erotic fantasy. If a woman is able to become highly aroused but is unable to have an orgasmic release, the use of a vibrator may help.
  • Talking and listening to each other more. This includes talking openly about sex, what each of you needs, and what you want to do differently together.
  • Learning more about sexual response. For example, it may help to learn that most women find it easier to have an orgasm from direct clitoral stimulation and that most couples do not have orgasms at the same time.
  • Decreasing inhibition with fantasizing, distractions, and/or listening to music.

Treatment for pain during intercourse

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

  • Pain that occurs during initial penetration by the penis may be caused by involuntary contractions of the vagina (vaginismus). Vaginismus is more common in young, inexperienced women and is sometimes related to a lack of education or preparedness for sexual intercourse.3 Treatment may include a program of progressive muscle relaxation and gradual vaginal dilation, possibly including psychotherapy. But pain during initial penetration also may be caused by vaginal irritation or an anatomical condition. If so, getting rid of the pain will require treating the physical reason.
  • Pain that comes from the vestibule, which is the area around the opening of the vagina, may be from localized vulvodynia.
  • After menopause, it is common to have vaginal dryness. This can cause pain during initial penetration or after intercourse has begun and the penis is in the vagina. Try using liberal amounts of vaginal lubricant. If this does not work as well as you need it to, talk to your doctor about vaginal estrogen, which can reverse vaginal dryness and sensitivity.
  • If the pain is caused by the deep thrusting of the penis, the cause may be a pelvic disease. But it may also be caused by an inability to relax. An open and trusting relationship with your doctor will enable you to explore the cause of the pain and decide on a course of treatment.

Treatment for aging and menopause-related sexual problems

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.

What to think about

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.

Prevention

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.

  • Look after your overall health—both your physical health and your emotional health.
  • Practice communicating your needs and desires to your partner.
  • Become familiar with your own patterns and methods of sexual arousal, perhaps through masturbation.
  • Try to separate your sexual life from the stresses of daily life, such as economic, career, and partner tensions.
  • Understand that many women do not always have orgasms during sex and that mutual pleasure can be a satisfying focus of sexual intimacy.
  • Use plentiful lubrication for your vagina to avoid the most common cause of painful intercourse.
  • Enjoy tenderness and closeness. And avoid expectations of reaching goals such as great sexual performances.

Home Treatment

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:

  • Increasing the level of intimacy and sexual arousal with your partner before penetration (plentiful foreplay).
  • Good communication with your partner.
  • Liberal use of vaginal lubricants.
  • Experimenting with different positions for intercourse to find the most comfortable ones.
  • Masturbation, possibly with the aid of a vibrator and/or with your partner.
  • Exercises to develop muscular control of contraction and relaxation of the pelvic muscles.
  • Enjoying sensual massage and other pleasurable physical activities without sexual intercourse.
  • Decreasing inhibition with fantasizing, distractions, listening to music, or using erotic videos or books.
  • Taking a warm bath and reducing anxieties before sexual activity.

You can improve pelvic floor muscle strength using Kegel exercises or vaginal weights.

  • To do a Kegel, you tighten the same muscles you use to control urine flow. Hold for 3 seconds, then relax for 3 seconds, repeating 10 to 15 times. Try to do a set of Kegels 3 or more times a day.
  • You can use a vaginal weight to strengthen the vaginal wall muscles. You do this by holding it inside the vagina while standing upright for 15 minutes. Over time, you become strong enough to hold a heavier weight.

Medications

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.

Medication choices

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.

What to think about

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

Surgery

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.

Surgery choices

There is no surgical treatment for sexual problems unless pain is caused by endometriosis or another medical condition.

What to think about

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.

Other Treatment

Studies of alternative medicines for sexual problems are limited. But some of them show possible benefits. These include studies of devices and herbal supplements.

Other treatment choices

DHEA. Like testosterone, DHEA (dehydroepiandrosterone) is an androgen made in the body. Over-the-counter DHEA:4

  • When taken by mouth, has the same risks of liver damage and negative effects on your cholesterol levels as oral testosterone. It also has the same unwanted hair-growth and acne side effects. This is because the body turns DHEA into testosterone.
  • Is not known to improve sexual well-being in healthy women.
  • Is not regulated by the government, so you cannot know for sure how much you are taking. Some DHEA supplements contain less DHEA than the labels claim. Others contain more than the labels claim.

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

What to think about

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.

  • Talk with your doctor before taking an alternative medicine or supplement, especially if you are pregnant or trying to become pregnant, if you take prescription medicines, or if you have another health problem.
  • As with all conventional medicines and supplements, be sure to follow the directions on the label.
  • Do not exceed the maximum recommended dose.

Other Places To Get Help

Organizations

American Association of Sexuality Educators, Counselors, and Therapists (AASECT)
P.O. Box 1960
Ashland, VA  23005-1960
Phone: (804) 752-0026
Fax: (804) 752-0056
Email: aasect@aasect.org
Web Address: www.aasect.org
 

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
Phone: (202) 638-5577
Email: resources@acog.org
Web Address: www.acog.org
 

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
Suite 350
Washington, DC  20037-1718
Phone: (202) 466-3825
Fax: (202) 466-3826
Web Address: www.arhp.org
 

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
Phone: 1-800-222-2225
Phone: (301) 496-1752
TDD: 1-800-222-4225 (TTY)
Email: niaic@nia.nih.gov
Web Address: www.nia.nih.gov
 

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
Phone: 1-800-994-9662
(202) 690-7650
Fax: (202) 205-2631
TDD: 1-888-220-5446
Web Address: www.womenshealth.gov
 

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
Suite 390
Mayfield Heights, OH 44124
Phone: (440) 442-7550
Fax: (440) 442-2660
Email: info@menopause.org
Web Address: www.menopause.org
 

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
Phone: 1-800-828-7866
Phone: (410) 689-3700
Fax: (410) 689-3998
Email: auafoundation@auafoundation.org
Web Address: www.urologyhealth.org
 

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.

References

Citations

  1. 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.
  2. Drugs for female sexual dysfunction (2010). Medical Letter on Drugs and Therapeutics, 52(1353/1354): 100–102.
  3. 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.
  4. 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.

Credits

By Healthwise Staff
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

Author: Healthwise Staff

Medical Review: Sarah Marshall, MD - Family Medicine & Kirtly Jones, MD - Obstetrics and Gynecology

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