Persistent, recurrent problems with sexual response, desire, orgasm or pain — that distress you or strain your relationship with your partner — are known medically as sexual dysfunction.
Many women experience problems with sexual function at some point, and some have difficulties throughout their lives. Female sexual dysfunction can occur at any stage of life. It can occur only in certain sexual situations or in all sexual situations.
Sexual response involves a complex interplay of physiology, emotions, experiences, beliefs, lifestyle and relationships. Disruption of any component can affect sexual desire, arousal or satisfaction, and treatment often involves more than one approach.
Symptoms vary depending on what type of sexual dysfunction you're experiencing:
If sexual problems affect your relationship or worry you, make an appointment with your doctor for evaluation.
Sexual problems often develop when your hormones are in flux, such as after having a baby or during menopause. Major illness, such as cancer, diabetes, or heart and blood vessel (cardiovascular) disease, can also contribute to sexual dysfunction.
Factors — often interrelated — that contribute to sexual dissatisfaction or dysfunction include:
Hormonal. Lower estrogen levels after menopause may lead to changes in your genital tissues and sexual responsiveness. A decrease in estrogen leads to decreased blood flow to the pelvic region, which can result in less genital sensation, as well as needing more time to build arousal and reach orgasm.
The vaginal lining also becomes thinner and less elastic, particularly if you're not sexually active. These factors can lead to painful intercourse (dyspareunia). Sexual desire also decreases when hormonal levels decrease.
Your body's hormone levels also shift after giving birth and during breast-feeding, which can lead to vaginal dryness and can affect your desire to have sex.
Psychological and social. Untreated anxiety or depression can cause or contribute to sexual dysfunction, as can long-term stress and a history of sexual abuse. The worries of pregnancy and demands of being a new mother may have similar effects.
Long-standing conflicts with your partner — about sex or other aspects of your relationship — can diminish your sexual responsiveness as well. Cultural and religious issues and problems with body image also can contribute.
Some factors may increase your risk of sexual dysfunction:
To diagnose female sexual dysfunction, your doctor may:
Your doctor may also refer you to a counselor or therapist specializing in sexual and relationship problems.
Keep in mind that sexual dysfunction is a problem only if it bothers you. If it doesn't bother you, there's no need for treatment.
Because female sexual dysfunction has many possible symptoms and causes, treatment varies. It's important for you to communicate your concerns, as well as to understand your body and its normal sexual response. Also, your goals for your sex life are important for choosing a treatment and evaluating whether or not it's working for you.
Women with sexual concerns most often benefit from a combined treatment approach that addresses medical as well as relationship and emotional issues.
To treat sexual dysfunction, your doctor might recommend that you start with these strategies:
Effective treatment for sexual dysfunction often requires addressing an underlying medical condition or hormonal change. Your doctor may suggest changing a medication you're taking or prescribing a new one.
Possible treatments for female sexual dysfunction might include:
Estrogen therapy. Localized estrogen therapy comes in the form of a vaginal ring, cream or tablet. This therapy benefits sexual function by improving vaginal tone and elasticity, increasing vaginal blood flow and enhancing lubrication.
The risks of hormone therapy may vary depending on your age, your risk of other health issues such as heart and blood vessel disease and cancer, the dose and type of hormone and whether estrogen is given alone or with a progestin.
Talk with your doctor about benefits and risks. In some cases, hormonal therapy might require close monitoring by your doctor.
Androgen therapy. Androgens include testosterone. Testosterone plays a role in healthy sexual function in women as well as men, although women have much lower levels of testosterone.
Androgen therapy for sexual dysfunction is controversial. Some studies show a benefit for women who have low testosterone levels and develop sexual dysfunction; other studies show little or no benefit.
Flibanserin (Addyi). Originally developed as an antidepressant, flibanserin is approved by the Food and Drug Administration (FDA) as a treatment for low sexual desire in premenopausal women.
A daily pill, Addyi may boost sex drive in women who experience low sexual desire and find it distressing. Potentially serious side effects include low blood pressure, sleepiness, nausea, fatigue, dizziness and fainting, particularly if the drug is mixed with alcohol. Experts recommend that you stop taking the drug if you don't notice an improvement in your sex drive after eight weeks.
Bremelanotide (Vyleesi). Bremelanotide is another FDA-approved treatment for low sexual desire in premenopausal women. This medication is an injection you give yourself just under the skin in the belly or thigh before anticipated sexual activity.
Some women experience nausea, which is more common after the first injection but tends to improve with the second injection. Other side effects include vomiting, flushing, headache and a skin reaction at the site of the injection.
More research is needed before these agents might be recommended for treatment of female sexual dysfunction:
Phosphodiesterase inhibitors. This group of medications has proved successful in treating erectile dysfunction in men, but the drugs don't work nearly as well in treating female sexual dysfunction. Studies looking into the effectiveness of these drugs in women show inconsistent results.
One drug, sildenafil (Revatio, Viagra), may prove beneficial for some women who have sexual dysfunction as a result of taking selective serotonin reuptake inhibitors (SSRIs), a class of drugs used to treat depression. Don't take sildenafil if you use nitroglycerin for angina — a type of chest pain caused by reduced blood flow to the heart.
Issues surrounding female sexual dysfunction are usually complex, so even the best medications aren't likely to work if other emotional or social factors remain unresolved.
To boost your sexual health, find ways to be comfortable with your sexuality, improve your self-esteem and accept your body. Try practicing these healthy lifestyle habits:
More research is needed, but therapies that may help improve sexual satisfaction include:
There are also some herbal supplements and topical oils marketed to increase libido and sexual pleasure. However, these products haven't been well-studied. One product has estrogen-like properties and may encourage the growth of breast tumors that need estrogen to grow. Talk to your doctor before trying any herbal or topical oil formulations.
At each stage of your life, your level of sexual desire, arousal and satisfaction can change. To better adapt:
Sexual response often has as much to do with your feelings for your partner as it does with physical sexual stimuli. Rediscover each other and reconnect.
If you have ongoing sexual difficulties that distress you, make an appointment with your doctor. You may feel embarrassed to talk about sex with your doctor, but this topic is perfectly appropriate. A satisfying sex life is important to a woman's well-being at every age.
You might have a treatable, underlying condition, or you might benefit from lifestyle changes, therapy or a combination of treatments. Your primary doctor will either diagnose and treat the problem or refer you to a specialist.
Here's some information to help you prepare for your appointment.
Gather information about:
Some basic questions to ask your doctor about your sexual concerns include:
Don't hesitate to ask other questions that occur to you.
Your doctor might ask a number of personal questions and might want to include your partner in the interview. To help determine the cause of your problem and the best course of treatment, be ready to answer questions such as:
Keep the lines of communication open with your partner. Be honest about your dissatisfaction or the problem you have. Consider alternatives for intimacy and engage in sexual activities that are rewarding for both of you.