Am Fam Physician. 2000;62(1):137-138
See related article on female sexual dysfunction.
What is sexual dysfunction?
When you have problems with sex, doctors call it “sexual dysfunction.” Men and women can have it. There are four kinds of sexual problems in women.
Desire disorders. If you have a desire disorder you may not be interested in having sex. Or, you may have less desire for sex than you used to.
Arousal disorders. When you don't feel a sexual response in your body or you start to respond but can't keep it up, you might have an arousal disorder.
Orgasmic disorders. If you can't have an orgasm or you have pain during orgasm, you may have an orgasmic disorder.
Sex pain disorders. When you have pain during or after sex, you may have a sex pain disorder. In some women, the muscles in the outer part of the vagina tighten when you start to have sex. A man's penis or a vibrator can't get into the tight vagina.
What causes sexual dysfunction?
Medicines, diseases (like diabetes or high blood pressure), alcohol use, or vaginal infections can cause sexual problems.
Depression, an unhappy relationship or abuse (now or in the past) can also cause sexual problems.
You may have less sexual desire during pregnancy, right after childbirth or when you are breast-feeding. After menopause many women feel less sexual desire, have vaginal dryness or have pain during sex.
The stresses of everyday life can affect your ability to have sex. Being tired from a busy job or caring for young children may make you feel less desire to have sex. Or, you may be bored by a long-standing sexual routine.
How do I know if I have a problem?
Up to 70 percent of couples have a problem with sex at some time. Most women sometimes have sex that doesn't feel good. This doesn't mean you have a sexual problem.
If you don't want to have sex or it never feels good, you might have a sexual problem. The best person to decide if you have a sexual problem is you! Discuss your worries with your doctor. Remember that anything you tell your doctor is private.
What can I do?
To improve your desire, change your usual routine. You may want to rent an erotic video or read a “sexy” book with your partner.
Arousal disorders can be helped if you use a vaginal cream for dryness. Mineral oil also works. If you have gone through menopause, talk to your doctor about taking estrogen.
If you have a problem having an orgasm, masturbation can help you. Extra stimulation (before you have sex with your partner) with a vibrator may be helpful. You might need rubbing or stimulation for up to an hour before having sex. Many women don't have an orgasm during intercourse. If you want an orgasm with intercourse, you or your partner may want to gently stroke your clitoris.
If you're having pain during sex, try different positions. When you are on top, you have more control over penetration and movement. Empty your bladder before you have sex. Try using extra creams or try taking a warm bath before sex. If your sex pain doesn't go away, talk to your doctor.
If you have a tight vagina, you can try using something like a tampon to help you get used to relaxing your vagina. Your doctor can tell you more about this.
What else can I do?
Learn more about your body and how it works. Ask your doctor about how medicines, illnesses, surgery, age, pregnancy or menopause can affect sex.
Practice “sensate focus” exercises where one partner gives a massage, while the other partner says what feels good and requests changes (example: “lighter,” “faster,” etc). Fantasizing may increase your desire. Squeezing the muscles of your vagina tightly and then relaxing them may increase your arousal. Try sexual activity other than intercourse, such as massage, oral sex or masturbation.
What about my partner?
Talk with your partner about what each of you like and dislike, or what you might want to try. Ask for your partner's help. Remember that your partner may not want to do some things you want to try. Or, you may not want to try what your partner wants. You should respect each other's comforts and discomforts. This helps you and your partner have a good sexual relationship. If you can't talk to your partner, your doctor or a counselor may be able to help you.
If you feel like a partner is abusing you, you should tell your doctor.
How can my doctor help?
Talk to your doctor about your sexual health. Explain your problems openly and honestly. Your doctor can also give you ideas about treating your sexual problems or can refer you to a sex therapist or counselor if it is needed.