Human sexuality encompasses more than the act of sexual intercourse and the associated physical contact. It satisfies essential physical and emotional needs in both men and women. A person’s individual sexuality is influenced by many factors, including personal health and wellness, feelings of self worth, previous sexual encounters, and relationship dynamics. Women vary greatly when it comes to interest level in sex and their response to sexual stimuli. This variance in sexual responsiveness and interest affects women’s satisfaction level with their sexual experiences. Things like age, lifestyle, culture, hormone levels, health, and personal situation all contribute to a woman’s overall sexual experience throughout her life.
“Sexual issues are extremely common in women. At least 16 percent of women report a knife-like pain during intercourse. Add to that, women who cannot reach orgasm and those with low libido and the number rises to at least 25 percent. The actual number is probably higher than this because women often don’t report their sexual problems due to embarrassment,” states urogynecologist Dr. Lara J. Burrows, MSc, a leading national expert in the diagnosis and treatment of female sexual problems and affiliated with Summa Health System in Akron.
A normal sexual response cycle includes four steps: desire, arousal, orgasm and resolution. Each woman passes through the steps and completes the cycle at her own rate. A woman who does not progress through one or more of these steps may have a sexual problem, which then diminishes her overall satisfaction. “Female sexual dysfunction (FSD) incorporates any sexual issue that bothers the patient. Whether it bothers her partner is not part of the criteria. But if it bothers her that she experiences pain during intercourse, has a lack of desire, or cannot achieve orgasm, then she has sexual dysfunction,” Burrows explains.
A chronic lack of desire squelches the sexual response cycle before it begins, signaling a sexual issue. Temporary lack of interest and desire occurs in almost everyone and does not usually signify a problem. University Hospitals Case Medical Center clinical psychologist Sheryl Kingsberg explains, “FSD refers generically to a number of sexual disorders. Women of all ages suffer from these disorders. The most prevalent are hypoactive sexual desire disorder (HSDD) and dyspareunia. Women with HSDD have a persistent loss of desire or interest in sex. Dyspareunia is characterized by painful intercourse.” Frequent painful intercourse experiences or a persistent failure to reach orgasm after arousal may cause women to lose interest in sex altogether, causing relationship problems and emotional issues.
Sexual dysfunction in women can originate from a variety of physical, gynecological and psychological conditions. Linda Bradley, an OB/GYN at the Cleveland Clinic, says, “When there’s no apparent physiological reason for the sexual complaint, I counsel my patients to begin to look for ways to develop their primary relationship. For example, I advocate that couples, whether they have children at home or not, plan regular date nights where they can relax and have fun outside of the home.”
Regarding painful intercourse, Burrows notes, “Some women are born with too many nerve endings at the vaginal opening, which causes the sharp pain during intercourse. Sexually transmitted diseases (STDs), such as vulvodynia, herpes, or other conditions, like yeast infections, can cause pain during intercourse as well. Recent data have shown that birth control pills can contribute to painful intercourse in some women.” A well-known clinical psychologist in Montreal, Canada, asks this question of his patients, “Is the pain sexual, or is the sex painful,” when determining the cause of painful intercourse. In other words, if the pain is sexual, the problem may have a psychological component, but if it’s purely painful sex, the problem frequently originates from a physiological issue.
Almost everyone will experience some form of sexual problem at some point. Frequently, these are short-lived and occur because of temporary stress, anxiety or situational changes. Seek help from a healthcare professional who specializes in sexual dysfunction for sexual issues that continue for several weeks or more. Kingsberg adds, “Many women don’t seek help because they are too embarrassed or they don’t know who to talk to about their sexual issues. Women should first report their sexual concerns to their OB/GYNs, primary care physicians or nurse practitioners. Women can also find providers and practitioners in their area who specialize in the field of sexual medicine from the website of the International Society for the Study of Women’s Sexual Health (http://www.isswsh.org/).”
Burrows has this to say about FSD and younger women, “Certainly, the lack of the sexual hormones in menopausal women causes vaginal dryness and a host of other sexual issues, but FSD is not limited to women over 50. I see many women in their early 20s, 30s, and 40s in my practice who report sexual problems that negatively impact their sexual satisfaction.”
The complex sexuality of women presents unique challenges in the treatment of FSD. Certain underlying causes respond quite well and easily to treatments, but others require the physician to develop a treatment approach that addresses the patient’s unique sexual history and physiological health status relevant to sexuality.
Hormonal changes and fluctuations have a significant effect on a woman’s sexual function, interest and satisfaction. Treatments for low or no libido can include cognitive behavioral psychotherapy to get around changes in drive levels. “But really, when there’s a drive issue, a biological component is to blame. Some women may find relief with pharmaceutical testosterone, but there aren’t any FDA-approved testosterone treatments for women with low or no libido,” remarks Kingsberg.
Treatments for painful intercourse depend upon the origin of the pain and the health status of the individual. According to Burrows, “There are a number of both topical and oral medications available for the treatment of painful intercourse. Topical treatments include a numbing jelly such as lidocaine, as well as Gabapentin, a neuromodulator that is applied topically. For some women, a surgical procedure called a vestibulectomy is the only thing that gives them relief.” She also mentioned that pelvic floor physical therapy is very effective in relieving painful intercourse.
Women have more personal power today than ever before. It’s up to you to reach out to your healthcare provider about your sexual concerns. Don’t feel as if you’re alone in your sexual problems. If your practitioner does not offer satisfactory help for your issues, seek out others until you find one that takes your concerns seriously and works diligently to find solutions.
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