Dissatisfaction with sexual life is an issue for both men and women. Dissatisfaction for women may be due to a lack of interest in sex, inability to achieve orgasm, or pain during sex. Unfortunately, pinpointing the underlying issues and conditions that cause sexual disatisfaction can be complicated. There may be both medical and psychological issues involved.
In exploring women’s sexual problems, doctors must realize that a woman’s sexual life is personal. For example, what may bother 1 woman may not bother another. And what may occur in 1 situation may not occur in every situation. Still, doctors may use a general classification system to help sort out the basis of a woman’s dissatisfaction with her sexual life. This classification system includes the following disorders:
Importantly, the underlying assumption of all these disorders is that the sexual problems are causing significant and ongoing personal distress to the woman, as well as to her partner.
Underlying medical disease or medications may also cause or contribute to sexual dysfunction.
For some women, a lack of desire before having sex is normal. But these women may become aroused or interested once they start to engage in sexual activity. A woman may have sexual desire disorder if she is worried or concerned about her lack of interest in sex. The lack of interest may be not having sexual thoughts or fantasies, not desiring sexual activity, or not being receptive to a partner’s desire for sexual activity. The causes of sexual desire disorder can vary from low hormone levels to chronic medical illnesses to social or psychological issues. Often several factors interact to create a situation of low sexual desire.
Sexual arousal disorder is the persistent inability to become sexually excited both physically and mentally, and its causes may be either physical or psychological. Physical causes include low blood flow to the genitals or inadequate lubrication. Psychological causes may include anxiety and stress. Arousal can also be affected by lifestyle factors, such as using drugs, alcohol, or smoking. It can also be affected by certain medications.
Some women do not achieve orgasm with intercourse or with their partners, but are otherwise satisfied with their sexual activity. Orgasmic disorder occurs when a woman cannot achieve orgasm. This disorder is only considered if a woman is severely bothered by not achieving orgasm. Women with an orgasmic disorder may have never achieved orgasm, or perhaps they have in the past but do not currently. Causes may include poor body image, fear of losing control, or distrust of a sexual partner. Other factors may also play a role.
Sexual pain disorders include persistent genital pain with intercourse, called dyspareunia, and involuntary spasms of the vaginal muscle, called vaginismus. Genital pain that occurs with sexual stimulation but without intercourse also falls into this category. Pain during sex can be a lifelong condition, or it may only occur for a short time.
Lack of lubrication is the most common cause of genital pain with intercourse. Women may have dyspareunia for a period of time after giving birth to a baby. Postmenopausal women may also experience pain with intercourse due to lowered hormone levels, which reduce the natural lubrication of the vagina. Infections and inflammation of the vagina or bladder may also cause these painful conditions.
Some women may have more than 1 sexual disorder type. In these cases, there are often many underlying causes that interrelate. For example, a postpartum woman may have pain with her first intercourse after delivery because of lack of lubrication or slow healing of vaginal injury during birth. She may also lose interest in sex because she is tired from taking care of an infant. If her partner desires sexual contact more than she does, she may then develop some anxiety or lack of excitement during sexual activity that will may increase the problem.
There are some simple steps you can take to increase arousal, achieve orgasm, and minimize pain during sex. Have a straightforward talk with your partner about your feelings and try some of these:
Although it is difficult to discuss, it’s important to talk to your doctor about your concerns. There may be some simple evaluations available, like checking hormone levels, reviewing medication lists, or just providing reassurance about what is normal.
Choosing the appropriate treatments will depend on what the main issue bothering a woman is and can range from hormone medications to counseling. For problems that stem from psychological or social issues, individual or couples counseling is often helpful. For a lack of lubrication, over-the-counter lubricants can be effective. For postmenopausal women, estrogen creams can also help reduce pain with intercourse.
Experts are encouraging more conversation, research, and the development of new treatments for women who are unhappy or unsatisfied with their sex lives. If you think you may experience sexual dysfunction, talk to your doctor to learn ways to regain satisfaction for both you and your partner.
American Association for Marriage and Family Therapy
The American Congress of Obstetricians and Gynecologists
The Canadian Women's Health Network
The Society of Obstetricians and Gynaecologists of Canada
Female sexual dysfunction. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 27, 2016. Accessed July 19, 2016.
Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA. 1999;281:537-544.
When sex is painful. The American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/~/media/For%20Patients/faq020.pdf?dmc=1&ts=20120821T1211356193. Updated May 2011. Accessed July 19, 2016.
Your sexual health. The American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/~/media/For%20Patients/faq072.pdf?dmc=1&ts=20120820T2143277365. Published November 2015. Accessed July 19, 2016.
Last reviewed August 2014 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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