What are female sexual problems?

Sexual problems are common in women and men, but especially in women. In a survey of men and women aged 18-59 years, about 43% of women and 31% of men reported some sexual problem.

A sexual problem is often referred to as female sexual dysfunction. This can be defined as anything that interferes with a woman's satisfaction with sexual activity. The sexual response cycle in female has four phases: excitement, plateau, orgasm and resolution. Any kind of problem that occurs during any phase of the sexual response cycle that prevents the individual or couple from experiencing satisfaction from the sexual activity is sexual dysfunction.

Types of sexual problems

There are four major sexual problems reported by women. These include:

1. Lack of sexual desire: This entails lack of interest or desire for sex in a woman. Lack of desire is temporary in some people and an ongoing problem in others. Many factors contribute to a lack of desire. Some of these include:

·Hormonal changes

·Medical conditions and treatments (for example cancer and chemotherapy)

·Depression

·Pregnancy

·Stress and fatigue

·Boredom with regular sexual routines

·Lifestyle factors, such as careers and the care of children

2. Difficulties becoming sexually aroused: Inability to become sexually aroused is sometimes related to lack of desire. Although in some cases, a woman might have sexual desire but cannot become aroused. This difficulty in become physically aroused during sexual activity may often be related to some factors such as:

·Insufficient vaginal lubrication

·Anxiety

·Inadequate stimulation

·Blood flow disorders affecting the vagina and clitoris may contribute to arousal problems

3. Difficulty in achieving orgasm: This is the delay or absence of sexual climax (orgasm). This happens in a relatively large number of women, and it is very distressing for a woman who feels desire and becomes aroused. Several factors can contribute to this, and they include:

·Sexual inhibition

·Inexperience in sex

·Lack of knowledge (a woman not understanding her body as it relates to sexual processes)

·Insufficient stimulation

·Anxiety

·Shame

·Guilt (in case of sex outside of marriage and the belief that it is sinful)

·Past sexual trauma or abuse

·Some medications

·Chronic diseases

4. Pain during intercourse: Pain during intercourse (dyspareunia) is also another common sexual problem in women. Like other sexual problems, it can cause a woman to lose interest in sex.Pain during intercourse can be caused by a number of problems, including:

·Endometriosis

·Pelvic mass

·Ovarian cysts

·Inflammation of the vagina (vaginitis)

·Poor lubrication

·Presence of scar tissue from surgery

·Sexually transmitted disease

·Involuntary spasm of the muscles that surround the vaginal entrance (vaginismus)

·Psychological, like previous traumatic or painful experience

Causes of Sexual Problems in women

Many factors contribute to sexual problems in women. They may have many and varied classes, but in it can be considered under two broad categories: psychological causes and physical/medical causes.

Psychological causes: These include:

1.Relationship/marital problems: Problems in relationship can cause sexual problems. Such problems may be related to money, work, childrearing, communication etc

2.Emotional problems: Emotional problems including depression, work related stress and anxiety (about sex or other things), resentment, feeling of guilt can all affect a woman's sexual function.

3.Past sexual abuse: Past sexual abuse may seriously affect present sexual performance. A woman who has been abused may be dealing with some internal issues such as fear, guilt, shame, lack of trust and resentment and that may affect sexual function.

4.Attitudes to sex: Women who have negative attitude toward sex may experience sexual dysfunction.

Physical/medical causes:

Physical conditions: Many physical conditions can decrease a woman's satisfaction with her sex life.

1.Tiredness (fatigue)

2.Menopause

3.Pregnancy

4.Alcohol or drug abuse

Medical conditions:

1.Diabetes

2.Heart disease,

3.Liver disease

4.Kidney disease

5.Cancer

6.Neurologic disorders 

7.Vascular (blood flow) disorders

8.Hormonal imbalances

Medical/gynecological

1.Vaginismus: This is the contraction of the muscles surrounding the vaginal opening that causes the vaginal opening to tighten and becomes painful. This condition can cause serious sexual problems. Several factors or conditions can induce vaginismus and these include:

a.Injuries or scars from surgery

b.Sexual abuse

c.Fear

d.Childbirth

e.Infection

f.Irritation from douches, spermicides, or condoms

2.Vaginal dryness: This is a situation where the vagina is not properly lubricated for sex, and can cause serious sexual dysfunction in women. The common cause in younger women is insufficient stimulation, whereas in older women, it is a result of decrease in estrogen that occurs in menopause.

3.Sexually transmitted diseases: Some of them such as gonorrhea, herpes, genital warts, and syphilis and can cause serious pain and sexual dysfunction

4.Vaginitis: Inflammation and irritation of vaginal tissues due to infection or other causes can make intercourse uncomfortable or painful.

5.Pelvic mass

6.Endometriosis

7.Ovarian cyst could cause obstruction and sexual problems

8.Pelvic inflammatory disease, a painful condition that can adversely affect sexual intercourse

9.Nerve damage after surgery, such as hysterectomy.

Other factors

Medications side effects: Some medications can reduce desire or arousal. These include:

·Antidepressants, like the selective serotonin-reuptake inhibitor (examples include )

·Drugs for cancer treatment

·Medications for high blood pressure

·Antipsychotic medications 

·Side effect of medical treatment, such as radiation therapy for cancer 

Diagnosis of female sexual problems

Physical exam and medical history of the patient would be taken by the doctor. The doctor may perform a pelvic examination to evaluate the health of the reproductive organs and a pap test to detect changes in the cells of the cervix 0.

The doctor can also make as assessment of some factors which can contribute to the condition. This will help the doctor understand the underlying cause of the problem and make appropriate recommendations for treatment. Some of these factors include:

·Attitudes regarding sex

·Fear

·Anxiety

·Past sexual trauma/abuse

·Relationship problems

·Alcohol or drug abuse

Some diagnostic tests may also be performed to try to identify any medical condition which may be causing or contributing to the dysfunction. Some of these may include lab tests, X-rays and other radiology tests in some circumstances.

Treatment

Not every sexual problem requires medical attention. The problems may be temporary, maybe due to anxiety or stress. These may require rest and patience to go through such situations.

For sexual problems that would require treatment, the treatment will vary depending on the type of problem. These are problems which are persistent and threatening health and relationship. In that case, a doctor, sex therapist, psychotherapist or even marriage counselor should be consulted.

Medical Treatment

If the sexual problem is caused by a medical or physical problem, then medical treatment may be necessary to correct or manage the problems. The specialist and the patient will agree on appropriate treatment plan, which suits the patient’s needs.

Some of these therapies include:

Vaginal lubricants: Lubricants are very useful in women with vaginal dryness. They lubricate the vagina and make sex more enjoyable. They are available in different delivery forms such as creams, gels, or suppositories. There are both water-based and oil-based products formulations of lubricants. The water based products are preferred because oil based lubricants interact with latex condoms and cause them to break.

Topical estrogen: Estrogen formulations either applied as a cream or vaginal insert, are very useful in menopausal women. These products can help ameliorate pains due to vaginal dryness or sensitivity making sex more comfortable for these women.

Clitoral therapy device: The Eros clitoral therapy device can be used for the treatment disorders of sexual arousal in women. This device increases lubrication, sensation, and even the number of orgasms in many women who have used it.

Medications: Sildenafil (Viagra) is very effective for the management of erectile dysfunction in men. Some studies in female show that they may be helpful in women with arousal problems.

Hormone replacement therapy: these come in two forms: estrogen only (ERT) and combined estrogen-progestin, a synthetic form of the hormone progesterone (HRT).

They have been shown to be beneficial in menopausal women in relieving symptoms, such as vaginal dryness and continue the protective effects that estrogen provides naturally before menopause.

It should be noted that studies have linked long term use of HRT or ERT with higher risk of some conditions such as:

·Breast cancer

·Heart attack

·Stroke

·Blood clots (from one kind of HRT)

·Ovarian cancer (from ERT)

Surgery

 This can be used to correct specific problems that interfere with satisfying sexual activity such as cysts, tumors and growths.

Other options

Psychotherapy

Psychotherapy can help a woman identify problems in her life that may be expressed as sexual problems. Some of these include past sexual or other abuse, or traumatic sexual encounters, attitude towards sex, relationship problems etc.

The goal is to identify and get rid of veiled problems that may interfere with enjoyable sex, establishing new attitudes that increase sexual responsiveness.

Sex therapy

The sex therapist goes beyond the psychological aspect or issues impeding sexual pleasures to focusing on the couple's physical relationship. After identifying the couple's sexual problem, the sex therapist recommends specific exercises to re-focus the couple's attention and expectations.

Some treatment strategies could focus on the following:

• Patient education: Proper education of the patient on the human body, sexual response, female sexual cycle and effects of aging on sex would help in sexual performance.
• Stimulation techniques: One way of achieving this is the use of erotic materials such as books, magazines and videos.
• Encouraging non-coital behaviors: The partners can engage in physically stimulating activities that does not include intercourse, such as sensual massage, which can be used to promote comfort and increase communication between partners. 
• Distraction routine: Some techniques could be used to engage the woman’s attention and distract from anxiety and stress. Some of these may be exercises, music, television etc 

Sex therapists may also use or recommend any or combination of the following methods or techniques depending on the need and preferences of the patients or couples:

·Sensate focus exercises

·Kegel exercises

·Use of dilators to relax vaginal spasms

·Group therapy or a support group

Prevention

Prevention method typically involves adopting a healthy lifestyle to promote overall well-being. This will increase your confidence and self-esteem, which will in turn increase your interest in sex and your responsiveness.

• Eat a healthy diet
• Don't use tobacco
• Get active physically for at least 30 minutes every day
• Get plenty of rest
• Keep stress under control
• Drink alcohol in moderation, if at all
• Have regular health screening, such as Pap test and mammogram