Patient Education

Sexuality and Sexual Problems

Sexual intimacy is a great way to feel connection and love with your partner. It can be very romantic, fulfilling, and fun. However, sometimes a woman may experience different sexual problems that make sex less enjoyable for her. Many women experience sexual problems at least once in their lives, regardless of age, relationship status, and sexual interests. There are many different causes of sexual problems. If a woman has any sexual concerns, it is important that she talk to her health care provider. This page explains the basics about sexuality, the pattern of sexual response, and some common sexual problems that affect women.

WHAT IS SEXUALITY?

Human sexuality is a very complicated, varying term that covers many different, ever-changing aspects of a human’s sexual abilities, including identity, attraction, arousal, function, and urge. A woman’s sexuality and sexual identity is formed early in life and changes throughout different stages of her life. A woman’s sexual identity may be influenced by many things, including religion, sexual experiences, role models, and environment. Although some women maintain sexual response throughout their entire lives, most women feel it peak around the age of 40. It can be very healthy for women to enjoy an active sex life during her later years in life.

There is a certain pattern of sexual activity that most couples follow during an encounter. Usually, it begins with caressing, kissing, and being close. It then involves bodily caressing and sexual intercourse. The most common activity is vaginal intercourse. Couples may also have oral or anal sex. Couples also may enjoy other activities such as mutual masturbation and clothing removal. However, there is no specific "rule" to a way that a couple has sex- it all varies greatly.

Sexual attraction is an important part of sexuality and sexual identity. Most women are attracted to men, which is called heterosexuality. However, many women are attracted only to other women, which is called homosexuality. A woman who is attracted emotionally and physically only to women is called a lesbian. Also, some women are attracted sexually and emotionally to both men and women, which is called bisexuality. A woman’s sexual preference in her partner depends entirely on her. Women can be sexually attracted to all different types of features in a partner- height, weight, physical appearance, shape, and personality:

WHAT IS THE SEXUAL RESPONSE CYCLE?

The sexual response cycle is a certain, regular pattern that a woman’s body experiences during sexual intimacy. The steps are:

  •  Desire- The urge to have sex.
  • Arousal/Excitement- Physical changes occur, including lubrication of the vagina and vulva and relaxation of vaginal muscles. The clitoris also swells and becomes enlarged, and the vagina becomes deeper and wider.
  • Plateau- Maintenance of stimulation; sexual tension becomes intensified to orgasm.
  • Orgasm- The muscles of the uterus and vagina flex to create a strong feeling of pleasure. This is the peak of sexual response.
  • Resolution- The sexual organs return to their original state.

How a woman experiences the sexual response cycle changes from each woman, as well as each different encounter. The sexual response cycle depends on both physical and emotional aspects between the parties involved. Oftentimes, the interplay between these two aspects can be complex, and sexual problems can arise. Sometimes, the problems can be isolated to a certain encounter, or they may be longstanding.

WHAT CAUSES SEXUAL PROBLEMS?

Sexual problems are described as missing one or more of the steps of the sexual response cycle, causing sex to not flow as it normally should. There are many different causes of sexual problems, some including pregnancy, illness, medications, stress, poor communication between partners, trust issues, or unrealistic ideas about sex. These all can affect performance during sex and make it less enjoyable with one or both individuals. Several common sexual problems include:

  • Lack of Desire: Lack of desire or urge to have sex is one of the most commonly reported problems in women. If a woman does not have the desire to have sex, it may become very difficult for her to become aroused, which is a very important part of sex. Sometimes, lack of desire can be caused by certain emotional factors, such as worry that she will not orgasm, daily stresses, bad sexual experiences, or concerns about money, life, or the relationship itself. These may all cause a woman to be preoccupied and not interested in sex. They also may cause her to be very difficult to arouse properly.
  • Lack of arousal: Most women have orgasms during sexual encounters, whether through intercourse or through manual stimulation. However, some women have a very difficult time reaching orgasm, which can be extremely frustrating. Usually, this is because she does not know what will bring her closest to orgasm, or she does not know how to tell her partner what she wants sexually. Orgasm problems can also be caused by-
    • Past traumatic sexual experiences
    • Negative feelings about sex taught in childhood
    • Fear of feeling safe or pleasured by someone
    • Anger problems
    • Depression
    • Alcohol, drugs, and certain medications
    • Lack of arousal

Sometimes, the pressure alone to perform well sexually and to orgasm can cause a woman to worry too much for it to occur. This self-consciousness can cause a woman to become distracted and feel less pleasure. Sometimes, in order to have an orgasm, a woman may need more time spent in foreplay activities such as caressing, kissing, and oral sex. Even if a woman does not experience orgasm during sex, it does not mean that there is something wrong with her, that she is a failure or that it is not enjoyable.

  • Painful Sex: Pain can occur either during or after sexual intercourse, including vaginal entry, pain from deep penetration, or after removal or orgasm. Pain during intercourse is medically referred to as dyspareunia. Many women have experienced dyspareunia at least once in their lives from many different circumstances, most commonly from taking certain medications, illnesses/infections, lack of arousal, vaginal dryness, cysts or tumors, or endometriosis.
    • Vaginismus: Vaginismus is a disorder that occurs when a woman’s pubic and vaginal muscles spasm painfully upon attempted insertion of anything into the vagina, most commonly during intercourse for the first time. Vaginismus can be very mild and only painful during sex, or it may be severe enough to interfere during regular pelvic exams. It can be a result of several different things:
      • Pelvic Infections
      • Irritation from spermicides, certain douches, and latex
      • Painful scars in the vagina from childbirth, injury, or surgery
      • Response to fear or emotional trauma from a previous bad sexual experience. This condition should be medically evaluated,

WHAT ARE SOME MEDICAL CONDITIONS THAT CAN AFFECT SEX?

There are some conditions that women have that may greatly affect sexual desire and response. They can be either short term or longstanding:

  • Pregnancy: Although sexual tendencies do not usually change during pregnancy, some women and men worry that it isn’t safe or that they are hurting the baby. Sex during pregnancy does not hurt the baby and cannot cause any harm unless the healthcare provider has specifically advised you to abstain from it.
  • Menopause: Menopause is the time in a woman’s life when hormone levels drop and ovulation stops. The large drop in the hormones can cause a woman to slowly lose her desire to have sex, because it becomes increasingly difficult for them to become aroused. Sometimes, menopausal women experience vaginal dryness, which can be easily managed with lubricants. Sometimes, hormone replacement therapy can help a woman feel better and regain desire to have sex.
  • Cancer: Cancer is a very serious illness for most women, and requires medical attention and aggressive treatments. Oftentimes, the worries of having cancer and the negative side effects caused from treatment contribute to a woman’s lack of desire to have sex. Women with cancer may fear rejection by their partner, disfigurement, and possibly death. Usually, these fears can be addressed during counseling and with her partner.
  • Chronic Illness: Certain diseases that are permanent and lifelong can affect a woman’s sex drive. Diseases such as arthritis, diabetes, obesity, and heart disease can oftentimes make a woman feel undesirable and not sexual. Sometimes, medications can even cause lack of libido, which can be reversed by switching medications.
  • Male Factors: Sometimes, women have trouble achieving orgasm or feeling pleasure if her male partner is experiencing sexual problems. The most common male sexual problem is difficulty getting or maintaining an erection- also called impotency. Many things can cause a man to become impotent, including stress, alcohol/drugs, and depression. However, it should be discussed with a health care provider because treatment options are available. Usually, his health care provider will be able to prescribe certain medications such as Viagra® to help him achieve and maintain an erection.

WHAT DO I DO IF I THINK I MAY HAVE A SEXUAL PROBLEM?

If you and your partner believe that you may have a sexual problem that is serious or increasing overtime, it is important to talk to your healthcare provider and see if anything may be wrong. If you believe that a certain medical health condition is affecting your ability to enjoy sex, talk to your health care provider about the symptoms and when they began.

Sexual problems can be worked out with patience and caring. If the problem is new or recent, make sure to have an honest, open talk with your partner about any worries or concerns that you may have. Clearing up any conflicts or differences of interest during sex with your partner oftentimes make sex much more enjoyable for both parties.

If your sexual problems stem from emotional trauma, it is important to tell your healthcare provider. He or she may refer you to a specialist to help you cope with these bad feelings and to explore the good side of sex and your relationship now. You may be referred to join a support group to talk with other couples who have similar sexual problems. It is important to remember that even if you experience a sexual problem, it does not mean that you are a failure.

IN CONCLUSION…

Sexuality and sexual identity are a very important part of a woman’s life. Discussing any special needs, desires, or concerns with your partner may allow your sex life to become more fulfilling and happy. Remember that sexual problems are common for almost all women. Talk to your health care provider if you believe that you are experiencing sexual problems.