Sex Problems in Women

Sexual problems in women can arise from various conditions that hinder their ability to engage in or enjoy sexual activity. These issues can impact every aspect of sexual experience, from desire to orgasm. Contributing factors may include physical illnesses, hormonal fluctuations, relationship difficulties, and societal influences on sexual expectations. These conditions sometimes affect mental health and interpersonal relationships. However, the perception of these symptoms can vary.

The extent to which they affect someone depends on their specific symptoms, underlying causes, and individual perspectives. Effective treatment of sexual dysfunction in females involves understanding the person’s treatment objectives, addressing their specific needs, and identifying the likely root cause of the issue. The following sections delve into the various types of sexual dysfunction that women may experience.

What is the source of such issues?

In females, sexual dysfunction can manifest in several ways, affecting different aspects of the sexual experience:

• Desire: Low libido can be considered a form of sexual dysfunction if it causes distress. This can occur in menopausal or perimenopausal women, as well as others who experience diminished sexual desire.
• Arousal: Difficulty in arousal refers to situations where a person desires sex but struggles with physical readiness, such as inadequate vaginal lubrication or lack of genital swelling.
• Pain: Dyspareunia is a condition where pain occurs before, during, or after sexual intercourse. This pain may result from various medical conditions affecting the genitals or pelvic floor, such as vaginismus, infections, skin diseases, endometriosis, low estrogen levels, pelvic organ prolapse, or pelvic floor dysfunction.
• Orgasm: Some individuals may have difficulty achieving orgasm despite enjoying sexual activity.

These dysfunctions can stem from physical, psychological, and social factors, and their severity and duration can vary. Factors contributing to a higher risk of sexual problems in females include lower education levels, relationship issues, male-centric sexual expectations, health conditions affecting genital health, stress, mental health concerns, marital practices like child marriage or polygamy, religious influences, history of abuse (including domestic violence and FGM), and gender inequalities limiting access to sexual health services.

Sexual pain

Sexual pain, also known as dyspareunia, can arise from various medical conditions affecting the reproductive and pelvic areas in women. Here are some common causes:

• Vaginismus: This condition involves involuntary contractions of the muscles around the vagina and pelvic floor, making penetration painful or impossible. It often has psychological triggers such as anxiety, fear of pain, or past sexual trauma.
• Infections: Sexually transmitted infections (STIs) and yeast infections can lead to inflammation and irritation of the genital area, causing pain during intercourse and sometimes even outside of sexual activity.
• Skin Diseases: Conditions like psoriasis and contact dermatitis can affect the tissue of the vulva, vagina, and surrounding areas, making sexual contact painful.
• Endometriosis: This condition occurs when tissue similar to the uterus’s lining grows outside the uterus. Endometrial adhesions and scarring can cause pelvic pain, including pain during intercourse.
• Low Estrogen: Insufficient levels of estrogen can lead to vaginal dryness and thinning of the vaginal tissue (vaginal atrophy), making sexual intercourse uncomfortable or painful. Low estrogen levels can occur during menopause, after childbirth, or due to other hormonal changes.
• Pelvic Organ Prolapse: When the pelvic floor muscles weaken, pelvic organs such as the bladder, uterus, or rectum can drop or prolapse into the vaginal area. While not always symptomatic, pelvic organ prolapse can cause discomfort and pain during sex.
• Pelvic Floor Dysfunction: Tight or injured pelvic floor muscles can result from various factors, including surgery, injury, pregnancy, childbirth, or conditions like interstitial cystitis. These issues can lead to pain and discomfort during sexual intercourse.

Addressing sexual pain typically involves a multidisciplinary approach, including medical evaluation, physical therapy, and psychological support. Treatment options may include medication, hormonal therapy, pelvic floor exercises, and counselling to address any underlying psychological factors contributing to the pain. Consulting with a healthcare provider specialising in sexual health can help determine the specific cause and appropriate treatment for sexual pain.

What is the treatment for sexual dysfunction in females?

Treatment for female sexual dysfunction varies depending on the underlying causes identified by a healthcare provider. Here are the common approaches used:

Addressing Psychological Factors:

• Therapy for Trauma: If previous experiences of abuse, sexual trauma, or female genital mutilation (FGM) are contributing to sexual dysfunction, therapy focused on addressing trauma and its impact may be recommended.
• Sex Education: Clearing up misconceptions about sex and learning about sexual techniques can help individuals overcome barriers to sexual enjoyment and satisfaction.
• Relationship Counseling: Resolving relationship issues that affect trust, desire, or attraction to a partner through counselling can improve sexual function.
• Therapy for Mental Health Issues: Treatment for conditions like anxiety, depression, PTSD, low self-esteem, and shame related to sex can be crucial in improving sexual well-being.

Medical Interventions:

• Hormone Therapy: For women experiencing low estrogen levels contributing to vaginal dryness and reduced arousal, topical estrogen or oral hormone replacement therapy may be prescribed.
• Medications: Drugs like flibanserin (Addyi) and bremelanotide (Vyleesi), known as “female Viagra,” are aimed at increasing sexual desire. Adjusting or changing medications that affect sexual function may also be considered under medical supervision.
• Surgical Options: Surgery might be necessary to address structural issues impacting sexual function, such as complications from childbirth, FGM, organ prolapse, or congenital structural differences.

Physical Therapies:

• Dilator Training: For individuals with vaginismus, dilator training involves progressively using larger dilators to help relax pelvic floor muscles and reduce pain during penetration.
• Pelvic Floor Exercises: Exercises like Kegels can strengthen pelvic floor muscles, which may be weakened due to injury or other factors impacting sexual function.

Lifestyle Changes:

• Healthy Lifestyle: Improving overall physical health through diet, exercise, and stress management can positively impact sexual function.
• Combination Therapy: Often, a combination of approaches tailored to the individual’s specific needs and circumstances is necessary for the effective treatment of female sexual dysfunction.