According to a 2008 study, approximately 43% of US women report a problem with sex, and about 12% of women feel distressed because of a sexual problem. Given the high prevalence of sexual concerns, it’s important for women and their health care providers to have open and honest discussions about these concerns. Sometimes women feel uncomfortable discussing sexual health with their providers, but trust me--a good clinician will recognize that sexual health is an important aspect of overall health and will want to discuss any concerns you may have. The National Health and Social Life Survey showed that sexual problems/complaints were associated with low physical and emotional satisfaction with sexual partners and low general happiness.
How are sexual problems evaluated?
First, a good history and physical exam are important when your provider is addressing sexual function. A careful review of medications may yield insight into why a woman has sexual dysfunction; for example, some medications used to treat psychiatric disorders can cause sexual problems. Sometimes blood work may be ordered to check hormone levels if there are other indications for hormonal problems.
What are the different types of sexual problems?
There are lots of different ways that female sexual problems can manifest. Here are a few, courtesy of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition:
Female sexual interest/arousal disorder (formerly known as hypoactive sexual desire disorder) – deficiency (or absence) of sexual fantasies/thoughts, and/or desire for sexual activity, and/or interest in or response to sexual cues, which causes personal distress and has been present for a minimum of 6 months
Female orgasmic disorder – difficulty, delay in, or absence of attaining orgasm following sufficient sexual stimulation and arousal, which causes personal distress
Genito-pelvic pain/penetration disorder – difficulty having intercourse, vaginal or pelvic pain with intercourse, or fear/anxiety/muscle tensing when attempting vaginal penetration, which causes personal distress and has been present for a minimum of 6 months
How are sexual problems treated?
One useful but often overlooked aspect of sexual function includes a healthy lifestyle approach. We emphasize several aspects: optimizing the symptoms of any medical illnesses, making time for leisure and relaxation, exercising, stopping smoking, and avoiding excessive alcohol use will all contribute to improved general health.
If there are concerns in the relationship outside of sex, these concerns should be addressed. Couples counseling can be of benefit to build communication between partners, share and learn one another’s expectations, understand the impact of a relationship on sex (and vice versa), and learn what your partner likes and dislikes.
If a pain disorder is present, there are multiple different treatment options depending on exactly what is causing the pain. A full discussion of these treatment options is beyond the scope of this blog post, but these options can include vaginal dilators, topical or oral medications, vaginal estrogen or DHEA (for menopausal women) and pelvic physical therapy.
What if there aren’t any obvious physical, relationship, or pain issues causing the sexual problem? Patients in this situation may fall into the category of female sexual interest or arousal disorder. They may remember a time when they felt sexual desire and attraction (or maybe not), but those feelings do not seem to be happening now. There are a couple of relatively new medications used to treat a lack of sexual desire that causes distress: flibanserin is a daily oral pill that can increase sexual desire and reduce the distress caused by a lack of desire, and bremelanotide is an as-needed injection that can also increase desire and reduce distress.
If you are having sexual problems, please feel empowered to discuss them with your health care provider…there are solutions available!