What is female sexual problems?

Most people have symptoms of a sexual problem at times. But sexual response is different for everyone. And what's normal at one stage of your life may change at another stage. It's common to have a lower sex drive as you age. But many causes of sexual problems can be treated.

Symptoms of sexual problems can include:

• Less desire. You may have fewer sexual fantasies or thoughts. You may not want to have sex.
• Less arousal. You may notice that you're not interested when a partner makes sexual suggestions. You may not be able to feel or maintain sexual excitement.
• Being unable to reach orgasm.
• Pain during sex.

These symptoms are problems only if they bother you or cause problems in your relationship with a partner.

Treatment will depend on the cause and the type of sexual problem you're having. Treatment may include:

• Treating any physical causes. This may include:
  • Using hormones, such as estrogen.
  • Taking steps to relieve pain or vaginal dryness.
  • Taking medicines.
  • Changing medicines that may cause sexual problems.
  • Doing pelvic floor physical therapy.
• Using counseling-based therapies. They can help you learn how to talk openly with your partner. You may also learn more about your body, your sexual signals and receptors, and changes in sexuality as you get older. Therapies may include:
  • Getting counseling for you and your partner.
  • Getting psychological therapy. This often involves cognitive-behavioral therapy.
  • Using sex therapy.

It's important to feel comfortable talking with your doctor. What works for one person may not work for another. So the more you can tell your doctor, the more the doctor will be able to help you.

Being sexually active (alone or with a partner) helps keep your vagina healthy. You can take the following steps to help prevent sexual problems.

• Look after your overall health. This includes both your physical health and your emotional health.
• Talk regularly to your partner about your needs and desires.
• Get familiar with your own patterns and methods of sexual arousal. One way to do this is through masturbation.
• Understand that many people don't always have orgasms during intercourse. Mutual pleasure can be a satisfying way to have sexual intimacy.
• Use plenty of lubrication. This can help you avoid vaginal dryness. That's the most common cause of painful sex.
• Enjoy being tender and close with your partner. And don't always expect great sexual performance.

Your doctor will work with you to identify your symptoms and may:

• Ask questions about your past health problems and the medicines you take.
• Ask questions about your sexual history.
• Do a physical exam, in some cases. This may include a pelvic exam if you're having pain during sex.
• Order tests, if needed. For example, blood tests can check hormone levels and thyroid function.

Medicines may be used to treat certain conditions that contribute to sexual problems. These medicines include:

• Lidocaine ointment or ospemifene (Osphena). They may be used for pain that occurs during sex.
• Estrogen, if you are past menopause. It can help with dryness, irritation, and thinning of vaginal tissue (atrophy).
• Flibanserin (Addyi). It may help increase sexual desire before menopause. It's for those who have low sexual desire that isn't caused by medical or psychiatric problems, other medicines, or relationship problems.
• Testosterone. It may play a part in sex drive and satisfaction.

There are several things you can try. Masturbation may increase your sexual arousal. Talk with your partner about what each of you needs, and try different positions. Use lubricating products like K-Y Jelly in your vagina to help prevent pain with sex. Kegel exercises can help increase sexual arousal and improve orgasm.

A risk factor is anything that increases your chances of having a problem. The main risk factors for sexual problems are having:

• Poor mental and emotional health.
• Problems with your sexual relationship.
• A partner who has problems with sexual function.

Other risk factors include:

• Exhaustion. This is often from round-the-clock care of a baby or small children or parenting and having a job.
• Normal hormonal changes. These are linked to pregnancy, recovery from pregnancy, menopause, or aging.
• Taking certain medicines that decrease your desire for sex.
• A history of physical or sexual abuse.
• Health problems that cause pain during sex or make it harder for you to have and enjoy sex. Such health problems include:
  • Nervous system problems. Examples include stroke, spinal cord injury, and Parkinson's disease.
  • Surgery that affects the pelvic organs or genitals.
  • Diseases such as diabetes or liver disease.
  • Peripheral arterial disease.

Treatment for sexual problems can include various kinds of therapies. The best ones for you depend on the cause of your sexual problem. Sex counselors and therapists are trained to help people with sexual issues. Therapies may include:

• Problem-solving methods.

  These can help you communicate with your partner.

• Ways to improve your sexual experience.

  For example:

  • If you have involuntary contractions of the vagina, you may learn how to dilate the vaginal opening.
  • If you aren't able to have an orgasm, you may learn ways to stimulate your genitals.
• Dual sex therapy.

  This treatment helps you and your partner work through problems as a team.

• Cognitive-behavioral therapy or hypnosis.

  This can help you gain control of symptoms that produce anxiety, such as fear or poor self-esteem.

• Behavior training.

  This may include techniques to help you express your sexual needs with confidence.

The American Association of Sex Educators, Counselors, and Therapists (AASECT) certifies sexuality health professionals. Go to the AASECT website at www.aasect.org for information.

When there's a problem in either the emotional or physical part of your life, you can have sexual problems. Things like stress, anxiety, and depression can be a cause. So can relationship problems. Other causes include an injury or disease, aging, and taking certain medicines. But sometimes a cause isn't found.

A sexual problem is something that keeps sex from being satisfying or positive. Most people have symptoms of a sexual problem at one time or another. For some, the symptoms are ongoing. But your symptoms are only a sexual problem if they bother you or cause problems in your relationship.