Sexual dysfunction in women

Sexual dysfunction means that you do not achieve normal sexual satisfaction. Many women experience problems with sexual function at some point. Female sexual dysfunction can occur at any stage of life. It can be lifelong or be acquired later in life. It can occur only in certain sexual situations or in all sexual situations.

Sexual problems often develop when your hormones are in flux, such as after having a baby or during menopause. Major illness, such as cancer, diabetes, or heart and blood vessel (cardiovascular) disease, can also contribute to sexual dysfunction.

What is sexual dysfunction?

The explanation may be reduced sexual desire, lack of sexual excitement, difficulty in getting orgasm, pain under intercourse, cramped skin and possible consequences of other underlying illness.

Reduced sex drive, lack of libido, is the most common sexual problem among women. But these problems are related. For example, little desire for low sexual excitement and pleasure results, and so rarely orgasm is achieved.

Lack of sexual desire is reported from 10-51% of women in studies in different countries. Among women in established relationships, sexual desire is far from always leading to sex. In an American study, 40% reported that they never or never felt like sex, but most experienced sexual excitement.

Sexual thoughts are rare among many women without being dissatisfied with their sex life, and the incidence of sexual fantasies or sexual thoughts reflects little to the ability to achieve sexual satisfaction in women.

Fewer seem to have trouble experiencing sexual excitement. In an American study, it was 5%, while in a British study it was 17%.

Cause of sexual dysfunction in women

The basis for sexual desire and excitement in women is little understood, but seems to be due to a mixture of several factors such as chemical neurotransmitters, sex hormones and external conditions.

Swelling of the female genitals – clitoris, genitals, vagina – usually occurs in women within seconds after erotic stimulation. This is due to nerve stimulation that leads to increased local accumulation of blood – cf. Erection in man. At the same time, the muscle tension in the wall of the wall decreases, so that the vagina can expand and increase the secretion of fluid from the wall of the vagina ensures that the vagina is well lubricated and prevents the stomach ulcer.

The effect of the female sexual hormone estrogen on secondary function is compounded. Although low estrogen levels and shrinkage of the esophagus in older women cause low blood clotting in the abdomen when the woman is not stimulated, women over 50 years of age respond equally to erotic stimuli as younger women with clearly higher estrogen levels. After stimulation, clitoris, sex lips and vagina change in the same way as in younger women due to increased blood flow.

Small amounts of the male sex hormone testosterone seem to affect the sexual reaction. But the importance of this is still unclear.

Factors that affect sex life

A number of factors are associated with reduced subjective excitement. There may be distractions (thoughts circle other things than sex), negative expectations of past bad sexual experiences, sexual anxiety, tiredness and depression. A partner who struggles with her sexual satisfaction, stress, pregnancy and a long-term relationship (“everything becomes routine”) are all factors associated with reduced sexual desire. Conversely, the ability to excite is strengthened when you have stable past and present mental health, good control over your own feelings and a good self, good past sexual experiences, positive feelings for the partner

Drugs like new antidepressants (SSRIs) and birth control pills have in some people a negative impact on sexuality. The same appears to apply to certain blood pressure medications (beta blockers).

Many diseases have a negative impact on sexuality. It may include multiple sclerosis, kidney failure, diabetes, diseases of the nervous system, cancer of the disease.

Preparing the problem

Your explanation and your description of the problem is what matters. Often it is beneficial for both partners to meet with the doctor or the therapist. For the doctor there are some conditions that are important to clarify, so prepare to answer the following questions:

– Do you really want sex?
– Can you be sexually excited?
– Do you achieve orgasm?
– Is there a good emotional relationship between you and your partner?
– How is your mental and emotional health?
– What is the quality of your previous sexual experiences?
– Have you been sexually abused?
– Do you have special concerns about sexual activity?
– Do you feel that you spend a sufficient amount of time on the erotic predicament?
– Do you have sexual fantasies?

Blood tests and other surveys have no place in the investigation of this problem. The explanation is very rare abnormal hormonal disorders.

Treatment of sexual dysfunction in women

The choice of treatment depends on what is your problem. This is an area that is little explored, and you are not sure how good the different treatments are. However, we can conclude that medications have at most no or very modest effect. International experts recommend that we concentrate on mental and general health, with particular focus on interpersonal problems between you and your partner, and possibly personal psychological problems that you may encounter.

As said, drugs seem to have a bad effect. Supplements of small amounts of male sex hormones have been tried in some studies, but at least the benefit is modest. The dilemma is that the use of male sex hormones can lead to some degree of masculinization – especially among elderly women. Viagra® has also been tested in women. Although theoretically it would be an opportunity for action, two major studies of nearly 800 women with lack of desire and excitement show that the preparation was without effect on sexual desire, experience, moisture in the vagina and satisfaction.

Psychological treatment seems to be able to produce the best results. So-called cognitive behavioral therapy is aimed at identifying and influencing factors that contribute to sexual dysfunction, such as inappropriate thoughts, unfair expectations, behavior that reduces the partner’s interest and trust (disrespectful behavior or dishonesty), inadequate erotic stimulation and inadequate physical stimulation elsewhere on the body. Cognitive behavioral therapy aims at improving the emotional proximity and communication of the couple, as well as reinforcing the erotic stimulation. The number of treatment meetings varies, it is suggested 3-6, and usually both parties should participate.

Another psychological method (focused sex therapy) consists in training the various elements of the sexual act. It starts with non-sexual physical contact that gradually increases sexual contact. The partners are encouraged to respond to each other and provide feedback on whether the caresses are comfortable.

Both of these techniques help remove focus from a performance goal (for example, reaching orgasm). Good research on this is inadequate, but in a study where these two methods were combined, 74% of women reported improved sexual and marital satisfaction.

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