February 02, 2022
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About 30 to 40% of women will experience sexual dysfunction at some point in their lives, according to the Cleveland Clinic.
An old adage states that what happens in the bedroom should stay in the bedroom. But sexual health specialists say that's not the case, particularly when it comes sexual dysfunction.
Though many people are uncomfortable discussing problems in the bedroom, these issues can affect quality of life and impair relationships when left untreated.
Sexual dysfunction in men tends to get more attention, but many women suffer from it too. About 30-40% of women will experience sexual dysfunction at some point in their lives, according to the Cleveland Clinic. And these conditions stem from much more than the happenings of the bedroom.
Yet, discussing sex can still feel taboo, making it difficult for patients to open up to their physicians about the problems they are having, said Dr. Paul Gittens, director of the Centers for Sexual Medicine and Wellness in Bala Cynwyd.
"It is important for women to know that there is a safe and comfortable place to get the help they need," Gittens said. "We take it seriously. Our patients leave that first consultation with hope and a smile."
There are four phases of sexual response: desire, arousal, orgasm and resolution, said Dr. Reneita Ross, a urogynecology physician at Jefferson Health. Sexual dysfunction refers to any persistent or recurring disturbance in any of these phases. It also includes any pain during sexual activity that affects the relationship or causes distress.
Female dysfunction can occur at any stage of life or throughout a woman's life. Its causes are varied and complex because sexual response not only involves physiology, but emotions, experiences, beliefs and lifestyle. Therefore, treatment often involves a multi-prong approach.
"It is not hard to diagnosis, but it can be a challenge to get women to bring up," Ross said. "Sometimes women say after pregnancy that their body has changed or they are just not interested in sex anymore. They may have difficulties achieving orgasm or experience pain during sex."
The most common types of sexual dysfunction that women experience include:
• Low sexual desire or lack of interest in sex
• Sexual arousal disorder – the struggle to become aroused during sexual activity
• Orgasmic disorder – the inability to reach orgasm despite sufficient sexual arousal and stimulation
• Pain with sexual stimulation or penetration
Though some women experience sexual difficulties throughout their lives, others develop them when their hormones fluctuate – like after having a baby or during menopause, experts say.
After giving birth or during breast-feeding, some women experience vaginal dryness that can affect their desire to have sex. The decrease in estrogen levels during menopause also can lead to changes in genital tissues, which affect sensation and the time it takes to reach orgasm.
One study of 1,000 postmenopausal women found that half of them experienced vaginal dryness.
Certain chronic illnesses including cancer, diabetes, multiple sclerosis and cardiovascular disease also can contribute to sexual dysfunction. So can antidepressants, blood pressure medications and chemotherapy drugs.
Sometimes, a gynecological condition such as an infection, endometriosis, ovarian cyst or uterine fibroid can cause pain during sex. Women who are not sexually active also may experience thinning of their vaginal linings. The lining may become less elastic, which can lead to more painful intercourse, a condition known as dyspareunia.
As many as 30% of women report pain during sex, according to a study published in The Journal of Sexual Medicine.
Anxiety, depression, long-term stress and a history of sexual abuse also can cause or contribute to sexual dysfunction. So can the stress of new motherhood and long-term conflict in a relationship. Cultural and religious influences and body image struggles are other factors.
Low libido, a common complaint as women age, can affect younger women, too. Medical issues such as diabetes, low blood pressure and depression can contribute to it. Antidepressants and hormonal contraceptives also can dampen a women's libido, research shows.
Sexual dysfunction not only can impact quality of life and interpersonal relationships, but it also can alter a woman's self-image and affect her mental health.
Health experts encourage women not to ignore distress. There are a variety of treatment options available, depending on the source of the dysfunction. A thorough evaluation is important to uncovering the root of sexual dysfunction.
"Health care providers need to ask questions and really listen," Ross said. "Ask about their sexual health. Ask about any past trauma, relationship difficulties and about any medications they are taking – all of which can play a role. It is amazing how much women will open up. They just want to know they are not alone."
Gittens said he spends an hour conducting an initial consultation to get as much information as possible so he can narrow down the cause.
Once the underlying causes are identified, a treatment plan can be developed. Treatment can involve trying different arousal techniques with a partner or going to counseling together.
Depending on a woman's symptoms, she may be prescribed flibanserin or bremelanotide – the only two medications approved by the U.S. Food and Drug Administration to treat a low libido in premenopausal women.
Hormone therapy also may make sex more comfortable for women and, in turn, improve desire. For pain during sex, vaginal lubricants or dilators can help.
Ross also recommends the Meet Rosy app, which helps women understand what sexual dysfunction is and how to treat it.
Some clinics offer more experimental remedies, like vaginal rejuvenation procedures, or recommend dietary supplements, but scientific research on many of these treatments is limited.
At the Centers for Sexual Medicine and Wellness, Gittens provides regenerative medicine therapies such as the O-Shot, a platelet-rich plasma injection intended to stimulate the body's stem cells and growth factor. He also offers the MonaLisa Touch, a fractional CO2 laser that stimulates the production of the vaginal wall tissue with the intent of improving sexual function.
Ross has recommended the dietary supplement Arginmax, which was designed to enhance the female sexual function by improving blood circulation. Some pilot studies have found the supplement can enhance sexual experience.
The most important thing doctors want women to know is that they don't have to silently live with these issues. Ross emphasized that sex isn't just for men. It provides women emotional and physical release too and helps them feel empowered, she said.
She also pointed out that some people don't want to be sexually active and, for them, treating any sort of dysfunction is not a priority.
"As a provider, the patient teaches you what is important," Ross said. "Many women get embarrassed talking about this, but it is universal. We need to help our patients – our fellow women."
