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You’ve enjoyed a healthy, satisfying sex life during most of your adulthood. But lately, intimate moments with your partner are less satisfying than they once were. You might feel as though your sexual desire has waned. Or perhaps things that once brought you pleasure now seem painful. You’re concerned about your sexual health.
You’re not alone. Many women experience sexual difficulties at some point in their lives. By some estimates as many as four in 10 women experience at least one sexual concern. In medical circles, this is known as female sexual dysfunction.
Female sexual dysfunction implies persistent or recurrent problems encountered in one or more of the stages of sexual response. What you’re experiencing isn’t considered female sexual dysfunction unless you’re distressed about it or it negatively affects your relationship with your partner.
Although sexual problems associated with female sexual dysfunction are multifaceted, they’re treatable. Communicating your concerns and understanding your anatomy and your body’s normal physiological response to sexual intimacy are important steps toward regaining sexual satisfaction.
Signs and symptoms
Sexual concerns occur in women of all ages but may become more prevalent during hormonally vulnerable times, such as postpartum or with the menopausal transition. Sexual concerns may also occur with major illness, such as cancer.
Your problems might be classified as female sexual dysfunction if you experience one or more of the following and you experience personal distress because of it:
• Your desire to have sex is low or absent.
• You can’t maintain arousal during sexual activity or you don’t become aroused despite a desire to have sex.
• You cannot achieve an orgasm.
• You have pain during sexual contact.
Causes
Several factors may contribute to sexual dissatisfaction or dysfunction. These factors tend to be interrelated. Women with sexual concerns benefit from a combined treatment approach that addresses medical as well as emotional issues.
• Physical. Physical conditions that may cause or contribute to sexual problems include arthritis, urinary or bowel difficulties, pelvic surgery, fatigue, headaches, other pain problems and neurological disorders such as multiple sclerosis. Certain medications, including some antidepressants, blood pressure medications, antihistamines and chemotherapy drugs, can decrease sex drive and your ability to achieve orgasm.
• Hormonal. Lower estrogen levels during the menopausal transition may lead to changes in your genital tissues and your sexual responsiveness. The folds of skin that cover your genital region (labia) shrink and become thinner, exposing more of the clitoris. This increased exposure sometimes reduces the sensitivity of the clitoris, or may cause an unpleasant tingling or prickling sensation.
In addition, with the thinning and decreased elasticity of its lining, the vagina becomes narrower, particularly if you’re not sexually active. Also, the natural swelling and lubrication of the vagina occur more slowly during arousal. These factors can lead to uncomfortable or painful intercourse (dyspareunia), and achieving may take longer.
Changes associated with the declining estrogen levels of menopause may impact sexual function. However, most women continue to have satisfying sexual intimacy during and after the menopausal transition.
• Psychological and social. Psychological factors that cause or contribute to sexual problems include emotional difficulties such as untreated anxiety, depression or stress, and a history of sexual abuse. During pregnancy, after childbirth or while breast-feeding, you may experience a decrease in sexual desire. You may find it difficult to fill multiple needs and roles, such as job demands, homemaking, being a mother and sometimes also caring for aging parents. Your partner’s age and health, your feelings toward your partner, and your view of your own body or that of your partner are additional factors that may combine to cause sexual problems. Cultural and religious issues also may be contributing factors.
Psychological factors may contribute to or result from sexual dysfunction. Regardless of the cause of sexual dysfunction, you usually need to address emotional and relationship issues for treatment to be effective.
Female sexual dysfunction is generally divided into four categories:
• Low sexual desire. You have poor libido, or lack of sex drive. This is the most common type of sexual disorder among women.
• Sexual arousal disorder. Your desire for sex might be intact, but you’re unable to become aroused or maintain arousal during sexual activity.
• Orgasmic disorder. You have persistent or recurrent difficulty in achieving after sufficient sexual arousal and ongoing stimulation.
• Sexual pain disorder. You have pain associated with sexual stimulation or vaginal contact.

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