Sexual Dysfunction in Women: Find Your Way back to Intimacy

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. During menopause, as many as half of all women -or even more - may experience sexual dysfunction.

As you age, many changes occur in the way your body functions. Sexual function is no exception. At age 60, for example, your sexual needs, patterns and performance may not be the same as they were when you were half that age.

Although sexual problems are multifaceted, they're often treatable. Communicating your concerns and understanding your anatomy and your body's normal physiologic response to sexual stimulation are important steps toward regaining your sexual health.

Defining the problem

Sexual dysfunction simply implies persistent or recurrent problems encountered in one or more of the stages of sexual response. It's not considered a sexual disorder unless you're distressed about it or it negatively affects your relationship with your partner. Female sexual dysfunction occurs in women of all ages.

Doctors and sex therapists generally divide sexual dysfunction in women into four categories. These are:

• 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 orgasm after sufficient sexual arousal and ongoing stimulation.

• Sexual pain disorder. You have pain associated with sexual stimulation or vaginal contact.

Not all sexual problems in women fit into these categories. With increased information about the complicated nature of female sexual response, a new view has emerged - one that focuses on sexual response as a complex interaction of many components, including your physiology, emotions, experiences, beliefs, lifestyle and relationship.

"All these factors must be favorable for a woman to create an emotional intimacy that can respond to sexual stimuli, which then can lead to arousal," says Rosalina Abboud, M.D., an obstetrician and gynecologist at Mayo Clinic, Rochester, Minn. "Arousal may or may not result in orgasm. Orgasm shouldn't be the goal of a sexual encounter, but rather the enjoyment of the experience."

Causes of sexual dysfunction

Several factors may cause or contribute to sexual dysfunction. Sometimes these factors are interrelated and require a combination of therapies.

• Physical. Physical conditions that may cause or contribute to sexual problems include arthritis, urinary or bowel difficulties, pelvic surgery and trauma, fatigue, headaches, neurologic disorders such as multiple sclerosis, and untreated pain syndromes. Certain medications, including some antidepressants, blood pressure medications, antihistamines and chemotherapy drugs, can decrease sexual desire and your ability to achieve orgasm.

• Hormonal. Menopause can affect women's sexual functioning during midlife. Estrogen deficiency after menopause may lead to changes in your genitals and in your sexual response. 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, your 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 difficult or painful intercourse (dyspareunia), and achieving orgasm may take longer.

• 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 or ongoing sexual abuse. You may find it difficult to fill multiple needs and roles, such as job demands, homemaking, being a mother and 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.

Treating your problem

For physical conditions, your doctor likely will treat the underlying cause of your dysfunction.

Medication-related side effects may require a change in medications. Physical changes brought on by menopause, such as vaginal dryness and thinning, might require the use of hormonal therapy or vaginal lubricants. To help strengthen your vaginal muscles or to increase sexual stimulation, your doctor may recommend a set of simple exercises (Kegel exercises), masturbation, use of a vibrator, or a clitoral-stimulation device available by prescription.

Other helpful suggestions may include position changes during intercourse, muscle relaxation exercises - alternately contracting and relaxing your pelvic muscles - or vaginal dilation exercises using a vaginal dilator.

For psychological or relationship problems, your doctor may recommend counseling or psychotherapy. Therapy often includes sex education, to include such topics as the physiology of your body and techniques to produce the stimulation you need to achieve orgasm.

A type of psychotherapy called behavior therapy includes self-guided exercises, such as nonsexual touching or sensual massage without intercourse, to increase sexual pleasure. The focus of these exercises is on stimulation, not intercourse.

A mind-body connection

For women, sexual response is complex and involves a mind-body connection.

"The brain is the most important sex organ in your body," says Dr. Abboud. "It's your brain's reaction to ideas, fantasies, images, smell and touch that triggers arousal and desire."

Sexual response often has as much to do with your feelings for your partner as it does with the sexual stimuli. Beyond having a sex drive, many women are sexual because they want to get closer to or communicate their affection for their partner. For them, emotional intimacy, such as touching and holding hands, is an essential prelude to sexual intimacy. Talking regularly and openly with your partner about your feelings may help you reconnect and discover each other again.

A good first step if you're experiencing problems is to recognize the problem and to seek the help of a doctor.

Discovering deeper intimacy

The need for intimacy is ageless. You never outgrow your need for affection, emotional closeness and intimate love.

Yes, changes to your body as you age will affect your sexuality. These changes don't bother everyone, but some women find that sexual dysfunction affects their relationships and their quality of life.

Knowing what you can expect and talking frankly about sex with your doctor as well as your partner can help you feel free to discover a deeper, more satisfying intimacy.