The Institute for Women's Health

Sexuality plays a tremendously important role in women’s lives.   It brings women an ever-evolving source of pleasure, intimacy, personal expression, interpersonal connectedness, and of course, reproduction.  It can be a wonderful part of a healthy relationship, but sometimes it can become a source of frustration, pain, or even become tedious and unfulfilling under certain circumstances.

Changes in women’s sexuality can occur at any point during their adult life.   Many things can impact a woman’s sexuality. I would like to take a little time to discuss some of these and hopefully provide some insight into what may be causes or contributing factors to these changes, and offer some treatment options.

One way to organize the various factors that affect women’s sexuality is by age, but that becomes problematic since most of these can occur at any age.   The following is a list of some of the factors that can have a negative impact on sexual health.

Pain during intercourse can be caused by many things.

Sexually transmitted infections:  can occur at any age, and while some cause no symptoms, most cause pain, sometimes chronic pain that can make sex difficult.

Endometriosis (which is more fully discussed in another “Girl Talk” episode that is archived) is very often a cause of pain during intercourse, especially causing pain in the lower pelvis during intercourse.

Vaginismus is a condition where the muscles at the opening of the vagina can go into spasms and tighten painfully with attempts at penetration.  Sometimes a ‘triggering’ event (something that caused the symptoms to start occurring) can be identified, but sometimes it can begin to happen without any obvious cause.

Interstitial cystitis is a condition of inflammation of the bladder that causes pain during intercourse.

Ovarian cysts, scar tissue “adhesions” from infections or previous surgeries can cause pain; the latter being a very difficult to diagnose and treat.  Uterine fibroids can cause pain in some cases (fortunately, a lot of they time they are small, and don’t cause any symptoms).

Vaginal dryness is a problem that can occur at any time during a woman’s life, but is most often seen during the menopause, when the loss of estrogen causes changes in the vaginal skin that make the skin very dry, and sensitive.  The loss of estrogen causes the vaginal skin to lose it’s ability to lubricate normally and to stretch – which can cause tearing of the skin and burning pain with attempts at intercourse.  Vaginal dryness can occur at younger ages sometimes due to dermatological skin conditions like lichen sclerosus, psoriasis or eczema.  Sometimes vaginal dryness from lack of lubrication or decreased arousal due to the use of oral contraceptive pills, or other hormonal contraceptives.

A history of physical or sexual abuse or trauma, or even emotional abuse can cause problems with pelvic pain, and/or pain during intercourse.

Changes in libido can affect women at any age.

Libido is the desire to have intercourse.  While excessive libido is an uncommon problem, it can occur, and can cause problems for the sufferer, particularly if the woman becomes excessively promiscuous, which can put her at risk for exposure to STDs or cause relationship problems of social stigma.  Decreased libido is a much more commonly encountered problem for women.  One of the biggest concerns can be due to a difference in libido in couples, with one couple wanting sex more often than the other.

Libido is a ‘multi-factorial’ condition, meaning that many things affect a woman’s libido.  While hormones contribute significantly and can often be a cause of decreased or absent libido, they are not the only factor.  Social factors affect women’s libidos as well.  Stress, fatigue, and family responsibilities as well as depression and other health conditions can have a huge effect on a woman’s sex drive.  For most women, being very stressed, or over-tired from working inside or outside of the home (or both) can leave them both emotionally and physically drained and have a negative impact on their libido.  Marital discord almost always has a negative impact on a woman’s sex drive.  Often women don’t desire to have a physical connection with their partner if the emotional connection is strained.  Many medications can have a negative impact on a woman’s libido, including birth control pills, anti-depressants, some blood pressure medications, even some anti-histamines can have a decreasing effect on libido.    Psychological factors are tremendously important in a woman’s sex drive.  A history of sexual abuse, or physical trauma can cause sexual dysfunction involving both libido and pain symptoms for victims.  Poor self-esteem, or body image disorders can leave women feeling undesirable and prevent them from having satisfying sexual interactions.

Changes in a woman’s production of hormones (specifically testosterone and or estrogen) can be a significant contributor to loss of libido.  These hormonal declines (in testosterone production) or imbalances are more commonly experienced as women age, especially from their mid-30’s and often more pronounced in their 40s and beyond.  Once a woman goes through menopause, her body’s own production of sex steroid hormones is very minimal (whether menopause occurred naturally, or due to having her ovaries surgically removed at a younger age) and low testosterone may be a significant contributor to decreased libido.  Before menopause (during something called ‘perimenopause’) many hormone changes occur in women that can have many effects on their lives; decreased libido being just one of those effects.  After giving birth is another time in womens’ lives that testosterone production has been shown to decline.  In the immediate post-partum period for breast-feeding women, their bodies produce minimal hormones, and they are in a period of temporarily suppressed hormones (almost like a ‘mini-menopause’) until they stop breastfeeding and their hormones return to more normal levels.   Even if women don’t breastfeed, having a child can result in lower than previously produced testosterone levels that can impact libido.  Although the exhaustion of having a  newborn (and small children, and, come to that, teenagers) – are also things that can negatively impact a woman’s sexual desire.

Orgasmic dysfunction.

Exact numbers vary by study, but it is estimated that only 25% of women are regularly able to have orgasms during vaginal intercourse.  Up to 10% of women never have orgasms.   It is important for women to know that it is ‘normal’ for them to not have orgasms with penile-vaginal intercourse alone.   For women who have never had an orgasm (or aren’t sure if they have) there are resources available to help them learn how to achieve orgasm.  Sometimes women can lose this ability, due to certain medications (anti-depressants being the most common cause of this), medical conditions, nerve injuries, or even due to hormonal declines.  A careful history by their gynecologist should be able to uncover possible causes and direct treatments.

Dr. Wendy Askew
The Institute for Women’s Health

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