THE BOYS' BRIGADE

There are some sexual problems common in women. A woman's sexuality is a complex mix of mental, emotional, and physical signals. A problem in one area can grow to involve others. For example, a physical problem can lead to fear of pain, and the fear can lead to guilt about its effect on your partner. So the causes of sexual problems in women are often interrelated.

The Sex Is Too Predictable

The problem: Getting into a romantic routine can be a good thing (think about the anticipation over a tryst you and your partner pencil in for Wednesday afternoons, suggests James Amoureux, MBA, a dating and sexual relationship coach in Chicago). But if that routine becomes too predictable, you and your partner may soon lose interest.
The solution: “Plan the unexpected,” Amoureux suggests. Roll a set of “sex dice,” in which one number indicates a sexual position and the other the location (the bedroom? the kitchen? the closet?) where you will have sex. "This can be a great tool to bring variety to a dull routine,” he says.


Psychological causes may be related to past or current physical or emotional problems. These mental and emotional causes include:

• Stress, depression, or anxiety.
• Marital or relationship discord.
• Fears that illnesses, such as cancer, or surgery, such as a mastectomy or hysterectomy, will make sexual activity unpleasant for the woman or her partner.
• Unhappiness with body image.
• Fear of spreading a sexually transmitted disease, such as genital herpes.

Physical causes can be normal hormonal changes, injuries, medical procedures, or other medical problems. Physical causes include:

• Hormonal changes such as those related to the menstrual cycle, use of birth control pills or hormone therapy, pregnancy, recovery from pregnancy, perimenopause, and postmenopause.
• Pain during intercourse. This may result from:
  • Vaginal dryness. Lack of lubrication in the vagina is the most common cause of pain with sex.
  • Vaginismus (say "vadj-uh-NIZ-mus"). This involves painful spasms of the vaginal muscles. Vaginismus may be linked to a fear that stems from losing control or from trauma such as rape or sexual abuse. But sometimes there is a medical cause, such as:
    • Scars in the vaginal opening from injury, surgery, or childbirth.
    • Pelvic infections, such as vaginitis or Bartholin's glands infections.
    • Chronic pain conditions, such as vulvodynia.
    • Skin conditions, such as lichen sclerosus or lichen planus.
    • Irritation from douches, spermicides, or latex condoms.
  • Dyspareunia (say "dis-puh-ROO-nee-uh"). This is physical pain that occurs during entry into the vagina, during deep thrusting, or pain after sexual intercourse.
• A physical abnormality.
• One or more of many medical conditions. This includes diseases that affect blood circulation, like diabetes, or problems with your thyroid, like hypothyroidism. Other medical problems, like endometriosis or arthritis, may cause pain during sex.
• Medical treatments. Sometimes treatments cause changes that result in pain during intercourse or other sexual problems. These include previous surgeries, treatments for infertility, and cancer treatments.

Aging may cause a decrease in sexual desire and changes in the vagina. These changes include:

• Thinner vaginal walls, so that the vagina may be easily bruised or chafed.
• Narrowing, shortening, and/or stiffening of the vagina, causing pain during intercourse (dyspareunia).
• A reduction in lubrication and a lengthening of the time needed to lubricate the vagina.
• More time needed to feel sexually aroused.
• Orgasms that do not last as long they once did.

Medicine use can sometimes decrease sexual desire and arousal. Such medicines include:

• Blood pressure and diabetes medicines, such as diuretics, alpha-blockers, and calcium channel blockers.
• Antidepressants. These include tricyclics and selective serotonin reuptake inhibitors (SSRIs).
• Antihistamines, which are allergy medicines.

Losing a partner is a common life event that can lead a woman to be less sexually active and satisfied. This is not a "sexual problem." But it can leave you with unmet needs for intimacy.
Cultural and societal factors may play a role in a woman's sexual health. Inadequate health services and/or a lack of sex education may result in a woman's lack of knowledge about sexual behavior.
Drinking alcohol and using illegal recreational drugs in small amounts may reduce sexual inhibitions at first. But continually using drugs, such as cocaine or amphetamines, or drinking too much alcohol will cause problems with orgasm for a woman. Also, illegal drugs as well as many medicines may cause a woman to have less sexual desire.

There are many reasons why a woman may have a sexual problem.
Physical influences

• Women normally experience a physical change during sexual arousal, as blood engorges the vulvar area. If a woman is aware of the exact places in her vulvar area where she feels increased sexual intensity (erectile tissue), her sexual pleasure may be increased by genital stimulation. It is possible for a woman not to be aware of this engorgement. It is also possible for a woman not to be aware of the spots that are most sensitive and responsive to stimulation.
• Any history of pain during intercourse may cause a woman to avoid sexual activity.
• Women who experience pain during intercourse may choose to continue to have intercourse, even though the experience is unpleasant and results in low sexual desire.
• Ongoing (chronic) illnesses, such as diabetes and arthritis, can affect sexual desire, enjoyment, and performance. Medicines for many medical conditions also affect desire and arousal.

Partner and emotional influences

• A partner's level of sexual skill and attention can play a big part in a woman's sexual enjoyment.
• A positive, respectful connection between partners sets the stage for sexual interest and arousal. Relationship problems can lower sexual interest and response.
• Living situations that give couples very little privacy can interfere with feelings of arousal.
• The physical changes that signal sexual arousal may for some women be accompanied by feelings of guilt, embarrassment, shame, or self-consciousness. Any of these emotions can reduce or negate physical arousal.
• Positive sexual experiences help build a healthy sexuality. On the other hand, a woman who has had a forced sexual experience is likely to have mixed feelings about sex. In one study, 1 out of 5 women reported having been forced to do something sexual. This was most often done by someone they were close to.

Age-related influences

• A decline in sexual activity as women age is most often caused by the lack of a partner.
• Many older women also report problems with lubrication.
• Women may note a decrease in sexual desire after menopause. In mild cases, the change may be almost unnoticeable. In more severe cases, there may be a decrease in mental and physical responsiveness to sexual stimuli.
• Many older women experience other changes in their sexuality. It may take longer to feel sexually aroused, and orgasms may be briefer. But orgasms still will offer mental and physical pleasure to most women.
• Women can feel sexual pleasure throughout their lives. But those who stop sexual activity after menopause have more shrinking and drying of the vagina than women who continue sexual activity.

The main risk factors for sexual problems are also those that affect a woman's sexual function and satisfaction. These include:

• A woman's mental and emotional well-being.
• Her sexual relationship.
• Her partner's sexual function.

A woman's physical well-being is also important. Being sexually active with a partner or through masturbation helps maintain vaginal health. And having regular sexual intercourse helps preserve vaginal elasticity and keeps vaginal tissues from shrinking.
Some physical risk factors include a current or long-term history of:

• Exhaustion, often from round-the-clock care of a baby or small children and/or parenting and having a job.
• Normal hormonal changes linked to pregnancy, recovery from pregnancy, menopause, or aging.
• Taking certain medicines that decrease a woman's desire for sex.
• Health problems that cause pain during sex or decrease a woman's ability to engage in and enjoy sexual activity. Such health problems include:
  • Neurologic diseases such as stroke, spinal cord injury, and Parkinson's disease.
  • Surgery that affects a woman's pelvic organs or genitals.
  • Endocrine diseases such as diabetes or liver disease.
  • Peripheral arterial disease.