Sexual Dysfunction and Intimacy

Sex is a normal, healthy part of life. But many women experience problems with sex at some point in their lives. If you are having any sexual problems that worry or upset you, you may want to find a solution, either with your partner or a trusted health care provider.

Sexual Desire and Response

Many people think that sex starts with desire, which leads to arousal and then orgasm. Although this may be true for men, research suggests that women’s sexual responses are more complex. For many women, physical desire is not always the starting point. A woman may want to have sex to feel close to her partner or to show her feelings. The physical desire may not occur until after sexual activity has started. A woman may not want to have sex if the situation does not feel right, or if she feels unsafe. Not responding sexually may be her body’s way of telling her to stop the activity.

Some women say they are satisfied even if they do not have an orgasm because the physical and emotional aspects of sex are pleasurable even without it. Lack of orgasm, however, is a concern for many others. Orgasm may be difficult to achieve from intercourse alone, and many women need more stimulation — kissing, caressing, stroking and touching of sensitive areas, such as the breasts and clitoris — to have an orgasm. It is important for both partners to understand that sex can include other activities besides sexual intercourse.

Causes of Sexual Problems

Sexual problems are common and have many causes. In fact, 40 percent of women in the United States have a sexual problem at one time or another.


A woman’s libido (desire for sex) sometimes decreases with age. This decrease is normal and usually is not a cause for concern. However, problems can arise if one partner desires sex more often than the other. Both partners should talk openly about these normal changes and discuss how each can please the other.

Hormonal Changes

The normal stages of womanhood can affect a woman’s interest in and response to sex. A woman’s libido can increase, decrease or fluctuate during pregnancy, menopause or even within a menstrual cycle. Research suggests that some of these changes are due to changing hormone levels. Androgens and estrogen are hormones believed to play a key role in female sexual response. When androgen levels decrease, desire and arousal are reduced. Decreased androgen levels may be caused by surgical removal of the ovaries, use of birth control pills, certain medications and some diseases. Decreased estrogen levels, which occur during perimenopause and menopause, may cause vaginal dryness and lead to pain during intercourse.

Other Causes

Sexual problems also can be caused by stress, illness, drugs, relationship problems, past negative experiences, depression and anxiety.

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Types of Sexual Problems

If you have persistent, recurring problems with sexual response or desire — and if these problems are causing you distress or straining your relationship with your partner — you’re experiencing what is medically known as female sexual dysfunction. This can be a lifelong problem or it can happen later in life, but it isn’t uncommon. Sexual problems fall into four groups — desire problems, arousal problems, orgasm problems and sexual pain disorder.

Sexual Desire Problems

Lack of desire is the most common sexual concern reported by women. Many women do not feel a desire to have sex until they begin to engage in sexual activity and subsequently become aroused. Lack of desire is considered a disorder when a woman:

  • Does not want to engage in any type of sexual activity, including masturbation
  • Does not have (or has very few) sexual thoughts or fantasies
  • Is worried or concerned about these issues

Arousal Problems

Arousal is the term for the physical and emotional changes that occur in the body as a result of sexual stimulation. During arousal, women experience the following changes:

  • Blood pressure increases
  • Heart rate, breathing and temperature increase
  • The nipples, labia and clitoris fill with blood and become more sensitive
  • The vagina lubricates and expands

Arousal can be affected by many things, including medications, alcohol, smoking, illegal drugs, illness, stress, relationship problems, past negative experiences, depression and anxiety. There are different kinds of arousal disorders — some women may not feel mental or physical excitement from sex; others may feel only mental or physical excitement, but not both. Arousal disorders often overlap with desire disorders.

Orgasm Problems

Many women have a hard time reaching orgasm. Some women are satisfied by the physical and emotional aspects of sex — sharing love and closeness — even if they do not have an orgasm. For other women, however, not reaching orgasm is a major concern that must be solved.

Some women with orgasm disorders have never had an orgasm from sex; others had them at one time, but no longer experience them, despite healthy arousal. The intensity of orgasms can decrease with age. Often women can orgasm during masturbation, but not during sex. Although this is not considered a disorder, women who experience this should talk with their partners about activities that help her achieve orgasm.

Orgasm disorder may be caused by poor body image, fear of losing control or when a woman does not trust her partner. It is common for women who do not have orgasms to have arousal problems.

Sexual Pain Disorder

Painful sex can be a lifelong or short-term condition. Pain that occurs during sexual activities other than intercourse is called noncoital sexual pain disorder. Pain during intercourse — during partial or complete entry into the vagina, thrusting or urination after sex — is called dyspareunia. Most sexually active women have experienced pain during sex at some point in their lives. If it occurs often or is severe, a woman should see her health care provider.

Sex Self-Help

Sexual problems are only a concern if they cause you distress or worry. Sexual problems may not affect your life at all. But if they affect your well-being or your relationship with your partner, you may want to seek a solution.

There are many things you can do alone or with a partner to address a sexual problem. Educate yourself. Check your library or local bookstore for books about sex. Learn about your body and how it works. Sex for both partners can include activities other than intercourse, including oral sex, manual stimulation, and masturbation with or without a partner. Try sensual, nonsexual activities like massage. Talk to your partner about your likes and dislikes. An open, honest dialogue can lead to greater understanding and help clear up conflicts. Learn to separate sex from stress. For example, couples with fertility issues may want to try having sex just for the sake of pleasure and intimacy rather than for achieving pregnancy.

Smoking, alcohol and drugs can affect sexual response for both women and men. Smoking can slow down blood flow in the sexual organs and cause arousal problems. Alcohol and drugs affect how your body responds. A good first step in addressing sexual problems is to stop or limit smoking and the use of drugs or alcohol.

Before you see your health care provider about sexual concerns…

Before you see your health care provider about sexual concerns, you may want to try some of the following tips.

For Increased Desire

  • Resolve relationship concerns, stresses, misunderstandings about sex and other issues that may be affecting you and your partner.
  • Focus less on intercourse and more on intimacy.
  • Improve your sexual knowledge and skills.
  • Make time for sexual activity and focus on and pleasuring each other.

For Increased Arousal

  • Be well rested.
  • Increase the time spent on foreplay.
  • Try using a vaginal lubricant for dryness.
  • Do Kegel exercises (contract and relax pelvic muscles).
  • Do not smoke.

To Help You Have an Orgasm

  • Increase sexual stimulation.
  • Try using sex toys.
  • Use mental imagery and fantasy.

To Minimize Pain

  • Try different positions or sexual activities that do not involve intercourse.
  • Allow plenty of time for arousal before penetration.
  • Use a lubricant.
  • Empty your bladder before sex.
  • Take a warm bath.

Talking to Your Healthcare Provider

If you’ve tried the self-help tips and still have a problem that is causing you distress, see your health care provider. If your provider does not ask you about sex, bring up the topic yourself. Some women find talking with their doctors about sex to be difficult or embarrassing. However, being open about it can help your provider know how to help you. Try bring up the subject early in the visit. You could start off with a statement like:

“I am having some concerns about my sex life.”
“I do not enjoy sex like I used to.”
“I am feeling sad lately; my partner is complaining I never want sex.”

Keep a Journal

Keeping a journal may be helpful. You can be more specific when you talk about your symptoms and any changes you have noticed if you write them down. Use your notes to describe your symptoms:

“It hurts when I have sex.”
“I am having problems with vaginal dryness.”
“Urinating after sex is painful.”
“I used to be able to have orgasms, but now I do not. Why is this happening?”
“Lately, I have been having trouble with intimacy. What can I do?”
“I am just not interested in sex. Do you have any advice?”
“Getting older has affected my love life. Is there a fix?”

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