Trouble with having sexual intercourse is known clinically as sexual dysfunction. It refers to experiencing problems during any part of the intercourse response cycle that interrupts a woman or couple from going through the normal stages of satisfaction during sex.
There are four stages to a normal sexual response cycle: excitement, plateau, orgasm and resolution.
For someone with sexual dysfunction, these stages do not transition from one to the other easily and prevents sexual satisfaction.
Research indicates that sexual dysfunction is more common in women (43%) than it is in men (31%). However, it can’t be ruled out that the numbers could be higher, as this is a topic that many are embarrassed to discuss.
Fortunately, most cases of sexual dysfunction are treatable, so it is important to share your concerns with your partner and doctor soon after experiencing recurring symptoms.
How does sexual dysfunction develop?
Physical causes: Medical and physical ailments can impair sexual function.
Common conditions include diabetes, heart disease, neurological disorders, hormonal imbalances, menopause, chronic diseases such as kidney or liver failure, alcoholism and drug abuse.
Unfortunately, medications used to treat these conditions can lower a person’s sexual desire.
Psychological causes: Work-related stress, anxiety or shyness over sexual performance, marital or relationship problems, depression and the effects of a past sexual trauma are all possible causes of sexual dysfunction.
Symptoms in women
Inhibited sexual desire: Hormonal changes, medical conditions and treatments (such as chemotherapy), depression, pregnancy, stress and fatigue can cause a loss of interest in sex.
Career priorities, caring for children, and even boredom, due to a predictable daily routine can also make someone lose interest in sex.
Inability to become aroused: Vaginal dryness in women due to insufficient foreplay or underlying health issues is a key reason for the inability to become physically aroused. Researchers are studying how blood flow disorders might affect arousal problems.
Lack of orgasm (anorgasmia): Sexual inhibition, insufficient stimulation, inexperience, lack of knowledge, and psychological factors such as anxiety, a past sexual trauma or abuse, may prevent someone from achieving orgasms.
Painful intercourse (dyspareunia): Endometriosis, pelvic mass, ovarian cysts, inflammation of the vagina (vaginitis), poor lubrication, menopause, scar tissue from a previous surgery and sexually transmitted diseases can cause painful intercourse and need immediate medical attention.
Another cause is vaginismus, a phobia of penetration that triggers an involuntary spasm of the muscles that surround the vaginal entrance.
When you see a gynaecologist, he/she will start a session by evaluating your symptoms one by one. A better understanding of a person’s attitude towards sex helps the doctor make more accurate recommendations for treatment.
It is important to answer a doctor’s questions as truthfully as possible, even if it may be embarrassing to reveal so much intimate detail to a stranger.
This is followed by a physical exam, which includes a pelvic examination.
If your symptoms are really bad, tests like ultrasound and pap smear may be needed to check on the health of your reproductive system, and to detect cancer or pre-cancerous cells in the cervix.
Treating female sexual dysfunction
Treatment of sexual dysfunction in women should be approached as a team effort that includes the patient, her gynaecologist and trained therapists.
Sexual dysfunction can usually be corrected by identifying the root physical or psychological problems.
Treatment methods focus on the following:
Education: Teaching the patient about the human body, sexual function and the changes associated with ageing, as well as sexual behaviours and responses, may help a woman overcome her anxieties about sexual function and performance.
Enhancing arousal: This can include the use of erotic materials and masturbation techniques.
Distraction techniques: To increase relaxation and eliminate anxiety, erotic or non-erotic fantasies, exercises with intercourse, music, videos or television can be used.
Encouraging more foreplay: Non-coital behaviours (physically stimulating activity that does not include intercourse), like a sensual massage, can be used to promote comfort and increase communication between partners.
Reducing or eliminating pain: Use sexual positions that allow a woman to control the depth of penetration and help relieve pain.
The use of vaginal lubricants can help reduce pain caused by friction, and a warm bath before intercourse can help increase relaxation.
Common questions about sexual dysfunction
How do hormones affect sexual function?
Many women experience changes in sexual function as they age due to declining oestrogen levels.
Research suggests that lowered levels of testosterone also contribute to a decline in sexual arousal, genital sensation and orgasm. Lack of oestrogen also results in dryness of the vagina.
How does a hysterectomy affect sexual function?
Women who undergo a hysterectomy experience changes in sexual function. A lowered libido may be linked to the hormonal changes that occur due to the removal of the uterus and ovaries.
Contributing to sexual dysfunction is damage to nerves and blood vessels critical to sexual function.
How does menopause affect sexual function?
Lowered levels of oestrogen in post-menopausal women can dampen sexual function.
Try using hormone replacement therapy to lessen vaginal dryness and heighten genital sensation to reduce some of the hormonal sexual problems.
On the flip side, a handful of post-menopausal women have indicated an increase in sexual satisfaction. Post-menopausal woman have fewer child-rearing responsibilities, and do not have to worry about getting pregnant, allowing them to enjoy better intimacy with their partners.
Is there a cure for sexual dysfunction?
Success in treating sexual dysfunction depends on the root cause of the issue.
Dysfunction caused by emotional health issues like stress, lack of confidence, shyness or anxiety will most likely go away once those stressors are eliminated with counselling.
Dysfunction caused by physical conditions that heal fully over time also have a good chance of being resolved.
When should I call my healthcare provider?
Many women will encounter sexual dysfunction at least once in their lifetimes.
Sometimes, it resolves itself. But when it is a persistent problem, not only will it aversely impact a relationship, but it is also symptomatic of more serious health issues.
If your problems persist for more than a few months, consult your gynaecologist for evaluation and treatment.
Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician and gynaecologist. For further information, visit www.primanora.com. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.