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How Do I Know If I Have Female Sexual Problems?

The most important way for your healthcare provider to diagnose a sexual problem is to listen carefully to the story you tell, review the list of medications and substances you use, and try to determine whether your difficulties are recent, long-standing, or have been a permanent fixture thus far in your life. It's also important for your healthcare provider to try to understand how much you know about your body and about sexuality. Your healthcare provider will probably encourage you to talk about your relationship with your partner, your past sexual history, any history of trauma, and any other stresses or concerns that may be interfering with your ability to respond sexually. While these topics may seem extraordinarily private, they must be covered to properly evaluate sexual dysfunction and help you have a more satisfying sex life.

A thorough physical examination and basic blood tests will help to determine whether a physical ailment could be causing your sexual problems. During a thorough pelvic examination, your healthcare provider will try to identify any possible sources for your sexual dysfunction, such as involuntary muscle spasms around the vagina (vaginismus) or prolapse of organs into the vagina. You may be asked to use a mirror to identify the parts of your body for the healthcare provider, to determine your level of knowledge about and degree of comfort with your own body.

What Are the Treatments?

Your healthcare provider will try to treat any underlying condition that might be interfering with your sexual functioning. For example, vaginal dryness after menopause may be treated with local estrogen creams, infections with antibiotics, and some conditions (organ prolapse into the vagina, anatomic defects, or flawed repair after childbirth) may require surgery. Better control of diabetes, thyroid conditions, kidney disorders and high blood pressure may alleviate problems with sexual functioning. Low sex drive after menopause may be treated with combinations of oral estrogen and testosterone.

Postmenopausal estrogen therapy should be tried first. Local hormone therapy can reestablish clitoral sensitivity and therefore return orgasmic capacity. If improvement does not occur with 3-6 months testosterone may be added. Research has not established a relationship between a specific level testosterone and diminished sexual symptoms. Androgen replacement should be considered in women with premature ovarian failure (menopause prior to age 40).

Arousal problems may be difficult to resolve if sexual satisfaction has never been experienced. Therapies are designed to help the patient relax, become aware of feelings about sex, and eliminate guilt and fear of rejection. Sensate focus exercises may help.

Inadequate lubrication in a healthy, premenopausal woman may reflect either a muted sexual response or inadequate arousal by the partner. Explore feelings about sex and seek to eliminate guilt and fear of rejection. Extended foreplay, masturbation, and relaxation techniques may help. Artificial lubricants are available over the counter.

For inability to achieve orgasm, the communication of your desires about sexual foreplay and intercourse to your partner is an essential first step toward satisfaction. Psychotherapy may also improve communication skills and resolve underlying conflicts about sexuality. With therapy and a supportive partner, the improvement rate is good.

For pain during intercourse, first make sure there is adequate stimulation and lubrication. A physical exam may reveal a need to medicate for infection, remove scars around the hymen, or gently stretch painful scars at the vaginal opening. Laser to relieve so-called deep pain can often treat endometriosis and pelvic adhesions. Problems related to menopausal change may be relieved with postmenopausal hormone therapy. If pain persists, psychotherapy may uncover hidden fears about intercourse. Sensate focus exercises can teach appropriate foreplay and de-emphasize intercourse until both partners are ready. Education can reduce fears of pregnancy or of harm to the fetus.

Vaginismus is difficult to reverse without professional help. If you have a partner, seek therapy together in a safe and supportive environment. To accustom your body to the feeling of penetration, a therapist may recommend inserting a series of vaginal dilators, each slightly larger than the last. You advance at your own pace until you are comfortable inserting a dilator the size of your partner's erection. Contraction and relaxation exercises can teach control of the vaginal muscles and increase sexual responsiveness.

Kegel exercises to improve vaginal muscle tone can help improve sexual responsiveness and enjoyment. These exercises involve clenching those muscles involved in stopping the flow of urine, holding for about five seconds, and then relaxing. You're usually asked to do three sets of 10 to 15 contractions daily.

Sex therapy treatment may include exercises that ask you to participate in sexually stimulating behaviors, initially avoiding genital contact. You are asked to concentrate on the pleasurable sensations, simultaneously attempting to relax and ward off any negative feelings, such as anxiety, fear or guilt. When you can do this, you are then given instructions on how to masturbate.

The goal is to learn how to derive pleasure from self-stimulation, without allowing negative feelings to interfere. When you are comfortable with these acts, and can participate in them without negative feelings or pain, you'll be asked to begin to include your partner. Slowly, gradually and progressively, you and your partner move towards increasing sexual intimacy, perhaps ultimately including vaginal penetration.