Let’s Talk About Sex

By: Dr. Amy Solomon

Whether I’m talking to patients in my office or lunching with my girlfriends, a popular topic of conversation is lack of sexual desire. In fact, it’s one of the most common complaints I hear from women. They—and their husbands/partners—want to know why they don’t feel like having sex anymore. Is there something wrong with them? Is there a magic pill to fix it?

Sexual dysfunction is divided into four categories, which are often intertwined.

Hypoactive sexual desire disorder

This is the category most commonly reported by my patients, and it’s defined as a lack of desire to have sex that causes the woman distress. A woman who would rather do laundry than have sex might fall into this category. However, she understands that her lack of sexual desire could be problematic and feels badly about it, as it might be detrimental to her relationship, or she might feel like there is something wrong with her.

Several things can affect libido like relationship issues, stress and certain medications, such as birth control pills and antidepressants. In addition, postpartum women report lack of desire caused by exhaustion, stress, hormonal and physiological changes. Studies show this typically improves after three to six months. Women in this category can lack interest initially, but once she feels pleasure, can respond and enjoy herself.

Sexual arousal disorder

This occurs when a woman has trouble lubricating for sex or feeling stimulated. She may want to have sex but not feel physically aroused. This can be based on psychological problems, external stressors or medical issues, such as decreased blood flow to the sex organs. Arousal disorder is often noticed around menopause with hormonal changes. Vaginal estrogen and over the counter lubricants can often help.

Orgasmic disorder

Orgasmic disorder is the inability to reach orgasm or delay in reaching orgasm despite adequate stimulation. Some women describe their orgasms as less intense or muted.

Primary orgasmic disorder is when a woman has never had an orgasm. This is seen in cases of sexual or emotional abuse. It is also experienced by women from some cultures who were taught that sex is dirty or not ladylike.

Secondary orgasmic disorder represents a change in the intensity of the orgasm or the ability to have one. This can be caused by medications, anxiety and relationship issues, and it can affect her partner’s sexual function as well.

Sexual pain disorders

The medical term for painful intercourse is dyspareunia. Painful intercourse can be caused by a vaginal infection like yeast or bacterial vaginosis. In addition, thinning of the vaginal tissue and dryness from menopause can cause pain and sometimes tears in the tissue. Your gynecologist can evaluate you for vaginitis or vaginal atrophy with an exam.

When a woman anticipates pain consciously or subconsciously, she may tighten her vaginal muscles. This is called vaginismus and can result in more pain, feeling like she is too tight or like her partner is hitting a brick wall.

Dyspareunia can sometimes be easily treated with medication. It can be more difficult to treat if it is the result of an emotional or relationship issue.

If you feel your sex life has deteriorated, it might be time to visit your gynecologist for an evaluation and help determining possible causes for your symptoms. Fortunately, many of these problems can be treated easily. Often just hearing your symptoms can help your provider direct you on a path to a healthy sex life again.