Common Causes of Sexual Dysfunction in Women

From peri-menopause to hysterectomies, many circumstances can reduce desire

Caucasian doctor and patient talking in office
Sex after Hysterectomy. Jetta Productions / Getty Images

If you're a woman who lacks sexual desire, or perhaps worse, you have desire but you can't enjoy sex because of pain, vaginal dryness, or other conditions, you're not alone. Many factors in a woman's life can interfere with sexual function, which often leads to lower quality of life for her and her partner. Research suggests that up to 40 percent of women experience some degree of sexual dysfunction, with about 12 percent reporting distressing sexual health concerns.

Sexual dysfunction refers to a problem during any part of sexual activity, from arousal to orgasm. Physical factors such as illnesses, surgeries, and hormonal changes related to menopause are often implicated in female sexual dysfunction, as well as the more obvious issues of life stress and relationship difficulties. Here we're going to discuss some of the most common physical causes that a woman may lack desire for sex or experience challenges enjoying sex. 

Hysterectomy

Hysterectomy is the most common gynecological surgery, and about 20% of women report deterioration in sexual function post-operatively. A woman may have a total hysterectomy, which the removal of the entire uterus and cervix, a partial or subtotal hysterectomy, which is the removal of the uterus while keeping the cervix in place, or a radical hysterectomy, which removes the uterus as well as structures around it such as the ovaries and lymph nodes (may be done to treat reproductive cancers).

 

Removal of the uterus and ovaries causes a large decline in sex hormones. Hormone replacement therapy—with or without testosterone replacement—may help to restore sexual function in women experiencing sexual difficulty after this surgery. Studies show that estrogen therapy in postmenopausal women who've had hysterectomies may improve vaginal blood flow, vaginal dryness, and inability to orgasm.

Testosterone treatment may improve sexual desire and arousal. 

Some women find that post-hysterectomy, they miss the contractions of the uterus they have previously associated with orgasm. Removal of the cervix may result in a change in the physical sensation experienced during deep penetration during intercourse. There is wide variation in sexual functioning post-hysterectomy.

Vaginismus

Vaginismus is a persistent or recurrent spasm of the outer third of the vagina that interferes with intercourse. It causes vaginal intercourse to be painful or difficult, and can also prevent pelvic exams. 

It can usually be treated by the use of vaginal dilators of increasing diameter, plus relaxation training. The success rate increases in couples where the partner is involved in the therapy process. While treatment can help, it is important to note that some women have very intimate, loving relationships without intercourse.

Peri-Menopause and Menopause 

When a woman approaches menopause she begins going through profound hormonal shifts, including plummeting estrogen levels. This often results in hot flashes, vaginal dryness, night sweats, mood swings, and decreased sensitivity to sexual touch. Testosterone drops with age for both men and women, which can also reduce a woman's sexual desire.

In postmenopausal or perimenopausal women, estrogen replacement can decrease pain during intercourse and facilitate vaginal lubrication.

Studies have also shown that testosterone increases libido in women, so if your decreased desire is due to a drop in hormones, it can very likely be resolved with testosterone. However, to date, these studies have used high doses of testosterone, which might lead to masculinization if taken for long periods of time.

Although DHEA is also a male hormone, there have been very few studies of its effect on women and none have shown that it improves a woman's libido.

If you are going through menopause, or you're in the years leading up to it, and you're noticing a change in sexual function, you might want to try increasing foreplay or sensual massage, which can boost the connection between you and your partner. You can also use lubricants and avoid sexual positions that allow very deeep penetration. 

While It Can Be Challenging, There Is Hope

Sexual response varies between women and within each individual, and  sexual concerns are very common. Some sexual problems, while distressing, may reflect normal variations in a woman's life. Shifting one's focus to enhancing intimacy rather than having all interactions result in intercourse may help. Not all sexual concerns or problems are "dysfunctions."

Women need to pay attention to changes in their daily lives that may cause sexual dysfunction. In cases where medications cause sexual problems, the solution may be as simple as changing the medication or adjusting the dosage.

Don't be afraid to talk to your doctor and your partner. It can be difficult and uncomfortable to initiate a conversation with a doctor about sex, but the majority of women can be helped if they are willing to talk openly to their healthcare provider to determine the best treatment for their specific problem.

Sources

Cleveland Clinic. Sex and Menopause. 

Risa Lonnée-Hoffmann and Ingrid Pinas. Effects of Hysterectomy on Sexual Function. Current Sexual Health Reports. 2014 Sep 14. 

Simon JA. Identifying and treating sexual dysfunction in postmenopausal women: the role of estrogen. Journal of Women's Health. 2011 Oct. 

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