What is sexual dysfunction?

Sexual dysfunction can happen to an individual or a couple. It refers to any problem that prevents pleasure during the sexual response cycle. This cycle includes four phases:

• Motivation, or desire.
• Arousal.
• Orgasm.
• Resolution.

What are the types of sexual dysfunction in women?

Sexual dysfunction in women is a disorder that can take many forms and have many causes. It can occur before, during or even after sex. The most common problems related to sexual dysfunction include:

• Anorgasmia: Orgasmic disorder, or inability to have an orgasm.
• Dyspareunia: Pain during sex.
• Hypoactive sexual desire disorder: Low libido, or lack of sexual desire.
• Sexual arousal disorder: Difficulty becoming aroused.

How common is sexual dysfunction in women?

Sexual dysfunction affects about 30% to 40% of women. A lack of desire is the most common complaint. Problems with sex tend to increase as women age, but can affect women at any stage of life. Sexual dysfunction may be temporary or chronic (long-lasting).

What causes sexual dysfunction in women?

Physical causes of sexual dysfunction in women may include:

• Blood flow disorders: Some research points to vascular (blood vessel) disorders. These disorders may prevent blood flow to parts of the female reproductive system. The vagina, clitoris and labia need increased blood flow for sexual arousal.
• Certain medications and treatments: Some medications affect sexual function. Antidepressants may reduce your sex drive or your ability to have an orgasm. Selective serotonin uptake inhibitors (SSRIs) are especially likely to cause sexual side effects. Chemotherapy and other cancer treatments can also affect hormone levels and cause problems.
• Gynecologic conditions: Endometriosis, ovarian cysts, uterine fibroids and vaginitis can all cause pain during sex. Vaginismus, a condition that causes vaginal muscle spasms, can also make intercourse uncomfortable.
• Hormonal changes: Hormone imbalances may cause vaginal dryness or vaginal atrophy, making sex painful. Low estrogen levels can also reduce feeling in genitals. Menopause, surgery and pregnancy can affect hormone levels.
• Particular health conditions: A number of health conditions can affect your ability to enjoy sex. These include diabetes, arthritis, multiple sclerosis and heart disease. Drug addiction or alcohol abuse may also prevent a healthy sexual experience.

Psychological causes of sexual dysfunction in women may include:

• Depression: Depression may cause a lack of interest in activities you enjoyed before, including sex. Low self-esteem and feelings of hopelessness can also contribute to sexual dysfunction.
• Stress: Stress at home or work can make it hard to focus on enjoying sex. Some studies show that stress can increase levels of the hormone cortisol. This increase may lower sex drive.
• Past physical or sexual abuse: Trauma or abuse may cause anxiety and a fear of intimacy. These feelings can make it difficult to have sex
• Relationship issues: Some women may be unhappy with their partner or feel bored during sex. Other strains on the relationship may lead to sexual dysfunction.

How is sexual dysfunction in women diagnosed?

If you’re experiencing sexual dysfunction, talk to your healthcare provider. The provider can do a thorough evaluation of physical and psychological factors tied to sex.

Your healthcare provider will likely start by taking a full health history. Past surgeries, such as a hysterectomy or oophorectomy, may contribute to sexual dysfunction. A physical exam can also rule out any gynecologic issues. Your provider may do a pelvic exam and a Pap smear. Your medications will also be reviewed.

In some cases, other tests such as imaging may be necessary. Your provider uses these tests to check for tumors, cysts or other unusual growths. Blood tests can help diagnose hormone imbalances. Vaginal cultures may be collected to look for an infection.

Your healthcare provider will also explore possible psychological causes. Talk openly and honestly about sexual challenges you’re experiencing. Don’t be afraid to share your fears or anxieties. In some cases, your provider may recommend that you speak to a mental health professional or a relationship counselor.

How is sexual dysfunction in women treated?

Women can work with their healthcare team to create a sexual dysfunction treatment plan. It’s important to understand the physical or psychological causes before choosing therapies.

Treatments include:

• Arousal techniques: Talk to your partner about different ways you can enhance desire and arousal. Consider making changes to your sexual routine. You may also try erotic materials (sexual stimulation devices, videos or books), massage or masturbation.
• Counseling: Talking with a mental health professional may help. You can work through emotional or psychological barriers to pleasurable sex. You may choose to have one-on-one counseling or couples counseling.
• Hormone therapy: depending on your symptoms, your provider may recommend topical creams, vaginally administered medications or hormones taken orally or applied to your skin.
• Medication: Flibanserin (Addyi®) and bremelanotide (Vyleesi™) are the only medications approved to treat hypoactive sexual desire disorder (low sex drive) in women. Only women who are premenopausal are candidates for this type of treatment. Your provider may discuss other medications that are used ‘off-label’ to treat sexual dysfunction.
• Pain management: There are several approaches to reducing pain during intercourse. You can try different sexual positions, vaginal lubricants or relaxation techniques before sex. Your provider may also talk to you about use of vaginal dilators.

Can I prevent sexual dysfunction?

While there isn’t a single way to prevent sexual dysfunction, you can reduce your risk by:

• Avoiding drugs and too much alcohol.
• Eating a balanced diet.
• Exercising regularly.
• Maintaining a healthy body weight.
• Seeking help from a health care professional if you are experiencing trouble with your mood or difficulty communicating with your partner.

Also, talk to your healthcare provider about sexual dysfunction risk before starting new medications or undergoing certain medical procedures.

Is sexual dysfunction a permanent condition?

For some women, sexual dysfunction may go away on its own. It also might only happen at certain times, such as after childbirth or during hormonal changes. For others, sexual dysfunction may need ongoing management. Sexual dysfunction often requires the assistance of different multiple different types of health care professionals, including physical therapists and counselors.

When should I call the doctor about female sexual dysfunction?

Many women experience the occasional sexual issue. But if it bothers you or becomes a frequent problem, it’s time to get help. Talk to your healthcare provider about evaluation and treatment.

A note from Cleveland Clinic

Sexual dysfunction can be a frustrating, challenging condition for many women. But it’s nothing you should feel ashamed of or embarrassed about. Talking openly and honestly with your partner and your healthcare provider can help get to the root of the problem. Therapies are available for the physical and psychological causes of sexual dysfunction. Most women are able to enjoy healthy, pleasurable sex with the right treatments.