Female Sexual Issues

Sexual issues are multi-dimensional and tend to combine elements of biological, psychological and social causes. 1 in 5 people (male or female) who is in a relationship reports having sexual difficulties, according to the National Survey of Sexual Attitudes. Sexual dysfunction of any nature can be the source of great distress and can have a major impact on quality of life and on partner relationships.

Female sexual issues are categorised within 3 main areas: Pain, Libido or Arousal and Climax. It is not uncommon to experience issues in more than one area. For example, an individual who will struggle to get aroused, will most likely experience pain as the lack of arousal will not prepare the body to respond as expected. The release of hormones needed in the sexual response will not be triggered and the body function will not be adequate.

Issues with pain can be subdivided into 3 categories:

-          Pain with penetration, or dyspareunia. This refers to pain specifically experienced with sex. It can be before, during or after. There are 2 levels: superficial dyspareunia which is experienced towards the surface around the vulval area, and deep dyspareunia which is experienced inside the body around the cervix area.

-          Pain in the vulval area which is unexplained and chronic, or vulvodynia. This refers to pain experienced on the vulva. Vulvodynia can be provoked (as a consequence of touch of any nature) or unprovoked (unexplained, just lingering pain, soreness).

-          Vaginismus. This is caused by an involuntary contraction of the pelvic floor muscles. Vaginismus can be primary (the difficulties have always been present) or secondary (the difficulties have appeared after experiencing sexual function without pain). Vaginismus has 4 levels which go from ability to tolerate some form of penetration (finger or small dilator) to complete inability to have any penetration.

Issues with libido or arousal manifest through a reduced interest in sex and will often lead to reduce sexual activity creating potential issues in relationships where there is desire discrepancy. This is one of the most common problems in relationships. Decrease in libido may also manifest through:

-          A reduction of erotic thoughts or fantasies, as well as a response to erotic material,

-          Lack of interest in initiating sexual activity or lack of responsiveness when sexual activity is initiated by a partner,

-          A reduction in excitement or pleasure linked to sexual activity,

-          A reduction in sensation when exposed to touch during sexual activity.

Issues with climax, or orgasm can be either linked to not experiencing climax (delayed response, or low frequency of orgasm, or no orgasm), or change in the intensity in which climax is experienced.

A number of causes can play a part in any of these issues, such as:

-          Substance consumption: this interferes with the hormones and chemicals in the body. It also impairs our brain function which plays a major role in the arousal stage of sexual response.

-          Medical conditions such as urinary infection, dermatological issues, scaring, cancer can all have an impact on our body’s ability to maintain sexual function as expected.

-          Medication can have side effects which can affect every stage of sexual response.

-          Menopause and the body changes that come as part of this process (vaginal dryness and/or atrophy, reduced desire, tiredness,…)

-          Emotional problems, stress and anxiety impact the ability to relax and trigger the arousal stage.

-          Prior negative experiences and the trauma they may carry.

-          Body image issues and self-worth / self-confidence issues affecting the ability to feel comfortable and bringing anxious thoughts which impact the ability to relax and trigger the arousal stage.

-          Beliefs and value systems which can trigger anxious thoughts,

-          Fear of pregnancy or catching an STI

-          Others…

Psychosexual therapy can help working through these and resolve the conflict which causes the issues. Taking a holistic approach to explore all the aspects which may be interacting with sexual functions is critical to resolving the issues and finding sexual wellbeing.