Sexual Problems in Women

Women often have concerns about sexual function. If the problems are serious enough to cause distress, they may be considered sexual dysfunction.  Sexual dysfunction can be identified and diagnosed as follows:

• Lack of interest in sexual activity or difficulty in arousal

• Involuntary contraction of the muscles around the vagina or pain during sexual activity

• Difficulty reaching orgasm despite normal interest in sexual activity ( female orgasmic disorder called )

• Substance/medication-induced sexual dysfunction

• Other sexual dysfunction 

Other sexual dysfunctions include sexual dysfunctions that do not fit into other categories. 

Persistent genital arousal disorder  It is a rare disease that can occur in both men and women but has no specific criteria for diagnosis. Women with persistent "genital arousal disorder" experience excessive physical arousal (indicated by increased blood flow to the genitals and increased vaginal secretion) but no sexual desire. No cause for arousal has been identified, and arousal does not usually resolve after orgasm.

Often women with sexual dysfunction have features of more than one specific problem. For example, women who experience pain during intercourse or have difficulty arousing often experience less pleasure from intercourse and may have difficulty reaching orgasm.

A woman's sexual response is strongly influenced by her mental health and the quality of her relationship with her partner.

Normal Sexual Function

Sexual function and responses involve the mind (thoughts and emotions) and body (including the nervous, circulatory, and hormonal systems). Sexual response includes:

• Desire, also called interest or libido

• arousal

• Orgasm

Desire (Libido)

Desire is the desire to engage in or continue sexual activity. Sexual interest or desire; It can be triggered by thoughts, words, images, smells or touch. Desire may develop initially or after sexual activity and arousal begin.

For women, sexual desire and arousal are often closely related. Sexual arousal can trigger excitement and physical responses (including increased blood flow to the genital area). As sexual activity and intimacy continues, the desire for sexual satisfaction increases.

arousal

Arousal has a subjective element; sexual excitement felt and thought. It also has a physical element; increased blood flow to the genital area. Blood flow may increase without the woman knowing and feeling aroused. In women, increased blood flow causes the clitoris and vaginal walls to swell. Increased blood flow also causes increased vaginal secretions (which provide lubrication).

 As women get older, genital blood flow from sexual stimuli decreases.

Orgasm

Orgasm is the peak of sexual excitement. Just before orgasm, muscle tension in the body increases. When orgasm begins, the muscles around the vagina contract rhythmically. Women can experience multiple orgasms. Hormones released during orgasm may contribute to the subsequent feeling of well-being, relaxation, or fatigue (resolution).

Resolution

Resolution is a feeling of well-being and widespread muscle relaxation. Resolution usually follows orgasm. However, dissociation may occur gradually after highly arousing sexual activity without orgasm. 

reasons

Many factors cause or contribute to various sexual dysfunctions. Traditionally the causes are considered physical or psychological. But the two types of reasons cannot be separated. Psychological factors can cause physical changes in the brain, nerves, hormones, and ultimately sexual organs. Physical changes can have psychological effects, resulting in more physical effects. 

Psychological Factors

Depression and anxiety often contributes to sexual dysfunction. Sometimes when depression is treated effectively, sexual dysfunction also improves. But some types of antidepressants (selective serotonin reuptake inhibitors) can also cause sexual dysfunction.

• Taking a selective serotonin reuptake inhibitor (a type of antidepressant) can affect sexual function, but untreated depression can likewise impair sexual function.

Various fears such as release, rejection, or loss of control, as well as low self-esteem, can cause sexual dysfunction.

Previous experiences can also affect a woman's psychological and sexual development, causing problems such as:

• Negative sexual experiences or other experiences, including sexual trauma, can lead to low self-esteem, shame, or guilt.

• Emotional, physical, or sexual abuse experienced during childhood or adolescence can teach children to control and hide emotions; This is a useful defense mechanism. However, women who control and hide their emotions may have difficulty expressing their sexual feelings.

Various sexual concerns can impair sexual function. For example, women may worry about undesirable consequences of sex (such as pregnancy or sexually transmitted infections) or about their own or their partner's sexual performance.

Factors related to a woman's current condition that may affect sexual function include:

• Self Image: For example, women may have low sexual self-image if their body image is negative, if they have incontinence, if they have fertility problems, or if they have had surgery to remove their breasts, uterus, or another gender-related part of their body.

• Relationship: Women may not trust their partners or have negative feelings towards them. They may be less interested in their partners than in the early stages of their relationship.

• Environment: The environment may not be safe enough.

• Culture: Women may come from a culture that restricts sexual expression or activity. Cultures sometimes cause women to feel shame or guilt about sexuality.

• Distractions or Emotional Stress: Family, work, finances or other things can keep women busy and therefore hinder sexual arousal.

Physical Factors

Various physical conditions, hormones, medications, and illegal drugs can lead to sexual dysfunction. Hormonal changes that may occur with aging or result from a disorder may interfere.

from menopause then changes in the vagina and urinary tract can affect sexual function. For example, as estrogen levels decrease after menopause, vaginal tissues may become thinner, dryer and lose their elasticity. This condition, called vulvovaginal atrophy (or atrophic vaginitis), can make sexual intercourse painful. Similar symptoms occur both after the removal of the ovaries and after the birth of the baby (postpartum ) may be caused by hormonal changes.

A type of antidepressant selective serotonin reuptake inhibitors often cause problems with sexual function. These medications may contribute to various sexual dysfunctions.

Alcohol It may also cause problems in sexual functions.

 

Diagnosis

• Talking to the woman and sometimes her partner

• pelvic exam

Sexual dysfunction is usually diagnosed when symptoms have been present for at least 6 months and are causing significant distress. Some women may not be distressed or bothered by decreased or absent sexual desire, interest, arousal, or orgasm. In such cases, a diagnosis of disorder cannot be made.

Female sexual dysfunction may be characterized by at least one of the following:

• Pain during sexual activities

• Loss of sexual desire

• impaired arousal

• Inability to reach orgasm

Diagnosis of sexual dysfunction disorders involves detailed questioning of the woman and sometimes her partner. Doctors first ask the woman to explain the problem in her own words. 

Doctors perform a pelvic exam to look for abnormalities in the external and internal genital organs, including the vulva, vagina, and cervix. Doctors can often identify where the pain is coming from. Some women with sexual pain or a history of sexual trauma find it difficult to have a pelvic exam.  Here are some strategies to make the pelvic exam more tolerable:

• The woman and her doctor can meet before the examination begins and agree on how they will communicate during the examination.

• A woman can hold a mirror during an examination to see what the doctor sees and to have the doctor point out to her any problems identified.

• A woman may place her hand over the doctor's to have more control during the examination.

However, doctors warn you of a sexually transmitted infection or another infection (yeast infection). or bacterial vaginosisIf suspected, they may insert a speculum (instrument) into the vagina to view the vagina and cervix, and may take a sample of fluid from the vagina or cervix and send it to the laboratory for testing.

Treatment

• Treatment of causes of sexual pain

• Medications, including hormone therapy

• Pelvic physical therapy

• Sometimes personal or couple psychotherapy or sexual therapy

Some treatments depend on the cause of sexual dysfunction. But some general measures can help regardless of the cause:

• Learning about the woman's anatomy and ways to increase libido or arouse it for both partners

• Improving communication, including the relationship between the woman and her partner

• Promoting trust, respect and emotional intimacy between partners: These qualities should be developed with or without professional help.

• Couples may need help learning to resolve conflicts that can damage their relationship.

• Setting aside non-sexual time together: Couples who talk to each other regularly are more likely to want and enjoy sexual activity together.

• Creating time and space for sexual activity: Women may be busy or distracted by other activities (such as work, household chores, or children). 

• Taking steps to prevent undesirable consequences: Such measures are especially important for fear of pregnancy or sexually transmitted infections. It is beneficial when it inhibits desire.

• Practicing mindfulness: Mindfulness involves learning to focus on what is happening right now, without judging or watching what is happening. Being mindful helps women tune out distractions and allow them to stay present and pay attention to sensations during sexual activity. Resources for learning how to practice mindfulness are available online.

Just becoming aware of what is needed for a healthy sexual response may be enough to help women change their thoughts and behaviors. However, since most women have more than one type of sexual dysfunction, more than one treatment is required.

Medicines

Estrogen Therapy: It can be used to treat sexual dysfunction in women with genitourinary menopause syndrome. When women experience only vaginal and urinary symptoms, doctors often prescribe forms of estrogen that are inserted into the vagina as a cream, tablet, or ring (with a plastic applicator). Estrogen cream can also be applied externally to the vulva. These treatments can effectively treat symptoms affecting the vagina (such as vaginal dryness and thinning, urgent need to urinate, and frequent urinary tract infections).

 For postmenopausal women taking estrogen and progestogen, adding testosterone (either pill or skin-applied cream given as ​​) can help relieve sexual interest/arousal dysfunction. maybe. However, the use of testosterone for this purpose is considered experimental, and women should discuss the risks and benefits with their doctors. Acne, excessive hair growth ( ) in women taking testosterone.hirsutism ) and the development of masculine characteristics ( virilizationSide effects such as  ) should be checked regularly.

Psychological Therapies

Psychological therapies can help women with sexual problems. Mindfulness-based cognitive therapy can be used to treat sexual interest/arousal disorder and pain that occurs when pressure is applied to the entrance to the vagina (a form of provoked vestibulodynia). If problems from childhood (such as sexual trauma) affect sexual function, more in-depth psychotherapy may be needed.

Couples therapy may be helpful for improving communication or resolving relationship problems

Other Treatments

Various types of physical therapy may be helpful in women with genito-pelvic pain/penetration disorders.

Physical therapists can use a variety of techniques to stretch and relax tight pelvic muscles:

• Soft Tissue and muscle exercises: Using a variety of movements (such as rhythmic pushing or massage) to apply pressure and stretch the affected muscles or the tissues covering the muscles (myofascia)

• Trigger Point Pressure: Applying pressure to very sensitive areas of the affected muscles, which may be where the pain begins (trigger points)

• Electrical Stimulation: Application of mild electrical current through a device placed at the entrance to the vagina

• Bladder Training and BRetraining of whorls:Having women follow a strict regimen for urination and prescribing exercises, sometimes with biofeedback, to strengthen the muscles around the urethra and anus

• Therapeutic Ultrasonography: Applying energy (produced by high-frequency sound waves) to the affected muscles (increasing blood flow to the area, enhancing healing, and relaxing tense muscles)

If tight pelvic muscles make sexual activity painful, women can self-insert some devices to stretch the vagina and make it less sensitive. Then sexual activity can be more comfortable.

Vaginal lubricants and moisturizersIt can reduce vaginal dryness that causes pain during intercourse. These treatments include food-based oils (such as coconut oil), silicone-based lubricants, and water-based products. Water-based lubricants dry quickly and may need to be reapplied, but petroleum jelly and other oil-based lubricants  are preferred accordingly. Food-based oils can damage latex birth control devices such as condoms and diaphragms. They should not be used with condoms. Silicone-based lubricants can be used with condoms and diaphragms, just like water-based lubricants. Women can ask their doctor which type of lubricant would be best for them.

Sexual Dysfunction in Older Women

The main reason older women give up sexual intercourse is the lack of a sexually functional partner. However, age-related changes, especially menopause those attached may increase women's likelihood of experiencing sexual dysfunction. Also diabetes , atherosclerosis , urinary tract infections and arthritis Medical conditions that can affect sexual function, such as menopause, become more common as women get older. However, these changes do not necessarily end sexual activity and pleasure, and not all sexual dysfunction in older women is due to age-related changes.

The most common problem in older women, as in young women, is indifference to sex.

After menopause, less estrogen is produced.

• The tissues around the vaginal opening (labia) and the walls of the vagina become less elastic and thinner (called vulvovaginal atrophy). As estrogen production decreases, tissues can also become inflamed and irritated (called atrophic vaginitis). Both of these changes  It may cause pain during sexual activity.

• Vaginal secretions decrease, causing less lubrication during sexual intercourse.

• The acidity of the vagina decreases, making the genitals more likely to become irritated and infected.

• Lack of estrogen can contribute to age-related weakening of the muscles and other supporting tissues in the pelvis, sometimes allowing a pelvic organ (bladder, bowel, uterus, or rectum) to protrude into the vagina (called pelvic organ prolapse).can give . As a result, urine may leak involuntarily and cause embarrassment.

• With aging, blood flow to the vagina decreases, causing it to shorten, narrow and dry. Blood vessel disorders (atherosclerosis)  etc.) can further reduce blood flow.

Women produce less and less testosterone starting in their 30s, and testosterone production stops around the age of 70. It is unclear whether this decrease leads to decreased sexual interest and response.

Other problems may affect sexual function. For example, older women may experience distress due to changes in their bodies caused by medical conditions, surgery, or aging.  Older women should not assume that sexual dysfunction is normal in later life. If sexual dysfunction bothers them, talk to the doctor. In many cases, treating a health problem (including depression), stopping or changing a medication, learning more about sexual function, or talking with a healthcare professional or counselor can help.

Vaginal dryness or painful intercourse due to menopause can be treated with vaginal hormone therapy, including low-dose estrogen (cream, tablet) or dehydroepiandrosterone (DHEA as a suppository). Estrogen can be taken by mouth or applied to the skin in gel form, but these forms of estrogen affect the whole body and are usually only used if a woman has other menopause symptoms (such as hot flashes). used.  Estrogen has benefits as well as potential risks (including blood clots and a slightly increased risk of breast cancer), so women should learn about the risks and benefits before starting to take estrogen.