Sexual Problems in Women - Treatment Overview

Treatment Overview

Many sexual problems can be managed when you understand what is causing them. Effective management requires a high level of comfort between you and your health professional, and possibly your partner.

Because a sexual problem often has multiple causes, treatments cannot be universally applied—what works for one woman may not work for another. An effective plan will address and manage the cause and then build and strengthen intimate communication between you and your partner. The best results will help you find methods of having a satisfying sexual life.

Treatment may include:

• Medical treatment for any underlying cause.
• Education about your body, your sexual signals and receptors, and changes in sexuality as you get older.
• Communication counseling for you and your partner.
• Psychological therapy.
• Sex therapy.

Treatment for decrease of sexual desire

A decrease in your level of desire might be expressed by fewer sexual thoughts and/or a reluctance to engage in sexual activity. Treatment for physical causes can include:

• Changing from a medicine that has been curbing your interest in sex.
• Relieving pain, illness, or sleep problems that are curbing your interest in sex.
• Hormone therapy with estrogen. After menopause, low levels of estrogen in the body cause vaginal dryness. This can be painful during sex. Estrogen reverses this.
• Testosterone with estrogen. Normally, a woman's testosterone slowly declines with age. It drops suddenly when a woman has surgery to remove the ovaries (oophorectomy, causing surgical menopause). Testosterone with estrogen is sometimes used after natural or surgical menopause to improve sex drive. When taken in too high a dose, testosterone causes male-type side effects, such as a deepening voice, thinning scalp hair, and growth of facial and body hair. Testosterone risks are not fully researched.

Your health professional can treat physical or hormonal causes, and you can work on other facets of sexual desire. This may include:

• Changing your setting and routine can improve your time together. Do you have enough privacy and time? Are you interested in trying something new?
• Having a partner you feel comfortable and nonstressed with plays a big part in your desire level.
• Getting counseling as a couple can help strengthen your emotional connection with your partner. Improving a stressed relationship is likely to improve your sexual relationship.
• It is normal to lack desire for a partner who forces sex or is verbally abusive or physically violent. For more information, see the topic Domestic Violence.

Treatment for decrease of sexual arousal

A decrease in the level of arousal might be noticed as an inability to feel or maintain sexual excitement. A woman's sexual arousal often is enhanced by, and is sometimes dependent on, stimulation in areas other than the genital area, especially the breasts. Treatment for a decrease in your sexual arousal may include:

• Increasing the level of intimacy and sexual arousal with your partner before penetration.
• Liberal use of vaginal lubricants.
• Masturbation, possibly with the aid of a vibrator and/or with your partner.
• Education about the role that emotions play in sexual arousal.
• Counseling, to help adjust expectations of sexual activity; if too much pressure is put on partners to perform, arousal may be reduced.
• Medicine or treatment changes for other conditions, if needed to eliminate side effects that decrease arousal.

Treatment for an inability to reach orgasm

A woman may seek treatment because she has never experienced an orgasm, is experiencing long delays in reaching orgasm, or has become unable to reach orgasm. Treatment usually begins with changing any medicine that is known to affect orgasm. (Talk to your health professional before you stop any medicine you are taking.)

It is also important to understand what a normal sexual stimulation phase would be for that woman. If a woman is experiencing a delay or absence of orgasm after adequate sexual stimulation, therapy often centers on guided home treatment, which may include:⁶

• Talking and listening to each other more. This includes talking openly about sex, what each of you needs, and what you want to do differently together.
• Reframing expectations, so that sexual intimacy is focused on mutual pleasure instead of a perceived need to achieve orgasm.⁷
• Increasing sexual stimulation through masturbation, possibly with the use of a vibrator and with your partner. This can also include doing exercises to develop muscular control (contraction and relaxation) of the pelvic muscles.
• Decreasing inhibition with fantasizing, distractions, and/or listening to music.

Treatment for pain during intercourse

Pain during intercourse often is caused by a physical reason, such as vaginal dryness or infection. This is why treatment must start with determining the underlying cause of a sexual problem. If a physical condition is the cause, treatment of that condition may eliminate the pain. But, pain during intercourse may have more than one cause, including psychological causes, such as anxiety or the memory of sexual assault.²

• Pain that occurs during initial penetration by the penis may be caused by involuntary contractions of the vagina (vaginismus). Vaginismus is more common in young, inexperienced women and is sometimes related to a lack of education or preparedness for sexual intercourse.⁸ Treatment may include a program of progressive muscle relaxation and gradual vaginal dilation, possibly including psychotherapy. But pain during initial penetration also may be caused by vaginal irritation or an anatomical condition; if so, getting rid of the pain will require treating the physical reason.
• After menopause, it is common to have vaginal dryness. This can cause pain during initial penetration or after intercourse has begun and the penis is in the vagina. Try using liberal amounts of vaginal lubricant. If this does not work as well as you need, talk to your doctor about vaginal estrogen, which can reverse vaginal dryness and sensitivity.
• If the pain is caused by the deep thrusting of the penis, the cause may be a pelvic disease, but it may also be caused by an inability to relax. An open and trusting relationship with your health professional will enable you to explore the cause of the pain and decide on a course of treatment.

Treatment for aging and menopause-related sexual problems

It is common for a woman's sexual desire to decrease gradually as she ages. In some cases this decrease is caused by the lack of a partner. But women continue to be sexually interested and to have the capability for sexual pleasure throughout their lives.² Hormonal changes may be a cause of decreased sexual function in older women. During and after menopause, levels of the hormones estrogen, progesterone, and testosterone in a woman's body decline.

• Nonprescription water-based products are available that provide vaginal lubrication. These products are typically available at pharmacies, usually near the condoms, and include Astroglide, Replens, and K-Y Jelly.
• Vaginal estrogen therapy can reduce vaginal dryness and irritation and increase the blood flow in the vagina. If you have only vaginal symptoms (and not hot flashes, for example), you can use a low-dose estrogen cream, ring, or tablet in your vagina. Many women find that using cream or a tablet twice a week is often enough.
• Systemic estrogen therapy is a high enough dose that it affects your whole body and can help with several menopausal symptoms. If you have symptoms that affect your physical and mental well-being, talk to your health professional about the risks and benefits of taking daily estrogen. Estrogen therapy can be oral (pills), vaginal, or transdermal (with a patch). Estrogen therapy may affect sexual desire, arousal, and enjoyment, as well as the capability to reach an orgasm.² But taking daily estrogen without progestin can cause cancer of the lining of the uterus (endometrial cancer). Therefore, a woman who has a uterus and wishes to take systemic hormones usually takes estrogen in combination with progestin to protect her uterus. This is called estrogen-progestin therapy, also known as hormone replacement therapy.

Testosterone therapy helps some postmenopausal women who have a low sex drive, especially those who have had their ovaries removed. Surgery to remove the ovaries (oophorectomy) causes sudden menopause—testosterone and estrogen, and sometimes sex drive, suddenly drop. (Normally, testosterone slowly declines with age.) Some postmenopausal women take testosterone to improve sexual desire and responsiveness and to increase the frequency of sexual fantasies and interest.

Possible side effects of testosterone therapy are a concern and are not fully known.

• Common side effects of taking too high a dose of testosterone include acne, facial hair, loss of hair, deepening of the voice, and liver damage.
• Taking testosterone by mouth (orally) can have a bad effect on your cholesterol levels. (At this time, a dosage for women is only available in pill form. A patch or gel may be available in the future.)
• No studies have yet looked at the risks and benefits of taking testosterone for longer than 6 months. The long-term effects of testosterone therapy in women are not known.

If you are considering taking testosterone supplements, talk to your health professional about these potential side effects. Make sure you are taking the lowest possible dose and are carefully monitored for side effects while taking testosterone.²

Decreased testosterone is a less common cause of sexual problems than the public might think; studies do not report a benefit from testosterone therapy for most women.⁹

What To Think About

Over time, an untreated sexual problem can increase its impact on your quality of life. As the cause of a sexual problem creates discomfort and dissatisfaction, sexual activity may become a tense and unwelcome experience.