Sexual Problems in Women

What are sexual problems?

A sexual problem means that sex is not satisfying or positive for you. In women, common sexual problems include feeling little or no interest in sex, having problems getting aroused, or having trouble with orgasm. For some women, pain during intercourse is a problem.

Most women have a sexual problem at one time or another. For some women, the problem is ongoing. But your symptoms are only a sexual problem if they bother you or cause problems in your relationship.

There is no "normal" level of sexual response—it is different for every woman. You may also find that what is normal at one stage of your life changes at another stage or age. For example, it's common for an exhausted mother of a baby to have little interest in sex. And it's common for both women and men to have less intense sex drives as they age. This is linked in part to hormone changes in the body.

What are some causes of sexual problems in women?

Female sexuality is complex. At its core is a need for closeness and intimacy. Women also have physical needs. When there is a problem in either the emotional or physical part of your life, you can have sexual problems.

Some common causes include:

• Emotional causes, such as stress, relationship problems, depression or anxiety, a memory of sexual trauma, and unhappiness with your body.
• Physical causes, such as hormone problems, pain from an injury or other problem, and certain conditions such as diabetes or arthritis.
• Aging, which can cause changes in the vagina, such as dryness and stiffening.
• Certain medicines that can cause sexual problems. These include medicines for depression, blood pressure, and diabetes.

What are the symptoms?

Sexual problems can include:

• Having less desire for sex.
• Having trouble feeling aroused.
• Not being able to have an orgasm.
• Having pain during intercourse.

How are sexual problems in women diagnosed?

Women often recognize a sexual problem when they notice a change in desire or sexual satisfaction. When this happens, it helps to look at what is and isn't working with your body and your life. For example:

• Are you ill, or do you take a medicine that can lower your sexual desire or response?
• Are you stressed or often very tired?
• Do you have a caring, respectful connection with a partner?
• Do you and your partner have the time and privacy to relax together?
• Do you have painful memories about sex or intimacy?

Your doctor can help you decide what to do. He or she will ask questions, do a physical exam, and talk to you about possible causes.

Some women find it hard to talk to their doctor about sexual problems at first. Sometimes it helps to write out what you want to say beforehand. For example, you could say something like “For the past few months, I haven't enjoyed sex as much as I used to.” Or you could say "Ever since I started taking that medicine, I haven't felt like having sex.”

How are they treated?

Treatment for sexual problems depends on what is causing the problem. There may be one or more issues causing the problems. Many sexual problems can be worked out once you know the cause or causes.

Sex involves emotional, physical, and relationship issues. Successful treatment requires a high level of comfort between you and your doctor. Ideally, you and your partner will also be able to talk openly about sexual concerns. Treatment may include treating health problems, getting communication counseling, and learning about things you can practice at home. For example, you might take a warm bath to relax, have plenty of foreplay before sex, or try different positions during sex.

Frequently Asked Questions

A woman's sexuality is a complex mix of mental, emotional, and physical signals. A problem in one area can grow to involve others. For example, a physical problem can lead to fear of pain, and the fear can lead to guilt about its effect on your partner. So the causes of sexual problems in women are often interrelated.

Psychological causes may be related to past or current physical or emotional problems. These mental and emotional causes include:

• Stress.
• Marital or relationship discord.
• Previous pelvic trauma.
• Involuntary and often painful contractions of the vagina (vaginismus), sometimes linked to memories of pelvic trauma or abuse.
• Depression.
• Fears that illnesses, such as cancer, or surgery, such as a mastectomy or hysterectomy, will make sexual activity unpleasant for the woman or her partner.
• Unhappiness with body image.
• Anxiety.

Physical causes can be normal hormonal changes, injuries, medical procedures, or other medical problems. Physical causes include:

• Hormonal changes such as those related to the menstrual cycle, use of birth control pills or hormone therapy, pregnancy, recovery from pregnancy, perimenopause, and postmenopause.
• Pain during intercourse. This may result from:
  • Physical changes from surgery, radiation therapy, or other medical procedures.
  • An injury.
  • A physical abnormality.
  • Vaginal dryness.
  • Painful, involuntary contractions of the vaginal muscles (vaginismus). This is sometimes linked to the body's "memory" of pelvic trauma or abuse.
  • Genital herpes.
  • A vaginal infection (vaginitis).
• Medical conditions, including diabetes, arthritis, urinary incontinence, urinary tract infection, stroke, coronary artery disease, hypertension, atherosclerosis, multiple sclerosis, hypothyroidism, endometriosis, or a nervous system problem (neurological disorder).

Aging may cause a decrease in sexual desire and changes in the vagina. These changes include:

• Increased vaginal sensitivity, so that the vagina may be easily bruised or chafed.
• Narrowing, shortening, and/or stiffening of the vagina, causing pain during intercourse (dyspareunia).
• A reduction in lubrication and a lengthening of the time needed to lubricate the vagina.
• More time needed to feel sexually aroused.
• Orgasms that do not last as long they once did.

Medication use can sometimes decrease sexual desire and arousal. Such medications include:

• Blood pressure and diabetes medications, such as diuretics, alpha-blockers, beta-blockers, and calcium channel blockers.
• Antidepressants. These include tricyclics and selective serotonin reuptake inhibitors (SSRIs).
• Antihistamines, which are allergy medicines.
• Opioids and tranquilizers. Opioids are used to treat pain. Tranquilizers are used to calm the nervous system.
• Appetite suppressants. These are also known as diet pills.
• Chemotherapy for cancer.

Losing a partner is a common life event that can lead a woman to be less sexually active and satisfied. This is not a "sexual problem," but it can leave you with unmet needs for intimacy.

Cultural and societal factors may play a role in a woman's sexual health. Inadequate health services and/or a lack of sex education may result in a woman's lack of knowledge about sexual behavior. In addition, a woman may feel unable to meet the societal standards of attractiveness or sexuality, or she may believe herself to be incapable of meeting family and cultural expectations of a woman's role in life.¹

Drinking alcohol to excess may increase the time it takes for a woman to reach orgasm. In addition, some women who feel sexually inadequate when sober may drink to mask those feelings temporarily. Alcohol can play a role in creating a cycle of drinking and sexual problems.

Symptoms of sexual problems can include:

• A decrease in the level of desire, which might be expressed by fewer sexual fantasies or thoughts and a reluctance to engage in sexual activity.
• A decrease in the level of arousal. A woman may notice that she feels unreceptive to sexual suggestions and is not able to feel or maintain sexual excitement.
• An inability to reach orgasm after sexual stimulation. (For most women, the clitoris is the main site of orgasm. Not all women have vaginal orgasms.)
• Pain during intercourse.

By definition, sexual problems are symptoms that are distressing for you and/or your relationship with a partner. If you have a symptom that you are not troubled by and that isn't causing a relationship problem, then it is not considered to be a sexual problem.

Most women have a sexual problem at one time or another. For some women, the problem is long-term. Surveys of the general population in the United States found that many women occasionally have sexual problems and worries, including:²

• Concerns about sexuality (6 out of 10 women).
• Lack of interest in sex (3 out of 10 women).
• Sex not always being pleasurable (2 out of 10 women).
• Pain with intercourse (1 to 2 out of 10 women).
• Difficulty becoming aroused (5 out of 10 women).
• Difficulty reaching orgasm (5 out of 10 women).
• Not being able to have an orgasm (2 to 3 out of 10 women).

A woman's sexuality is influenced by her physical, psychological, and emotional state. Women have varied and interrelated reasons for feeling sexual. Women may be sexually active to:³

• Feel an emotional connection.
• Satisfy sexual hunger.
• Nurture and experience commitment.
• Feel attractive and be attracted.
• Enjoy physical pleasure.

With all of these reasons to be sexually active, a woman may engage in sexual activity as much for emotional reasons as for physical ones. In addition, a woman's sexuality is influenced by her society and culture, as well as by her medical and sexual history. Throughout a woman's sexual life, her sexuality is a complex web of mental, physical, and emotional signals.³

Physical influences

• Women normally experience a physical change during sexual arousal, as blood engorges the vulvar area. If a woman is aware of the exact places in her vulvar area where she feels increased sexual intensity (erectile tissue), her sexual pleasure may be increased by genital stimulation. It is possible for a woman not to be aware of this engorgement. It is also possible for a woman not to be aware of the spots that are most sensitive and responsive to stimulation.
• Any history of pain during intercourse may cause a woman to avoid sexual activity.
• Women who experience pain during intercourse may choose to continue to have intercourse, even though the experience is unpleasant and results in low sexual desire.
• Ongoing (chronic) illnesses, such as diabetes and arthritis, can affect sexual desire, enjoyment, and performance. Medications for many medical conditions also affect desire and arousal.

Partner and emotional influences

• A partner's level of sexual skill and attention can play a big part in a woman's sexual enjoyment.
• A positive, respectful connection between partners sets the stage for sexual interest and arousal. Relationship problems can lower sexual interest and response.
• Living situations that give couples very little privacy can interfere with feelings of arousal.
• The physical changes that signal sexual arousal may for some women be accompanied by feelings of guilt, embarrassment, shame, or self-consciousness. Any of these emotions can reduce or negate physical arousal.
• Positive sexual experiences help build a healthy sexuality. On the other hand, a woman who has had a forced sexual experience is likely to have mixed feelings about sex. In one study, 1 in 5 women reported having been forced to do something sexual. This was most often by someone they were close to.²

Age-related influences

• A decline in sexual activity as women age is most often caused by the lack of a partner.⁴
• Sexual problems are most common among young women and tend to decrease with age and experience.⁵
• Women may note a decrease in sexual desire after menopause. In mild cases, the change may be almost unnoticeable; in more severe cases, there may be a decrease in mental and physical responsiveness to sexual stimuli.
• Many older women experience other changes in their sexuality. It may take longer to feel sexually aroused, and orgasms may be briefer. But, orgasms still will offer mental and physical pleasure to most women.⁴
• Women can feel sexual pleasure throughout their lives. But those who stop sexual activity after menopause have more shrinking and drying of the vagina than women who continue sexual activity.²

Risk factors for sexual problems include a current or long-term history of:

• Exhaustion, often from round-the-clock care of a baby or small children and/or parenting and having a job.
• Normal hormonal changes linked to pregnancy, recovery from pregnancy, menopause, or aging.
• Emotional or stress-related problems, such as personal relationship tensions or economic concerns.
• Taking certain medications that decrease a woman's desire for sex.
• Health problems that cause pain during sex or decrease a woman's ability to engage in and enjoy sexual activity. Such health problems include:
  • Neurologic diseases such as stroke, spinal cord injury, and Parkinson's disease.
  • Surgery that affects a woman's pelvic organs or genitals.
  • Endocrine diseases such as diabetes or liver disease.
  • Peripheral arterial disease.
• Sexual trauma, such as rape or childhood abuse.

A common sexual problem is pain during intercourse. Call a health professional for immediate care if sudden, severe pelvic pain occurs with or without vaginal bleeding.

Call a health professional if you experience pain or discomfort in your vagina. You may have a vaginal infection or a sexually transmitted disease.

Watchful Waiting

Watchful waiting is a wait-and-see approach. If you improve on your own, you won't need treatment. If you don't improve, you and your health professional will decide what to do next. During this time, you may be using home treatment, such as liberal lubrication to reduce fears of pain and exercises to stimulate sexual desire. Maintaining honest and frequent communications with your health professional will help you decide whether medical treatment is needed.

Who To See

Health professionals who can help you evaluate your symptoms, discuss treatment options, and treat a sexual problem include:

• Gynecologists.
• Therapists who specialize in healthy sexual behavior and an understanding of human sexuality (sex therapists).
• Psychologists.
• Family medicine physicians.
• Urologists.

You may want to start with your regular health professional, because a sexual problem may be related to a physical condition or a medication. It is important to identify any physical causes before entering therapy for sexual concerns.

To prepare for your appointment, see the topic Making the Most of Your Appointment

Women often begin the process of diagnosing a sexual problem by noticing an absence of sexual desire or satisfaction.

Your health professional will work with you to identify your symptoms and the history of those symptoms by:

• Asking questions about your complete medical history, including any history of childhood sexual abuse or adult sexual assault, and your current sexual activity.
• Doing a physical exam.

Your health professional will use the information from the history and examination to determine the cause of your sexual concerns.

Throughout the appointment and future treatment of a sexual problem, your health professional should establish an encouraging atmosphere for you to discuss your concerns. All of your communications about your sexual concerns should be maintained in a professional, confidential, and nonjudgmental manner. See a list of questions you might be asked by your health professional.

What to Think About

By definition, a sexual problem is a sex-related stressor for you and/or your relationship with a partner. If you have a symptom that you are not troubled by and that isn't causing a relationship problem, then it is not considered to be a problem.

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.

Women have varied and interrelated reasons for desiring sexual activity and feeling sexually fulfilled. A woman's sexuality is influenced by her physical, psychological, and emotional states. Some causes of sexual problems, such as medical conditions, may not be within your control. But your emotional and psychological states are as important as your physical state in influencing your sexuality. You can take the following steps to help your sexual well-being.

• Practice communicating your needs and desires to your partner.
• Become familiar with your own patterns and methods of sexual arousal, perhaps through masturbation.
• Try to separate your sexual life from the stresses of daily life, such as economic, career, and partner tensions.
• Understand that many women do not always have orgasms during sex and that mutual pleasure can be a satisfying focus of sexual intimacy.
• Use plentiful lubrication for your vagina to avoid the most common cause of painful intercourse.
• Enjoy tenderness and closeness, and avoid expectations of reaching goals such as great sexual performances.

Treatment of sexual problems is guided by you, your partner, and your health professional. You may find that it depends largely on changes you try at home. Techniques you can learn and practice at home include:

• Increasing the level of intimacy and sexual arousal with your partner before penetration (plentiful foreplay).
• Good communication with your partner.
• Liberal use of vaginal lubricants.
• Experimenting with different positions for intercourse to find the most comfortable ones.
• Masturbation, possibly with the aid of a vibrator and/or with your partner.
• Exercises to develop muscular control of contraction and relaxation of the pelvic muscles.
• Enjoying sensual massage and other pleasurable physical activities without sexual intercourse.
• Decreasing inhibition with fantasizing, distractions, listening to music, or using erotic videos or books.
• Taking a warm bath and reducing anxieties before sexual activity.

You can improve pelvic floor muscle strength using Kegel exercises or vaginal weights.

• To do a Kegel, you tighten the same muscles you use to control urine flow. Hold for 3 seconds, then relax for 3 seconds, repeating 10 to 15 times. Try to do a set of Kegels 3 or more times a day.
• You can use a vaginal weight to strengthen the vaginal wall muscles. You do this by holding it inside the vagina while standing upright for 15 minutes. Over time, you become strong enough to hold a heavier weight.

Because a woman's sexuality encompasses physical, emotional, and psychological factors, the causes of sexual problems are often complex and interrelated. Medications may be used in treating certain conditions that contribute to sexual problems.

Medication Choices

Estrogen. If you only have vaginal dryness and irritation (and not other symptoms such as hot flashes), you can use a limited amount of estrogen in a cream, tablet, or ring in the vagina. The daily estrogen makes your tissue less thin and sensitive and more moist. Many women find that using a cream or tablet twice a week is enough. This may increase vaginal tone and lubrication, which will decrease vulvar dryness, irritation, and shrinkage (atrophy).

If you also have other menopausal symptoms that affect physical and mental well-being, talk to your health professional about taking daily (systemic) estrogen therapy. Estrogen can increase the blood flow in the vagina, as well as reduce hot flashes and other symptoms of menopause. Estrogen therapy or estrogen-progestin therapy can be oral (pills), vaginal, or transdermal (with a patch). In a small number of women, hormone therapy causes heart disease, breast cancer, ovarian cancer, dangerous blood clots, stroke, and dementia. Talk to your health professional about whether this therapy is right for you.

Testosterone. This hormone may play a part in a woman's sex drive and satisfaction. The ovaries make testosterone throughout a woman's lifetime. Women have the most testosterone in early adulthood; testosterone levels drop by half between the early 20s and the early 40s.

In women who have their ovaries removed (oophorectomy), testosterone drops by 50%.¹⁰ If you have had an oophorectomy, your health professional may suggest trying testosterone therapy. But the U.S. Food and Drug Administration (FDA) has not approved any testosterone therapy for women.

What To Think About

The methyltestosterone-estrogen formula called Estratest is not approved by the FDA. The company that makes it markets it for moderate to severe menopausal symptoms. It is also prescribed to some menopausal women to improve sexual desire and response. But Estratest is made with methyltestosterone, which the body uses differently than testosterone. It does not directly raise the amount of testosterone in your body. And, taking a testosterone by mouth does put you at risk for problems with your liver and possibly your heart. Using a patch or cream does not.

At this time, there is no testosterone pill, patch, or cream approved for women—those made for men have too high a dose for women. Side effects of too much testosterone include acne, facial hair, and loss of hair and a deepening of the voice, which may be permanent.

No studies have looked at the benefits and risks of taking testosterone for longer than 6 months. The long-term effects of testosterone therapy in women are not known.¹⁰

Sildenafil (Viagra) is used to treat erectile dysfunction in men. The maker of this medicine has decided not to market it for improving women's sexual desire and arousal. This was based on research showing that sildenafil was not effective for most women. The maker has commented that women's sexuality is a complex mix of physical, emotional, and relationship factors, and it is not as simple to treat with a medicine as male erectile dysfunction is.¹¹

Currently no medications are approved by the FDA to treat female sexual problems, although several paths are being studied, including stimulation of certain molecules (receptors) in the brain and increasing blood flow to the genitals. It is still too early in the process to know whether any of these medications will prove to be effective and safe treatment options.¹²

One type of sexual problem in women is pain during intercourse. Pain often is caused by a physical reason, such as injury or anatomical problems. If examinations and tests confirm that a physical condition is causing pain during intercourse, treatment of that condition may get rid of the pain. In some cases, such as with the medical condition endometriosis, surgery may be recommended.

Surgery Choices

There is no surgical treatment for sexual problems unless pain is caused by endometriosis or another medical condition.

What To Think About

Certain surgical procedures may cause sexual problems. For example, it is common for a woman who has had her breast or breasts removed (mastectomy) or has had her uterus and ovaries removed (hysterectomy and oophorectomy) to report decreased sexual desire afterward. Sexual therapy may be recommended after surgery to assist you and your partner in developing methods to stimulate sexual arousal and achieve sexual satisfaction.

Studies of alternative medicines for sexual problems are limited, but some of them show possible benefits. These include studies of herbal supplements and devices.

Other Treatment Choices

ArginMax, a nutritional supplement containing ginseng, ginkgo, damiana, and other ingredients, is the subject of a small study. Early reports show improvement in sexual desire. Studies on ArginMax continue.¹³

Ginkgo biloba may be helpful for women who lack sexual interest and response while taking antidepressants.¹⁴Ginkgo improves blood circulation throughout the body. But if you are taking a blood thinner, such as daily aspirin or warfarin, ginkgo may not be for you. Talk to your health professional about whether ginkgo is safe for you—it may increase the effect of a blood thinner.

DHEA. Like testosterone, DHEA (dehydroepiandrosterone) is an androgen made in the body. Over-the-counter DHEA:¹⁵

• When taken by mouth, has the same risks of liver damage and negative effects on your cholesterol levels as oral testosterone. It also has the same unwanted hair growth and acne side effects. This is because the body turns DHEA into testosterone.
• Is not known to improve sexual well-being in healthy women.
• Is not regulated by the government, so you cannot know for sure how much you are taking. Some DHEA supplements contain less DHEA than the labels claim. Others contain more than the labels claim.

Vaginal weights can strengthen the pelvic floor and vaginal muscles. They usually come in five sizes. Start with the smallest weight, and work up to the largest over time. Insert a weight into your vagina, then hold it in place while standing upright for 15 minutes. Your muscles will feel the urge to tighten and hold it in. After a few days, the vaginal muscles become strong enough that they no longer feel an urge to hold the weight. This is when you use the next larger weight. Once you've used all five weights, keep your muscles toned by using the largest weight for 5 to 7 days in a row, each month.

Also under study is the EROS-Clitoral Therapy Device (CTD), in which a small battery-operated device is used to stimulate engorgement of the clitoris as a way to increase a woman's sexual arousal and satisfaction. Early studies report improved ability to achieve orgasm. Studies on EROS-CTD continue.^{9, 16}

What To Think About

Researchers continue to look for treatments for raising sexual desire, arousal, and satisfaction. Some products, such as different vitamins and herbs, are promoted as natural treatments for sexual problems. But most of these products have not been subject to the same kind of rigorous scientific testing for safety and effectiveness that standard medical treatments must go through before they are approved in the United States. Be sure to talk with your health professional about which therapies might be best for you. If you decide to use an alternative medication or supplement, follow these precautions.

• Talk with your health professional before taking an alternative medication or supplement, especially if you are pregnant or trying to become pregnant, you take prescription medications, or you have another health problem.
• As with all conventional medications and supplements, it is important to follow the directions on the label.
• Do not exceed the maximum recommended dose.

Organizations

• Sexuality and Physical Changes With Aging

Citations

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6. Phillips NA (2000). Female sexual dysfunction: Evaluation and treatment. American Family Physician, 62(1): 127–137.

7. Eyler AE (2000). Sexual function and dysfunction in women. In RE Rakel, ed., Saunders Manual of Medical Practice, 2nd ed., pp. 631–635. Philadelphia: W.B. Saunders.

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