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Female Sexuality And Female Sexual Dysfunction Frequently Asked Questions
Can women ever expect sex to be the same again after a hysterectomy?
Absolutely. A recent, large study found that hysterectomy (removal of the uterus) did not interfere with sexual function.
However, removal of the uterus and ovaries (hysterectomy plus oophorectomy, sometimes referred to as total hysterectomy) causes large declines in sex hormones. Hormone replacement therapy--with or without testosterone replacement--may help to restore sexual function in women experiencing sexual difficulty after this surgery.
As with any major change in physical functioning, some women do find their sexual functioning negatively impacted. Some women miss the contractions of the uterus they have associated with orgasm. Removal of the cervix may result in a change in the physical sensation experienced during deep penetration during intercourse. In our clinical experience with women, there is wide variation in sexual functioning post-hysterectomy.
What is vaginismus? Is there any hope for women with vaginismus ever having a healthy sexual relationship?
Vaginismus is persistent or recurrent spasm of the outer third of the vagina that interferes with intercourse. It can usually be treated by the use of vaginal dilators of increasing diameter plus relaxation training. The success rate increases in couples where the partner is involved in the therapy process. While treatment can help, it is important to note that some women have very intimate, loving relationships without intercourse.
Will hormones help women with decreased sexual desire? Which hormones? Testosterone? Estrogen? Progesterone? What about DHEA?
In postmenopausal or peri-menopausal women, estrogen replacement can decrease pain during intercourse and facilitate vaginal lubrication.
Studies have also shown that testosterone increases libido in women, so if someone's decreased desire is due to a drop in hormones, it can very likely be resolved with testosterone. However, to date, these studies have used high doses of testosterone, which might lead to masculinization if taken for long periods of time.
Although DHEA is also a male hormone, there have been very few studies of its affect on women and none have shown that it improves a woman's libido.
Is there anything else that's important for women to understand about female sexual dysfunction?
Sexual response varies between women and within each individual. Sexual concerns are very common. Some sexual problems, while distressing, may reflect normal variations in a woman's life. Shifting one's focus to enhancing intimacy rather than having all interactions result in intercourse may help. Not all sexual concerns or problems are "dysfunctions."
Women need to pay attention to changes in their daily lives that may cause sexual dysfunction. In cases where medications cause sexual problems, the solution may be as simple as changing the medication or adjusting the dosage.
Don't be afraid to talk to your doctor and your partner. It can be difficult and uncomfortable to initiate a conversation with a doctor about sex, but the majority of women can be helped if they are willing to talk openly to their healthcare provider to determine the best treatment for their specific problem.
What signs may indicate that a woman has a sexual problem?
In order for a woman to be considered as having a sexual disorder, the symptoms must be persistent and pervasive and her problem must cause her personal distress. Sexual dysfunction can be psychological, physiological or a combination. Symptoms can include: vaginal dryness, decreased genital sensation, difficulty achieving orgasm, genital pain with or without sexual contact, lack of sexual interest. Other underlying problems can include history of abuse, pelvic surgery (hysterectomy, pregnancy, straddle injuries), medicines, hormonal problems and blood flow problems.
What are the most common sexual dysfunctions experienced by women?
We have identified four classifications of female sexual dysfunction:
Hypoactive Sexual Desire Disorder: A lack of sexual desire that causes a woman personal distress. Includes a persistent or recurring deficiency or absence of sexual fantasies or thoughts.
Sexual Arousal Disorder: An inability to attain or maintain adequate genital lubrication, swelling or other somatic responses, such as nipple sensitivity.
Orgasmic Disorder: A difficulty or inability to reach orgasm after sufficient sexual stimulation and arousal.
Sexual Pain Disorders: These include dyspareunia, which is recurrent or persistent genital pain associated with sexual intercourse.
Sexual Arousal Disorder: An inability to attain or maintain adequate genital lubrication, swelling or other somatic responses, such as nipple sensitivity.
Orgasmic Disorder: A difficulty or inability to reach orgasm after sufficient sexual stimulation and arousal.
Sexual Pain Disorders: These include dyspareunia, which is recurrent or persistent genital pain associated with sexual intercourse.
How should a woman talk to her partner about a sexual problem?
Realize that communication is the most important part of identifying and dealing with a sexual problem. The first rule is honesty - let your partner know what you like and want, but never fake an orgasm. The best time to talk is not during sex. Set aside time to talk about what's bothering you.
If your partner is dismissive at first, keep trying. For instance, some partners who act impatient with a partner's problems are really feeling insecure and taking it personally that their partner is not responding sexually. They don't want to consider that they may have a causative role in the problem. You can try educational videos, books and experimenting with what is learned. Therapy is always a good choice, but it may not be available, the partner may refuse to go or the couple may feel uncomfortable.
What is the best way for women to reach orgasm? Is sexual intercourse necessary for orgasm? Is one position better than another?
First, let go of the goal-oriented approach. Orgasms are not the center point of sex. Focus on sensuality. Once we let go of becoming orgasm-focused, sex becomes much more of an act of intimacy, connection, eroticism and arousal.
There is no one orgasm that is better than another. There are several techniques to enhance orgasm with intercourse including trying different positions, and practicing kegel exercises to strengthen the pelvic floor muscles. Intercourse is not necessary for orgasm.
What role do birth control pills, hormone replacement therapy, antidepressants, and other drugs play in female sexual dysfunction?
Many commonly prescribed medicines can cause a variety of sexual complaints ranging from vaginal dryness and low arousal to vaginal itching and orgasmic disorder.
How do normal life events such as pregnancy and menopause affect female sexual function and/or desire?
Problems related to the production of the hormones estrogen and testosterone can lead to sexual dysfunction. Menopause, endocrine disorders, pregnancy and postpartum deficiencies, endometriosis, diabetes and fibroids can all affect sexual function because of the way in which hormones are released or suppressed.
What is VENIS?
This stands for Very Erotic Non Insertive Sex, an alternative to intercourse; a program developed by Dr. Laura Berman that teaches ways to give sexual pleasure and orgasm through activities that do not require erections.
Many women feel uncomfortable talking to their doctors about sexual problems. How can women talk to their doctor about sexual problems without feeling embarrassed?
Talking with your doctor about your sexual problems can cause you anxiety, but in order to get the best care you must be able to communicate your needs. Some doctors may minimize your problem or dismiss it, but that's usually because they don't know how to help, they think it may be psychological, or they are not aware of potential treatment. Arm yourself with information found on newshe.com as well as "For Women Only". Information you take to your doctor will be extremely helpful to him or her as well as to you. Most doctors will be open and receptive to your comments and will be happy to learn of any new information, particularly if it is based on science and research.
What else do you believe women should understand about female sexuality?
That sex, like life, is fluid. It changes and grows just as women do. Sex at 20 is not like sex at 30 nor sex when you're a mother, nor sex when you are menopausal, nor sex when you are crazy about your partner or when you are furious with him or her. The context in which women experience their sexuality is probably the most important part of understanding it. The brain is the main sexual organ and sex is about intimacy, sharing, trust, and making yourself vulnerable to another person. It is a basic part of our general health and wellness and something every woman is entitled to.
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