Women’s Sexual Health Guide: Facing Challenges in Your Sex Life - GoodRx

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HomeHealth TopicSexual Health

Facing Challenges in Your Sex Life: A Guide for Women

Written by Sarah Gupta, MD | Reviewed by Sophie Vergnaud, MD
August 27, 2021

Key takeaways:

  • Sexual health problems are common in women of all ages.

  • Your sex life is affected by your physical and mental health, and your personal experiences.

  • If you’re having trouble in your sex life, there are many different treatments that can help.

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If you’ve ever felt unhappy about your sex drive, your ability to get aroused, or your ability to enjoy sex, you’re not alone. In fact, a 2016 meta-analysis found about 40% of premenopausal women worldwide had experienced challenges with their sex life.

What types of sexual health problems can women face?

Though there’s a lot of overlap, sexual problems tend to fall into one of these five categories:

  • Libido (desire) problems: Having a low libido is one of the most common sexual problems, affecting over 28% of women worldwide. People with a low libido are often less interested in sex than they would prefer and have very few sexual thoughts and fantasies. Having a low libido can also decrease your interest in masturbation or in initiating sex with a partner.

  • Arousal problems: People with arousal problems have a hard time getting physically “turned on” before or during sex. You may have a harder time getting lubricated (wet), and might feel like your erogenous zones are less sensitive. You might also feel distracted during sex, or find sex less exciting or pleasurable.

  • Trouble with orgasm: Orgasm problems are when you are not satisfied with the frequency or quality of your orgasms. You might have a hard time reaching orgasm, take an especially long (or short) time to orgasm, or find that your orgasms are less pleasurable than usual — even when you are sexually aroused.

  • Pain or discomfort during sexual activity: Some women experience pain or discomfort with sex, genital contact, or other sexual touching. Muscle spasms or mobility problems can also make sexual penetration and positioning challenging.

  • Sexual problems caused by medications or illnesses: Many medications or chronic illnesses can cause sexual problems in all of the above categories (libido, arousal, orgasm, and pain).

What causes women’s sexual health problems?

There are many things that can affect your sex life: your mental and physical health, your emotions, and even your lifestyle. Your sex life is also influenced by past experiences, cultural beliefs and messages, and your current and past relationships. All of these things can influence how you think about and experience sex.

Here are just some of the many different factors that can affect your sex life:

Physical conditions

  • Heart and blood vessel disease

  • Neurologic and psychological disorders

  • Hormonal changes (like pregnancy or menopause)

  • Chronic liver or kidney disease

  • Alcohol or substance abuse

  • Medication side effects

  • Sexually transmitted infections

  • Gynecological conditions

Psychological factors

  • Stress

  • Fear

  • Concern about sexual performance

  • Relationship problems

  • Depression

  • Anxiety

  • Guilt

  • Concerns about body image

  • Past or current sexual trauma or abuse

  • Inexperience

Medications

Social factors

  • Sexual identity conflicts

  • Sexual performance expectations

  • Religious beliefs or taboos

  • Cultural beliefs or taboos

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How do sexual problems affect daily life?

Sexual challenges can impact not only your personal sexual satisfaction but also your relationships, your self-esteem, and your mental health. You may even find that problems with your sex life lead to feelings of shame or embarrassment.

In a 2015 FDA research discussion with women, here’s what participants had to say about how problems with libido and arousal had affected their lives:

  • “[My partner] feels stupid at times when he keeps getting shut down. I know he feels rejected.”

  • “I lost a major relationship to this issue, and I never want to go back there.”

  • “[My condition] affects things like my self-confidence and how I approach the world.”

  • “I became so frustrated that any attempt to have [sex] would end up in me crying.”

  • “I find myself avoiding any situations where a sexual experience may occur ... going to bed after my husband fell asleep or jumping out of bed in the morning before he got up ... ”

When is a sex-life problem a sexual health disorder?

If you feel sad, discouraged, or anxious about your sex life, it’s possible that you could have a sexual health condition (sexual disorder). Sexual disorders are sometimes grouped together under an umbrella diagnosis called female sexual dysfunction (FSD).

In general, FSD includes any persistent, recurrent sexual problem that puts a strain on your personal life or relationships. In most cases, the symptoms need to bother you for at least 6 months — and make you feel unhappy in some way — to be considered a sexual disorder.

Here are some examples of sexual disorders.

Female sexual interest/arousal disorder (FSIAD)

Women with this disorder have a very low libido and/or problems getting sexually aroused. FSIAD is sometimes divided up into two separate conditions: hypoactive sexual desire disorder, or HSDD (low libido), and female arousal disorder (low sexual arousal). In both cases, the symptoms are severe enough to cause personal or relationship distress. Some people have this condition for their whole lives. Other times, it can be caused by a certain situation, like stress or pregnancy.

Hypersexual disorder (or sexual addiction)

People with hypersexual disorder (or sexual addiction) are preoccupied with sex and can find sexual behaviors difficult to control — even when the behaviors have negative consequences.

Persistent genital arousal disorder (PGAD)

This is a rare disorder where women have sudden, frequent genital arousal. It is also called persistent sexual arousal syndrome. In PGAD, the genital arousal is not associated with sexual desire or activity, though it can sometimes lead to orgasm. People with PGAD usually find the arousal distressing rather than pleasurable.

Female orgasmic disorder (FOD)

Women with female orgasmic disorder (FOD), or anorgasmia, are almost never able to have an orgasm, even when sexually aroused. In this condition, the problems with orgasm are ongoing and cause you to feel sad, worried, or anxious.

Female premature orgasm (FPO)

Women with female premature orgasm (FPO) regularly have orgasms too quickly when aroused, to the point where it causes personal or relationship problems.

Genito-pelvic pain/penetration disorder (GPPD)

In this condition, women have either ongoing pain and/or difficulty with vaginal penetration. This disorder is sometimes divided up into two separate conditions: dyspareunia (pain during sex) and vaginismus (muscle spasms that interfere with sex).

How can I talk to my doctor about sex?

If you feel shy or embarrassed about discussing your sex life with your healthcare provider, you’re not alone: Many women feel the same way. But the truth is, most healthcare providers welcome the opportunity to talk with you about sex. From a doctor’s perspective, sex is just another part of your overall health. Talking about sex with your provider can help them to understand what’s important to you and to support you in having (or maintaining) a fulfilling sex life at any age.

Here are some tips that can help you prepare for your appointment:

  • Do some research ahead of time, to help you understand your body and your concerns.

  • Keep track of your symptoms before the appointment.

  • Before the appointment, write down the questions and concerns you would like to discuss.

  • Take a list of your medications and/or supplements with you to the appointment.

  • Consider bringing a support person (or your partner) with you to the visit.

  • When talking with your provider, be as specific as possible about what you’re experiencing.

  • Ask questions, especially if your provider uses words or phrases that you don’t understand.

  • Don’t end the visit until you feel like you understand — and agree with — the treatment plan.

During the appointment, your provider may ask you some questions about your sex life. Though these questions may seem personal, they help your provider to understand you as a whole person. And rest assured: Your provider is legally required to keep details about your sex life private, just like all of your medical information.

When you meet, your provider may want to know more about:

  • Your sexual history

  • Your gender identity and sexual orientation

  • Your current sexual practices

  • What birth control (if any) you currently use

  • Any symptoms you have

  • If you could be pregnant

  • If you have recently been exposed to a STI

As part of the interview, some healthcare providers also use a special questionnaire, called the female sexual function index (FSFI). The FSFI is a detailed assessment of sexual function. Women with a higher score may be more likely to have a sexual disorder. Your healthcare provider may also suggest a physical exam (including a pelvic exam) and lab or urine tests. These will help rule out any physical problems that could be affecting your sex life.

And keep in mind: You deserve to feel good about working with your healthcare provider. If you feel unsafe or uncomfortable for any reason, follow your instincts. It’s always OK to get a second opinion or to look for another provider.

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What treatments can help with my sexual problems?

Dealing with a problem in your sex life can be hard — both mentally and physically. But fortunately, there are many options for treatment, including:

  • Herbal supplements

  • Prescription medications

  • Wellness devices

  • Therapies

These treatments can be helpful for everything from mild and moderate symptoms to more severe sexual disorders.

Available treatments can potentially:

  • Boost or reduce sex drive, depending on desired outcome

  • Improve sexual arousal

  • Make sex more pleasurable

  • Encourage orgasm

  • Reduce pain

  • Address physical challenges and mobility issues

  • Address physical and psychological trauma

Some treatments and therapies focus on just one or two of these areas. Others are more general. And since different parts of your sex life are connected, making a change in one area can help you in other areas as well. For example, using a lubricant (lube) to help reduce pain during sex could also have the added benefit of boosting your libido, or making sex more pleasurable.

First steps

Before jumping in, ask yourself: What’s most important to me in my sex life? With so many options, it can be helpful to have a sense of what you’d like to change.

Take some time to think about what an “ideal” sex life means to you. Look for sex-positive education resources that can help you understand your body. Also, think about what makes you feel good. If you have a partner, think about including them in the conversation — both for support and for collaboration.

Prescription medications

For some women, medications are another way to support a healthy sex life. Medications are often used as a second choice, after nonmedication options haven’t worked. Below are some examples of medications.

Flibanserin (Addyi)

Addyi is an FDA-approved medication for hypoactive (low) sexual desire (HSDD) in premenopausal women. Addyi is a pill that you take daily. In clinical trials by the manufacturer, women taking Addyi had an increased libido and an increased number of satisfying sexual events per month — though this only happened for about 10% of participants.

Also: Be aware that this medication has only been tested in cisgender, heterosexual, mostly white women. It is also very expensive, and it can also have dangerous side effects when combined with alcohol.

Bremelanotide (Vyleesi)

Vyleesi is another FDA-approved medication for HSDD in premenopausal women. The difference is that Vyleesi is an injection that you use 45 minutes before sexual activity. In clinical trials by the manufacturer, women using Vyleesi had an increase in sexual desire — but only by a very small amount.

Vyleesi has not been tested at all in Latina, Indigenous, or Asian women and only in a small number of Black women. It also has a high rate of side effects, with about 40% of women experiencing nausea after taking it.

Hormone replacement therapy (HRT)

HRT is a treatment that replaces the hormones that your body makes less of during and after menopause. There are many different types of HRT, including pills, creams, and vaginal inserts. In particular, vaginal estrogen can help with menopause-related vaginal dryness and pain during sex — which can boost libido and improve sexual pleasure. Visit the GoodRx HRT guide to learn more.

Ospemifene (Osphena)

Osphena is an FDA-approved medication for menopause-related vaginal dryness and pain during sex. It is a nonhormonal treatment that encourages healthy tissue growth in your vagina, decreasing pain during sex and improving satisfaction. It may also help to restore and protect healthy bones after menopause. Osphena may be a good option for women who cannot use vaginal estrogen or osteoporosis medications.

Nonmedication treatments

Herbal supplements

There are many natural products on the market that claim to support sexual health. Examples include chasteberry, ginseng, maca, and more. Some products are also specifically marketed for use during and after menopause.

You can read more about specific herbal supplements in these two GoodRx guides:

Ideas to try at home

  • Get creative. The human brain is hardwired to like novelty (new things) — including when it comes to sex. In fact, there’s evidence that desire and arousal decrease over time if you’re in a monogamous relationship. Consider introducing novelty by experimenting with new sexual positions or activities, reading or watching erotica, or experimenting with sex toys.

  • Use more lubricant. A water-based or silicone-based lubricant can help with dryness. This can increase arousal and pleasure — and decrease pain — during sex.

  • Fantasize about sex. Thinking about sex can help with libido and arousal, and it may actually increase testosterone levels, a hormone that is related to sexual function and satisfaction.

  • Don’t be afraid to masturbate. Not only is masturbation common (by some estimations, 76% of American women do it), it may help to improve sexual problems. It also increases blood flow to the genital area, which can help to keep vaginal tissue healthy, especially after menopause.

  • Try using a vibrator. Vibrators are sex toys that can be used on your body to help with sexual arousal or orgasm. Vibrators come in all shapes and sizes, and they’re designed for all genders and body types. Certain vibrators can also be especially helpful for trans women and people with disabilities (link includes explicit images).

  • Try using a comfort or support device. Positioners (link includes explicit images), spacers, and supports (link includes explicit images) can all help you control your body’s position and movements during sex. These can be especially helpful for people who experience pain during sex or who have a disability (link includes explicit images).

  • Limit alcohol. One or two drinks can help with arousal, but excessive alcohol use can get in the way of sexual arousal and orgasm.

  • Stop smoking. Cigarette smoking can decrease blood flow to your genitals and interfere with sexual arousal and orgasm.

  • Exercise regularly. Physical activity can reduce stress, increase stamina, and enhance well-being, all of which can help to improve your sex life. It may also directly help with sexual arousal and reverse sexual problems induced by antidepressants.

Sexual wellness devices

Sexual wellness devices are medical devices that can help with physical arousal, as well as comfort and enjoyment during sex. Though they are available without prescription, they’re often used under the guidance of a trained health professional like a:

  • OB-GYN

  • Pain specialist

  • Sex therapist

  • Physical therapist

Here are examples of some sexual wellness devices:

  • Vaginal dilators (trainers): Vaginal dilators are medical devices that slowly train the vagina to relax with penetration. This can help to treat pain during sex and to reduce sex-related anxiety. Dilators are also used to help with sexual function after cancer treatment and as a standard treatment for trans women who have had (bottom) gender confirmation surgery.

  • Eros therapy device: The Eros is an FDA-approved medical device used to treat female arousal disorder (FAD). It uses a small vibrating vacuum that increases blood flow to the clitoris, increasing sensation and improving sexual satisfaction.

  • Kegel exercisers: These are devices used to strengthen your pelvic floor muscles. They can help to improve muscle tone in your genital area, which can help with arousal and orgasm.

Read more about sexual wellness devices — and the scientific evidence behind them — in this GoodRx article about the link between natural products and an improved sex life.

Therapy and education

There’s a huge variety of options when it comes to educating yourself about sex and learning new techniques that can boost your sex life. Some of these options can be done at home on your own. Others require you to work with a trained health professional.

For example, you can educate yourself at home by reading books about sex or taking an online sex education class, like OMGyes or Bodysex (link includes explicit images). Getting educated can guide you to explore new techniques and to understand your body. Ultimately, it can improve libido, arousal, and orgasm.

And if you’d like to work with a professional, there are also many options. Be aware that sexual health professionals are licensed specialists — not sex workers — though some professions do use physical touch. Here are some examples.

Sex therapy

A sex therapist is trained mental health professional with knowledge about sex and relationships. Sex therapists provide counseling designed to help you — and sometimes your partner — understand your thoughts and feelings about sex and to resolve issues in your sex life. Sex therapy does not involve any physical contact between you and the therapist. But they may suggest activities for you to do at home, like sensate focus exercises.

Pelvic-floor physical therapy

A pelvic-floor therapist is a licensed physical therapist who focuses on your pelvic-floor muscles, ligaments, and tissues. All of these parts of your body work together to support your internal organs, control your bowels and bladder, and contribute to sexual arousal and orgasm. The therapist uses a combination of physical techniques to help ease pain and restore normal functioning. Though this is a hands-on therapy, the touching is nonsexual.

Sexological bodywork

Sexological bodywork is similar to pelvic-floor physical therapy but with more of an integrative approach. In addition to hands-on physical techniques, sexological bodyworkers educate their clients about sex, arousal, and orgasm. Be aware that this type of therapy can sometimes involve sexual therapeutic touching.

The bottom line

When it comes to your sexual health, you deserve to feel confident and safe and to experience pleasure — whatever that means for you. If you are struggling with your sex life, think about reaching out for support. There are great options for getting help, no matter your concern.

References

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American College of Obstetricians and Gynecologists. (2017). When sex is painful.

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