Women’s sexual concerns: libido, arousal, pain and more.
Human sexuality is complex, involving the interplay of psychological, emotional, spiritual, and biological factors. For this reason, when sexual concerns arise, they can take time to sort out and resolve. However, as is evidenced by the Viagra craze, society often seeks simple solutions in the form of drugs with an emphasis on the biological or physical aspects of sex.
Even today, decades after the sexual revolution, women receive conflicting messages around sexuality. They are encouraged by popular culture to look sexy but not to be sexual. Because of the context in which they are raised, it is not uncommon for many women to be ignorant about sexual anatomy and function, have problems with body image, and experience ambivalence about using sex for pleasure. Even when this is not the case, there is a prevalent attitude that men and women experience the same sequence of physical events during sexual encounters. Research on female sexuality over the past decade has elucidated that the female sexual response may not be as classically described by Masters and Johnson. For example, it is not uncommon for sexual desire to come after sexual stimulation in women.
Sexual problems in females can be divided into four general categories: desire, arousal, orgasm, and pain. Based on recent research, in order for any sexual condition to be considered a “disorder,” it must create distress for the woman experiencing it. This is important because we are moving away from sexual “expectations” and “norms” to consider individual situations.
Women frequently report concerns about sexual interest or libido, and they often inquire about the role of hormones. Research has not generally found hormone levels to be correlated with sexual function and, therefore, hormonal supplementation does not usually improve sexual interest or libido. A notable exception is when menopausal women are experiencing vaginal dryness and pain, which can understandably affect their interest in sex. In this situation, the use of topical (vaginal) estrogen results in marked improvement. A number of studies have found that prior sexual functioning and relationship factors rather than hormone levels are better determinants of sexual functioning of women in midlife.
We feel it is important to appreciate the complexity of human sexuality and avoid the “medicalization” of it. We use a multidisciplinary approach to the evaluation and treatment of sexual problems. If help in our Boulder office is not sufficient, we refer patients to local experts in the field. For more information, see “Sexuality and Sexual Problems” under Links to Health Information in the Resources section.