What are the common female psychosexual issues?
Low or Absent Sexual Desire (Hypoactive Sexual Desire Disorder – HSDD)
- A lack of interest in sexual activity or thoughts, which may lead to distress and discordance between partners.
- Sexual Aversion: A strong aversion or avoidance of sexual activity, often accompanied by feelings of fear, disgust, or anxiety about sex.
Arousal Issues
- Female Sexual Arousal Disorder (FSAD): Difficulty becoming or staying sexually aroused, which can include a lack of lubrication, genital sensation, or emotional arousal despite having the desire to engage in sexual activity.
- Persistent Genital Arousal Disorder (PGAD): Involuntary and persistent feelings of genital arousal not associated with sexual desire or activity. This can cause significant discomfort and distress.
Orgasm Disorders
- Anorgasmia (Inability to Orgasm): Difficulty or inability to reach orgasm, even with sufficient sexual stimulation and arousal. This can be primary (never experienced an orgasm) or secondary (developing after a period of normal function).
- Delayed Orgasm: A prolonged period of stimulation is required to reach orgasm, or orgasms are weak or unsatisfying.
- Reduced Orgasmic Intensity: Experiencing orgasms but finding them less pleasurable or less intense than previously.
Pain Disorders
- Dyspareunia (Painful Intercourse): Experiencing pain during or after sexual intercourse. This can occur as Entry Dyspareunia, at the start of penetration or with Deep Dyspareunia, during thrusting. It can be due to psychosexual issues but may have a physical cause. First, try different positions, and ensure you are well-lubricated and aroused. If not improving, see your health professional as this may have a physical cause, such as skin conditions, and infections and an underlying physical cause such as endometriosis.
- Vaginismus: Involuntary spasms or contractions of the vaginal muscles that make penetration painful or impossible. It is an automatic response which you do not have control over. However, with help and patience, this can be overcome. It may be linked to anxiety, past trauma, or a conditioned response to the fear of pain from a previous episode which may or may not be linked to sexual activity.
- Vulvodynia: Chronic pain or discomfort around the vulva, defined as lasting more than 3 months. Vulvodynia is often described as sensations of burning, stinging, or irritation. This is not necessarily related to intercourse but may affect sexual activity. Always check that there are no skin conditions such as Lichen planus or , infections, or dermatitis. For additional information check out: The Vulval Pain Society
What can help?
- Hormone Replacement Therapy (HRT): For some women, HRT can relieve vaginal dryness, help with libido, and alleviate other menopausal symptoms.
- Counselling or Therapy: Psychosexual therapy or couples therapy can address relationship issues and psychological barriers to sexual satisfaction.
- Vaginal Lubricants or Estrogen Creams: These can help with physical discomfort during intercourse.
- Pelvic Floor Exercises. This can help with all the above conditions. Good pelvic floor tone improves sensations, addresses continence issues, can help with pain and increases orgasmic potential.
- Communication. This is essential. Communicate with your partner/s so that they understand what you are experiencing. Also, communicate with your health professional. Psychosexual referrals are available on the NHS but may be limited in some areas.
- Other Medication: Some medications can help mood disorders such as SSRIs. (though these can negatively impact sexual function).
- Testosterone: This is useful for some women with low libido but take medical advice
- General Health: Ensuring any long-term conditions are well managed can help general well-being and reduce health anxiety which may impact sexual enjoyment.
It’s important to remember that every woman’s experience of menopause is different. While some may see a decline in sexual health, others might find new ways to adapt and enhance intimacy during this phase. Anxiety and fear of pregnancy and birth can be resolved, and contraception issues and side effects are no longer an issue. Help is available for psychosexual issues, but availability does differ across the UK. Do seek out help and advice from your Primary care provider or local sexual health clinic. Go prepared with any questions and don’t be embarrassed. Sexual function and pleasure are part of our enjoyment of life and have many physical and mental health benefits. Remember also you do not need to be sexually active with a partner/s to seek help if you are not enjoying self-pleasure due to psychosexual issues that is just as valid a reason for seeking help.