Sexual Health Concerns are More Common than You Think
Female sexuality is an intimate topic and often associated with stigmas. Unfortunately, that leaves many women too ashamed or embarrassed to talk about sexual health with their physicians, especially when they are having challenges. According to Lyndsey Harper, MD, Ob-Gyn, Sexual Health Specialist, and CEO of Rosy Wellness, “Women’s sexual health problems are actually very common, and are experienced by 43% of women.” 2
Sexual Dysfunction in Women 2
A wide range of sexual dysfunctions is experienced by females at any age. When women reach age 40 and older, their sexual health is often related to hormonal changes (decrease in estrogen) due to perimenopause and menopause.
1. Low or absent sexual desire: 30% (up to 38%*)
2. Trouble with sexual arousal: 10-20% (up to 25%*)
3. Chronic sexual pain: 10-15% (up to 20%*)
4. Orgasmic disorder: 10-15% (up to 20%*)
5. Vaginal dryness/lack of lubrication
In addition to hormonal changes, some conditions have other causes. For example, heart conditions, diabetes, and certain medications can put a damper on desire and arousal. Sexual pain is likely due to endometriosis or scarring but can also be due to vaginal dryness. Sexual trauma and sexual violence can cause sexual dysfunction as well.
* Dr. Harper indicated that current numbers of women experiencing sexual dysfunction are even higher than prior research has shown.
Sexually Transmitted Diseases (STDs)
Dr. Harper noted that women in long-term relationships often come up with “sexual scripts” about what their sex life should look like with their partner. New relationships offer an opportunity to rediscover what you want and rewrite that script. Dr. Harper emphasized that it’s never too late to reimagine your life — but also, you’re never too old to get a sexually transmitted disease. Having unprotected sex with non-monogamous or multiple partners opens you up to the risk of being exposed to STDs. To that end, Dr. Harper cautions women to “express our sexual freedom by also protecting ourselves from these things that can kind of get in the way of that as well.”
Effective Treatments for Sexual Dysfunction
In her practice, Dr. Harper indicated that the most common sexual health issue she hears patients complain about is low sexual desire (libido). Although there can be many physical factors, she attributes the most common cause of low libido to stem from stress and anxiety. She also notes that many older anti-depressant medications can lower sexual desire and inhibit orgasms as well. In any case, she offers several approaches as treatment options.
Mindfulness – Stress and anxiety can make it so as to not “allow room in our brain for sexual thoughts,” says Dr. Harper. For example, you may brush off intimate advances or tell a partner to leave you alone in a not-so-nice way. Research-proven mindfulness tools can help you learn how to pay attention to sexual arousal, feel better about your body, reduce stress levels, and enjoy sex to a greater degree.3 Mindfulness is rooted in the ancient Buddhist practice involving “the moment-to-moment awareness of one’s experience without judgment.” 4
Erotica – Dr. Harper described erotica as an interesting evidence-based non-pharmacologic intervention. Erotica is best understood by knowing the difference between spontaneous sexual desire (from the brain) and responsive sexual desire (from sexual cues). When you’re young, the desire often just comes spontaneously from the brain. As you get older, you begin to respond more to sexual cues, which send messages to the brain, making you feel aroused. So tools like erotica can be used to increase libido when you lack sexual desire.
Exercise – It’s been proven that exercise improves sexual desire, so Dr. Harper recommends: “20 minutes of vigorous exercise three times a week.” In fact, a report showed that cycling boosted women’s libido by 169%.6 Exercise helps because it increases blood flow and boosts your mood. It’s also been shown to drastically change estrogen metabolism, which decreases the risk of breast cancer even in postmenopausal women.6
Medications – As a last resort, sexual dysfunction can be treated with medications following a clinical diagnosis. Your doctor may prescribe hormones such as estrogen and testosterone (though not FDA-approved)5 for low sexual desire in menopausal women or flibanserin (Addyi®) and bremelanotide (Vyleesi®) for low sexual desire in premenopausal women. Vaginal preparations of estrogen and DHEA , also prescription medications, can be used for vaginal atrophy, and over-the-counter lubricants help with vaginal dryness.
Sexual dysfunction and sexual health issues can negatively affect one’s overall quality of life.2 That’s why it’s so important to get to the bottom of things by talking to a medical professional.
How to Talk to Your Doctor
As a woman, in the context of what’s most important to you, you’re entitled to live the most sexually fulfilled and sexually healthy life. This can be done with the help and guidance of physicians, sex therapists, and other medical professionals, even in the context of religion. Dr. Harper emphasized that sexuality should not be viewed as something that’s bad, dirty, or gross, so it’s vital to release whatever shame or guilt you’re holding on to.
It's also important to bring up the issue with your physician, especially if it’s a new problem. That could mean there is something else going on, like a medical problem that needs to be addressed.
Openly Answer Your Doctor’s Questions
To help you overcome these negative feelings, it’s vital for physicians to be open with their patients about sexual health. Ideally, pointing out that social health issues are common, can disrupt life, and must be addressed. In addition, your doctor should be asking if you have any questions or concerns about your sexual health.
Here’s what to talk about with your doctor to provide answers they can use to help you:
What sexual health issue you’re having?
When did it first start?
Where does it hurt?
What makes it worse or better?
What have you tried to remedy your situation?
Don’t Be Afraid to Start the Conversation
If your doctor doesn’t create a safe place to discuss sexual issues, then it’s up to you to start the conversation. According to Dr. Harper, “There may be physicians who feel like it would be prying or that the woman might be offended or something like that.” To help you, they need to know the facts of what’s bothering you. This is especially important if what you’re experiencing is new because there could be an underlying medical problem that needs to be addressed. Even if your doctor doesn’t know the answers, their responsibility is to refer you to someone who can.
It’s challenging for patients, doctors, and people, in general, to be outspoken about sexuality, sexual awareness, and sexual health. Because it’s been taboo, Dr. Harper stated that sexual health is “hard for any of us to talk about” and “very emotionally charged.” Like many women, you may feel guilt, shame, or embarrassment, but you can take steps to take charge of your sexual health.
Take Charge of Your Sexual Health
Women, young and old, face challenges with addressing sexual health problems. Most deal with these types of issues at some point in their lives, especially when they reach 40 and over. Although many go untreated, there are solutions. Now that you know about the common issues and can take comfort in knowing that you’re not alone, there’s one key factor to keep in mind — communication. No, it’s not about “pillow talk” with your partner (though that’s important too); this is about sharing your concerns with a medical practitioner. Why? Because sexual health matters. So, be sure to talk with your doctor about anything that’s bothering you or to simply ask questions.
Footnotes:
2. National Institute of Health (NIH), Prevalence and risk factors of sexual dysfunction in men and women, https://pubmed.ncbi.nlm.nih.gov/11122954/
3. National Institute of Health (NIH), A Pilot Study of Eight-Session Mindfulness-Based Cognitive Therapy Adapted for Women's Sexual Interest/Arousal Disorder, https://pubmed.ncbi.nlm.nih.gov/27712106/
4. The Greater Good Science Center at the University of California, Berkeley, Mindfulness Defined, https://greatergood.berkeley.edu/topic/mindfulness/definition
5. National Institute of Health (NIH), Transdermal Testosterone in Female Hypoactive Sexual Desire Disorder: A Rapid Qualitative Systematic Review Using Grading of Recommendations Assessment, Development and Evaluation, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5984263/
6. Psychology Today, Can Excercise Give Your Sex Life a Boost?https://www.psychologytoday.com/us/blog/the-roots-health/202110/can-excercise-give-your-sex-life-boost
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