Cause

A woman's sexuality is a complex mix of mental, emotional, and physical signals. A problem in one area can grow to involve others. For example, a physical problem can lead to fear of pain, and the fear can lead to guilt about its effect on your partner. So the causes of sexual problems in women are often interrelated.

Psychological causes may be related to past or current physical or emotional problems. These mental and emotional causes include:

• Stress, depression, or anxiety.
• Marital or relationship discord.
• Fears that illnesses, such as cancer, or surgery, such as a mastectomy or hysterectomy, will make sexual activity unpleasant for the woman or her partner.
• Unhappiness with body image.
• Fear of spreading a sexually transmitted disease, such as genital herpes.

Physical causes can be normal hormonal changes, injuries, medical procedures, or other medical problems. Physical causes include:

• Hormonal changes such as those related to the menstrual cycle, use of birth control pills or hormone therapy, pregnancy, recovery from pregnancy, perimenopause, and postmenopause.
• Pain during intercourse. This may result from:
  • Vaginal dryness. Lack of lubrication in the vagina is the most common cause of pain with sex.
  • Vaginismus (say "vadj-uh-NIZ-mus"). This involves painful spasms of the vaginal muscles. Vaginismus may be linked to a fear that stems from losing control or from trauma such as rape or sexual abuse. But sometimes there is a medical cause, such as:
    • Scars in the vaginal opening from injury, surgery, or childbirth.
    • Pelvic infections, such as vaginitis or Bartholin's glands infections.
    • Chronic pain conditions, such as vulvodynia.
    • Skin conditions, such as lichen sclerosus or lichen planus.
    • Irritation from douches, spermicides, or latex condoms.
  • Dyspareunia (say "dis-puh-ROO-nee-uh"). This is physical pain that occurs during entry into the vagina, during deep thrusting, or pain after sexual intercourse.
• A physical abnormality.
• One or more of many medical conditions. This includes diseases that affect blood circulation, like diabetes, or problems with your thyroid, like hypothyroidism. Other medical problems, like endometriosis or arthritis, may cause pain during sex.

• Medical treatments. Sometimes treatments cause changes that result in pain during intercourse or other sexual problems. These include previous surgeries, treatments for infertility, and cancer treatments.

Aging may cause a decrease in sexual desire and changes in the vagina. These changes include:

• Thinner vaginal walls, so that the vagina may be easily bruised or chafed.
• Narrowing, shortening, and/or stiffening of the vagina, causing pain during intercourse (dyspareunia).
• A reduction in lubrication and a lengthening of the time needed to lubricate the vagina.
• More time needed to feel sexually aroused.
• Orgasms that do not last as long they once did.

Medicine use can sometimes decrease sexual desire and arousal. Such medicines include:

• Blood pressure and diabetes medicines, such as diuretics, alpha-blockers, and calcium channel blockers.
• Antidepressants. These include tricyclics and selective serotonin reuptake inhibitors (SSRIs).
• Antihistamines, which are allergy medicines.

Losing a partner is a common life event that can lead a woman to be less sexually active and satisfied. This is not a "sexual problem." But it can leave you with unmet needs for intimacy.

Cultural and societal factors may play a role in a woman's sexual health. Inadequate health services and/or a lack of sex education may result in a woman's lack of knowledge about sexual behavior.

Drinking alcohol and using illegal recreational drugs in small amounts may reduce sexual inhibitions at first. But continually using drugs, such as cocaine or amphetamines, or drinking too much alcohol will cause problems with orgasm for a woman. Also, illegal drugs as well as many medicines may cause a woman to have less sexual desire.