Symptoms

Symptoms of sexual problems can include:

• A decrease in the level of desire, which might be expressed by fewer sexual fantasies or thoughts and a reluctance to engage in sexual activity.
• A decrease in the level of arousal. A woman may notice that she feels unreceptive to sexual suggestions and is not able to feel or maintain sexual excitement.
• An inability to reach orgasm after sexual stimulation. (For most women, the clitoris is the main site of orgasm. Not all women have vaginal orgasms.)
• Pain during intercourse.

By definition, sexual problems are symptoms that are distressing for you and/or your relationship with a partner. If you have a symptom that you are not troubled by and that isn't causing a relationship problem, then it is not considered to be a sexual problem.

Most women have a sexual problem at one time or another. For some women, the problem is long-term. Surveys of the general population in the United States found that many women occasionally have sexual problems and worries, including:¹

• Concerns about sexuality (6 out of 10 women).
• Lack of interest in sex (3 out of 10 women).
• Sex not always being pleasurable (2 out of 10 women).
• Pain with intercourse (1 to 2 out of 10 women).
• Difficulty becoming aroused (5 out of 10 women).
• Difficulty reaching orgasm (5 out of 10 women).
• Not being able to have an orgasm (2 to 3 out of 10 women).

What Happens

There are many reasons why a woman may have a sexual problem.

Physical influences

• Women normally experience a physical change during sexual arousal, as blood engorges the vulvar area. If a woman is aware of the exact places in her vulvar area where she feels increased sexual intensity (erectile tissue), her sexual pleasure may be increased by genital stimulation. It is possible for a woman not to be aware of this engorgement. It is also possible for a woman not to be aware of the spots that are most sensitive and responsive to stimulation.
• Any history of pain during intercourse may cause a woman to avoid sexual activity.
• Women who experience pain during intercourse may choose to continue to have intercourse, even though the experience is unpleasant and results in low sexual desire.
• Ongoing (chronic) illnesses, such as diabetes and arthritis, can affect sexual desire, enjoyment, and performance. Medicines for many medical conditions also affect desire and arousal.

Partner and emotional influences

• A partner's level of sexual skill and attention can play a big part in a woman's sexual enjoyment.
• A positive, respectful connection between partners sets the stage for sexual interest and arousal. Relationship problems can lower sexual interest and response.
• Living situations that give couples very little privacy can interfere with feelings of arousal.
• The physical changes that signal sexual arousal may for some women be accompanied by feelings of guilt, embarrassment, shame, or self-consciousness. Any of these emotions can reduce or negate physical arousal.
• Positive sexual experiences help build a healthy sexuality. On the other hand, a woman who has had a forced sexual experience is likely to have mixed feelings about sex. In one study, 1 out of 5 women reported having been forced to do something sexual. This was most often done by someone they were close to.¹

Age-related influences

• A decline in sexual activity as women age is most often caused by the lack of a partner.
• Many older women also report problems with lubrication.
• Women may note a decrease in sexual desire after menopause. In mild cases, the change may be almost unnoticeable. In more severe cases, there may be a decrease in mental and physical responsiveness to sexual stimuli.
• Many older women experience other changes in their sexuality. It may take longer to feel sexually aroused, and orgasms may be briefer. But orgasms still will offer mental and physical pleasure to most women.
• Women can feel sexual pleasure throughout their lives. But those who stop sexual activity after menopause have more shrinking and drying of the vagina than women who continue sexual activity.¹