February 14th, 2020
Ladies, let’s talk about sex.
You may be thinking why on earth your sex life is your primary care provider’s business and why we want to talk about it with you.
The truth is sex impacts your health and quality of life and if we aren’t addressing talking about this with you, we are missing important information about your wellness. According to a recent study, 73% of women want their healthcare provider to start the conversation about sex with them and it is not happening.
Sex is an important aspect of physical intimacy, relationships, and pleasure, however, 43% of women report some sexual dysfunction, and 1 in 10 of those women are reporting this before menopause.
Sexual dysfunction can be anything that makes sex less enjoyable for a woman. This could be a lack of sexual desire or interest, pain, discomfort or displeasure during intercourse, or difficulty or inability to achieve orgasm.
When men have sexual dysfunction, in most cases it can be pretty simple to address. In women, however, sexual dysfunction isn’t as simple as a little blue pill. Women do not have to suffer in silence. There are treatments to improve your sex life, but to know how best to treat sexual dysfunction, we need to understand the causes. Here are six possible causes of a woman's sexual dysfunction.
- Painful Intercourse- Dyspyrunia or painful intercourse is usually caused by a structural issue. Vaginal Dryness - One of the most common causes of dyspareunia is vaginal dryness caused by vaginal atrophy or what is now being called by the North American Menopause Society “Genital Urinary Syndrome of Menopause”. Vaginal dryness is one of the first symptoms of loss of estrogen in the body, women can start to experience this as early as their 30’s. The vaginal mucosa is full of estrogen receptors and as estrogen decreases, that tissue becomes dry and thin. This can make sex uncomfortable, painful, and even cause that tissue to tear after intercourse. This can also increase a woman’s risk of the recurrent urinary tract and vaginal infections because the lack of estrogen changes the balance of bacteria in the region. This is easily treated- mild dryness may be addressed with over the counter lubricants but if you are experiencing recurrent infections, bleeding after sex, or extreme pain, you should consider some low dose topical estrogen or DHEA cream which breaks down into both estrogen and testosterone.
Pelvic Floor Dysfunction- This can occur when the muscles and connective tissue that hold the pelvic organs in place tear or weaken. This causes pelvic organs such as the uterus, bladder or bowel to fall down into the vagina. This can cause pain, leakage of urine or bowels, or difficulty urinating or moving bowels. Pregnancy and childbirth is the most common risk factor but other risk factors include obesity, heavy weight lifting, health problems that cause repeated straining, loss of estrogen, and genetics (American Urogynecological Society. org). This can be treated with pelvic floor exercises, pelvic floor physical therapy, pelvic floor devices that help with exercises, laser treatments, or surgery. In some instances pain can be caused by nerve damage, other structural issues or can even be unexplained but usually, when we address the most common issues, pain is improved. Additionally changing positions may be helpful.
- Hormone Imbalance - Stress hormones, thyroid, estrogen, progesterone, even testosterone drive our natural sex drive.
When these are off you can bet your desire for sex will be too. This could be addressed by checking your hormone levels with a lab test and then discussing if hormone replacement may be right for you. With all medications, hormone replacement, even bioidenticals come with some risks however if you don’t smoke, don’t have a high risk for cardiovascular disease or high risk for breast cancer, hormone replacement is generally safe.
- Lack of Intimacy with Partner- Women associate an emotional connection with sex. If your relationship with your partner is not in the best place it is natural to lack desire for sex with them.
If you are having relationship issues, relationship counseling is the best advice. In long term relationships where there aren’t major issues, we can still get caught up in losing the romance. Between work, running the house, keeping up with the kids, a relationship can start to feel more like a partnership. You need to do things together to reignite the spark.
Dedicate time for romance, date nights without kids or friends. Do physical activity together- when you exercise some of the same feel-good endorphins that are released with sex are released. This will naturally connect you and your partner physically and can increase your desire for each other. Touch each other outside of the bathroom. Make an effort to kiss, embrace, or even give each other massages. Those physical connections can help get you in the physical mindset. Make time for foreplay- women are not turned on at the drop of a hat. Explain to your partner you need time to warm up.
- Stress & Mindfulness- Women are extremely good multitaskers. Their minds can be simultaneously on multiple things. This can be a problem in the bedroom.
It is hard to get into the mood when you are thinking about stress at work or worries about the kids and everything else that you need to get done. It makes sex feel more like a chore. You need to get your mind in the mood for sex. Here are some things you can try:
Meditation Read erotica to get your mind on sex Talk or send erotic messages with your partner throughout the day
- Medication & Chronic Illness- Many medications cause a decrease in libido or issues with orgasm.
For example, sexual dysfunction is one of the most common side effects of most antidepressants. If you are using a medication with these side effects there may be other options to switch to. Certain chronic diseases especially diabetes or cardiovascular disease can decrease blood flow to the pelvic organs resulting in decreased desire or function. Getting these chronic illnesses under control can help.
- Medication treatment- What if we've everything and you still are having issues with libido and pleasure in sex? Or what if you are not a candidate for hormone replacement or changing your medication?
This is where medication treatment may be a great option. There is a new medication on the market called ADDYI (flibanserin) that addresses sexual dysfunction in women and it is approved for use in women before and after menopause. In trials it has shown to increase sexual desire in women by 80% and increase pleasure in sexual events by 58%. It works by addressing neurochemical imbalances in the brain and takes about 8 weeks before women start to feel results. It has also been shown to help some women with anxiety, so this may be a great option for women who are perimenopausal women where low libido and increased anxiety are common (although this is not a statement verified by the FDA). Most common side effects are dizziness, tiredness or insomnia, nausea, and dry mouth.
Finally, you can’t have good sexual health without safe sex. If you are not in a monogamous relationship and are having sex, you should be using a condom with every partner, every time you have sex. Sexually transmitted infections do not discriminate based on age, and as divorce rates increase in America and women are reentering the dating scene in later ages we are seeing an incline of sexually transmitted infections in later ages. The CDC reported a 19% increase in Chlamydia, a 63% increase in Gonorrhea, a 71% increase in Syphilis and a 185% increase in Syphilis passed to babies in utero from 2014-2018 (CDC, 2019). Condoms are your first-line defense against these infections if you are enjoying sex.