What is sexual dysfunction?

When you have problems with sex, doctors call it "sexual dysfunction." Both men and women can have it. There are 4 kinds of sexual problems in women:

• Desire disorders ­- When you are not interested in having sex or have less desire for sex than you used to.
• Arousal disorders ­- When you don't feel a sexual response in your body or you cannot stay sexually aroused.
• Orgasmic disorders ­- When you can't have an orgasm or you have pain during orgasm.
• Sexual pain disorders ­- When you have pain during or after sex.

How do I know if I have a problem?

Up to 70% of couples have a problem with sex at some time in their relationships. Most women will have sex that doesn't feel good at some point in her life. This doesn't necessarily mean you have a sexual problem.

If you don't want to have sex or it never feels good, you might have a sexual problem. Discuss your concerns with your doctor. Remember that anything you tell your doctor is private and that your doctor can help you find a reason and possible treatment for your sexual dysfunction.

What causes sexual dysfunction?

Many things can cause problems in your sex life. Certain medicines (such as oral contraceptives and chemotherapy drugs), diseases (such as diabetes or high blood pressure), excessive alcohol use or vaginal infections can cause sexual problems. Depression, relationship problems or abuse (current or past abuse) can also cause sexual dysfunction.

You may have less sexual desire during pregnancy, right after childbirth or when you are breastfeeding. After menopause many women feel less sexual desire, have vaginal dryness or have pain during sex due to a decrease in estrogen (a hormone in the body).

The stresses of everyday life can also affect your ability to have sex. Being tired from a busy job or caring for young children may affect your sexual desire. You may also be bored by a long-standing sexual routine.

What can I do?

If desire is the problem, try changing your usual routine. Try having sex at different times of the day, or try a different sexual position.

Arousal disorders can often be helped if you use a vaginal cream or sexual lubricant for dryness. If you have gone through menopause, talk to your doctor about taking estrogen or using an estrogen cream.

If you have a problem having an orgasm, you may not be getting enough foreplay or stimulation before actual intercourse begins. Extra stimulation (before you have sex with your partner) with a vibrator may be helpful. You might need rubbing or stimulation for up to an hour before having sex. Many women don't have an orgasm during intercourse. If you want an orgasm with intercourse, you or your partner may want to gently stroke your clitoris. Masturbation may also be helpful, as it can help you learn what techniques work best for you.

If you're having pain during sex, try different positions. When you are on top, you have more control over penetration and movement. Emptying your bladder before you have sex, using extra lubrication or taking a warm bath before sex all may help. If you still have pain during sex, talk to your doctor. He or she can help you find the cause of your pain and decide what treatment is best for you.

Can medicine help?

If you have gone through menopause or have had your uterus and/or ovaries removed, taking the hormone estrogen may help with sexual problems. If you're not already taking estrogen, ask your doctor if this is an option for you.

You may have heard that taking sildenafil (Viagra) or the male hormone testosterone can help women with sexual problems. There have not been many studies on the effects of Viagra or testosterone on women, so doctors do not know whether these things can help or not. Both Viagra and testosterone can have serious side effects, so using them is probably not worth the risk.

What else can I do?

Learn more about your body and how it works. Ask your doctor about how medicines, illnesses, surgery, age, pregnancy or menopause can affect sex.

Practice "sensate focus" exercises where one partner gives a massage, while the other partner says what feels good and requests changes (example: "lighter," "faster," etc.). Fantasizing may increase your desire. Squeezing the muscles of your vagina tightly (called Kegel exercises) and then relaxing them may also increase your arousal. Try sexual activity other than intercourse, such as massage, oral sex or masturbation.

What about my partner?

Talk with your partner about what each of you like and dislike, or what you might want to try. Ask for your partner's help. Remember that your partner may not want to do some things you want to try, and you may not want to try what your partner wants. You should respect each other's comforts and discomforts. This helps you and your partner have a good sexual relationship. If you feel you can't talk to your partner, your doctor or a counselor may be able to help you.

If you feel like your partner is abusing you, tell your doctor.

How can my doctor help?

Your doctor can suggest ways to treat your sexual problems or can refer you to a sex therapist or counselor if needed.

• I'm having sexual problems. Is there something wrong with me?
• What can I do at home to help resolve my problems?
• Could my symptoms be a sign of a more serious condition? Do I need any tests?
• I'm worried that my problems will cause tension in my relationship. What should I do?
• Is it safe for me to have sex?
• Can I get pregnant?