Arousal Problems
Also referred to as hypoactive sexual desire, lack of interest in sex is the most frequent sexual problem reported by women in the United States. Causes of female lack of interest in sex include restrictive religious upbringing, having learned a passive sexual role, and physical factors such as stress, illness, drug use, and fatigue. More often, lack of interest in sex and difficulty in becoming aroused can be explained by the woman’s emotional relationship with her partner. In addition to a negative emotional context, there may be lower testosterone levels in women reporting low sexual desire.
The following are some of the ways in which lack of sexual desire in women is treated.
- Improve relationship satisfaction. Treating the relationship before treating the sexual problem is standard therapy in treating any sexual dysfunction, including lack of interest in sex. A prerequisite for being interested in sex with a partner, particularly from the viewpoint of a woman, is to be in love and feel comfortable and secure with the partner. SKYPE therapy is available through Heartchoice.com to help you get your relationship on track.
- Practice sensate focus. Sensate focus is a series of exercises developed by Masters and Johnson used to treat various sexual dysfunctions. Sensate focus may also be used by couples who are not experiencing sexual dysfunction but who want to enhance their sexual relationship. In carrying out the sensate focus exercise, the couple take turns pleasuring each other in nongenital ways, with each taking turns giving and receiving pleasure (while getting feedback from the partner about what is and is not pleasurable). On subsequent occasions, genital touching is allowed, but orgasm is not the goal. Indeed, the goal of sensate focus is to help the partners learn to give and receive pleasure by promoting trust and communication and by reducing anxiety related to sexual performance.
- Be open to re-education. Re-education involves being open to examining and reevaluating the thoughts, feelings, and attitudes learned in childhood. The goal is to redefine sexual activity so that it is viewed as a positive, desirable, healthy, and pleasurable experience. Women with conservative religious or Catholic backgrounds who have learned that sex is negative must rethink this earlier learning. Women from nonreligious homes who have high education are more likely to be sexually assertive and enjoy sex.
- Masturbation.Women who masturbate regularly are more likely to enjoy sex and to be orgasmic. Using a sex toy (e.g. vibrator) is helpful in achieving an orgasm (the “bullit” is a specific example). Anti-depressants such as Paxil, Prozac, Zoloft may interfere with sexual desire. Consult one’s physician some of whom recommend Wellburtrin as an alternative.
Unpleasurable Sex
Sex that is not pleasurable may be both painful and aversive. Pain during intercourse, or dyspareunia, occurs in about 10 percent of gynecological patients in the United States. Dyspareunia may be caused by vaginal infection, lack of lubrication, a rigid hymen, or an improperly positioned uterus or ovary. Because the causes of dyspareunia are often medical, a physician should be consulted. Sometimes surgery is recommended.
Dyspareunia may also have a psychological basis. Guilt, anxiety, or unresolved feelings about a previous trauma, such as rape or childhood molestation, may be operative. Therapy with a local therapist should be sought.
Some women report that they find sex aversive. Sexual aversion, also known as sexual phobia and sexual panic disorder, is characterized by the individual’s wanting nothing to do with genital contact with another person. The immediate cause of sexual aversion is an irrational fear of sex. Such fear may result from negative sexual attitudes acquired in childhood or sexual trauma such as rape or incest. Some cases of sexual aversion may be caused by fear of intimacy or hostility toward the other sex.
Treatment for sexual aversion involves providing insight into the possible ways in which the negative attitudes toward sexual activity developed, increasing the communication skills of the partners, and practicing sensate focus- gradually learning to find pleasure in sex. Through communication with the partner and through sensate focus exercises, the individual may learn to associate more positive feelings with sexual behavior.Inability to Achieve Orgasm
Difficulty achieving an orgasm, also referred to as inhibited female orgasm, or orgasmic dysfunction, occurs when a woman is unable to achieve orgasm after a period of continuous stimulation. Difficulty achieving orgasm can be primary, secondary, situational, or total. Situational orgasmic difficulties, in which the woman is able to experience orgasm under some circumstances but not others, are the most common. Many women are able to experience orgasm during manual or oral clitoral stimulation but are unable to experience orgasm during intercourse (i.e., in the absence of manual or oral stimulation).
Biological factors associated with orgasmic dysfunction can be related to fatigue, stress, alcohol, and some medications (see above). Diseases or tumors that affect the neurological system, diabetes, and radical pelvic surgery (e.g., for cancer) may also impair a woman’s ability to experience orgasm.
Psychosocial and cultural factors associated with orgasmic dysfunction are similar to those related to lack of sexual desire. Causes of orgasm difficulties in women include restrictive childrearing and learning a passive female sexual role. Guilt, fear of intimacy, fear of losing control, ambivalence about commitment, and spectatoring may also interfere with the ability to experience orgasm. Other women may not achieve orgasm because of their belief in the myth that women are not supposed to enjoy sex.
Relationship factors, such as anger and lack of trust, can also produce orgasmic dysfunction. For some women, lack of information can result in orgasmic difficulties (e.g., some women do not know that clitoral stimulation is important for orgasm to occur). Some women might not achieve orgasm with their partners because they do not tell their partners what they want/need in terms of sexual stimulation out of shame and insecurity. Or, even in those cases where the woman is open about her sexual preferences, the partner may be unwilling to provide the necessary stimulation. Hence, a cooperative partner rather than a nonorgasmic woman may become the focus for resolution.
Since the causes for primary and secondary orgasm difficulties vary, the treatment must be tailored to the particular woman. Treatment can include enhancing positive communication, rest and relaxation, testosterone injections, or limiting alcohol consumption prior to sexual activity. Sensate focus exercises might help a woman explore her sexual feelings and increase her comfort with her partner. Treatment can also involve improving relationship satisfaction and teaching the woman how to communicate her sexual needs.
Teaching the woman how to masturbate is also a frequent therapeutic option. The rationale behind masturbation as a therapeutic technique for a nonorgasmic woman is that masturbation is the behavior that is most likely to produce orgasm and can enable her to show her partner what she needs. Masturbation gives the individual complete control of the stimulation, provides direct feedback to the woman of the type of stimulation she enjoys, and eliminates the distraction of a partner.
