Sexual Dysfunctions in Women

Overview

A woman’s sexuality is a complex interplay of physical and emotional responses that affects the way she thinks and feels about herself. When a lady incorporates a sexual drawback, it can impact many aspects of her life, including her personal relationships and her self-esteem. Many women are hesitant to talk about their sexuality with their health care professionals, and many health professionals are reluctant to begin a discussion about sexuality with their patients. Instead, ladies could needlessly suffer in silence once their issues may well be treated.

Sexual activity includes a good type of intimate activities, like arousal, self-stimulation, oral sex, epithelial duct penetration and intercourse. Every lady differs in her sexual interest, response and expression. A woman’s feelings concerning gender will modification in step with the circumstances and stages of her life. Women can also expertise a range of sexual issues, like lack of want, issue turning into aroused, issue having associate degree consummation or pain throughout sex. When a physical or emotional drawback related to sex persists, it is time to contact a health care skilled.

Characteristics of Sexual Arousal: Scientific Research

Early Research: Masters & Johnson
Research on the sexual response in the mid-1960s by Masters & Johnson established what is known as the traditional linear sexual-response cycle: desire-arousal-orgasm-resolution. The stages are defined as follows:

• Excitement/Arousal: The sensation that you simply wish to own sex, followed by physical changes that occur in your body as you become sexually excited. These include moistening of the vagina; relaxation of the muscles of the vagina; and swelling of the labia, (skin folds that are part of the vulva), and the clitoris (a small, sensitive organ higher than the channel, wherever the inner labia, which surround the vagina, meet). The nipples also become erect.
• Plateau: The above changes in the genitals continue, there is an increase in blood flow to the labia, the vagina grows longer, and glands in the labia produce secretions. There is an overall increase in muscle tension.
• Orgasm: Known as the peak of the sexual response, the muscles of the vagina anduterus contract leading to a strong, pleasurable feeling.
• Resolution: You return to your normal state.

Contemporary Research: Rosemary Basson, MD

More up to date analysis suggests that a woman’s sexual response is each additional complicated and varied than this model suggests, notably once the girl is concerned in a very long relationship. In 2002, the leader in this field, Rosemary Basson, MD, introduced a new cycle for the female sexual response that focuses on women’s need for intimacy.

These differences are important to understanding your sexual health as well as for accurately diagnosing and treating sexual dysfunction. The variations, in part, embrace recognizing that women’s sexual responses square measure connected additional to relationship and intimacy than to physical wants, and that the orgasm stage can be highly variable for women without actually being “dysfunctional.”

In addition, it’s important to distinguish a woman’s sexuality and sexual response from a man’s. In men, wondering sex interprets to erection, but in women, arousal often comes about after the actual lovemaking begins. In other words, a woman may start out making love with her partner somewhat uninterested, but as things progress and she focuses on the stimulation and sensations she’s feeling, she becomes increasingly more aroused.

Sexual Dysfunctions in Women
Sexual dysfunctions are disturbances in one or more of the sexual response cycle’s phases or pain associated with arousal or intercourse. A study revealed within the Journal of the yank Medical Association (JAMA) involving a national sample of one,749 women estimated that sexual dysfunctions occur in 43 percent of women in the United States. According to this 1999 study, you’ll be at larger risk for sexual issues if you are:

• single, divorced, widowed or separated
• not a high school graduate
• experiencing emotional or stress-related problems
• experiencing a decline in your economic position
• feeling unhappy, or physically and emotionally unsatisfied
• a victim of sexual abuse or forced sexual contact

Causes of Sexual Dysfunctions
There are several types of sexual dysfunctions. They can be womb-to-tomb issues that have continually been gift, noninheritable issues that develop when a amount of traditional sexual perform or situational issues that develop solely underneath bound circumstances or with certain partners. Causes of sexual dysfunctions may be psychological, physical or related to interpersonal relationships or sociocultural influences.

Psychological causes can include:

• stress from work or family responsibilities
• concern about sexual performance
• depression/anxiety
• unresolved sexual orientation issues
• previous traumatic sexual or physical experience
• body image and self-esteem problems

Physical causes can include:

• diabetes
• heart disease
• liver disease
• kidney disease
• pelvic surgery
• pelvic injury or trauma
• neurological disorders
• medication side effects
• hormonal changes, including those related to pregnancy and menopause
• thyroid disease
• alcohol or drug abuse
• fatigue

Interpersonal relationship causes may include:

• partner performance and technique
• lack of a partner
• relationship quality and conflict
• lack of privacy

Sociocultural influence causes may include:

• inadequate education
• conflict with religious, personal, or family values
• societal taboos

Types of Sexual Dysfunctions

Lack of physical attraction is that the most typical sexual drawback in ladies. The Association of procreative Health Professionals reports within the National Health and Social Life Survey that thirty three p.c of ladies lacked interest in sex for a minimum of a couple of months in the previous year.

The American College of Obstetricians and Gynecologists (ACOG) reports that a woman’s sexual response tends to peak in her mid-30s to early 40s. That’s to not say, however, that a woman can’t have a full physical and emotional response to sex throughout her life. Most women can have a passing sexual drawback at some purpose in their lives, and that is normal. However, sexual dysfunction in its true sense is most common in women aged 45 to 64.

Often, physical attraction is littered with a woman’s relationship together with her sexual partner. The additional a lady enjoys the connection, the greater her desire for sex. The stresses of daily living will have an effect on want, however, and sometimes feeling bored with sex isn’t any cause for concern.

• Hypoactive Sexual Desire Disorder: When sexual fantasies or thoughts and desire for sexual activity are persistently reduced or absent causing distress or relationship difficulties, the problem is known as hypoactive sexual desire disorder, or inhibited sexual desire disorder. The Merck Manual estimates inactive desire disorder happens in regarding twenty p.c of girls.
• Sexual aversion disorder: Diagnosed after you avoid all or most reproductive organ sexual contact with a sexual partner to the purpose that it causes personal distress and relationship difficulties. This condition could have an effect on girls United Nations agency have seasoned some style of sex offense or United Nations agency grew up in a very rigid atmosphere during which sex was taboo. A study within the journal Archives of Sexual Behavior found that among patients with anxiety disorder, seventy five p.c had sexual issues, which sexual aversion disorder was the foremost common criticism, moving fifty p.c of girls with the disorder.
• Sexual arousal disorder: The persistent or repeated inability to achieve or sustain the lubrication and swelling reaction within the arousal part of the sexual response to the purpose that it causes personal distress. It is the second most common sexual problem among women, affecting an estimated 20 percent of women, and most frequently occurs in postmenopausal women. Low oestrogen levels once biological time will build duct tissue dry and skinny and cut back blood flow to genitalia. As a result, the arousal part of the sexual response could take longer and sensitivity of the duct space could decline. However, this can happen at any age.
• Female orgasmic disorder: The persistent absence or repeated delay in orgasm once adequate stimulation and arousal, inflicting personal distress. According to the Association of generative Health Professionals, twenty four to thirty seven p.c of girls have issues reaching climax. Most women are biologically able to experience orgasm. Never having Associate in Nursing climax, or not having one in bound things, are problems that can often be resolved by learning how the female body responds, how to ensure adequate stimulation and/or how to overcome inhibitions or anxieties. Some medications, including but not limited to those used to treat highblood pressure, depression and psychosis, can reduce your sexual desire and sexual arousal and interfere with orgasm. If you’re taking such medicine and experiencing sexual facet effects, speak together with your health care skilled regarding ever-changing your dose or prescription.

Another style of arousal disorder has the alternative result. Some girls could perpetually feel sexually aroused, Associate in Nursing expertise which will be quite uncomfortable and displeasing. Although most health care professionals recognize hyperactive sexual desire as a problem, it is not an official condition according to the DMS-IV. Women United Nations agency have a active sexual drive tend to be terribly exacting sexually as a result of their need for sex is constant.

Sexual Disorders Involving Pain

Dyspareunia: Pain during or after intercourse, called dyspareunia, occurs in nearly two out of three women at some time during their lives, according to ACOG. Like alternative sexual disorders, it can have physical and/or emotional causes. The most common reason behind pain throughout sex is insufficient duct lubrication occurring from an absence of arousal, medications or secretion changes. Painful sex also can be a sign of illness, infection, cysts or tumors requiring medical treatment or surgery, another reason why you should discuss the problem with your health care professional.

Vaginismus: The involuntary spasm of the muscles at the opening of the vagina, making anything entering the vagina painful. Vaginismus can have medical causes, including:

• scars in the vagina from an injury, childbirth or surgery
• irritations from douches, spermicides or latex in condoms
• pelvic infections

Vaginismus also can have psychological causes. It can be a response to a fear, such as fear of losing control or fear of pregnancy. It can also stem from pain or trauma such as rape or sexual abuse.

Vulvodynia: Defined as any pain in the vulva. It could be outside the vulva on the labia or an itching, burning or sharp pain within.

Treating Sexual Dysfunctions
If your relationship or sexual drawback is new, strive having Associate in Nursing open, honest speak together with your partner to alleviate issues and clear up disagreements or conflicts. Women who learn to tell their partners about their sexual needs and concerns have a better chance at a more satisfying sex life. If the sexual problem persists, discuss your concerns with your health care professional. Most sexual problems can be treated.

Diagnosis

Treatment for sexual dysfunction depends on the cause of the problem. If the cause is physical, medical treatment is aimed at correcting the underlying disorder. If the cause is psychological, treatment consists of counseling. Treatment can include a combination of medical and psychological approaches.

Sometimes, treatment may be behavioral. For example, with loss of want, changes in the environment, timing, lovemaking techniques or foreplay can produce desire. With arousal disorder, the employment of toys and vibrators will facilitate with canal circulation. A warm bath and a massage from your partner can also help.

Medical Treatment

• Lubricating creams, gels or suppositoriesIf you are suffering from vaginal dryness caused by medications, a chronic condition or declining estrogen levels, your health care professional may suggest water-based, over-the counter vaginal lubricants such as Astroglide or K-Y Jelly to make sex more comfortable. Or you might try Replens, a long-acting vaginal moisturizer that releases purified water to produce a moist film over the vaginal tissue. Do not use oil-based product, like mixture, baby oil or mineral oil with latex condoms because they can cause a condom to break.
• Topical estrogenFor menopausal women with vaginal thinning, dryness or insensitivity, your health care professional may prescribe an estrogen cream such as Estrace or Premarin, or a vaginal ring, such as Estring, Phadia (low-dose) or Femring (higher dose), to ease sexual discomfort. And a canal pill (Vagifem) containing oestrogen, a kind of steroid, is out there by prescription for canal waterlessness. Unlike creams, that sometimes square measure used in the dark, Vagifem can be inserted any time of day.
• Hormone therapyFor menopausal women, hormone therapy (either a combination of estrogen and progestin or estrogen-only therapy) may improve the sensitivity of the clitoris, ease discomfort caused by vaginal thinning and dryness and improve blood flow to the pelvic area. In addition, endocrine medical aid (HT) will facilitate relieve different pestiferous biological time symptoms, including hot flashes, which can interfere with intimacy. A woman shouldn’t take any sort of HT till she has weighed the execs and cons and mentioned the risks and advantages along with her doctor. Because of the potential risks that go along with HT, the U.S. Food and Drug Administration (FDA) now advises health care professionals to prescribe it at the lowest possible dose and for the shortest possible length of time to achieve treatment goals.Although HT can result in increased sensitivity and decreased discomfort during sex for menopausal women, the therapy may not improve sexual desire. Some health care professionals add androgenic hormone, a endocrine created by the ovaries and adrenal glands that plays a job in concupiscence, to HT to stimulate arousal. Treatment with testosterone is controversial, however. Estratest, associate degree estrogen/testosterone combination, is presently the sole androgenic hormone treatment obtainable. However, there is conflicting evidence and opinion in the medical community concerning whether or not the benefits of the drug outweigh the risks, which include increased risk of breast and carcinoma, adverse effects on blood sterol and liver toxicity. Studies on other androgen products used to treat sexual dysfunction have also had mixed results.Although there is no FDA-approved form of testosterone available to treat women’s sexual dysfunction, many doctors order it “off label” in little amounts, particularly for women whose ovaries have been removed. Removing the ovaries drastically reduces androgenic hormone levels, and some research shows that women who have had their ovaries removed are most likely to benefit from androgen therapy.Supplementing with testosterone has potential risks. In too high a dose, testosterone can produce masculinizing effects, such as increased facial hair and enlargement of the clitoris. The oral form can also produce liver damage, acne and a decrease in HDL cholesterol (the “good” cholesterol). The use of androgenic hormone in men and girls is extremely moot, so be sure to discuss with your health care professional whether androgen supplementation is right for you.

Clitoral therapy device

The Eros erectile organ medical aid device is associate degree FDA-approved device designed to treat feminine arousal disorder. It consists of atiny low, soft suction cup attached to a palm-sized, battery-operated vacuum pump. The suction cup is placed over the clitoris before sex. The light vacuum will increase reproductive organ blood flow, thus increasing sexual arousal and enhancing orgasm. Studies have shown that the Eros erectile organ medical aid device effectively boosts sensation, orgasms, lubrication and overall sexual satisfaction. The device is available by prescription.

Vaginal weights

Women with orgasmic disorders might like treatment with canal weights. Vaginal weights square measure accustomed strengthen the girdle floor muscles, improving awareness of sexual response and also potentially correcting urine leakage, which can cause problems during sexual activity.

Vaginal weights square measure sometimes obtainable in sets of 5. To use them, you insert the lightest weight and remain upright for 15 minutes, two times a day. When the weight is in place, you should feel the urge to hold it in. After a few days, as the muscles strengthen, this urge will go away, and you will be able to move up to the next weight. When you get to the fifth weight, you will insert it for five to seven consecutive days each month to maintain strength in your pelvic muscles.

Sildenafil (Viagra)

The drug that treats erectile dysfunction in men is also being studied in clinical trials for female sexual arousal disorder. Some studies have found it should increase blood flow to the feminine reproductive organ space and increase relaxation of erectile organ and canal muscles. However, many giant placebo-controlled studies as well as concerning three,000 women with female sexual arousal disorder had inconclusive results. Therefore, the manufacturer of virility drug has determined to not obtain office approval to use the drug for feminine arousal disorder.

Other Medical Approaches

Better management of chronic diseases, switch prescriptions to cut back facet effects and treating epithelial duct infections by taking antibiotics will eliminate sexual issues associated with want, arousal, sexual climax and pain. On terribly rare occasions, surgery is also required to get rid of structural issues, like cysts, tumors or growths that manufacture pain throughout sex.

Psychological Treatment

Psychological treatment for sexual disfunction sometimes involves a series of steps distinguishing and modifying emotions and behaviors that interfere with sexual response, dynamic behaviors that act as barriers to sexual responsiveness and learning new physical and emotional behaviors that encourage sexual responsiveness.

Sex medical care is speak medical care within which you and your counselor, beside your partner, discuss issues, however and why they occur and ways in which to unravel them. You and your partner receive exercises and techniques to do reception, then report on the results at the subsequent session. Depending on your wants, goals and designation, such counsel generally will involve a one-hour session once per week for regarding 2 to 6 months.

Poor communication between partners is commonly gift with sexual disfunction. Learning to speak, resolution conflict and handling negative emotions ar the main focus of medical care designed to handle this issue. Group therapy or support teams additionally is also counseled.

Behavioral changes may also help. These include: changes within the setting, love creating at totally different times of the day, warm baths, autoeroticism, massage and also the use of sexual toys and vibrators.

Sensate focus exercises ar usually counseled by therapists to treat arousal disorder and sexual climax disorder. These exercises assist you and your partner relate to every different physically with none pressure to perform sexually. You begin by touching one another, slowly about to reproductive organ stimulation and presumably eventually continuing to intercourse.

Learning the functions of sexual organs and the way the body responds sexually, as well as clitoric and epithelial duct stimulation, will facilitate with arousal and sexual climax disorders. Kegel exercises will strengthen voluntary management of girdle muscles, rising the sense of management and quality of orgasms.

Treatment for contraction (involuntary spasm of the muscles at the epithelial duct opening) might specialise in techniques to relax the duct. One possibility is victimization dilators in graduated sizes that ar placed into the duct and unbroken in situ for ten minutes. The woman usually places the dilators herself. Performing workout whereas the dilator is in situ helps you learn to regulate your epithelial duct muscles. The exercises also can be done with your fingers. Sometimes, anticipating the muscle to relax once penetration might facilitate.

FSD Research

Research is progressing on a couple of drugs aimed at helping women with sexual problems. At a recent meeting of the International Society for the Study of Women’s Sexual Health, a study was released on bremelanotide, a drug undergoing trials for treatment of female sexual dysfunction (FSD). In the trials, the drug was well-tolerated and inflated arousal, want and also the range of sexually satisfying events in ladies with inactive physical attraction disorder (HSDD) and ladies with both HSDD and female sexual arousal disorder. The final phase of testing could start near the end of this year.

Another drug that’s being studied for potential treatment of overall sexual perform is tibolone. It is a synthetic steroid currently used in Europe and Australia to treat postmenopausal osteoporosis, but, in one study, it was also shown to enhance sexual function in postmenopausal women. It has not been approved for use in the United States because of concerns over increased risk of breast cancer and stroke.

Studies also are looking at the effectiveness of phosphodiesterase inhibitors, the class of drugs that includes sildenafil (Viagra). So far, results show little effectiveness in treating FSD, but these drugs may help women who experience sexual dysfunction as the result of taking certain antidepressants. However, sildenafil should not be taken by anyone using nitroglycerin for angina.

Prevention

A healthy life-style will go an extended means toward preventing chronic diseases and diseases which will contribute to sexual disfunction. Eating a diet, getting plenty of exercise, stopping smoking, limiting alcohol consumption and controlling stress will help you feel well, build a healthy self-image, boost your energy and help you maintain confidence in your sexuality. Visit your health care skilled frequently to avoid medical issues which will have an effect on your sexual responses.

Other things you can do to enhance your sexual desire and pleasure include:

• Communicate with your partnerEmotional intimacy is the essential beginning for sexual intimacy for many women. Talk frankly and honestly about your feelings with your partner to help build your relationship. Silence may end up in pent-up feelings, anger and alienation that can harm your well-being and even your long-term mental and physical health.
• Express your desiresTell your partner what you want sexually and what “turns you on,” and guide your partner to do those things that please you.
• Be less predictable and more spontaneous in your sexual experiencesPartners who have been together for years can get into patterns in which sex is always the same. Try new ways in which to couple, and prolong your sexual experience by being more creative with touching, positions, timing and location of sexual activities.
• Examine your prioritiesDon’t let work or family responsibilities take time away from your relationship with your partner. Spending time together is part of building intimacy and helps both partners feel connected to each other.
• Stay sexually active after menopauseRegular sexual activity, with a partner or through self-stimulation, can improve vaginal lubrication and elasticity as estrogen levels decline.

Sexuality is very personal and varies from girl to girl. A woman’s sexual responses will vary from only once to a different, and no one pattern is more “normal” than another. Nearly everyone has a problem with sex at some time in their lives, and often the problem can be worked out with patience and talking with your partner. When the problem is life-disrupting, causes trouble in your relationships or involves physical pain, it’s time to talk with your health care professional. In several cases, your sexual downside may be treated with medical treatments, psychological medical care or each.

Facts to Know

1. Sexual problems occur in 43 percent of women in the United States, according to a study published in 1999 in the Journal of the American Medical Association.
2. A lack of desire is the most common sexual problem in women The Association of Reproductive Health Professionals reports that in the National Health and Social Life Survey, 33 percent of women lacked interest in sex for at least a few months in the previous year.
3. Sexual arousal disorder is the second most common sexual problem among women, affecting an estimated 20 percent of women.
4. Twenty-four to 37 percent of women have problems reaching orgasm, according to the Association of Reproductive Health Professionals.
5. Pain during or after intercourse occurs in nearly two out of three women at some time during their lives, according to the American College of Obstetricians and Gynecologists.
6. Low estrogen levels can cause vaginal dryness, thinning of vaginal tissues, reduced blood flow to genital areas and reduced vaginal sensitivity that can contribute to arousal and, in turn, orgasm problems. Low androgen levels may contribute to desire problems. Hormone therapy often can help.
7. The most common cause of pain during sex is inadequate vaginal lubrication, which can occur from a lack of arousal, medications or hormonal changes.
8. It is common for women who breast-feed to notice a lack of vaginal lubrication and sexual interest caused by an elevation of the hormone prolactin, which is stimulated by lactation.
9. Sexual disorders can have medical causes, psychological causes or both.
10. One way women can help prevent sexual dysfunction is to have sex frequently. Sexual activity increases blood flow, which leads to better overall sexual function.

Key Q&A

1. What is the sexual response cycle?Masters & Johnson, pioneering sex therapists, defined a classic sexual response cycle in the mid-1960s. The stages of this model are:
   • Excitement/Arousal: The feeling that you want to have sex followed by physical changes that occur in your body as you become sexually excited. These include moistening of the vagina, relaxation of the muscles of the vagina; swelling of the labia, (skin folds that are part of the vulva) and the clitoris (a small, sensitive organ above the vagina, where the inner labia, which surrounds the vagina, meet that acts as a source of sexual excitement). The nipples also become erect.
   • Plateau: The above changes in the genitals continue, there is an increase in blood flow to the labia, the vagina grows longer, and glands in the labia produce secretions. There is an increase in muscle tension.
   • Orgasm: Known as the peak of the sexual response, the muscles of the vagina and uterus contract leading to a strong, pleasurable feeling.
   • Resolution: You return to your normal state.

   However, it’s important to point out that more contemporary research suggests that women’s sexual response is more complex and includes more elements than the traditional model outlines. Relationship and intimacy needs appear to play a greater role in women’s sexual health. According to sexual health experts, a better understanding of the complexity of women’s sexuality will help to more accurately diagnose and treat sexual dysfunction.

2. How do I know if I have sexual dysfunction?Sexual dysfunctions are defined as one or more disturbances in the sexual response cycle, or pain associated with arousal or intercourse. Lack of desire, difficulty becoming aroused, lack or delay in orgasm or pain during or after sex are all examples of sexual problems faced by women. Such problems can be occasional and seem to go away on their own. But when they are persistent or recurrent, disrupting your life or your relationships and causing you emotional upset, they may be dysfunctions that should be discussed with your health care professional.
3. What causes sexual dysfunctions?Causes of sexual dysfunctions can be physical, psychological or related to interpersonal relationships or sociocultural influences. Psychological causes can include:
   • stress or anxiety from work or family responsibilities
   • concern about sexual performance
   • conflicts in the relationship with your partner
   • depression
   • unresolved sexual orientation issues
   • previous traumatic sexual experience
   • body image and self-esteem problems

   Physical causes can include:

   • diabetes
   • heart disease
   • liver disease
   • kidney disease
   • pelvic surgery
   • pelvic injury or trauma
   • neurological disorders
   • medication side effects
   • hormonal changes, including those related to pregnancy and menopause
   • thyroid disease
   • alcohol or drug abuse
4. How are sexual dysfunctions treated?Treatment depends on the cause. If the cause is physical, the treatment will be aimed at correcting the medical or biological problem. For example, if the cause is hormonal imbalance, hormonal supplements may be prescribed. If the cause is a structural problem, such as a cyst or tumor, surgery may be needed. Sometimes, treatment can involve changes in behavior. Better control of chronic illnesses and disease often solves sexual problems associated with them.Some medications can cause sexual problems, and changing prescriptions to those with fewer side effects can treat the problem. Regardless of the cause, counseling, ideally with a sexual therapist, is recommended and should include both partners together. Treatment can include both treating the physical or medical problem and counseling.
5. I just don’t feel like having sex anymore. Is there something wrong with me?Lack of desire is the most common sexual problem in women. It can be caused by problems in a woman’s relationship with her partner, stress, fatigue, medications and low levels of the hormones estrogen or androgen. Often, lack of desire is affected by a woman’s relationship with her sexual partner. The more a woman enjoys the relationship, the greater the desire for sex.The stresses of daily living can affect desire, and occasionally feeling uninterested in sex is no cause for concern. But, when sexual fantasies or thoughts and desire for sexual activity are persistently or recurrently reduced or absent and cause distress or interpersonal difficulties, the problem is known as hypoactive sexual desire disorder or inhibited sexual desire disorder.If you are approaching menopause (a time frame, typically in a woman’s mid- to late 40s, known as perimenopause) or have reached menopause, declining estrogen levels can cause vaginal lubrication problems that make sex uncomfortable, and, as a result, less desirable to you. Changing hormone levels during and after pregnancy can also contribute to decreases in sexual desire. Talk with your health care professional about your problem and what treatment may be best for you.
6. Does menopause mean the end of my sex life?No. Many women find the end of their reproductive years sexually invigorating because they no longer face the risk of pregnancy. Plus, regular sexual activity for postmenopausal women improves vaginal lubrication and elasticity after estrogen declines. However, menopause can bring bodily changes that contribute to arousal problems, and in turn, orgasm problems. Low estrogen levels can cause vaginal dryness, thinning of vaginal tissues, reduced blood flow to the genital area and reduced vaginal sensitivity. Postmenopausal women often find the arousal phase of the sexual response cycle takes longer or is less intense.Changing hormone levels also can produce mood swings and emotional upsets that make some women nearing menopause feel less interested in sex. Hormone replacement therapy relieves these symptoms for many perimenopausal women. Using over-the-counter vaginal lubricants may help with dryness problems. Discuss your treatment options with your health care professional, particularly the latest research regarding the safety of HT and ET and how the risks and benefits affect your personal health needs.
7. I have pain during intercourse. Should I see my health care professional about it?Yes, especially if the pain is felt deep inside the vagina, lower back, pelvis, uterus or bladder. Pain associated with sexual activity can be a sign of a medical problem that needs treatment. Deep pain can be a sign of pelvic inflammatory disease, endometriosis, a pelvic tumor, ovarian cysts, bowel or bladder disease or scar tissue.Pain felt in the vagina can be caused by inflammation from an infection or sexually transmitted disease, but it is most commonly caused by lack of vaginal lubrication. Pain felt at the opening of the vagina can be a sign of infection, cysts or scarring. Such vulvar pain also can be caused by irritation from soaps or feminine hygiene products.
8. What kinds of medications can cause sexual problems?Blood pressure, antipsychotic and certain antidepressant medications are commonly prescribed drugs that can interfere with the sexual response. Birth control pills change your hormone levels and can cause a decrease in desire or vaginal dryness.

   Anti-estrogen hormonal medications for breast cancer or drugs used to prevent recurrence of breast cancer, such as tamoxifen (Nolvadex), also can produce vaginal dryness and difficulties with vaginal penetration. Chemotherapy for cancer can impair many bodily functions and responses, including sexual desire and arousal. Anti-convulsants for seizures also can cause sexual problems.