What are they?
Sexual problems in women are common. They are estimated to affect around one-third of young and middle-aged women and about half of older women.
The main types include:
- A lack of sexual desire
- A lack of sexual arousal
- Problems with orgasm
- Pain during or after sex
Lack of desire and/or arousal
A lack of sexual desire (or ‘sex drive’) is often described as a loss of libido and many women can experience a variety of symptoms. A lack of sexual arousal (not feeling ‘turned on’) may result from a lack of vaginal lubrication, a relationship worry or ill health. A lack of sexual desire and a lack of sexual arousal often occur together. And treatment of one often improves the other. It is important you see your doctor to describe the symptoms you are having as there are a variety of treatments available (see our factsheet ‘Lack of sexual desire/arousal’).
Problems with orgasm
These include never having an orgasm, delayed or infrequent orgasms, and a reduction in the strength of orgasmic sensations. While some women do not need to have an orgasm to enjoy sex, this may be a real problem for others and their partners (see our factsheet ‘Problems with orgasm’).
Pain during or after sex
Some women can experience pain during sex. This may be due to reduced vaginal lubrication and insufficient foreplay before penetration. It can become a problem and stop a woman from having or enjoying sexual intimacy (see our factsheet ‘Pain during/after sex’).
How are they treated?
Treatments for sexual problems in women can be divided into those that are hormonal and those are non-hormonal. It is important to remember that relationship issues are also important and should be considered.
You may want to try helping yourself increase your desire and/or arousal, or experiment to find out what helps you orgasm or makes sex less painful. Sexual or erotic materials of all kinds are now easy to find online. These include books, DVDs, vibrators, clitoral stimulators, erotic games and lingerie.
Sex therapy is talking therapy where an individual or couple work with an experienced therapist to assess and treat their sexual and/or relationship problems. Together they will identify factors that trigger the problems and design a specific treatment programme to resolve or reduce their impact.
Sex therapy is considered highly effective in addressing the main causes and contributing factors of sexual difficulties. And it helps people to develop healthier attitudes towards sex, improve sexual intimacy, become more confident sexually, and improve communication within the relationship.
Sex therapy can also be used in combination with other forms of treatment.
Your GP or another health professional on the NHS may be able to refer you for sex therapy (depending on area), or you can contact a therapist directly and pay privately. It is important to make sure that they are qualified and are registered with an appropriate professional body. You can find more information on sex therapy in our factsheets ‘Sex therapy’ and ‘How to find, choose and benefit from counselling support’
Vaginal lubricants and moisturisers
If vaginal dryness is a problem this may be improved with lubricants and moisturisers.
Vaginal lubricants are used at the time of sexual intercourse. There are many different kinds available and they can be bought over-the-counter. Some are also available on prescription. They may be water-based (e.g. KY® Jelly), silicone-based (e.g. Replens™ Silky Smooth Personal Lubricant) or oil-based (e.g. peach kernel or sweet almond oils). The oil-based products may damage the latex in condoms, and it’s important to remember this if you want to prevent a pregnancy or sexually transmitted infection (STI). Some lubricants may feel better and last longer than others, so it is worth trying the different types to see which works best for you.
Vaginal moisturisers (e.g. Replens™ Longer Lasting Vaginal Moisturiser) help retain moisture in the vagina. These can be applied regularly and at least 2 hours before sex. They are available over-the-counter or on prescription.
Flibanserin (addyi™) is a new drug for treating low sexual desire. It has to be taken every day and should not be combined with alcohol. It was approved for use in the United States in 2015 but has not been approved for use in the UK yet. Women should always see their doctor before using this medication to ensure there are no health or medical concerns contributing to the symptoms.
Treating other conditions such as diabetes or depression may also help improve sexual problems.
Oestrogen levels fall after the menopause and after trauma to the pituitary gland in the brain (usually the result of a head injury, subarachnoid haemorrhage or radiation to the head.) Oestrogen replacement can be given either systemically to increase levels throughout the whole body, or vaginally to increase levels in this area only.
Systemic oestrogen, which can be given by tablet, patch or skin gel, will also help other menopausal symptoms such as hot flushes. Vaginal oestrogens are inserted into the vagina and come as a tablet, ring or cream. Long-term treatment is needed, because symptoms will return if the treatment is stopped.
In women, testosterone is produced naturally in the ovaries and adrenal glands, and it is linked to female sexual function. A loss of sexual desire may be associated with a drop in testosterone levels. When a woman has her ovaries removed surgically (oo-phorectomy), her levels of testosterone suddenly fall.
Several studies have shown a benefit of testosterone therapy in women who have been through the menopause, but mainly in those using oestrogen. In the UK, the only licensed testosterone treatment for many years was an implant put under the skin using local anaesthetic. Testosterone gel and testosterone patches have also been used, but the patches have been withdrawn and the gel is not licensed for use in women.
Tibolone (Livial®) is often classed as a type of hormone replacement therapy (HRT). It is a man-made steroid with similar effects to the female hormones oestrogen and progesterone as well as testosterone. It can improve menopausal symptoms such as hot flushes and can improve lack of libido (‘sex drive’).
While women may find sexual problems difficult to talk about and very isolating, help is available. You can try to help yourself or see a sex therapist as discussed above. But if a sexual problem continues long term and is causing you distress, it is sensible to see your GP. They are trained to deal with these and can examine you for any physical problems and check your general health.
If possible, share your concerns with your partner and see if you are able to seek help together. You should be welcomed either on your own or as a couple when you ask for help from your GP, local hospital clinic or sex therapist (NHS or private).
Where can you get more information?
The Sexual Advice Association is here to help. We cannot give individual medical advice, but we can answer your questions on any sexual problems and put you in touch with local specialist practitioners. We also have a number of factsheets and booklets on sexual problems and related issues for men and women that can be downloaded from our website or requested. Please feel free to email us or phone our Helpline (our contact details are at the bottom of this page).
You can also visit the NHS Choices website at www.nhs.uk for information and advice on many different health and lifestyle topics.
What is the Take Home Message?
Sexual problems in women may be due to physical and/or psychological causes – both should be investigated.
By donating to the Sexual Advice Association, you will know that you are helping improve the lives of people living with sexual problems. If you are interested in donating, please click here or contact us for more information (details at the bottom of this page).
Thinking About Sex Day: February 14th
Launched by the Sexual Advice Association, Thinking About Sex Day (TASD) is designed to encourage everyone to think about the physical and psychological issues surrounding sexual activity.