Sexuality plays an important role in the health and wellbeing of women across the lifespan. There are biological, psychological and social aspects to a woman’s sexuality that impact upon her experience of sexuality and sex.
Different stages of life, such as adolescence, trying for a pregnancy, pregnancy itself, and then after childbirth and menopause, all provide a good opportunity to discuss your thoughts and concerns about your sexuality.
Although normal ageing causes physical changes and the frequency of sexual activity may change, there is no reason why enjoyable and fulfilling sexual relationships cannot continue. Sometimes, there is a need to find your ‘new normal’.
Some people find it embarrassing to seek help or talk about sexual issues, but your sexuality can be an important part of who you are. If you have concerns, it is helpful to talk to someone you feel comfortable with and trust, such as your regular doctor, or a doctor or psychologist who specialises in sexual concerns.
| Aspects | What this includes | Sex can be affected by |
|---|---|---|
| Biological |
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| Psychological |
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| Social | Your culture Your community Your family Your home environment |
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When people discuss sexual function they often divide sex up into the different areas of libido (desire), arousal, orgasm and frequency:
| Libido | The desire to take part in sexual activity, either with a partner or by yourself. |
|---|---|
| Arousal | The physical response to sexual thoughts or activity such as increased blood flow to the pelvis, increase in the amount of vaginal lubrication, expansion of the vagina and increase in heart rate and blood pressure. |
| Orgasm | The climax of sexual excitement, characterised by a peak of pleasure centred in the genitals. |
| Frequency | How often you take part in sexual activities. |
Whether you have a suitable partner or not, you will have sexual needs and desires. It should be your choice as to how you express your sexuality.
Sexual problems
Just over 60% of Australian women have reported that they have had a sexual problem in the past year1. Half of women reported a lack of interest in sex, and about a quarter report pain or lack of pleasure with sex.
Sexual problems (often called sexual dysfunction) refer to a situation where you are not able to experience sex as you would like to and this causes you, and/or your partner distress.
Different types of problems often relate to the different areas of sexual functioning: libido, arousal, orgasm and frequency of sexual activity. Below are some examples of problems that impact on sexual functioning:
| Libido | Your libido may fluctuate because of:
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|---|---|
| Arousal | You may not be able to become as aroused as you would like because:
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| Orgasm |
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| Frequency | Desire discrepancy can happen in any relationship. This term describes a situation where one partner may desire or want sex more frequently than the other partner. Levels of desire change over time and are influenced by a number of factors. There is no level of desire that is ‘correct’; the challenge for couples is to find a balance that works for them. |
There are a number of causes of sexual dysfunction in women.
Some of the more common causes include:
- vaginismus – where there is involuntary spasm of the muscles of the pelvic floor
- dyspareunia (superficial and deep) – where sexual intercourse is painful
Things that increase sexual problems
| Factor | Issues that increase the likelihood of sexual problems such as reduced libido or arousal |
|---|---|
| Age | With increasing age sexual problems can also increase. |
| Menopause |
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| Medical conditions | Cancer or a pelvic/neurologic/vascular disease, other chronic medical issues. |
| Treatment/ medications |
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| Psychological function | Depression, anxiety, stress, low self-esteem, negative body image. |
| Sexual experiences | Previous sexual abuse, sexual assault or problems with sexual function. |
| Partner | Decrease in the quality or harmony of the relationship. |
| Lifestyle | Substance abuse, excess alcohol, lack of physical exercise, poor work-life balance. |
Management & treatment of sexual problems
Management of sexual problems includes:
- first, acknowledging that there is a problem (this can take courage!)
- finding an appropriately qualified health care professional to help you
- discussing a program of action appropriate to the cause of the problem:
- considering hormone replacement therapy (HRT) – if this is suitable for your particular concerns, health status and age
- changing medications to ones with less impact on sexual functioning – this may not be appropriate in the setting of cancer therapy
- treatment of reproductive or urinary symptoms
- counselling to reduce stress, improve communication and hence understanding and respect between partners
Remember that sexual concerns are common and solutions can be found. Unfortunately, there is no ‘quick fix’. As this webpage has explained, the problem often has a number of causes. The solution needs to look at all of these.
Self-help books can be a good place to start, and finding a chapter in a book that applies to you and asking your partner to read it, can be a non-threatening way to begin.
