You wish you wanted to – or you want to but it hurts. Should you bother your doctor? Can you even work up the courage? Of course! Sexual problems are worth your undivided attention.

Every woman deserves a happy, healthy sex life. If you don’t want to have sex, then you don’t have a problem. But if you’re dissatisfied, there are things you can do to change the status quo. Because some sexual problems can signal under­lying disease, you might improve your overall health – as well as your sex life -just by talking with your doctor.

What is sexual dysfunction?
Experts recognize four types of sexual problems in women:

• Lack of desire or less desire than previously,
• Problems becoming aroused;
• Difficulty having an orgasm; and
• Pain during or after sex.

Desire disorders. Many women feel less sexual desire during pregnancy, after childbirth (especially during breastfeeding) and later in life, after menopause Relationship problems, such as past or current abuse and feelings of anger or guilt, can also reduce desire. Some medical conditions, including depression, and chronic condi­tions that affect wellbeing may also result in decreased sexual drive. Chemotherapy and certain other medications, notably drugs for high blood pressure, pain, depression or anxiety, can reduce desire as well as sexual response. Or, lack of desire might simply be due to fatigue – or boredom with the same sexual routine.

Arousal disorders. Difficulty becoming sexually aroused is often related to vaginal dryness. During arousal, a woman normally has increased blood flow to the genital area. This causes vaginal lubrication, and enlargement of the clitoris and surrounding area. Both make the vagina opening wider. Postmenopausal women and women with certain conditions, including thyroid disease, diabetes and multiple sclerosis, often have reduced lubrication. Anxiety, insufficient stimulation and blood flow problems in the genital area are other possible causes.

Orgasmic disorders. If you can’t have an orgasm, or if it takes you longer to have one than you would like, consider whether you’ re experiencing guilt, anxiety, or the effects of past or current sexual trauma. Some other possible causes are sexual inhibition, ­lack of knowledge about your body’s responses, poor communication between you and your partner about what you like, and insufficient stimulation. Many women don’t have an orgasm during intercourse unless the clitoris is also being stimulated.

Sexual pain disorders. Pain during sexual stimulation is generally felt in the vulva, or at or near the opening of the vagina. It may be caused by scars, cysts, infections or irritation from soaps, vaginal sprays or douches. Pain in the vagina is often caused by dryness or inflammation (vaginitis). Vagnismus is a spasm of the muscles at the vaginal opening that causes pain on penetration. Discomfort deep within the vagina or in the pelvic region, lower back, uterus or bladder might indicate an internal physical problem, such as pelvic infection, bowel disease, bladder disease or even ovarian cysts. Guilt, anger, painful memories, and fear of pregnancy or a sexually transmitted disease may cause pain during sex if they make it hard to relax. It’s important to rule out any physical causes before tying your problem to emotions alone.

So, what you can do?

For desire disorders
Try an erotic book or video, or suggest a different sexual activity to your partner – one you’ve always wanted to try!

For arousal disorders
Hormone replacement therapy or an estrogen cream can be useful for some women, especially those with vaginal dryness or loss of genital sensation after a hyster­ectomy or natural menopause. For arousal disorders related to lack of blood flow, the Food and Drug Administration (FDA) has approved a battery-operated vacuum device, called the Eros Clitoral Therapy Device, that stimulates the clitoris and labia. Sildenafil (Viagra), well known as a treatment for male erectile dysfunction, is sometimes prescribed to women for arousal and orgasmic problems, although those are not FDA-approved uses of the drug. Studies of Viagra in women have had mixed results. Some women find that nonprescription ointments, such as Via crème or viagel, help them with arousal and orgasms.

For orgasmic problems
Self -stimulation may help you learn more about your anatomy and sexual responses. It can also give you extra stimulation before you have sex with your partner. Some women need strong stimulation with a vibrator, or prolonged stimulation for about an hour, in order to have an orgasm.

For pain during sex
Try a nonprescription lubricant and different sexual positions. When a woman is “on top”, she has more control over penetration and movement. Music, fantasies, massage or a warm bath before sex may help you relax. If the pain persists, some treatments your doctor might prescribe are vaginal cream, antibi­otics, antispasmodics and vaginal relaxation exercises.In many cases, psychotherapy can be effective for sexual problems, with or without other treatments. It’s helpful especially if you’re having problems with relationships or past abuse. In rare cases, sexual dysfunction is due to a gender identity conflict, which requires specialized counseling.

Your doctor will listen
In treating the “whole person,” family physicians recognize that sexual intimacy is an important part of your overall wellbeing. It’s natural to feel uncomfortable talking about your sex life, but your doctor is trained to respond in a caring, nonjudgmental way. In fact, most women with these problems who get help enjoy satisfying sexuality lifelong.

It makes sense
Although not considered sexual dysfunction, infertility is certainly related to women’s sexual health.

• Doctors define infertility as the inability to become pregnant during one to two years of unprotected sex.
• The most common cause is simply age. The older you are, the smaller and older your egg supply. But you may also have problems related to ovulation or your fallopian tubes.
• Men may have a reduced sperm count or poor sperm quality that can play a role in infertility, so your partner’s health will need to be checked, too.
• If you’re 35 or younger, consider talking with your doctor if you have been unable to conceive after trying for a year or more. If you’re over 35, initiate the conversation after six months.
• Treatment of infertility depends on the cause. It may include behavior changes, medication, surgery and/or procedures to assist in fertilization, such as in vitro fertilization.
• At any age, consult your physician if you notice a physical problem, such as irregular menstruation.

The Ultimate Tip!
Open and honest communication between you and your partner can contribute to a satisfying sex life, no matter what your age.