How Stella Got Her Groove Back is a 1998 romantic comedy which epitomizes the lives of so many of my obstetrics and gynecology patients. Stella is a 40-something, single, working mother, who is forced to take a personal inventory of her life and try to find balance between her desire for love and companionship and her responsibilities as a mother and corporate executive.
The imbalance and chaos of day-to-day living is an ongoing struggle for many women. It affects women’s physical and mental health, including their sex drive. For many women, their sex life takes the first hit.
Hypoactive sexual arousal and desire disorder, or what many refer to as female sexual dysfunction, is an underdiagnosed group of disorders defined as persistently deficient or absent desire for sexual activity or an inability to become aroused or orgasm.
Sexual dysfunction can affect women of all ages. Midlife and post-partum women are most commonly affected, and they experience the greatest distress. College-age and elderly women are affected too, usually for different reasons. Nevertheless, women living with sexual dysfunction are frequently ignored by the medical community.
If you’re affected by sexual problems, this information can give you a basis to have a discussion with your provider and form a treatment plan that works for your individual needs and goals.
1. Medical problems may cause sexual dysfunction.
Many factors affect our sexual desire and arousal, and female sexual dysfunction is rarely caused by one condition. However, when discussing your sexual problems with your doctor, expect them to rule out medical causes first. Examples of medical problems that may cause a decrease in sexual desire include:
- An unhealed scar from a vaginal delivery
- Urinary or fecal incontinence during intercourse
- Undiagnosed endometriosis
- Vaginal infections
- Inflammation of the vulva
- Androgen or estrogen deficiency
- Undiagnosed diabetes
- Multiple sclerosis
2. Seek treatment if you experience painful sex.
Many patients in an attempt to please their partner will continue to experience painful and dissatisfying intercourse. If you regularly engage in sex that is painful, your brain begins to associate sex with pain and initiates avoidance behaviors, which can be particularly damaging to relationships. In an attempt for the body to avoid pain, women may experience an involuntary response to painful penetration called vaginismus. This is a spasm of the muscles of the vagina that can make sex hurt. The mind-body connection is real: If we neglect to discuss sexual problems, sometimes our body speaks up on our behalf. Vaginismus can be treated with expertise of a certified pelvic physical therapist.
3. Depression and anxiety may impact sex drive.
A woman’s mental health may also be an underlying cause of sexual dysfunction that needs to be discussed and recognized. Not only can a mood disorder, if left untreated, zap our sexual desire and arousal, but many of the medications used to treat depression and anxiety may affect a woman’s ability to orgasm. Depression and anxiety can be safely treated while limiting sexual side effects. However, changing or adjusting psychiatric medications should be performed under close medical supervision with your doctor. Many people choose to self-treat depression and anxiety with drugs and alcohol, and this is a poor treatment plan that will also negatively impact desire, arousal, and orgasm.
4. Unresolved trauma should be addressed.
For many women, evaluation of sexual dysfunction reveals unresolved childhood or adult issues, such as emotional, physical, or sexual abuse. Some patients have developed maladapted responses to life trauma, such as body dysmorphia and personality disorders. Therefore, it is typically necessary to work with a qualified psychologist who has expertise in trauma.
5. It’s possible to get your groove back.
Treatment should be directed first and foremost on self-discovery. Be like Stella. Sex is a vital part of the human experience, but there are many other factors that contribute to healthy relationships too. Focus on eliminating pain, increasing pleasure, and improving satisfaction – not creating the perfect genital response.
Representations of sex on television, in movies, and across the Internet can foster unlikely expectations about sex in our culture, and in my practice, I spend a great deal of time managing these outlooks. Sex can and should be wonderful throughout one’s adult life. However, it’s probably unrealistic to expect your partner to have sex in an elevator in the middle of a workday.
When I reflect on characteristics of patients with sexual dysfunction who have experienced the best medical outcomes, four common themes come to mind:
- Seek treatment for any underlying medical disorders, like endometriosis, depression, diabetes, or heart disease.
- Commit to getting better and be willing to make lifestyle modifications to find privacy or adjust your life situation to reduce stress.
- Acknowledge and manage any negative cultural or religious beliefs you might have about sex.
- Maintain an emotionally healthy and trusted relationship with your partner.
Women certainly have more successful treatment outcomes if they can involve their partner in their individual treatment plans. Sometimes, this involves communication training and sex therapy. It’s frequently necessary for a male partner to be evaluated by his primary care doctor or his urologist. Commitment to the belief that sexual dysfunction may be a couple’s problem is always appreciated by a woman.
Roberta Renzelli-Cain, DO, is the director of the West Virginia Center of Excellence in Women’s Health, an assistant professor of Obstetrics and Gynecology at West Virginia University, a fellow of the American College of Obstetricians and Gynecologists, a certified menopause physician by the North American Menopause Society, and an active member in the International Society for the Study of Women’s Sexual Health.
If you’re concerned about sexual dysfunction, make an appointment: 855-WVU-CARE.