Sexual issues are very common in women. In the United States, approximately 40 percent of women have sexual concerns and 12 percent report distressing sexual issues.
Female sexual dysfunction takes many different forms, including lack of sexual desire (low libido), impaired arousal, inability to achieve orgasm, or pain with sexual activity. Sexual dysfunction may be a lifelong problem, or it may be acquired later in life after a period of normal sexual functioning.
FEMALE SEXUAL RESPONSE CYCLE — An understanding of normal sexual response is helpful in understanding female sexual dysfunction. The female sexual response cycle is divided into four phases:
●Desire (libido) – desire to have sexual activity, including sexual thoughts, images, and wishes
●Arousal (excitement) – subjective sense of sexual pleasure accompanied by physiologic changes, including genital vasocongestion and increases in heart rate, blood pressure, and respiratory rate
●Orgasm – peaking of sexual pleasure and release of sexual tension, with rhythmic contractions of the perineal muscles and reproductive organs
●Resolution – muscular relaxation and a sense of general well-being following sexual activity
The above is a general framework for the female sexual response cycle. However, for many women, the phases may vary in sequence, overlap, repeat, or be absent during all or some sexual encounters. For an example, many women in long-term relationships report that desire is not initially present. However, it is common for such women to have desire arise as a response to pleasurable activity in the arousal phase. The desire to exercise is an analog, in that the desire to exercise is absent, but exercise is undertaken, then part way through or perhaps even after, good feelings arise.
The sexual response cycle must also be understood within an interpersonal context. While desire may be an initiating factor for sexual activity, women are often motivated by other reasons, including a wish for emotional closeness and to strengthen a relationship with a partner. Additionally, subjective satisfaction with the sexual experience may not require achieving all response phases, including orgasm.
The etiology of sexual dysfunction is often multi-factorial and may include psychological issues such as depression or anxiety, difficult within the relationship, fatigue, stress, change in roles, lack of privacy/environmental issues, history of prior physical or sexual abuse, medications, or physical problems that make sexual activity uncomfortable, such as endometriosis or genitourinary syndrome of menopause.
Unlike men’s main sexual concern, which is erectile dysfunction, women’s biggest sexual issue is low libido, or low desire.
The largest United States study of female sexual dysfunction, Prevalence of Female Sexual Problems Associated with Distress and Determinants of Treatment Seeking (PRESIDE), found low desire was reported by 39 percent of women and associated with distress in 10 to 14 percent.
Over the years of working with women, I’ve had hundreds of opportunities to listen to women’s concerns about low libido. Having examined the physical and metabolic aspects of libido, I almost always found it to be a life stage issue, an emotional issue, a relationship issue, or a fatigue/stress issue, which is not alleviated by taking a pill.
Life stage refers to a common phase in life, such as having a child. Sexual concerns such as low desire, are common during the period after having a child. In one study of over 400 women who had their first child, 83 percent reported sexual issues at three months after delivery and 64 percent at six months. Of course there are many factors to consider within this such as change in body image, change in roles as in taking on the role of mother while loosing the role of maiden, change in sleep patterns, etc.
Another life stage is becoming a caregiver for an elderly relative. The caregiver role draws upon the resources of time, energy, and emotions for a woman. This too is a common factor that decreases sexual desire for women.
The important thing to remember about life stages is that they are transient. They also require a resourceful approach. So it can be a very useful exercise to explore what life skills, strengthens, and prior experiences could be employed for this situation that are already within the person. Lastly exploring creative options as far as assistance through a life stage is helpful. This may be hiring help or hiring a counselor, calling upon family or friends, or creating a neighbor/community share group.
Low libido may arise also just out of the natural phases within a long-term relationship. Relationship duration has been found to have a major effect on sexual satisfaction. In a study of over 1800 men and women between the ages of 19 to 32 years in stable relationships, sexual activity and satisfaction declined as the duration of partnership increase. Interestingly, sexual desire over time declined only for women, while desire for tenderness declined in men and rose in women.
I have found questions such as “Are you attracted to your partner? Do you feel completely seen and accepted by your partner? Do you feel unconditional love from your partner…can they see your cellulite and yet know your soul? Do you feel relaxed with your partner? Do you laugh together? Do you play together? Do you make time for each other outside the bedroom? Do you know you come first in your partner’s life? What is your current stress level? What is your partner’s current stress level? Who do you take care of?” to be the most revealing in terms of why there is an experience of low libido.
Over the years that I served as a gynecologist, these are the questions that I found really need to be explored to have a true and lasting impact on libido. Counseling is invaluable in exploring these questions.
My best to you!
Acknowledgement: This article is not intended to exclude LBGT community, rather it is simply written from my personal and professional experience about this issue.