Sexual Concerns for Women*
Sexual Desire Concerns
“I want to want.” “If I never had sex again that would be fine.” “Ever since we had this medical problem/child/crisis/change our sex life is gone.” “Everything else in our lives together is perfect – except sex.” If this sounds like you, you are not alone! This is the most common sexual concern in women. 1 in 7 premenopausal women and almost 1 in 10 postmenopausal women are distressed about low sexual desire. You read that right, younger women are usually more distressed about their low desire. Some feel they have no choice but to avoid their partner because of concerns that sex might come up (even if they love them deeply). Many attempt to fix this problem with date night, scheduled sex, or gentle touching exercises. If that was enough for you, then you would not be reading this. There is still hope.
Dr. Kranz and Mr. Rosen run an 8 week in person program specifically for couples with these problems. Sometimes people need to develop a whole new way to make sex satisfying. And sometimes there is a biological issue contributing to this problem. Mr. Rosen, Mr. Kelly and Ms. Barrett all see individuals and couples to do the deeper work to connect sexually.
At times, medical evaluation may be helpful, such as evaluation for medications that are decreasing desire as well as medications that are decreasing arousal. Often there are medication adjustments that can help. There are also two FDA approved medications for premenopausal women with distressing low desire– Flibanserin (Addyi) and Bremelanotide (Vyleesi)— in select cases these medications can be helpful. While there is no FDA approved medication for postmenopausal women, there are medical options. If you are interested in a medical evaluation or treatment to help with desire, please call for an appointment with Dr. Kranz.
Helpful books and other resources on this issue:
Getting the Sex You Want by Tammy Nelson, Ph.D.
Rekindling Desire by Barry and Emily McCarthy
Magnificent Sex by Peggy Kleinplatz, Ph.D.
Come As You Are by Emily Nagoski, Ph.D.
Debunking Desire website– take the quiz to test your knowledge about influencers on sexual desire.
Try this first
Not sure you want to try sex or relationship counseling? We understand. Counseling costs money and takes time. Perhaps you are not sure you can share your issues with another person? Again, we understand. Undertaking counseling at the wrong time is not a good idea: you should feel ready and willing to engage. If you are not, here are some activities you can try right now.
Not enough sex with your partner or your partner wants too much sex from you:
Sex is often not about sexual release. Sex is often a method to create intimacy with your partner, or a way to reduce relationship anxiety, to get a physical release – both orgasm and relaxing touch, to ensure your partner stays with you, or a way to feel good about yourself (“I am wanted”). If you can first recognize what sex is for you and reflect on this that may take some of the urgency away for a higher drive partner and may be helpful information for a partner who wants less sex. You’ve learned to navigate difficult negotiations on so many other things in your relationship– housework, parenting, financial decisions– why should this issue be any different?
Here are a few things to remember:
Working together on how to get satisfaction as well as a better understanding of what sex means for each partner can help. Low desire partners often resent sex they don’t want. Coercion and guilt can damage a relationship further. Low desire partners should recognize that high desire partners often do not know how to talk about this. They may be doing the best they can to meet their needs. Listening to each other in a forgiving way can be helpful.*
*whenever there are threats of violence or guilt tripping, force or coercion people should think about safety first.
Sexual Pain
Sex, as a rule, should not hurt, even the very first time, even after menoopause, even after childbirth, even the first time. You do not need to “just relax” “use it or lose it” or “have a glass of wine.” Unless you get pleasure from sensations of pain, there is NO reason to endure painful sex repeatedly. It is often a sign of a medical problem that needs evaluation. Unfortunately, people don’t always get the best information from all their medical providers. Because the medical providers may not know how to evaluate this concern and may not know how to treat it. Self-help is hard for this problem. There are many effective treatments for sexual pain. Sometimes treatment may include using medications and other topical treatments, physical therapy that is especially for the pelvic floor, using medical devices called dilators, and sometimes either individual or couples therapy can be helpful as well. Sometimes we also see people who have had significant difficulty tolerating gynecological exams. There are many approaches to managing this as well!
Helpful books and other resources on this issue:
When Sex Hurts by Andrew Goldstein MD, Caroline Pukall PhD, and Irwin Goldstein MD
Heal Pelvic Pain by Amy Stein, DPT
Healing Painful Sex by Deborah Coady, MD & Nancy Fish, MSW, MPH
Difficulty with Orgasm
The lack of sexual climax (orgasm) is called anorgasmia. Many factors can contribute to this problem, including sexual inhibition, inexperience, or lack of knowledge of one’s own body. Psychological contributors to anorgasmia may include guilt, anxiety, or sexual shame. Not getting enough or the right kind of stimulation is an important cause of difficulty with orgasm. It’s also important to know that many drugs or medications and chronic diseases can also result in lack of orgasm- medical evaluation may be helpful in this case.
Helpful books and other resources on this issue:
Becoming Orgasmic by Julia Heiman (an oldie but a goodie)
Sex for One by Betty Dodson PhD
A Women’s Guide to Masturbation: Getting Off by Jayme Waxman
Are You Coming: A Vagina’s Owners Guide to Orgasms by Laura Hiddinga
Article about Orgasm Concerns from The Sexual Medicine Society of North America
Persistent Genital Arousal Disorder
Persistent genital arousal disorder (PGAD) is an uncommon but very disturbing sexual concern. People with PGAD have unrelenting, unwanted, intrusive, spontaneous sensations in the genitals without thoughts of sexual desire or sexual interest. This was first described in 2001 and often is unreported as people may feel ashamed for having genital feelings that in other situations may feel like sexual arousal. PGAD is often associated with significant personal distress. There is hope– with a thorough evaluation and proper treatment, we are able to help decrease these sensations and the distress that accompanies them.
Sexual Arousal (Lubrication) Problems
A wide variety of issues can contribute to problems with arousal– from psychological and relational concerns to physical concerns. Are you having the sex you want to have? Are you able to communicate with your partner(s) about what feels good to you? Is it hard to keep your attention on satisfying sensations? Do you have vulva and vagina dryness due to menopause and low estrogen? Many medications can contribute to problems with arousal. And chronic medical illnesses such as diabetes, high cholesterol,hypothyroidism as well as cancer and its treatments can affect arousal. Childbirth, breastfeeding, and infertility treatments may also have an impact. We can help sort these reasons out and help you on your way to having more satisfying sex. We are also experts at helping couples manage and even thrive when sex is less satisfying.
For some initial things to try, please check out our page on lubricants and moisturizers.
These are just some of the most common sexual concerns we hear about. There are a wide variety of other sexual concerns — changes in genital sensation, post orgasmic illness syndrome, orgasmic headaches — the list goes on and on. If you are concerned about any aspect of your sexual experience, call us, we can help.
*We recognize that gender is a complicated and evolving topic. Often people with penises are men, but sometimes they are not. Often people with vulvas and vaginas are women, and sometimes they are not. Truly, we are all more alike than different. Language continues to be complicated in this area. Please note we care for clients where they are and respect the language each client chooses for their gender, their parts, and their identity.