Sexual Problems in Women: Causes, Symptoms & Treatment

Sexual difficulties are common among women and can be related to the body, emotions, stress or relationships. Understanding what is happening—without shame or judgment—is often the first step towards feeling better.

Talking about sex is not always easy. Even today, many women feel embarrassed or uncomfortable discussing sexual concerns—even with their partner, doctor or therapist.

Things are slowly changing. The internet, television, magazines and social media have made conversations about sexuality more visible. Yet, for many women, sexuality remains a very private subject.

And sexuality is not just about having sex.

It is also about how we feel about ourselves, our bodies, our emotions, our need for closeness and intimacy, and the relationship we share with our partner. So when something goes wrong sexually, it can affect much more than what happens in the bedroom.

What do we mean by sexual problems in women?

A woman may have problems with sexual desire, becoming aroused, reaching orgasm, or experiencing pain during sex.

Sometimes there is a clear physical reason. At other times, emotions, stress, relationship difficulties or past experiences may be involved. Very often, there isn't just one reason—several things may be coming together.

Sexual difficulties are quite common among women, although the exact numbers vary from study to study. More importantly, having a sexual difficulty does not automatically mean that something is “wrong” with you.

Our sexual lives naturally change with age, health, relationships, pregnancy, childbirth, menopause, stress and many other life circumstances.

It becomes a problem when the change is troubling you, continues for some time, affects your wellbeing or begins to affect your relationship.

Why do sexual problems happen?

There can be many reasons.

Sometimes the body is involved

Health problems such as diabetes, thyroid or other hormonal problems, neurological illnesses and some chronic diseases can affect sexual functioning.

Menopause and the changes around it can also bring changes in desire, arousal, vaginal lubrication and comfort during sex.

Some medicines can affect sexual desire or response as well. Alcohol and substance use may also play a role.

Pain during sex, vaginal dryness, pelvic-floor problems and other gynecological conditions can make sexual activity uncomfortable—and understandably, this can affect desire too.

Sometimes the mind is involved

Our minds and bodies are closely connected when it comes to sexuality.

Stress, tiredness, anxiety and depression can all affect sexual desire and enjoyment.

A woman may also worry about her body, her attractiveness, pregnancy, sexual performance or whether she is “normal.” These worries can themselves make it difficult to relax and enjoy intimacy.

Past negative or unwanted sexual experiences can also continue to influence sexuality.

And sometimes it is about the relationship

It is difficult to feel sexually connected when there is anger, hurt, poor communication or emotional distance in a relationship.

Differences in sexual desire between partners are also very common.

This does not necessarily mean that the relationship is failing. But if the difference is causing repeated tension or hurt, it may be worth talking about.

In many women, the physical, emotional and relationship factors overlap. That is why simply looking for a physical cause may not always give us the complete answer.

What should make me pay attention?

You may want to talk to a professional if:

You have lost interest in sex and this is bothering you.
You want intimacy but find it difficult to become aroused.
You feel anxious, fearful or uncomfortable about sexual activity.
You are able to become aroused but have difficulty reaching orgasm.
Sex has become painful, burning or uncomfortable.
You have noticed a significant change in your sexual response.
You feel that something about your sexuality is troubling you, even if you cannot quite put it into words.

You don't have to wait until the problem becomes severe.

And you don't need to have a particular diagnosis before asking for help.

How do we find out what is happening?

The first—and often the most important—step is simply talking about it.

A doctor or therapist may ask about your sexual concerns, when they started, your general health, medicines, menstrual or menopausal changes, stress, emotional wellbeing and your relationship.

These conversations can feel awkward at first. But a good professional should make you feel safe rather than judged.

A physical examination may sometimes be useful, particularly if there is pain, dryness or another physical symptom.

Blood tests or other investigations may be recommended when there is a reason to suspect a medical or hormonal problem. They are not necessary for every woman with a sexual concern.

Sometimes we also look at anxiety, depression, relationship difficulties, attitudes towards sex or other emotional factors that may be affecting the situation.

How are sexual problems treated?

There is no single treatment that works for every woman.

And sometimes, the most helpful thing is simply understanding what is happening and being reassured that you are not abnormal.

Depending on the situation, treatment may involve one or more of the following:

Understanding the sexual response and what may be affecting it
Making changes in sleep, stress, exercise or alcohol use
Treating an underlying medical or gynecological problem
Reviewing medicines that may be affecting sexual function
Counseling or psychotherapy
Sex therapy
Working on communication and intimacy with your partner
Treating pain, vaginal dryness or pelvic-floor problems
Medicines or hormonal treatment when appropriate

Sometimes a woman may need help with herself, sometimes with her relationship, and sometimes with both.

The important thing is to understand what is causing or maintaining the problem rather than simply treating the symptom.

When should I seek help?

Not every sexual difficulty needs treatment.

There are times when we simply have less interest in sex because we are stressed, exhausted, unwell, going through a difficult period in life or dealing with changes in a relationship. These changes can be temporary.

But please consider seeking help if the problem:

Continues for some time
Keeps coming back
Is causing you worry or distress
Is affecting your relationship
Makes sex painful or unpleasant
Started after a new medicine or a significant health change

And if you have pain, unusual bleeding, discharge or another new physical symptom, it is particularly important to have it medically assessed.

There is no need to feel embarrassed

One of the biggest problems with sexual difficulties is that women often suffer silently.

They may think, “Maybe this is just how I am now,” or “Other women don't have this problem.”

Neither assumption is necessarily true.

Sexual difficulties are common, and there is considerable variation in how women experience desire, arousal and pleasure at different stages of life.

You don't have to be embarrassed about talking about your sexuality. Sexual wellbeing is a part of overall wellbeing.

Sometimes, simply having a safe person to talk to can be the beginning of understanding what has changed—and what can be done about it.