What are female sexual problems?

Female sexual problems can be caused by a number of social, personal and physical factors. The term covers the following:

• Lack of libido (sex drive)
• Problems having sexual intercourse
• Lack of orgasms

It is very difficult to know what constitutes 'normal' sexual function for women, which in turn makes defining sexual problems very difficult. For instance:

• Is it 'normal' to have an orgasm every time you make love?
• Is it 'normal' not to get orgasms from penetrative sex?

The fact that, for women, having an orgasm doesn't have an obvious physical result (as male orgasm does) means in some way that women's sexual response is very much different from men's.

Having said that, not being physically able to have sex at all is obviously not normal. It seems also reasonable to suggest that a woman would expect to have orgasms at some point in her sexual life. Other aspects might be considered abnormal if they are a change from what you're used to - for instance, if you completely 'go off' sex, having wanted it in the past.

How common are female sexual problems?

The first estimated figure of sufferers - 43 per cent of women aged 18-59 - was published in the Journal of the American Medical Association (JAMA) as recently as 1999, giving a much-needed boost to coverage of the issue.

In 2002, the company Datamonitor carried out research into female sexual problems. Like the JAMA report, it found that more than 40 per cent of women suffer from sexual problems, but less than 20 per cent actually seek help from their doctors.

What are the causes of female sexual problems?

Below are details of some of the different manifestations of female sexual problems, with some pointers on the possible causes and potential treatments.

Loss of sex drive

In the UK, family planning clinics and Relate clinics see large numbers of women who complain of lack of desire. It's important to stress that many of these women have no problems with having orgasms. However, they still have no real desire to have sex, and their minds are not turned on by the prospect of lovemaking. Fortunately, for many women, lack of libido is only a temporary phenomenon. Some will get over it by themselves - and a lot more can be helped by expert medical or psychosexual advice. The causes of loss of sex drive can be divided into physical causes, where there is some definite physical issue, and psychological causes. Possible physical causes include:

• Anaemia - which is very common in women, because of iron loss during their periods (and in childbirth).
• Contraception. Certain forms of contraception can reduce your sex drive - look in the leaflet that comes with your tablets, or talk to your GP.
• Generalised disorders, such as diabetes.
• Getting older. Age-related loss of sex drive tends to be gradual, although it may get more marked when you reach the menopause. Having said this, it is not uncommon for a woman's sex drive to increase after the menopause.
• Having a baby: It is natural to go off sex for a few weeks after you have a baby. If your loss of sex drive persists, it might signal postnatal depression or a problem with your relationship. This loss of sex drive could be linked to the changes in hormones that occur at this time. The general trauma of childbirth also plays a part - and after having a baby, many women are simply too exhausted to think about sex!
• Medication side effects. Some medicines, especially certain antidepressants, can reduce your sex drive.
• Other causes can include alcoholism, drug abuse and certain specific medical conditions such as hyperprolactinaemia, a disorder in which the pituitary gland is overactive.

Psychological causes are very common. It's entirely understandable that when a woman is having a bad time emotionally, she may lose interest in sex. Psychological causes include:

• Depression. You will probably lose interest in all aspects of sex, as well as other things you used to enjoy. Consider talking to your GP about whether you need counselling or antidepressants.
• Stress/anxiety. Generally reducing your stress levels may stop anxiety from interfering with your natural urges.
• Hang-ups from childhood.
• Past sexual abuse or rape.
• Latent lesbianism.
• Difficult living conditions - eg. sharing a home with parents or parents-in-law.
• Relationship problems. If this is the case, you may find that you are attracted to others but not to your partner. If you can resolve the problems in your relationship (by marriage guidance with an organisation such as Relate), you may well find the sexual side of things improves too.

What do I do if I'm suffering from lack of desire?

As yet there are no magic remedies for loss of desire. You need to work through what's causing your loss of libido, and then take the appropriate action. Far more important than any 'magic' remedy is to have the support and understanding of a partner who wants to help you defeat the problem.

It's sensible to begin by going to your GP who can discuss the problem with you and do any necessary tests.

But a very good alternative is to go to a woman doctor at a family planning clinic, since these people deal with this particular problem every day of the week and are used to sorting it out.

If psychological or relationship factors are predominant, it may well be worth going to Relate or Couples Counselling Scotland.

Pain on sexual intercourse

Pain on sexual intercourse is not uncommon and has a variety of causes. Possible causes include:

• Lack of lubrication. This may be due to lack of arousal or lack of oestrogen after the menopause or while you are breastfeeding. It can be more marked at certain times of your cycle. It tends to make intercourse painful right from the start of penetration. Try and work out what the cause is, and address that cause (such as lack of arousal) if possible. Otherwise try a lubricant - water-based if you are using a barrier method of contraception.
• Vaginismus. This is a spasm of the muscles around the opening of the vagina that makes penetration pretty much impossible. It almost always has a psychological cause, and is more common if you have had major sexual trauma such as sexual abuse or rape. Get yourself referred to a sexual dysfunction clinic with your partner.
• Vaginal infection. Common infections such as thrush can make intercourse painful all the way up your vagina. Other infections, such as pelvic inflammatory disease may cause deep pain, more marked in certain positions. If you are fairly sure you have thrush, buy treatment from your chemist. If not, consult your GP.
• Endometriosis. This can cause deep pain on intercourse as well as painful periods.
• Painful episiotomy scar after childbirth. These scars are always painful at first, but the pain should settle within a couple of months. If it doesn't, talk to your GP.

Lack of orgasm

Not having an orgasm usually has a psychological cause, causing lack of arousal. This may be because of relationship problems; anxiety; past sexual trauma; deeply ingrained negative feelings about sex (such as being taught from an early age that sex is dirty); or inadequate stimulation from your partner.

Lack of orgasm may mean that you have never had an orgasm, or that you have never had one from penetrative sex but can masturbate to orgasm. If lack of orgasm doesn't worry you, there is no reason why you should seek help. If it does, you may want to get help before it damages your relationship. There are plenty of self-help books around, but referral to a psychosexual clinic with your partner may be the most productive option.