Questions Asked by Women

Who should I talk with about my sexual dysfunction – it bothers me but I don’t know who can help me – is there a particular kind of doctor for me to see?

You should speak with your primary care physician or gynecologist (for women) regarding your sexual health. If he or she does not have a broad enough knowledge base in this field, there are physicians who specialize in sexual medicine, some of whom see only men, some only women, and some who treat both.

I have not had intercourse for years, but my husband of 40 years is not interested in sex, and neither am I. Should I be concerned?

Sexual dysfunction occurs in 43% of women. Sexual dysfunction can be associated with significant loss of self-esteem, frustration, humiliation, anger, depression, and unwanted termination of relationship. However, sexual dysfunction may cause none of the above. It should only be treated if it is associated with personal distress.

My partner has become increasingly frustrated with my lack of sexual interest. I am afraid that my marriage won’t survive if my libido doesn’t improve soon. What can I do?

Most treatments for low sexual desire are gradual and improve the desire over a period of several months. Unfortunately, stress in a relationship has often been building up for a long period and the relationship may be at a breaking point before seeking professional care. It can be very helpful to bring your partner with you whenever you see the doctor. If this is impossible, bring your partner with you during the initial office appointment. The more information that s/he receives the better. Often knowing that there is a physical reason for this problem helps the partner not to perceive the problem as a rejection or to take it as overly personal. Also, if there is tension in your relationship because of the lack of sexual activity consider couple or marital counseling. This may be a helpful outlet to discuss the situation and to seek some interim solutions.

I have three children and a husband I love very much, but I have absolutely no interest in sex. My gynecologist suggested I leave the kids with my parents and go away on a romantic weekend with my husband. I did that, and it was a tender time, but I still had absolutely no interest in sex. Why is that?

Desire is considered to be your needs and wants, thoughts and fantasies, and hunger for sexual activity. Sexual desire disorder is the persistent or recurrent deficiency (or absence) of sexual fantasies/thoughts, and/or desire for receptivity to sexual activity, which causes personal distress. Desire is related to many factors, including issues with your present or past relationships, past sexual history, partner availability, overall health, medications, and your hormonal status. A complete evaluation for someone with consistent loss of desire would include a history, physical, psychological evaluation and hormonal evaluation (estrogens and androgens, including DHEA and testosterone).

Should I force myself to be sexually active with my partner even if I am not in the mood?

This is an individual decision that only you can make. Communication with your partner before this point may be preferable. Some women do have sex out of a sense of obligation while other women find this too difficult if they are not in the mood. The important thing is to talk about the lack of intimacy in the relationship. By doing this, many couples can find other ways to maintain the emotional and physical intimacy of their relationship. If intercourse is uncomfortable, are there other sexual acts that are more acceptable and enjoyable? Are there non-sexual ways to keep the emotional closeness in a relationship? These are important questions that couples should discuss. If not, there is a danger that each individual will find him or herself becoming emotionally distant from the other.

My doctor told me to start exercising, so I bought a bicycle, but I heard that riding a bike can cause sexual problems. Is this true?

Sitting on a seat you are sitting on your ischial tuberosities or sit bones. This is a safe region to bear your body weight on your sit bones. Fat and muscle lay over the sit bones and there are no associated nerves and arteries. In contrast, straddling a bike saddle forces the rider to bear the body weight on the perineum (hidden part of the labia and clitoris). Compression of the perineum may lead to permanent nerve damage, leading to numbness and sexual dysfunction, such as loss of ability to have orgasm. To avoid injury to the perineum while riding, it is recommended to use a noseless two cheek split seat. If sexual dysfunction occurs following riding, a full evaluation is indicated.

I’ve been married to a wonderful lover for 10 years but have never had an orgasm. Is there anything that can be done?

The short answer: Try a vibrator! Orgasmic dysfunction is defined as the persistent or recurrent difficulty, delay in or absence of attaining orgasm following sufficient sexual stimulation and arousal, which causes personal distress. It is a sensory reflex that is initiated by stimulation of the genitals, with neurologic information passing into the spinal cord and then into the brain (septum of the thalamus). After appropriate stimulation is received in the brain, a spreading discharge of chemicals is released spreading upward to higher levels of the brain resulting in pleasure and spreading downward initiating motor stimulation resulting in ejaculation. In general, therefore, problems with orgasm are due to neurologic issues such as MS, injury from a bicycle saddle, hormonal issues or aging or inhibition of the reflex from psychologic stress, such as psychologic trauma or abuse. Partner issues such as premature ejaculation may also result in anorgasmia. A complete evaluation for someone with consistent anorgasmia would include a history, physical, psychological evaluation, hormonal evaluation (estrogens and androgens, including DHEA and testosterone) as well as neurologic assessment of genital sensation. If neurologic assessment if abnormal, a practical strategy to increase sensation is to use a vibrator.

My boyfriend broke up with me because sex was so painful I kept saying no and he finally got too frustrated. He bought lubricated condoms, but it didn’t help. Is there any hope for me? I am depressed about the whole situation.

Dyspareunia is defined as the recurrent or persistent genital pain associated with sexual intercourse. Recent population studies of women with sexual dysfunction have shown that approximately 14% of women have dyspareunia. Based on US population statistics, this translates into 20,000,000 American women with dyspareunia. Biologic and psychologic disorders may result in dyspareunia. Psychologic issues include history of trauma and abuse, past experiences and partner issues. Biologic issues include disorders of the clitoris such as clitoral neuroma, clitoral phimosis, clitoral fibroepithelioma, disorders of the urethra such as urethral prolapse, disorders of the labia such as dermatitis, disorders of the vestibule such as vestibular adenitis (vulvar vestibulitis) and vulvodynia, disorders of the pelvic floor such as vaginismus (pelvic floor spasm), disorders of the vagina, uterus and ovaries, such as endometriosis, fibroids and ovarian cysts. Patients with dyspareunia need a detailed history and physical examination, psychological evaluation and hormonal evaluation. Management requires specific diagnosis of the cause of the dyspareunia. In cases of vulvar vestibulitis, conservative management is tried for a period of time such as 3 months. Conservative management may include relaxation biofeedback exercises, pain management with agents such as Neurontin or topical lidocaine ointment, and hormonal management. Surgical management may follow failed attempts at conservative treatment.

Can women with complete spinal cord injuries have an orgasm?

Until a few years ago, there was a common belief that men and women with complete injuries were not capable of achieving a physiological orgasm. Instead, memories of the past, feelings of closeness and a sense of well-being were described as an “emotional orgasm” and were offered as a substitute to a physical orgasm. The research done by Marca Sipski, M.D. at Kessler Rehabilitation Center and at the University of Miami has clearly demonstrated otherwise. This ground breaking research is worth reviewing by women who see this as important. Although the physical reasons for this are still unclear, many women of all levels and with complete injuries can be orgasmic under the right conditions. Some of the factors that have been found to correlate with the ability to have an orgasm are: comfort with one’s body, persistence, knowledge about one’s sexuality and intensity of stimulation. To date, no studies have demonstrated similar results for men with spinal cord injuries.

Do Viagra, Levitra or Cialis improve sexual functioning for women with spinal cord injury?

Research is still trying to answer this question and a multi center SCI study is currently underway. Early studies with women did show that Viagra was no better than a placebo for women who had low desire and poor lubrication. Currently, the new studies with women have been redesigned to exclude women with poor desire. Thus, in addition to the SCI studies now underway, Pfizer is exploring the impact of Viagra on women with poor lubrication and normal desire. It is just a matter of time before oral medications to improve women’s sexual functioning make their debut. Today however, we just don’t have the answers.