Three common sexual problems women have, and what helps

When a common experience becomes a problem

A widely cited US survey by Laumann EO, Paik A and Rosen RC, “Sexual dysfunction in the United States: prevalence and predictors” (JAMA, 1999), found that 43% of women and 31% of men reported some form of sexual dysfunction. Its data were collected in 1992 from adults aged 18 to 59, so treat it as an older baseline rather than a current figure.

A much larger 2008 survey of more than 31,000 US women found almost the same share, about 43%, reporting a sexual problem. But only about 12% had a problem that caused them distress. Distress was most common among women aged 45 to 64.

That gap matters. A dip in desire, a dry spell or an uncomfortable night is common and is not automatically a disorder. Doctors diagnose a disorder only when the problem lasts around six months or longer and genuinely bothers you. Your own distress, not a number on a chart, is the line that counts.

For many women, desire does not arrive first. It often builds after touch or closeness has begun, which is a normal way for desire to work. There is more on this in our piece on the biggest myth about women’s desire.

Low desire

Low desire means less interest in sex than you used to have or would like to have, and its causes run across body, mind and daily life. In a follow-up analysis of that 2008 survey, low desire that caused distress was reported by about 10% of US women, more often than distressing arousal or orgasm problems.

Common causes include:

• Stress, relationship problems, and past painful or negative sexual experiences. Messages about sex absorbed from family, culture or religion can play a part too.
• Changes in the body, including pregnancy and a new baby, breastfeeding, perimenopause and menopause, and conditions such as endometriosis or an infection. Pain or dryness during sex can lower desire as well.
• Depression and anxiety. In the same survey analysis, about 4 in 10 women with a desire, arousal or orgasm problem also had depression, though the survey could not say which came first.
• Medicines and substances, including some antidepressants, blood pressure and heart medicines, some hormonal birth control and hormone therapy, alcohol, marijuana and opioids.

Antidepressants deserve a special note, because untreated depression can dampen desire too. Rather than stopping a medicine on your own, ask your doctor or pharmacist to review everything you take and whether a change makes sense.

What you can try: protect your sleep, look for ways to lower day-to-day stress, and make time for touch and closeness without pressure for it to lead anywhere. Talk with your partner about what is going on. A sex therapist, or couples or individual counseling, can help when stress, history or the relationship is part of the picture.

What a doctor can offer: treating the underlying cause, adjusting a medication, or, around menopause, discussing menopause hormone therapy. There are also two FDA-approved non-hormonal prescription medicines, flibanserin and bremelanotide, for premenopausal women whose low desire causes distress.

Vaginal dryness

Vaginal dryness is a lack of natural moisture in the vagina. It is often linked to falling estrogen around menopause, but it has many other causes and can happen at any age. Cleveland Clinic notes that it affects more than 15% of women before menopause and over half after it.

Arousal is part of the story. When you are not aroused, your body makes less lubrication, so rushing can leave you dry. Body and mind do not always line up, either: blood flow to the genitals can rise even when you do not feel turned on.

Beyond menopause and perimenopause, dryness can come from:

• childbirth and breastfeeding
• hormonal birth control
• some antidepressants, and cold and allergy medicines
• cancer treatment or removal of the ovaries
• smoking, alcohol and stress
• scented soaps, washes and other products
• conditions such as diabetes, lupus and Sjögren’s syndrome

Lubricant or moisturizer? They do different jobs. A lubricant goes on just before or during sex to reduce friction. Water-based or silicone-based types are the usual choices, and only those two are safe with latex condoms; oil-based products can weaken latex and may irritate. A vaginal moisturizer is for everyday dryness and is used every few days, whether or not you are having sex. Either way, allow more time for arousal.

When to see a doctor: if dryness affects daily life or sex, if over-the-counter products have not helped after about two months, or if you notice bleeding. A doctor can offer prescription options such as low-dose vaginal estrogen, ospemifene or vaginal DHEA.

Painful sex

Painful sex, which doctors call dyspareunia, is very common. ACOG, the professional body for US ob-gyns, says nearly 3 out of 4 women have pain during sex at some point, and that pain which is frequent or severe should be checked by an ob-gyn.

Where it hurts gives a clue. Pain at the entrance is often linked to dryness, irritation, an infection or tight pelvic floor muscles. Deeper pain can point to conditions such as endometriosis, pelvic floor problems, or bladder and bowel conditions.

Possible causes include:

• too little lubrication, or low estrogen after menopause or while breastfeeding
• vaginal infections and sexually transmitted infections
• skin irritation from soaps, washes or other products
• vulvodynia (ongoing pain of the vulva) and vaginismus (tightening of the muscles at the vaginal opening)
• healing after a tear or episiotomy during childbirth
• endometriosis, ovarian cysts, pelvic inflammatory disease or scar tissue

Pain is not something to push through or quietly put up with. Most causes can be treated once they are found, which is why frequent or severe pain deserves an appointment. Ongoing pain can also make orgasm harder to reach, a separate topic covered in our guide to why orgasm can be difficult for women.

At the appointment, expect questions about your health, medicines, relationships and past experiences, and usually a pelvic exam. Depending on the cause, treatment may include medicine for an infection, vaginal estrogen, ospemifene for pain linked to menopause, vaginal dilators, or pelvic floor physical therapy, where a physical therapist works with the muscles of the pelvis to help them relax.

Until then, a few things can make sex more comfortable: more foreplay, a lubricant, a different position, emptying your bladder beforehand, or a warm bath first. Intimacy without penetration counts too.

Signs you should see a doctor soon

Most of the above can be raised at a routine appointment. These signs call for a prompt one.

Sign	Why it matters
Sex suddenly becomes painful	It can point to an infection or another problem that needs checking.
You think you might have an STI	An infection needs testing so it can be treated properly.
Bleeding after sex	Bleeding is a reason to be examined rather than to keep treating dryness at home.
New or worsening pain, sores or unusual discharge	Changes like these need to be looked at rather than waited out.
You might be pregnant and have pelvic pain or abnormal bleeding	These can be signs of an ectopic pregnancy, which needs prompt care.
Headache or chest pain after sex	MedlinePlus advises contacting a provider right away for these.

For everything else, book a routine visit if a problem has lasted around three months or is bothering you or your relationship.

Where a supplement fits

Some women, after trying the steps above, also look at herbal supplements for desire or dryness. The National Center for Complementary and Integrative Health, part of the NIH, reminds readers that “natural” does not always mean safe, that many supplements have not been tested in pregnant or nursing women, and that you should tell your doctors about every supplement you take.

Individual herbs carry their own cautions. Ginkgo may raise bleeding risk if you take a blood thinner such as warfarin. Rare cases of liver damage have been reported with products labeled black cohosh, though the cause is uncertain. Licorice root can cause serious side effects, particularly in people with high blood pressure. If you are pregnant, nursing or on any medication, check with a doctor or pharmacist first.

One option some women consider is Provestra, an herbal daily supplement from Leading Edge Health. The maker says it is designed to support desire and natural lubrication. You take one tablet a day, a box holds 30, and the maker lists 21 ingredients, including damiana leaf, ginseng, ginkgo biloba, black cohosh and licorice root; you can see the full list of what is inside. The maker shows the amount of each ingredient per tablet on the Supplement Facts label on its product page (ginkgo biloba, black cohosh and licorice root are 25 mg each), and you can find the full table on how Provestra is meant to work. Before you start, it is worth taking that label to your doctor or pharmacist and asking about the herb cautions above.

A supplement is not a treatment for low desire, dryness or pain, and it is never a reason to delay seeing a doctor about pain. For more detail, read Provestra’s safety notes and ingredient cautions.

Starting the conversation

The hardest part is often the first sentence, so it can help to have one ready. With a doctor, you might say something as simple as “Sex has been painful lately and I’d like to find out why,” or “My interest in sex has dropped and it’s bothering me. Could any of my medicines be involved?” Saying it plainly gives your doctor a clear place to start.

With a partner, honesty works best in both directions: what feels good, what hurts, and what you would like to try instead. That conversation will not fix every cause on its own, but it takes the guesswork, and some of the pressure, out of the bedroom.