Female sexual dysfunction: common, quiet and worth talking about

Men got a pill and the spotlight, women got silence

Not so long ago, erectile dysfunction was something nobody mentioned in polite company. Then the FDA approved Viagra in 1998, and men’s sexual problems slowly moved into everyday conversation. Today it barely registers when an ad about them comes on during prime time, while you sit on the sofa with your kids, your partner or your mother.

The next year, the Journal of the American Medical Association published a national study that could have started a second conversation. In Laumann, Paik and Rosen’s analysis (JAMA, 1999;281(6):537-544) of a 1992 survey of US adults aged 18 to 59, 43% of women reported sexual dysfunction, compared with 31% of men. The authors also noted that interest in treating erectile problems had grown while data on sexual problems in both women and men were still relatively scant.

That second conversation never really took off. We have grown used to hearing the word “penis” on television. Say “vagina” and plenty of rooms still go quiet.

So if your desire has faded, sex has started to hurt, or you simply wonder whether what you feel is normal, you have a lot of company. These problems are common, they are defined by how much they bother you, and according to the American College of Obstetricians and Gynecologists (ACOG), there is often a solution.

How common it is, and why the number needs context

That 43% figure is often repeated without its date. It comes from interviews done in 1992, so it describes US adults of that time, not women today. And the study’s published summary counts reported problems without saying how much they bothered anyone.

A later, larger study helps with that second point. In a 2008 study of 31,581 US women, published in Obstetrics & Gynecology by Shifren and colleagues, 43.1% reported some kind of sexual problem. Only about 12% had a sexual problem that also caused them personal distress. Those distressing problems were most common among women aged 45 to 64.

ACOG’s current patient guidance sums it up: about 4 in 10 women have problems with sex at some point.

Having a sexual problem and being troubled by it are two different things, and the second is what tells you something is worth acting on.

What counts as a problem

There is no normal number of times a week and no standard level of interest you are supposed to reach. Mayo Clinic describes female sexual dysfunction as ongoing sexual problems that upset you or your partner, and elsewhere says it is a problem only if it bothers you. ACOG’s guidance for doctors also defines it by personal distress. Your own standard is the one that counts.

Doctors usually sort these problems into four areas:

• Desire. Little or no interest in sex. According to Mayo Clinic, this is the most common one.
• Arousal. Trouble becoming aroused or staying aroused during sex, even when you want it.
• Orgasm. Ongoing trouble reaching orgasm, even when you are aroused.
• Pain. Pain during sex.

More than one can show up at once. Our guide to the most frequent sexual complaints women have goes deeper on each.

One more point can change how you read your own situation. According to ACOG, it can be normal not to feel desire until sexual activity has already started. Desire that shows up after touch begins is still desire. If you have been waiting for a spark to arrive out of nowhere, read about the biggest myth about women’s desire.

Why it stays so quiet

The silence has a clinical side, and it runs both ways. ACOG’s 2019 practice bulletin on female sexual dysfunction notes that women are unlikely to bring up sexual problems with their health care providers unless they are asked. It also notes that many clinicians are uncomfortable asking. The reasons given are lack of training, too little time in the appointment, and underestimating how common these problems are.

So you wait to be asked, your doctor waits for you to mention it, and the visit ends with neither of you saying a word. In practice, you may have to raise it first.

Words play a part too. If you never had comfortable language for your own body, it is hard to describe a problem with it, especially in a short appointment. That is not a personal failing.

What can be behind it

Before you decide something is wrong with you, look at what has been happening in your life and your body. ACOG, Mayo Clinic and the NHS list similar contributors:

• Hormonal change, such as pregnancy, the months after a baby, breastfeeding, perimenopause and menopause. Breastfeeding and the hormone changes of menopause can both bring vaginal dryness.
• Some medicines for depression, high blood pressure and allergies, cancer treatment, and hormonal birth control all appear on these lists.
• Depression, anxiety and stress that does not let up.
• Long-term illness. In the 2008 study, poorer overall health, thyroid conditions and urinary incontinence were among the things linked with distressing sexual problems.
• Relationship problems, past negative sexual experiences and how you feel about your body.
• Drinking too much alcohol.

These can overlap. A new baby, for example, can bring hormonal change, dryness and the demands of caring for an infant all at once, and it helps to name each piece rather than blame yourself for the whole.

ACOG says nearly 3 out of 4 women have pain during intercourse at some time. Pain now and then is common, but frequent or severe pain is a reason to see an ob-gyn, who can check for a gynecologic condition behind it.

Where to start

Small steps you can take now

ACOG and Mayo Clinic suggest:

• Use a lubricant during sex, and consider a vaginal moisturizer if dryness bothers you between times.
• Talk with your partner about what has changed for both of you and what feels good now.
• Make room for touch that is not meant to lead to sex.
• Learn what you enjoy, by reading about sex and getting to know your own body.
• Look after sleep and stress, stay active and go easy on alcohol.

When to see a doctor

Book an appointment with your ob-gyn or primary care doctor if:

• the problem has lasted more than a few months, or it is causing you distress
• sex hurts often, or the pain is severe
• the change came on suddenly
• you also feel low or anxious most days

What to say when you get there

ACOG’s patient guide on your sexual health suggests simple openers, such as “I do not enjoy sex like I used to.” A few more you could adapt to your own situation:

• “Since my baby was born, I have had almost no interest in sex.”
• “Sex has started to hurt, and I would like to find out why.”
• “Could any of my medicines be affecting my sex drive?”

ACOG also suggests keeping notes: when it started, what has changed in your life and which medicines you take. If you suspect a prescription is involved, do not stop it on your own. Ask your doctor whether it could be playing a part.

What a doctor may offer

Treatment depends on the cause, and Mayo Clinic says a mix of treatments most often works best. That might mean vaginal estrogen for dryness, pelvic floor physical therapy, or counseling for you or for both of you.

There are also two FDA-approved prescription medicines for low desire in women in specific situations: flibanserin (Addyi), approved in 2015, and bremelanotide (Vyleesi), approved in 2019. They get far less attention than Viagra, and only a doctor can tell you whether either one fits your situation. As for Viagra-type pills, Mayo Clinic says they have not worked as well for women, with mixed results in studies. Mayo also points out that even the best medicines are unlikely to work if emotional or social factors are not addressed.

Where a supplement fits

Mayo Clinic notes that herbal supplements sold to increase sex drive have not been studied well, and it advises talking with a health professional before you try one. A supplement does not replace the steps above, or a doctor’s visit when sex hurts or something changed suddenly.

If you would still like to add one to a wider plan, Provestra is one option. It is an herbal daily supplement taken as one tablet a day. The maker, Leading Edge Health, says it combines herbs traditionally used for desire, such as damiana leaf, with vitamins and other herbs it links to women’s well-being. The maker lists 21 ingredients and shows the amount of each one per tablet on the Supplement Facts label on its product page, and you can see the full ingredient list for yourself.

Fact sheets from the National Institutes of Health flag a few of those ingredients: ginkgo may raise bleeding risk with blood thinners, black cohosh has rare reports of liver problems (though it is unclear whether the herb caused them), and licorice can be a concern for people with high blood pressure. Our guide to ingredient safety and talking to your doctor covers the details. Check with your doctor or pharmacist before starting, especially if you are pregnant, nursing or take any medication.

You are allowed to want this

Women want sex too. Wanting to feel desire again is a reasonable thing to want for yourself, and not only for a partner or a marriage. If you are having sex only to keep someone else happy, or you have quietly stopped altogether, that is worth an honest look at the reasons why.

It matters beyond the bedroom. In the 1999 JAMA study, sexual problems went along with poorer physical and emotional health and lower overall well-being, and Cleveland Clinic counts sexual health as an important part of quality of life.

So start small. Pick the one or two reasons above that fit your life and change what you can. If something hurts, has lasted for months or came on suddenly, take one of those sentences to your doctor. You do not need perfect words, only the first one.