Let’s Talk About Sex

The Facts About Women’s Sexual Dysfunction

There is a moment in Thornton Wilder’s 1938 Pulitzer Prize-winning play “Our Town” that breaks my heart. It’s not just what you’d expect: not only when Emily realizes she can never go home again or when George cries on her grave. No, I’m always struck by the moment when Emily walks down the aisle, so young, to marry her best friend. Two minutes earlier she’d been begging her father to just let her remain his little girl; she wasn’t ready to grow up.

Her mother turns to the audience and says, “I hope some of her girl friends have told her a thing or two. It’s cruel, I know, but I couldn’t bring myself to say anything. I went into it blind as a bat myself.”

What is “it” that scared Emily and her mother so badly that they couldn’t talk to each other?       

The play, which CBS says is performed more than any other in the country, is all about the common American experience. Therefore, we all know what “it” is, don’t we? Sex.

But it’s even more than that: “It” includes all the things about our bodies, our health and our physical desires that mothers traditionally didn’t tell their daughters because, unfortunately, they were “blind as bats” themselves.

So, if we are left to figure “it” out on our own, what do we do if there’s a problem? Who can we ask for advice? We can’t, as Emily’s father explains, remain naive forever.

Sex Through the Ages

As Dr. Ilana Kirsch, M.D., FACOG, of South Bend Family Medicine says, “If a woman [such as Emily or her mother] was taught to always view the act of intercourse as something forbidden, she may always be intellectually uncomfortable with it and would need a lot of reassurance and counseling to overcome her fears. For those women, reluctance to enjoy intercourse truly is natural, and they may never be able to overcome that because they may never want to.”

This may make talking to their own daughters all the more difficult, or impossible.

Admittedly, today’s generation is more likely to confront the topic of sex; they have been schooled by popular culture (Sex and the City, Cosmopolitan) to know they have the right to enjoy it.

However, this leads to new problems. Since their mothers may not have expected to like sex, they may not have been disappointed or confused if they didn’t. Now, many women expect to be adventurous lovers and have orgasms, high sex drives. If they don’t, what’s wrong?

What a mess – a mess that can’t simply be fixed with a Viagra pill for women, partially because there isn’t one (despite all the money some companies are spending on R&D). So, women are left in the dark or on Wikipedia whenever they have questions about sexual dysfunction. But they don’t need to be.

You Are Not Alone

No, women don’t need to do this on their own, Dr. Kirsch explains. First of all, women should understand what a sexual dysfunction or disorder is. By definition, a sexual disorder causes discomfort. Dr. Kirsch gives an example: “If both members of a couple are not interested in sex, and they're both comfortable with that, then there is no disorder. A woman should consider that she has a problem if she is either more or less interested than her partner, and they can't work it out to their mutual satisfaction. Also, she has a disorder if sex causes pain.”

Face facts: you do not have to be uncomfortable or apathetic during sex. You do not have to dread sex. If you are, know that there are solutions.

Also know this: according to University of Chicago researcher Dr. Edward Laumann, 43 percent of women suffer from sexual dysfunction, as opposed to 31 percent of men. Female sexual dysfunction is common.

A Midwife’s Tale

So, whom should you talk to if you think you may have a sexual dysfunction? A qualified medical provider who makes you feel comfortable. He or she should be a good listener and be able to offer constructive advice or aid. Since many sexual dysfunctions are associated with the stresses and changes of pregnancy, some women find themselves turning to midwives as their primary resource.

Kristen Vincent, CNM, of Memorial Medical Group’s Women’s Reproductive Medicine, reassures patients who come in for their annual exam. “They say they just have no sex drive. So I start asking some pretty frank questions: How is your relationship with your partner? Can you orgasm? Do you have any pain?”

Vincent doesn’t hesitate; she asks the questions that can help her get to the root of the problem.

Option 1: Stress Test

There are generally two, often interrelated, causes for women’s sexual dysfunction: psychological or physical. Vincent’s questions address both of these, but let’s start with the psychological.

Once Vincent opens the door to talking about sex, women (of all ages) generally relax and start speaking openly.

Women may say they don’t feel cherished by their partner, that sex has become a chore. We don’t have “a switch that controls our arousal,” Vincent explains. “When women are stressed, distracted, depressed, or simply don’t feel special, we often don’t find sex appealing…and sometimes we simply have selfish or ignorant partners.”

Dr. Kirsch agrees. She points out that many of her patients with sexual disorders, even those who do have orgasms, often simply don’t want to initiate sex, so she talks with them about the importance of sex in a committed relationship, and how to talk to their partner about their “needs/desires such as foreplay, snuggling without proceeding to sex, and even the importance of their partners doing chores around the house, which shows loves for more than just her body. One thing I usually suggest is making a date for lovemaking, so that my patient knows she's committing to share this with her partner on, say, next Saturday night, and he won't approach her when she's not psyched up for it on a different night.”

And don’t think you are alone if you can’t experience a vaginal orgasm. “Contrary to what the media would have us believe, most women are not capable of having an orgasm just with vaginal intercourse,” argues Dr. Kirsch. So be more open-minded about other forms of stimulation, such as oral sex or using a vibrator.

Option 2: It’s Not All In Your Head

Sexual dysfunction can also be caused by a medical condition. Vincent often explains to women that fluctuating estrogen and other hormone levels can cause vaginal dryness, which can make sex uncomfortable. Women also experience such hormonal fluctuation during breastfeeding, menopause and for other medical reasons, so if you are experiencing dryness, hormonal imbalance may be one of the first possibilities your doctor will check.

Women may also notice that their body feels different after giving birth. This is because after a woman has a child, her tissue changes shape. Vincent recommends pelvic floor (kegel) exercises to rebuild the muscles. Also, she advises women to try a variety of sexual positions, as their arousal points may have changed. In some cases, surgery is necessary to repair the damage caused by a birth. Dr. Kirsch has performed such surgeries.

Other medical causes, such as endometriosis or vaginal infections can also lead to sexual dysfunction, which is all the more reason to be up front with your health care provider and seek medical attention when you are concerned.

Survivors of sexual abuse may experience physical pain during intercourse because of involuntary spasms of the vaginal muscles (vaginismus), which can also be detected during gynecological exams. These women are advised to have pelvic floor therapy and, ideally, intensive counseling.

Both Dr. Kirsch and Vincent agree that the best way to overcome sexual dysfunction is to talk to your provider, to be open with your partner, and to learn as much as possible about yourself and your health.