Female Sexual Problem

Evidence suggests that healthy sexual functioning is an important contributor to women’s sense of well-being and quality of life. But women (and their clinicians) often avoid discussions of this topic.

Female sexual dysfunctions result from multiple factors such as

Physiological —

- Medical conditions/complications,
- Use of certain medications and
- Hormone imbalance as in menopause

Psychological —

- Mood disturbances
- Previous traumatic experiences (like sexual abuse) and
- Stress related to work, family, studies or together

Interpersonal relationships —

- Problematic or unsatisfactory marriage/relationship
- Unhappy with the partner – in general or particularly about sex
- Partner’s medical condition, or
- Other concerns such as children living at home

Socio-cultural –

- Demographic characteristics: age, education, religious beliefs and values

VAGINISMUS: A very common complaint among to-be-married and newly married women

Vaginismus is an involuntary spasm (squeezing together) of the muscles of the lower end of the vagina. This condition causes penetration to be difficult and painful, or even impossible. It happens because instead of relaxing the muscles tense up. A woman with vaginismus can't control when the muscles will spasm. It can happen when she is trying to have sex or when she is having a medical examination, like a pap smear. The spasm can be so strong that nothing can go into the vagina and she feels pain when trying to put anything into the vagina (including fingers, tampons, penis or speculum for pap smears). There can also be no obvious cause and yet the muscle spasm still happens.

Symptoms?

When there is an attempt at putting something into the vagina the woman becomes anxious, the muscles tense up and it is painful. Not surprisingly, this leads to further anxiety the next time and the same thing happening again. The anxiety can be caused by inexperience with sex, not having enough privacy to relax or pain from another cause such as an infection. Sometimes there are traumatic past memories like rape or sexual assault.

Management?

The treatment of choice with vaginismus is program that combines education, including information about sexual anatomy, physiology, the sexual response cycle, and common myths about sex, counselling and exercises. Exercises include pelvic floor muscle contraction and relaxation (Kegel exercises) to improve voluntary control of the muscles.

Vaginismus and Sex?

Vaginismus does not mean that women cannot achieve or sustain sexual arousal. Many are very sexually responsive and may have orgasms through clitoral stimulation. Women with vaginismus may seek sexual contact and sexual play as long as vaginal penetration is avoided.

Female sexual dysfunction in India:

In any developing country including India, information on the prevalence and determinants of female sexual dysfunction are scant. One study, done among 149 Indian women (Singh et al.) reported the following sexual difficulties

Lubrication – 97%
Sexual arousal – 91%
Orgasm – 87%
Satisfaction – 81%
Sexual desire – 77%
Sexual pain – 65%

Other key aspects of female sexual health:

Many women DON’T have the basic understanding of their own sexual anatomy or functioning, menstruation, sexual intercourse, ‘female masturbation’ and many other topics. Having the basic knowledge around these topics is very essential for a positive and healthy sexual life.