Sexuality

Sexual health

Sexuality plays an important role in the health and wellbeing of women across the lifespan. There are biological, psychological and social aspects to a woman's sexuality that impact upon her experience of sexuality and sex.

Biological

What this includes:

• Physical changes brought about by normal ageing or medical issues
  

Sex can be affected by:

• General health and wellbeing
• Health issues and even the medications used to treat the problem
• Changes in some hormone levels, such as oestrogen and testosterone (hormones produced by the ovaries) –these hormones impact on mood, sexual desire, and the physical changes that occur during sexual arousal

Psychological

What this includes:

• Beliefs and feelings about yourself
• The quality of your relationships
• Your personal history

Sex can be affected by:

• Mood (depression, anxiety, grief)
• Self-esteem
• Body image
• Past experience of sexual activities
• Relationship satisfaction

Social

What this includes:

• Your culture
• Your community
• Your family
• Your home environment

Sex can be affected by:

• What is considered appropriate, such as what age to start and finish your sexual life
• The environment, for example:
  • you might have a house full of toddlers or
  • there may be a lack of privacy
  • you or your partner may be working long hours or shift-work
• Cultural influences and expectations about what is an appropriate sexual response and identity

When people discuss sexual function they often divide sex up into the different areas of libido (desire), arousal, orgasm and frequency:

Libido

The desire to take part in sexual activity, either with a partner or by yourself.

Arousal

The physical response to sexual thoughts or activity such as increased blood flow to the pelvis, increase in the amount of vaginal lubrication, expansion of the vagina and increase in heart rate and blood pressure.

Orgasm

The climax of sexual excitement, characterised by a peak of pleasure centred in the genitals.

Frequency

How often you take part in sexual activities.

Whether you have a suitable partner or not, you will have sexual needs and desires. It should be your choice as to how you express your sexuality.

Different stages of life, such as adolescence, trying for a pregnancy, pregnancy itself, and then after childbirth and menopause, all provide a good opportunity to discuss your thoughts and concerns about your sexuality. Although normal ageing causes physical changes and the frequency of sexual activity may change, there is no reason why enjoyable and fulfilling sexual relationships cannot continue. Sometimes, there is a need to find your 'new normal'.

Some people find it embarrassing to seek help or talk about sexual issues, but your sexuality can be an important part of who you are. If you have concerns, it is helpful to talk to someone you feel comfortable with and trust, such as your regular doctor, or a doctor or psychologist who specialises in sexual concerns.

Sexual problems

Just over 60% of Australian women have reported that they have had a sexual problem in the past year[1]. Half of women reported a lack of interest in sex, and about a quarter report pain or lack of pleasure with sex.

Sexual problems (often called sexual dysfunction) refer to a situation where you are not able to experience sex as you would like to and this causes you, and/or your partner distress.

Different types of problems often relate to the different areas of sexual functioning: libido, arousal, orgasm and frequency of sexual activity. Below are some examples of problems that impact on sexual functioning:

Libido

Your libido may fluctuate because of:

• changes in hormone levels with:
  • premenstrual syndrome (PMS)
  • pregnancy
  • breastfeeding
  • menopause
• medication for: mood, blood pressure control, contraception, treatment of cancer
• medical conditions: iron deficiency anaemia, hypothyroidism, diabetes, chronic pain conditions
• lifestyle: fatigue, lack of sleep, poor work-life balance
• psychological influences such as stress, depression or anxiety
• Your relationship with your sexual partner

Arousal

You may not be able to become as aroused as you would like because:

• sex is painful
• anticipation that sex is going to be painful reduces your ability to become aroused, and then sex is more likely be uncomfortable, or not be pleasurable – this can then feedback to negatively impacting on libido

Orgasm

• Inability to orgasm or reach orgasm in an acceptable amount of time – orgasm is dependant on libido, arousal and all three are interconnected
• Men can sometimes achieve orgasm more quickly than women, and may not be interested in continuing with sexual activity after orgasm – this can be an issue if the woman needs more time to achieve orgasm
• This difference in time to achieve orgasm can be a problem in same-sex relationships as well

Frequency

Desire discrepancy can happen in any relationship. This term describes a situation where one partner may desire or want sex more frequently than the other partner. Levels of desire change over time and are influenced by a number of factors. There is no level of desire that is 'correct'; the challenge for couples is to find a balance that works for them.

There are a number of causes of sexual dysfunction in women. Some of the more common causes include:

• vaginismus – where there is involuntary spasm of the muscles of the pelvic floor
• dyspareunia (superficial and deep) – where sexual intercourse is painful

Things that increase sexual problems:

Age

With increasing age sexual problems can also increase.

Menopause

• Premature or early menopause at 40-45 years
• The transition to menopause during your mid-40s and early 50s
• Surgical menopause leading to a very sudden drop in hormone levels

Medical conditions

Cancer or a pelvic/neurologic/vascular disease, other chronic medical issues.

Treatment/ medications

• Medications to block hormone production such as aromatase inhibitors, tamoxifen and GnRH agonists can cause vaginal atrophy and superficial dyspareunia
• Pelvic chemotherapy can cause bladder and bowel irritation and vaginal mucositis (inflammatory changes)
• Some antidepressants, antipsychotics and anticonvulsants
• Some anti-hypertensive medication (in particular those from the beta-blocker class)
• Decreased nipple sensation following breast surgery

Psychological function

Depression, anxiety, stress, low self-esteem, negative body image.

Sexual experiences

Previous sexual abuse, sexual assault or problems with sexual function.

Partner

Decrease in the quality or harmony of the relationship.

Lifestyle

Substance abuse, excess alcohol, lack of physical exercise, poor work-life balance.

Management & treatment of sexual problems

Management of sexual problems includes:

• first, acknowledging that there is a problem (this can take courage!)
• finding an appropriately qualified health care professional to help you
• discussing a program of action appropriate to the cause of the problem:
  • considering hormone replacement therapy (HRT) – if this is suitable for your particular concerns, health status and age
  • changing medications to ones with less impact on sexual functioning – this may not be appropriate in the setting of cancer therapy
  • treatment of reproductive or urinary symptoms
  • counselling to reduce stress, improve communication and hence understanding and respect between partners

Remember that sexual concerns are common and solutions can be found. Unfortunately, there is no 'quick fix'. As this webpage has explained, the problem often has a number of causes. The solution needs to look at all of these.

Self-help books can be a good place to start, and finding a chapter in a book that applies to you and asking your partner to read it, can be a non-threatening way to begin.

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at December 2013.