Sex is important to many women, yet many feel deeply conflicted about sex and their sexual selves. Influenced by society’s impossible ideals of physical beauty and sexiness as well as many ambiguous developmental messages women receive about female sexuality many women are pained to allow their sexuality free expression.

Below is the description of many potential sexual stumbling blocks for women:

Low or No Sexual Desire

Lack of Arousal

Negative Body Experience

Lack of Orgasm

Pain During Sex

Discrepancy of Sexual Desire

Discrepancy of Sexual Interest

Vaginismus

Persistent Genital Arousal

Sexual Avoidance and Aversion

 

LITTLE, LOW OR NO SEXUAL DESIRE

The feeling of wanting sexual activity or sexual pleasure is common for most men and women and may be a little sign of health and vitality, but also of healthy sexuality. It is a problem when there is little or no desire for sexual activity, especially when in a relationship with a partner who does have sexual desire. This discrepancy of desire between partners can lead to significant conflict and tension between partners. Lack of desire may indicate an unhealthy physical condition, but also may be caused by numerous emotional conditions. Some people, but a small percentage, do, naturally, have little sexual desire without any accompanying health or emotional problems. Lack of sexual desire may also be accompanied by lack of sexual fantasies, lack of interested in others as sexual partners, and lack of a sexual response.

An important exception is vital knowledge. A majority of women, especially those who are older and post-menopause, do not have a regular or common experience of sexual desire.  A healthy pattern for mature women is desire that appears after an intimate experience has begun and her body has become aroused. This differs greatly from how men function. The difficulty posed by this difference is the tendency for women to hold the male pattern of sexual desire as the norm and assume because they do not feel regular sexual desire there exists something wrong with them. Women function differently than men in their experience of desire, which indicates no pathology.

“Getting over the hump” is a stressor for many women, which contributes to them choosing to say “no” to sex or avoid it altogether. For these women the “hump” seems just too high.  A good sexual experience requires a relaxed state, openness and receptivity.  These conditions seem to be impossible to achieve especially for women who are stressed, facing a constant onslaught of demands, have difficulty slowing down their busy minds and must cope with negative feelings, such as as the uncomfortable feelings that will be provoked by exposing their bodies during a sexual experience.  For such women, sexual interest is buried under too many negative elements.  Many women find that they just cannot “get over the hump” by letting to of all these issues to make themselves shift gears into a positive, receptive state.

There are exceptions. A significant percentage of post-menopausal women report no sexual desire and no response of arousal even after a sexual experience has started, a significant loss for some. (See section below on lack of arousal) An important consideration may be that many post-menopausal women are in long-term relationships which may not possess the positive emotional connection many women report is vital to arousal. More than a few women voice in a frustrated, resentful manner, “If I never had sex again it would be fine with me.” Such a statement may suggest that sex has not been a positive or satisfying experience that supports desire.

Some of the potential causes of low or absent sexual desire are:

▪️Relationship difficulties: If partners are not emotionally connected, it may lead to one or both partners having low desire. Relationship conflict, lack of trust between partners, the build up of resentment, or feelings of anger between partners all can dampen or fully put out any flames of sexual desire.

▪️Stress, feeling overwhelmed, preoccupied, anxious and fatigued may all kill sexual desire.

▪️Having small children at home is one cause of reduced sexual desire in caregivers.

▪️Depression, which is often internalized anger or feelings of powerless usually will eliminate sexual desire.

▪️Anxiety, like it’s sister, depression, may reduce desire and cause a person to avoid closeness.  In some people anxiety tends to heighten sexual desire.  People who have strong feelings of shame regarding their sexuality may have anxiety which negatively impacts the ability to have sexual desire.

▪️Medications often have a negative effect on sexual response and functioning.  Many medications also reduce sexual desire.  Anti-depressant drugs are notorious for the reduced sexual desire side-effect.  Birth control pills also tend to reduce the user’s level of sexual desire.

▪️History of trauma or abuse tends to cause those traumatized to avoid closeness, and especially the intense closeness of sexual activity.

▪️Having had negative previous sexual experiences with the partner or previous partners that have caused frustration, disappointment or hopelessness about having a satisfying sexual experience.

▪️Physical causes may also contribute. There are many possible sources, of which I will not list here. If you suspect that a physical problem may contribute to your loss of sexual desire, consult your physician.

▪️Poor body image: if a person feels uncomfortable with their body, and thus would feel ashamed or embarrassed to reveal the body, this may result in having little or no desire to engage in sexual activity. This category can include feelings of shame associated with a person’s genitals and breasts.

▪️A history of participating in sex when one does not wish to be sexual. This includes one’s needs and feelings being unknown to or invalidated by he partner.

▪️When sex with the partner is dissatisfying because of lack of sexual education, lack of communication, lack of skill and lack of desired outcome, such as good sexual performance, emotional connection or orgasm.  Andrew Aaron, LICSW 

See article on Low Female Sexual Desire

See article on: Curing the Sexless Marriage

 

LACK OF PHYSICAL AROUSAL

After partners have already begun to engage in sexual activity, whether it be talking about sex, kissing or even stimulating each other’s body or genitals, a physical arousal response is normal and healthy.  A distinction should be made between a physical and psychological arousal.  A person may feel aroused or turned-on, but not have the accompanying physical response. The opposite is also possible.

This typically means an enlarging of her nipples, sometimes a red flush on her breasts, a swelling of her vulva due to a condition called vasocongestion and the presence of wetness, lubrication from within her vagina, which functions as lubrication for comfortable intercourse.  Lack of arousal may mean that the swelling of the vulva due to vasocongestion does not occur, the nipples do not enlarge, and lubrication is not produce from within the vagina. The potential causes are several:

Physical causes which range from an unhealthy physical condition, hormone fluctuations, a past hysterectomy, or the onset or presence of menopause, which tends to reduce or eliminate the lubrication. If a women experiences pain during intercourse, or has in the past, this can prevent arousal. Such pain may or not be physical in nature.

Emotions may also interfere with arousal.  Any negative emotion such as anger, resentment, depression, anxiety, fear, etc.can have this effect. A history of trauma or abuse can result in reduced or absence of an arousal response.  Andrew Aaron, LICSW 

Medications or drugs may also eliminate arousal.

See article on: Tiny But Mighty: The Clitoris

NEGATIVE BODY EXPERIENCE

While not exactly a sexual problem, how a woman feels about her body has an enormous, profound and negative impact on how she feels about herself as a sexual being. A woman looks upon her body through the filter her self-esteem. If she struggles within to feel good enough, proud of herself, she will experience this inner self-rejection as manifested as ugliness in her body. For her, her shame shows up as body imperfections which justify self-criticism, self-deprecation.

Poor self-esteem expressed as body shame has strong negative influence on women as sexual beings, especially within the context of a long-term love relationship. All of the sexual problems listed in this article may be caused by or contributed to by inner shame and poor body experience. Andrew Aaron, LICSW 

See article on: For the Love of the Female Body

PROBLEMS WITH AN ORGASMIC RESPONSE

The lack of an orgasmic response to stimulation during  sexual activity can cause frustration and disappointment, but also hurt feelings and conflict between sexual partners. Orgasm is an extremely pleasurable physical/emotional/spiritual reaction to enough stimulation in which physical tension is reduced and is accompanied by a pulsing of the muscles in the genital area.

As many as 30% of women have not yet been successful at achieving orgasm. Some women may believe that they are incapable of an orgasmic response. Unlike men, for whom an orgasm is a physical reflex for which no learning is required, women may have to focus their efforts to learn how to have an orgasm.  Some women may have orgasms, but may have difficulty achieving it, and the necessary amount of stimulation for orgasmic response may be significant require an half-hour or longer. For most women direct stimulation of the clitoris is essential for the achievement of orgasm. Roughly half of women do not achieve orgasm through the experience of intercourse.  Other factors may interfere with a woman’s ability to have an orgasm:

Physical conditions, such as health problems and physical discomfort may interfere with orgasm.

Emotions, always the negative kind such as anger, resentment, fear or anxiety. A past which included experiences of physical, sexual, emotional, or verbal abuse and trauma may emotionally eliminate a woman’s ability to have an orgasm.

Inability to focus, relax or concentrate have a negative impact on achievement of orgasm.  If a woman cannot relax, or if she has difficulty eliminating stray thoughts, orgasm may not be possible.  A woman who feels uncomfortable with her body may be unable to relax sufficiently to have an orgasm.

Knowledge and experience play a part.  A woman who does not have much sexual experience, or is not familiar with her own body, genitals, or sexual response, and has not “practiced,” such as through the self-stimulation of masturbation to have an orgasm, may be unable to do so. Developing orgasmic capacity takes some practice.

Medications or drugs commonly have a negative effect on a woman’s ability to achieve orgasm.  Medicine may reduce the orgasmic ability, slow the orgasmic response or eliminate it altogether. Andrew Aaron, LICSW 

See also article: Eroticism: What Turns Us On

See also article: Anatomically Different…Intimately

PROBLEMS WITH PAIN

Women at times experience pain during intercourse, which is called dyspareunia. Pain is a problem and is not part of healthy sex. If pain is experienced routinely during intercourse, there exists a problem which is best addressed with a doctor or another professional. The feelings of pain may or may not have physical causes. Sometimes a simple solution may be the use of a lubricant, but this will only eliminate pain caused by dryness.  Physical causes may include yeast infections, the presence of a sexually transmitted disease (STD), skin irritations and possible a cut or tear in the opening of the vagina or the inner vaginal wall.  Such pain during intercourse may also have an emotional source.  Women who have experienced physical or sexual abuse may have painful emotions associated with sexual activity and may experience this as physical pain during intercourse. Andrew Aaron, LICSW 

DISCREPANCY OF SEXUAL DESIRE

When sexual partners differ on the preferred frequency of sexual activity, tension may build between partners and even be the source of arguments. Unresolved, discrepancy of sexual desire may result in significant damage to the relationship and connection between partners, well beyond the arena of sex. As relationships transition through developmental phases, differences in sexual interest will increase and decrease causing tension due to frequency or infrequency. Andrew Aaron, LICSW 

See article: Sexual Desire and Men

See article on: Discrepancy of Sexual Desire

See article: Battling Desire Discrepancy

DISCREPANCY OF SEXUAL INTEREST

What each one of us defines as good or great sex varies from person to person. When sexual needs or interests vary widely, problems with sex are sure to follow.  Couples who easily and openly talk about sex may be able to resolve such a discrepancy, but most couples are not comfortable with talk of sex and do not engage in this kind of communication.  Unsolved, discrepancy of sexual interest may result in tension between partners, but also an accumulation of frustration, resentment and loss of interest in sex and infrequent sex. Andrew Aaron, LICSW 

See also article: Eroticism: What Turns Us On

See also article: Battling Bedroom Boredom

See article on: Curing the Sexless Marriage

VAGINISMUS

A different pain-related problem is called vaginismus. This is also a condition that is experienced only by women. This occurs when the muscles surrounding the vaginal opening are tightly closed, and prevent penetration for sexual intercourse. Vaginismus may be caused by emotions often related to discomfort with sexual intercourse and possibly due to uncomfortable feelings such as anger, resentment, disrespect for the partner, or from emotions related to past trauma, such as sexual abuse or rape. A physical cause may be the consequence of a woman having experienced painful intercourse chronically for a long period of time. The vaginismus may be an anxiety reaction to the anticipation of pain.

Originating from emotional or physical causes, women who suffer from vaginismus are unable to experience the comfortable penetration for intercourse.  In more extreme cases, penetration is prevented completely.  This results from the involuntary tightening of the muscles surrounding the opening to a woman’s vagina either in reaction to the moment of penetration or more permanently, interfering with or preventing sexual intercourse.  So long as the basis for the development of vaginismus is emotional, as fear and anxiety may play a large role, sex therapy can be very effective at reducing the negative effects of vaginismus and of eliminating the negative effects from a woman’s sex life. Andrew Aaron, LICSW 

Women complain that upon presenting to the gynecologist for an internal exam, the doctor is dismissive of their concern due to no physical evidence of a problem.  Women must not be dissuaded and instead accept their own experience as proof of a problem

See article on female problem with intercourse: Vaginismus: Painful and Harmful to Intimacy

DYSPAERUNIA

Is an emotionally-based sexual problem in which women experience pain during intercourse. If the problem is truly dyspaerunia, the pain is emotionally based, such as anxiety, fear, or unresolved past trauma, rather than physically-based, as the painful symptoms will suggest. Women complain that upon presenting to the gynecologist for an internal exam, the doctor is dismissive of the concern due to no physical evidence of a problem. Women must not be dissuaded and accept their own experience as proof of a problem.

PERSISTENT GENITAL AROUSAL DISORDER (PGAD)

Even though this a rare condition it merits inclusion here to potentially save a few women from tremendous discomfort.  This disorder in one in which a woman experiences chronic arousal, continuous orgasm or frequently spontaneous orgasm throughout every day, irregardless of situation or activity.  For most of us, orgasm is a positive and pleasurable experience, but for women who suffer with PGAD, orgasm is distracting and uncomfortable as well as unwelcome and unwanted. It is not a response to sexual stimulation, but instead it is a condition that may be emotional, hormonal or emotional or he combination of all three. Women afflicted with PGAD are often embarrassed and ashamed of a condition which introduces what is normally a sexual experience into all situations of daily life.  The condition is confusing.  Without much literature available and being a condition unknown to the general public, women with PGAD are unable to explain it to others without being dismissed because most think of orgasm and arousal as a positive experience. Even gynecologists may be unaware of this very difficult condition. Andrew Aaron, LICSW 

SEXUAL AVOIDANCE AND AVERSION

Lack of sexual desire and avoidance of sex are commonly confused.  While lack of desire shows up as no interest in sex, avoidance is expressed as opposition to sex.  At its foundation, sexual avoidance is based upon fear or discomfort with sexual activity.  A woman may not be conscious of her motives, but may notice that she would rather do most anything other than have sex, and is likely to cite reasons, rational and irrational, to escape from a situation in which sexual activity is a possible outcome.

Aversion is a deep revulsion of sex and sexual activity.  A history of sexual abuse may produce sexual aversion as can a variety of other historic emotionally harmful experiences.