Just like men, women can experience difficulties in desiring and participating in sex with their partners. Recent research suggests that approximately 40% of women may be affected by some sexual dysfunction. Such women may have never felt sexually excited or had an orgasm. What was once a pleasurable experience shared by a couple may now be a painful act which can lead to dissatisfaction, unhappiness and consequently have a serious impact on the quality of life of the couple. Many women find great difficulty in talking about sexual difficulties with their partner and many more women fail to seek treatment due to shame, embarrassment or fear that health professionals will misunderstand them. Sex becomes a problem only if one partner feels unhappy about it. Couples often experience periods of "ups and downs" and their frequency of lovemaking may vary greatly. For one couple it may not matter if they do not engage in regular penetrative sex whereas for another couple this may present considerable distress to one or both of them.

As with men, there are many factors that can contribute to sexual problems for women, some of which may be of psychologicai origin but others which may be due to physical causes. Recent research indicates that there are more physical (or biological) causes for "sexual dysfunction than were recognised before." Certain medical conditions such as diabetes, cardiovascular disease, multiple sclerosis and "certain prescription drugs may be linked with dysfunction."

Inhibited Desire Disorder

A difference in sexual desire is one of the most common problems couples face and can cause much unhappiness and frustration if it is not talked about. Tiredness, depression, iliness, stress, anxiety, relationship disharmony, drug or alcohol abuse can affect energy levels and sexual desire. Changes in contraception, certain times in a woman's monthly cycle, medication, childbirth or approaching menopause can also be linked to female loss of desire. Inhibited sexual desire is thought to affect 80% of women who seek help. Women who suffer from this condition may lack spontaneous interest in sex but can respond to their partners' approaches, experience arousal and orgasm. Others, however, may be totally adverse to the sexual advances of their partner. Women who experience low sexual desire may still want to be intimate with their partners but may not want penetration. Such confused signais can lead to frustration in the relationship and' cause resentment.

Sex therapy can be an effective treatment, rekindling the sexual spark and encouraging the couple to talk through problems and learn new techniques in lovemaking. Loss of sexual desire can be confused with a low sex drive. Physiological causes e.g. hormone changes, thyrOid disorders or changes in brain chemistry, may all playa part in female drive disorder. Medical assessment and tests can determine whether the woman is suffering from a drive or desire problem. More research is needed to uncover the causes and drug companies are beginning to show an interest in developing drugs to help women regain sexual feelings.

Lack of ability to orgasm

One of the most frequently used sexual myths is that all women experience orgasm with penile penetration and thrusting. In fact, research has shown that only 25% of women achieve orgasm in this manner, leaving a huge 75% of women who need additional clitoral stimulation. It is estimated that 12% of women are anorgasmic (never reach a climax). Many women enjoy pleasurable sex and feel close and loving towards their partner during lovemaking without achieving orgasm. Lack of orgasm is therefore only a difficulty if the woman or her partner feels it is a problem. It is now recognised that physiological factors can prevent arousal, e.g. hormone imbalance or poor blood flow to the clitoris or vagina.

The orgasmic response, however, depends on many things: sexual arousal, feeling comfortable with oneself, fixed ideas about men and women and attitudes about sex. Concern and worry can in fact become the very factors that prevent orgasm. For those who are unable to experience orgasm but would like to, there are various selfhelp methods available through books or pre-orgasmic groups (further information available on the back of this leaflet). Sex and relationship therapists also work with individual women, encouraging them to learn about their own bodies and how to pleasure themselves. Once a woman has learned to experience pleasure at her own touch and to feel better about her body, she can share what she has learned with her partner.

Pain on intercourse (dyspareunia)

Pain on intercourse can be deep or superficial. Deep pain is often associated with lack of lubrication, pelvic inflammatory disease, endometriosis or other causes. Lack of arousal can cause pain and discomfort due to a failure of the womb to lift up and the walls of the vagina to swell and open to accommodate the thrusting penis. Superficial pain is often associated with thrush (a common vaginal infection), genital herpes, vestibulitis (an acute inflammatory condition) or muscle spasm as in vaginismus. A sensitivity to condoms and other contraceptive creams or devices can also be associated with this condition. The level of pain can range from mild discomfort to severe, preventing further penetrative sex. It can also be felt as a burning sensation, sharp, dull or intense pain during or after intercourse. Pain or bleeding on or after intercourse should always be discussed with a doctor and treatment will vary from change of position during lovemaking, use of lubricants, drug therapy or further investigation according to the cause of the problem. "Unfortunately, when sex has equalled pain," a vicious cycle often sets in and women avoid sex altogether. Once pain has been resolved the mental association between sex and pain will often need to be dealt with too. Talking about the problem as a couple and reading self-help books can be useful. In more difficult cases the problem may be dealt with by treatment with sex therapy.

Vaginismus

Vaginismus is an involuntary spasm of the muscles of the pelvic floor, especially those which surround the vaginal entrance. When the muscles go into spasm the vagina becomes difficult or impossible to penetrate. This condition is a major cause of nOrKonsummation of marriage. Some women with vaginismus are otherwise sexually responsive and are able to become aroused and orgasm. This condition has a good treatment success rate and is usually treated by a psychosexual doctor or therapist. Many different factors can cause vaginismus: painful intercourse, recurrent vaginal infections, anxiety and difficulty in achieving arousal and lubrication are just a few. Past traumatic experiences such as sexual abuse, rape, complicated childbirth, surgery or negative attitudes to sex may all contribute to the involuntary muscle spasm of the vaginal wall.

About ESHA
The European Sexual Health Alliance (ESHA) is an umbrella organisation for patient support groups across Europe. The main role of this patient focused organization is to assist patients suffering from sexual dysfunction. to inform them about the solutions available as well as to provide awareness and understanding of the condition to their partners, media and other interested parties.

ESHA's purpose is to help every couple affected by sexual dysfunction to communicate openly about their sexual concerns in order to find a solution that improves the patient's sexual function and the couple's quality of life.