Female sexual dysfunction affects around half of older women and many don't know it—are you one of them?

Did you know that sexual dysfunction is more common in women than in men? One in three young and middle-aged women and about half of older women suffer from sexual dysfunction of some kind according to the Sexual Advice Association—whether that means issues with desire, arousal, or orgasm—yet it's a topic that's rarely discussed. It's time to stop treating female sexual dysfunction as taboo.

Luckily, there are many treatment options available, ranging from kegel exercises to being prescribed medication by your doctor to treat any underlying causes. But the first step is recognizing and confronting the issue. According to statistics from the Cleveland Clinic, 31% of men report some form of sexual dysfunction, while a huge 43% of women will be affected throughout their lifetime. Nonetheless, many women are often unaware of what sexual dysfunction is or that they're suffering from it, with many women shying away from discussing female masturbation habits or a decline in sex drive. Experiencing sexual dysfunction can have a huge impact on your general wellbeing, and symptoms can often cause distress or frustration for those suffering—so it's important to tackle the condition head-on. 

To help you better understand what female sexual dysfunction is and the treatment options available, we spoke to sex experts about the way forward. 

How to recognize female sexual dysfunction 

Essentially, female sexual dysfunction means a change in sexual behaviour when it comes to desire, arousal and orgasm. Female sexual dysfunction can present itself in various forms, including: 

• Lack of sexual interest
• Lack of arousal
• Difficulty becoming aroused
• Difficulty orgasming 
• Vaginal dryness
• Pain during sex or after sex

While experiencing these things from time to time is common, if your symptoms become recurring they could be an indicator of sexual dysfunction and it's important to then get some medical advice. Attempting sex despite these symptoms can lead to further issues, such as burning, frequent urination, vaginal tears, or recurring infection, as well as low moods and frustration. 

Causes of female sexual dysfunction 

It’s often hard to identify the root cause of female sexual dysfunction because there are so many possibilities. Sexual dysfunction can be caused by changes to a person’s physical health, mental health, or both. 

Some common physical causes of female sexual dysfunction include:

• Menopause 
• Hormonal changes 
• Medication 
• Vaginal atrophy 
• Endometriosis
• Bladder cystitis

Some common mental causes of female sexual dysfunction include:

• Anxiety 
• Trauma 
• Relationship problems 

Physical causes of sexual dysfunction

Underlying physical health conditions such as vaginal atrophy, endometriosis, or bladder cystitis are some of the most common causes of female sexual dysfunction. All of these conditions can cause severe pelvic pain, vaginal dryness, or sexual anxiety and lead to sexual dysfunction. 

So why can these physical conditions affect our sexual desire? Dr Terry Dunn of Foothills Urogynecology in Denver, Colorado notes these physical issues often cause, “a decreased libido, because, when it hurts, our desire is reduced as sex isn't pleasurable”. Essentially, what begins as a physical symptom can become worse because of the person’s reaction to the pain. Associating sex with pain builds up anxiety and fear around the act for the sufferer, leading to a reduced sex drive and further confusion over why they are uninterested or anxious about sex. 

Menopause is also another factor to consider when it comes to sexual dysfunction due to the hormonal changes women experience. Read our guide to sex and menopause to find out more about how to navigate your sex life during the change.  

Mental causes of sexual dysfunction

Female sexual dysfunction can also be related to mental health challenges. Dr Nichola Marchant of Ruby Psychological Services in Derbyshire specializes in helping people of all genders with sexual issues and has found that negative life experiences can negatively impact a person’s perception of sex.

“Often [sexual issues] will have their roots in some kind of trauma or negative life experiences, but not necessarily sexual trauma,” Dr Marchant explains. “For lots of people with sexual issues, you might see early difficult experiences combined with messages within the family or community that sex is bad or wrong or problematic in some way, then a later trigger, such as birth trauma, relationship problems, menopause, or a difficult sexual interaction.”

Sexual problems stemming from mental health causes can present with similar symptoms as those from physical causes, such as vaginal dryness and lack of libido, but will likely require very different treatment to solve the issue via a sex counsellor or therapist. 

Why aren’t women talking about female sexual dysfunction?

Despite how common female sexual dysfunction is and the many treatment options available, many people don’t seek advice because they don’t even realize the problem exists. 

A major barrier to people seeking help for sexual problems is the taboo around female sexual health. “Historically, women’s pelvic health has been far behind men’s pelvic health in both research and treatment options,” Dr DuFlo says. “It's thought the shame surrounding talking about women’s sexual desire or genitalia was for so long culturally indoctrinated within our system, that often female sexual dysfunction has been so normalized it goes underreported and undertreated.”

Dr Marchant goes on to add that, “with a penis, it's much easier to observe if it’s aroused, whereas, with vulvas and vaginas, it’s not always possible to tell. It’s easier to ignore or hide issues and can be hard for women to know if they have an issue, or what’s ‘normal’ when it comes to sex. Particularly if they have very limited positive sexual experiences to draw on.”

Ultimately, it’s important for women to know female sexual dysfunction is common and can be caused by any number of factors out of their control—and there's no shame in experiencing it. But—most importantly—know there is help readily available, no matter the cause or symptoms. 

Female sexual dysfunction treatment options

"Women need to know is that there are treatment options available that can help,” Dr Dunn says. “They don’t have to suffer unnecessarily. It's a matter of talking to your physician frankly so that they can help you.”

With the help of a doctor, you can establish the root cause of your sexual dysfunction and find the right treatment for you. For example, menopause can cause vaginal dryness, but treatment could be as simple as using a lubrication cream to offset the symptoms and prevent pain during sex (see our guide to the best lubes for recommendations). Other causes of female sexual dysfunction—particularly if the root is a mental health issue—may require more long-term treatment.

Dr Samantha DuFlo, the owner of Indigo Physiotherapy, notes that treatment, “is often a collaborative effort between a gynecologist, a mental health practitioner such as a certified sex therapist, and a pelvic physical therapist". 

Treatments options include: 

1. Medication—this is used to address any underlying conditions or hormone imbalances often experienced during menopause. It can include hormone replacement therapy, which works to replace the hormones women lose during menopause.
2. Lifestyle changes—limiting alcohol, exercising more, getting better sleep, and eating a well-balanced diet can naturally balance hormones by reducing stress.
3. Sex toys—using a stimulation device such as a bullet vibrator alone or with a partner can help ease sexual anxiety. Female masturbation can boost body confidence and help you get to know what you like and don't like in the bedroom. See our guide to the best sex toys and best vibrators for our experts' top picks. 
4. Talking therapy—speaking with a sex therapist or certified counselor can help you address any conscious and subconscious trauma and find ways to overcome your worries. If your sexual dysfunction is down to relationship problems, it's a judgment-free zone for you to open up about how you are feeling.
5. Lubrication—much like introducing a sex toy in the bedroom, adding lube into the mix can make sex more comfortable and pleasurable if you suffer from vaginal dryness (see our guide to the best lubes).
6. Pelvic floor therapy—doing kegel exercises with the help of kegel balls will build a strong pelvic floor. This is important because your pelvic floor supports everything from your bladder to your butt, bowel, and uterus. 

woman&home thanks Dr Terry Dunn of Foothills Urogynecology, Dr Nichola Marchant of Ruby Psychological Services, and Dr Samantha DuFlo, owner of Indigo Physiotherapy, for their time and expertise.