Why should I seek help?
Is it my fault?
What anatomy is involved?
What is healthy sexual function?
How do I know when to seek help?
Where do I go for help?
What can I expect when seeking help?
How do I seek help?
What self-help options do I have?
Is it my fault that I have sexual problems?
Short answer: no.
Many factors impact women’s sexual function
There are so many reasons women experience sexual problems: biological reasons, psychological reasons, social/cultural reasons, interpersonal reasons, etc. Let’s take a quick look at the broad range of factors that can impact female sexual function, and then we’ll dive into some of the social and cultural impacts.
Even though sexual dysfunctions used to be blamed on psychological factors, we now know that they can be caused by all kinds of things, only some of which are psychological. Below is a table showing some possible risk factors for female sexual dysfunction (FSD). Note that each risk factor is not necessarily a risk factor for every FSD and notice how many factors are not “in your head.”
Pregnancy, childbirth, menopause, age, medications (e.g., birth control pills, Accutane, antidepressants), nerve damage, neuropathy, surgery in the genital area, hormonal imbalances, diabetes, thyroid problems, hypertension, hyperlipidemia, heart disease, atherosclerosis, cancer, dermatological conditions, clitoral adhesions, endometriosis, infections, muscular factors, poor overall health.
|Psychological Factors |
Poor mental health (e.g., emotional distress, stress, depression, anxiety), sexual abuse, self-image, body image, unrealistic expectations, lack of knowledge and skills.
Religious or cultural beliefs (especially in strict or patriarchal cultures or religions), upbringing, societal pressures, cultural norms and expectations, deterioration of socioeconomic status, low educational attainment, ethnicity (due to cultural influences, not biology).
Relationship factors, being unmarried (premarital, divorced, widowed, separated), being married, partner’s sexual dysfunction.
Risk Factors for Sexual Dysfunction
The fact that there are so many factors that can impact female sexuality makes it really hard for women to know what’s causing their problem, which means it’s hard to know where to seek help! Having so many possible contributing factors can also make it hard for healthcare providers to figure out the problem. None of this is your fault.
Nobody talks about women’s sexual pleasure
Teaching people of all genders about women’s sexual function can both prevent FSD and treat FSD. Comprehensive sexual health education enhances a person’s physical, emotional, mental, and social well-being in relation to sexuality. Sexual health education should teach people what normal and healthy sexual functioning is, when and where to ask for help, and that sexual health and pleasure are their rights. Albertan resources (e.g., Alberta Health’s TeachingSexualHealth.ca) do not mention pleasure or the clitoris (but they do mention the vagina and penis), while Canada’s resources (e.g., SIECCAN’s Question & Answers or Canadian Guidelines for Sexual Health Education) do at least mention pleasure.
Unfortunately, Alberta Education’s requirements for sexual health education also fail to mention pleasure or sexual function, instead focusing on prevention of negative outcomes (e.g., STIs, unplanned pregnancy), mostly by abstinence. It’s likely that neither your schooling nor your parents taught you about sexual pleasure or the clitoris, and you may not have learned much more as an adult. You may have learned to feel shame and embarrassment about your genitals as a child and carried much of this shame into adulthood. Do you relate to this person’s experience of sexual health education?
My sex-ed was a failure. I didn’t learn about body parts and their proper names…. I never learned that sex shouldn’t or doesn’t have to hurt. I never heard about reproductive control, like birth control and abortion. I was left to my own devices, many of which were unreliable, biased, and inaccurate, in learning about these topics.(Action Canada for Sexual Health & Rights)
Lots of women haven’t learned about their bodies through masturbation
Masturbation is the stimulation of the genitals with a hand or another object by yourself or someone else. I’m going to refer to solo masturbation simply as “masturbation.”
There is no correct method of masturbation—it is simply what works best for each person. Women may touch their bodies (usually their clitorises) using their fingers, vibrators or dildos, though almost all women who masturbate with a dildo add clitoral stimulation, and few women masturbate only through vaginal penetration. Women may enhance their masturbation through fantasies, pornography, erotica, music, or thinking about previous sexual experiences. On average, it takes women about four minutes to orgasm from masturbation—the same amount of time it takes a man to orgasm from masturbation. So don’t let anyone tell you women take too long to orgasm!
How many women masturbate?
In a 2017 study of 1046 American women, 41% had masturbated in the last month and 22% had never masturbated. Another 2017 study found that over 70% of asexual women and over 90% of sexual women masturbate at least monthly. Women tend to underreport masturbation, so it is safe to assume that many women are masturbating.
85% of women aged 25 to 29 have ever masturbated while only 58% of women aged 70 or more have ever masturbated! Masturbation seems to be becoming more popular with women.
Is masturbation harmful?
Masturbation was referred to as “self-love” in ancient Ireland, but Christianity misinterpreted the Biblical story of Onan as referring to masturbation, and the name changed to “self-abuse.” Masturbation is considered a sin by some religions, including Orthodox Jews (though it is not a sin for women), Latter-day Saints, and Catholics. The demonization of masturbation has led to personal shame, fear, and misinformation. There are many myths about masturbation, such as the myth that it causes physical deterioration and deformity. These myths were intended to prevent masturbation and lead to a bunch of unproven prevention techniques, including cutting off the clitoral glans. This shame about masturbation has resulted in some women being unwilling to masturbate, many people being reluctant to discuss or admit to masturbation, and the myth that women simply do not masturbate. But is masturbation harmful? No, it is not.
Is masturbation beneficial?
Yes! Masturbation has many benefits. It allows for sexual exploration, sexual expression, and sexual gratification without the risks (e.g., STIs, pregnancy) and stressors of partnered sex (e.g., partner judgment, worrying about partner enjoyment). Women are more likely to experience orgasms and multiple orgasms during masturbation than during sexual intercourse or other partnered sexual activity—specifically, masturbation leads to orgasm for 94% of women. Masturbation is beneficial for partnered sex too, as it helps women to learn about their sexual response, and this knowledge can be transferred to partnered sex. Masturbation is also beneficial for women with sexual dysfunctions. Because some sexual dysfunctions are often treated with “directed masturbation,” learning about their own sexual response through masturbation would probably prevent some women from experiencing sexual dysfunctions.
Women masturbate for a variety of reasons, including for sexual pleasure, to relieve tension, for fun, for self-care, or to avoid being sexual with another person. And four out of five women continue to engage in masturbation when they are in a relationship!
What if I don’t masturbate?
Some women do not masturbate at all, and there are a variety of reasons for this, including being asexual, not knowing how, shame, fear of being caught, low sex drive, a partner’s insecurity, lack of interest, being in a relationship, and religious prohibition, though many religious people masturbate despite their prohibitive religious beliefs. If a woman is seeking help for FSD, however, refusing to masturbate may be a treatment barrier, as masturbation is a standard recommendation for some sexual dysfunctions, particularly orgasm dysfunctions. I highly recommend masturbation, but it is entirely up to you whether you do it!
Asexuality is a sexual orientation describing people who do not experience sexual attraction to other people. While significantly fewer asexual women masturbate than sexual women, many asexual women do masturbate and they masturbate for somewhat different reasons than sexual women (e.g., “I feel that I have to”).
Female sexuality is not complex, just misunderstood
Another reason it’s not your fault that you have a sexual function problem is that female sexuality is misunderstood, especially by the average person. You may believe that women’s sexuality is complicated. Have you seen this sculpture before? Does it resonate with you?
Man, Woman by Miller Levy, photographed by Barend Jan de Jong. Permission granted by photographer.
This sculpture represents Western views of female sexuality. Desire, arousal, and orgasm are very straightforward for men but very complicated for women—so complicated, in fact, that it’s probably not even worth trying to figure it out. However, this is because we are judging women’s sexuality by the standard of men’s sexuality. Vaginal intercourse easily stimulates a man’s primary pleasure organ (his penis), and that is why his desire, arousal, and orgasm are so straightforward. Vaginal intercourse does not easily stimulate a woman’s primary pleasure organ (her clitoris), but many other behaviours do—such as cunnilingus (oral sex on a vulva), masturbation, and even vaginal intercourse with added clitoral stimulation. And women tend to experience arousal and orgasm just as easily and quickly as men do when their clitorises are stimulated. The takeaway: women’s sexuality isn’t complicated. The clitoris just needs to be stimulated. (I cannot emphasize this enough.)
I would also argue that women do not have significantly lower sexual desire than men do. Women simply experience more barriers to sexual desire than men do, such as being responsible for a greater proportion of the gendered division of labour and significantly fewer sexual encounters that take women’s needs into account. If men were expected to endure painful or boring sex and if men’s penises were ignored during sex, I think men would have lower sexual desire too.
So why don’t women ask for pleasure?
By now, you may have a burning question in your mind: If women are not receiving pleasure, why don’t they just ask for it or demand it? Great question! There are many factors at play here. Young women are generally quite motivated to have sex, but they do not necessarily feel entitled to experience pleasure. Asking for pleasure assumes that one deserves pleasure, but female sexual pleasure has been shamed by Western society. Further, some women don’t ask out of habit, fear of losing their partner’s love, or fear of losing economic stability. Some women have partners who seem reluctant to fulfill their female partners’ sexual needs, and some people follow the sexual script that says sex is over when the man orgasms.
We know that most women know how to orgasm from masturbation, but for some reason this information is not translated over to partnered sex. Why? One factor is men’s egos. To protect men’s egos, some women fake orgasms or avoid asking for the clitoral stimulation they need. This concern isn’t without a basis: most men view vibrators with either indifference or negativity, so women don’t exactly feel empowered to use them with male partners. This is unfortunate, given that vibrators are so successful at producing women’s orgasms and the lack of evidence that women become dependent on vibrators. Most men do, however, view clitoral stimulation with the hand positively. Regardless of how your partner feels about clitoral stimulation with a hand or vibrator, you should feel free to ask and receive the stimulation you need.
Despite the fact that women tend to really enjoy cunnilingus (and it is the most reliable partnered path to orgasm), women may not necessarily want it. However, this may be due a number of factors, such as the belief that they should orgasm from vaginal intercourse, being self-conscious about their genitals, or having an untalented sexual partner, or it maybe a way to avoid feeling obligated to perform fellatio (oral sex on a penis). That may seem like a fair trade for people who think that vaginal intercourse to be as pleasurable for women as it is for men, but it simply is not. In heterosexual sex, vaginal penetration and clitoral stimulation should be considered equal. However the clitoris gets stimulated is up to the couple!
Another reason that women are less likely to ask for or demand pleasure because they have less power than men do. This is a big topic and you can read more about it elsewhere, but let’s look at women’s power in Alberta. In a 2019 report on the best and worst places to be a woman in Canada, the two Albertan cities included (Calgary and Edmonton) scored 21st and 25th out of 26 cities, and women occupied only five of the 28 city council seats between Calgary and Edmonton. Sally Hunter put it best: “We like to think women are empowered in [the West] and yet we are underrepresented in board rooms and in parliament…. Is it any wonder, then, that women find it hard to negotiate their own sexual satisfaction?”
You may not even realize that your body has the ability to experience sexual pleasure—or how much pleasure or how easily. This isn’t your fault either! (Remember, sex education is inadequate in most countries, and Alberta is no exception.) Many older women have had a life of vaginal intercourse with no orgasm because they didn’t know any better. Many younger women report high sexual satisfaction simply because sex didn’t hurt, they felt close to their partner, and their partner had an orgasm. This injustice is demonstrated especially well when we look at the differences between how women and men describe the low and high ends of a sexual satisfaction scale. Check it out:
Women’s and men’s descriptions of the high and low ends of a sexual satisfaction scale, based on their experiences. Adapted from Sara McClelland’s 2009 doctoral dissertation, Intimate justice: Sexual satisfaction in young adults.
You may notice that women and men seem to be measuring sexual satisfaction with completely different scales. And you may notice how the high end of this scale is skewed in favour of women’s partners’ sexual satisfaction. Well, that’s the next thing we’re going to discuss!
Straight women and men prioritize men’s sexual pleasure
Alright, this is a big topic, so buckle in. You may have been trained to prioritize men’s sexual pleasure at the expense of your own. You may have experienced sexual interactions that end when the man ejaculates, and if you didn’t orgasm before he did, you might not have orgasmed at all. You may have given a lot more oral sex than you received in return or you may have learned that being sexy is more important than receiving sexual pleasure. All of these things teach women that their pleasure does not matter and that their partners’ pleasure is more important.
There are several important ideas intertwined with this phenomenon (prioritizing men’s sexual pleasure), including the coital imperative, the difference between sexual behaviours that pleasure women and those that women actually engage in, and the orgasm gap. Let’s dive in!
The coital imperative
Western culture overvalues vaginal intercourse. And even though few women orgasm from vaginal intercourse alone, Western society still expects them to do so (and makes them feel like something is wrong with them if they don’t). Why does Western society expect women to orgasm from vaginal intercourse? Three reasons:
- The belief that sexual pleasure ensures reproduction (even though women’s orgasms are not required for reproduction).
- The “coital imperative,” a Western belief that vaginal intercourse is “real sex” and all other behaviours (cunnilingus [oral sex on a vulva], hand jobs) are foreplay or adolescent sexual behaviours. And because of the coital imperative, Western society expects women to orgasm from vaginal intercourse (despite the fact that about one third of women rarely or never orgasm with vaginal intercourse).
- Freud’s teachings that clitoral orgasms are immature and that the mature orgasm must transfer to the vagina. This is nonsense, and is akin to teaching that men must learn to transfer their orgasm from their penis to their testicles (or their “prostatic utricles” if we want to compare the vagina to the male organ that developed from the same reproductive tissues in fetuses). However, even women who orgasm from vaginal intercourse alone have easier or better orgasms when clitoral stimulation is added, so Freud’s teachings are damaging to all women.
This emphasis on vaginal intercourse, which is very effective at producing men’s orgasms but not women’s, inevitably leads to a difference between the sexual behaviours that straight couples engage in and those that lead to women’s orgasms.
Many women aren’t having the kinds of sex that give them the most pleasure
The coital imperative and the prioritization of men’s pleasure leads to women having more sex that pleasures men and less sex that pleasures themselves. It’s common for Western society to believe that the best or healthiest way to experience sexual pleasure is with a partner, and that the best way to be sexual with a partner is vaginal intercourse. This faulty belief comes from many sources, including the early Christian prohibition on all sexual behaviours that weren’t attempts at making babies and the myth that masturbation causes disease.
So what kinds of sex do women enjoy the most?
Women have sex for different reasons at different times (e.g., pleasure, their partner’s desire, intended pregnancy), so just because a woman has a lot of a certain type of sex does not necessarily mean it’s her favourite type of sex. Let’s look at behaviours that women find appealing or satisfying and that reliably lead to women’s orgasms.
You may not be surprised to find that 70% of women find vaginal intercourse “very appealing”—the highest rated of any partnered sexual behaviour. Somewhat surprisingly (at least to me), only 43% of women rate cunnilingus as “very appealing,” (though I will address why this may be). It’s interesting that women view vaginal intercourse so positively, as vaginal intercourse alone does not reliably lead to women’s orgasms, especially in casual sex. However, many women say that vaginal intercourse is sexually satisfying. This may be due to a number of factors, such as orgasm not necessarily being correlated with sexual satisfaction, women’s low expectations of pleasure, or women’s limited knowledge about their capacity for pleasure. Women may also prefer vaginal intercourse because they prioritize men’s sexual pleasure and base their own satisfaction on how satisfied their partner is. (We’ll dive more into these reasons later in this section.)
While women rate vaginal intercourse as very appealing, women experience sexual satisfaction when they receive more cunnilingus, reach orgasm more consistently, and experience sexual variety (which can include vaginal intercourse but should not be exclusively vaginal intercourse). The most reliable path to female orgasm is clitoral stimulation, such as of cunnilingus or other “foreplay.” In fact, cunnilingus is the most reliable partnered path to orgasm.
Okay, so what sexual behaviours are most common for women?
Vaginal intercourse, cunnilingus, masturbation, and vibrator use are common Western sexual behaviours for women. Over three quarters of adult women have ever had vaginal intercourse or received cunnilingus, but frequency of these behaviours varies greatly with age. Research suggests that women are having significantly more vaginal intercourse than they are receiving cunnilingus. (Women also perform somewhat more oral sex than they receive, though this research included women who have sex with women, so the gap is likely larger for straight women.) This is disappointing for women, given that clitoral stimulation is necessary for most women’s orgasms, but it does provide a very concrete explanation for the orgasm gap.
While you might think older women would be more sexually experienced because they have been alive longer, this is not necessarily true. Having ever had vaginal intercourse increases with age, but having ever received cunnilingus peaks with women in their 30s. For all sexual behaviours included in one study (e.g., vaginal intercourse, giving and receiving oral sex, receiving anal sex, wearing lingerie), women aged 25 to 49 are the age group most likely to have done them in the last month, in the last year, or ever. Regarding intercourse and cunnilingus specifically, women in their 30s are the age group most likely to have done these behaviours in the last month. It seems that that middle-aged women and younger women are increasing their sexual repertoires to include more orgasmic activities, which is great!
Are some women enduring unwanted sex for their male partners?
Unfortunately, yes. Many women endure unwanted sex to prevent their partners from straying or to maintain their relationships, even when sex hurts. More than half of women who experience sexual pain do not tell their partners about the pain. Worse, women are even less likely to speak up about pain if they are experiencing little to no pleasure. So why don’t they speak up? The main reasons are that painful sex has been normalized for women, some women view pain as unimportant, some women (or even their partners) prioritize their partner’s enjoyment, and women may try to avoid awkwardness or manage their partner’s emotions. Some doctors may also reinforce the idea that painful sex is normal or that women do not need to enjoy sex. You may have been told to expect pain with vaginal intercourse (especially first penetration) and some men may even use the Bible to justify the expectation that women endure painful sex for their male partners’ enjoyment. Women also endure unwanted sex with men to avoid seeming rude or to avoid men’s negative reactions, including hurt, disappointment, anger, and violence.
Why are you blaming men for so much?
I’m actually blaming a system that supports an unequal balance of power between women and men (the patriarchy), which many men and women uphold. Whether or not you agree with that isn’t important. We can look at research on women who have sex with women (WSW) for concrete answers!
Compared to heterosexual women, lesbians are at less risk of sexual dysfunction, have better orgasmic function and less sexual pain. 88% percent of lesbian women orgasm with a partner frequently or always, while only 66% of heterosexual women orgasm with a partner frequently or always. Additionally, few lesbians (2%) never experience orgasm, compared to 13% of heterosexual women. Among lesbian, bisexual, and heterosexual women, lesbians report having the most orgasms. Lesbians are also just as sexually satisfied as heterosexual women, if not more satisfied.
The difference between sexual problems in WSW and heterosexual women may be due to WSWs’ understanding of pleasuring a female partner and the fact that WSW sexual interactions do not prioritize vaginal penetration (a possible source of pain and a limited source of pleasure). These studies suggest that the introduction of men (or, more likely, penises) into women’s sexuality is inhibiting women’s orgasms. As one sex educator explains, “When women are put in a situation where the penis is not involved—as in the situations I described before [masturbation or sex with other women]—then sex differences disappear.” You’ll find more information about this in the next section on the orgasm gap.
The orgasm gap
The orgasm gap is the inevitable result of the coital imperative and the difference between the sexual behaviours that women practiceand those that lead to their orgasms. What’s the orgasm gap? Essentially, the orgasm gap is the phenomenon where men have significantly more orgasms than women do during partnered sex, especially during vaginal intercourse. About 95% of straight men usually/always orgasm but only 65% of straight women usually/always orgasm! That’s a big gap, and it’s even bigger with casual sex because women and men prioritize men’s orgasms and undervalue women’s orgasms. Women aren’t happy about it either. When their male partners orgasm and women do not, women feel angry, resentful, frustrated, and cheated.
While the orgasm gap is often blamed on women’s supposedly “complicated” sexuality or psychological issues (e.g., body image, anxiety), it’s actually a social issue, not a biological issue. That is to say, women’s orgasmic capacity is the same as men’s, but Western society expects women’s bodies to function like men, which generally means orgasming from vaginal intercourse.
There is almost no orgasm gap for masturbation—94% of women orgasm with masturbation compared to 98% of men. Women and men also take about the same amount of time to orgasm during masturbation. Most (95%!) of women report that clitoral stimulation is their most reliable route to orgasm. What is notable is that straight women orgasm more during masturbation than during vaginal intercourse and heterosexual sex and that about one third of women rarely or never have orgasm with vaginal intercourse.
Among those women who can orgasm during vaginal intercourse (about one third), additional clitoral stimulation improves their orgasm or makes it easier to achieve for most of them. In fact, in research on thousands of women, 95% said that clitoral stimulation is their most reliable route to orgasm. This is normal sexual function for women. Vaginal intercourse stimulates the vagina but tends to neglect the external clitoris, so it inherently provides inadequate clitoral stimulation for most women. The clitoris and the penis both developed from the same tissues in utero, which means they are essentially different versions of the same organ, so they both require adequate stimulation for orgasm to occur. (Imagine if men were expected to orgasm with minimal touch to their penises!) So there’s no need to feel inferior, broken, or guilty if you aren’t having an orgasm from vaginal intercourse—that’s normal! The vagina isn’t the primary pleasure organ for most women. (But if you want to have an orgasm with vaginal intercourse, we’ll address that later.)
Sexual scripts (socially expected sexual behaviours) are another important contributor to the orgasm gap. For example, many people follow sexual scripts that place the responsibility of women’s orgasms on men’s penises. Many people also follow sexual scripts that believe that “foreplay” is only needed to prepare for vaginal penetration, followed by vaginal intercourse (the main event), which leads to a woman’s orgasm and ends when the man orgasms. Following these scripts—which do not promote clitoral stimulation—decreases a woman’s ability to orgasm with her male partner, especially if he orgasms before she does. Again, not orgasming from vaginal intercourse alone is normal sexual function for women because their clitorises are not adequately stimulated.
You may now be wondering whether women actually have lower sexual desire than men do, or if straight women would have equal sexual desire to men if their clitorises were getting as much attention as men’s penises do—and if this would reduce or eliminate the orgasm gap. I believe it would.
Lack of research, training, treatments, and insurance coverage for FSD
You may have sought help and given up because it was too difficult, pointless, or expensive. This isn’t your fault either.
Doctors receive little to no education in sexual health during medical school or residency training, and when they do, it tends to have a heavy emphasis on contraception and STIs (though sexual violence and FSD may be the next most common topics). Many doctors are unaware of FSD treatment options and don’t know where to refer patients for FSDs. Sexual medicine specialists exist, but they are less common.
Mental healthcare providers don’t usually have any training in sexual health either, and those programs that do include sexuality training also tend to have a heavy emphasis on infection and disease. Neither the College of Alberta Psychologists nor the Canadian Counselling and Psychotherapy Association requires any training in sexuality beyond sex role development, sex role differences, and sexual orientation. However, AASECT-certified sex therapists are required to undergo extensive sexuality training and supervision.
Quick! Can you name some possible treatments for male sexual dysfunction? If you did, I bet you came up with Viagra, maybe Cialis, and maybe even a penis pump or testosterone supplementation. Now quickly try naming some treatments for FSD. If you can’t think of any, I’m not surprised. In the USA in 2020, there were 26 FDA-approved drugs for male sexual dysfunction and zero for women. As of March 2021, there were 30 for men and three or four for women.
Another problem is that treatments for sexual dysfunction are more often covered for males than for females (though neither are covered very often in Canada). This meme depicts the problem in a humorous way.
I know the situation seems bleak, but there are healthcare providers out there who can help. You just have to find them. (We’ll get to that.)