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?
Why should I seek help for female sexual problems?
Sexual health, sexual pleasure, and sexual satisfaction are human rights according to the World Health Organization and the Sex Information & Education Council of Canada. Your sexual satisfaction is important to your sexual wellness, sexual health, and general well-being, as well as your social life, relationship, and your partner’s mental health and sexual function. Sexual satisfaction within a relationship can also predict future relationship satisfaction and stability.
However, whether you seek help or not is completely up to you (even if your partner really wants you to). You may have very important reasons for not seeking help or delaying help. But if you want to know why I think you should seek help if you think you have a sexual dysfunction, we’ll dive into the negative impacts of female sexual dysfunction (FSD). Most of this information pertains specifically to the impacts of sexual pain, but I believe it applies to all sexual dysfunctions to varying degrees.
Can my sexual problem affect my mental health?
FSD, especially sexual pain, can have a negative impact on women’s mental health, including self-esteem and body image. Women with sexual pain experience a negative impact on their quality of life and often experience depression and anxiety. Many women with sexual pain feel guilt and internalized pressure to be sexual with their male partners—they feel obligated to have sex, as though they do not have a choice. A woman like this cares about and wants to please her partner, views her partner’s needs as more important than her own, and assumes responsibility for her partners’ reactions (e.g., frustration, disappointment, anger) if she turns him down. She also fears negative consequences if she refuses sex, feels social pressure to engage in sexual interactions, and views sexual interactions as part of her role as a wife or woman.
Women may experience negative thoughts, feelings, and behaviours as a result of sexual pain. Mental distress and a range of negative feelings are common, including shame, embarrassment, frustration, worsened mood, anger, fear, grief, and confusion. Many women with sexual pain feel inadequate as women and sexual partners because of the Western belief that vaginal intercourse is the only “real sex” and that all other sexual behaviours are foreplay. They may begin to view themselves as broken, damaged, abnormal, and incomplete. Their self-esteem may suffer and they may feel a loss of femininity, loss of self, and diminished confidence.
Body image is often impacted by the experience of sexual pain as well. Women with vulvodynia view their bodies as “not normal,” “worthless,” “useless,” “broken,” and “dysfunctional” for not being able to satisfy their partners’ sexual needs and they describe their bodies with the words “garbage,” “trash,” “useless,” “mutant,” and “gimp.” Some women with sexual pain view their genitalia as a useless and dead part of their body and may begin to resent their body for being “faulty.” Women with sexual pain are not only suffering from physical pain but intense emotional pain as well.
People with lasting sexual dysfunctions, especially those involving abnormal genital sensations (PGAD/GPD) or lasting genital numbness (e.g., PSSD), appear to experience mental health impacts of a different magnitude. People with PSSD and PGAD/GPD experience severe depression and loss of quality of life, sometimes leading to suicide, due not only to the devastating effects of these sexual dysfunctions, but also likely to the experiences of not being believed by healthcare providers and the absence of a cure.
Can my sexual problem affect other aspects of sexual function?
It is no surprise that women with sexual pain experience a negative impact on their sexuality, including decreased sexual interest, arousal ability, sexual satisfaction, and sexual self-esteem. Sexual satisfaction is an important component of sexual health. Decreased sexual desire, sexual arousal, and orgasm ability can also lead to a woman’s decreased sexual satisfaction.
Some women with sexual pain avoid sexual interactions and refuse their partners’ advances to avoid or reduce pain. These women may fantasize about circumstances in which they could avoid vaginal penetration, such as being single or being a lesbian.
Many women engage in painful and unwanted vaginal intercourse for their partners’ benefits, to prevent their partners from cheating or leaving, and in hopes of experiencing pleasure themselves. Some women feel detached from the experience and their partner. They focus on their partners’ sexual arousal and tell themselves things like “Grin and bear it” to get through the encounter. They may experience physical pain, ranging from “annoying” to “very excruciating” during sexual interactions. They may be entirely motionless during the sexual act or mentally detach from the experience and think about other things. When the sexual interaction is over, these women are relieved, but the experience may also leave them feeling frustrated, guilty, sad, depressed, lonely, insecure, uncertain, anxious, and fearful. Meeting others’ needs while not having their own needs met may lead them to feel exhausted, hurt, and angry. It is unlikely these women experience much sexual satisfaction.
Can my sexual problem affect my partner or my relationship?
Research findings are mixed on whether sexual pain causes relationship problems, but points more to “yes” than “no.” These negative impacts are reported by both the women with sexual pain and their male partners. (There’s no research on female partners.) As PSSD can impact all aspects of sexual function, particular erotic sensation, people with PSSD may experience failed relationships.
Beyond the negative views of herself, a woman with sexual pain may have negative views toward sexual activity, viewing sex as a chore or a duty or even as “disgusting” and “dirty.” She may have negative thoughts about her male partner, such as thinking he is abnormal and needy, believing that he resents her, or questioning her choice of partner. She may also wonder why her partner is with her while also believing that other men would be less understanding than he is.
A woman may not speak up about painful intercourse because she fears her partner’s rejection or infidelity or views herself as an inadequate woman. Some women cope with their sexual dysfunction and its impacts through alcohol use, compulsive eating, and overworking themselves.
Lubrication difficulties may not have much impact on a woman’s partner because synthetic lube is such an easy solution, though some men feel this solution is “unnatural.” A woman’s orgasm difficulties may not prevent intercourse or other sexual activities, but men do view women’s orgasms as “masculinity achievements” and men are more sexually satisfied with women who orgasm more intensely and more frequently. However, low desire and sexual pain are factors that could interfere with the frequency or occurrence of intercourse or other sexual activity at all. Given that Western society places such an emphasis on vaginal intercourse, women’s sexual pain and low desire could impact their male partners by inhibiting women from desiring or consenting to some or all partnered sexual activities.
Male partners of women with sexual pain may experience negative emotions, such as anger, disappointment, frustration, guilt, and depression. They are likely to experience sexual distress, either through decreased sexual experiences (e.g., decreased quality and quantity of intercourse) or reduced intimacy (e.g., decreased physical intimacy, disconnection). A man may experience relationship strain (e.g., fighting or questioning the relationship) and communication challenges, such as difficulty discussing his partner’s sexual pain with her or anyone else. Erectile function, sexual satisfaction, and sexual communication may all suffer as a result of his female partner’s sexual pain.
Can my sexual dysfunction be a sign of other health issues?
FSDs have implications for a woman’s physical health. They are often associated with other health problems, though it is not always clear if the FSD is the cause or the effect of other conditions. For example, women’s sexual desire can be impacted by testosterone levels, and testosterone levels can impact bone density, body fat, lean muscle mass, risk of coronary heart disease, insulin sensitivity, and mood. Low testosterone (which causes low desire in some women) can also be a result of other conditions, including hypopituitarism, premature ovarian failure, or adrenal insufficiency. So it’s possible that low desire is a sign of another problem, especially if low desire is not normal for you. Similarly, a variety of health conditions are associated with vaginal dryness, sexual pain, and other FSDs. Thus, seeking help for your sexual function problem may be important in caring for your overall physical health.
What if I’m still not sure about seeking help?
There may be a number of reasons you’re reluctant to seeking help. Let’s take a look at these barriers, and how this web-based guide can help.
I don’t think I have a problem
Women may not recognize their own sexual experiences as a problem for a variety of reasons and, as a result, do not necessarily seek help. Poor or inaccurate sex education (at home, at school, or through socialization) rarely, if ever, mentions sexual pleasure—especially women’s sexual pleasure—and may include false and damaging beliefs about women, such as the idea that sexual desire is unfeminine, that women’s enjoyment of sex is unfeminine and interferes with reproduction, or that the female body is inherently dysfunctional. Women may believe that having sexual problems (e.g., low desire, limited pleasure, orgasm difficulties) is normal, that this is just how women experience sex (e.g., “I don’t care for sex but neither do most women” or “sex should hurt”), or that sexual problems are a normal part of aging, motherhood, first-time vaginal intercourse, or even all intercourse.
Many Canadian women do not seek help because they are comfortable the way they are, they do not think the problem is very serious, or they are waiting to see if the problem goes away. Additionally, women may never even have considered seeking help and may be less likely to seek help if they are not bothered by their sexual function problem. Not seeking help should not be taken as an indication of contentment, however, as many women who have not sought help would like to do so. Women may also not wish to have any treatment.
I’m uncomfortable discussing the problem
Older age, poor health, not knowing what services are available, and self-stigma may be barriers to help-seeking. Some women believe that their healthcare provider cannot help them or that the healthcare provider will be dismissive of their concerns. Women may be too embarrassed to bring up sexual function problems or believe that their doctors will be embarrassed. Similarly, women may expect or prefer that doctors initiate discussions about sexual function.
A healthcare provider’s personal characteristics, including age and gender, may contribute to women’s discomfort with seeking help. Specifically, women may be reluctant to seek help if their provider is too young, too old, significantly younger or older than them, or a different gender than them. Many women (but not all women) prefer seeing female physicians. Finally, women may be reluctant to seek help from a provider who does not seem approachable or seems uncomfortable discussing sex.
If you have concerns about your healthcare provider’s ability or willingness to provide help, or you’re not sure how to bring up the topic yourself, check out the webpage on how to seek help. That webpage will give you information on how to interview healthcare providers so that you can pick the best one for you.
I don’t have enough time or money
Limited time with physicians is a common barrier for women who wish to discuss sexual function problems. People may also assume that health services cost more than they really do. A fifth of Canadian women reported that they had not consulted a doctor because they did not have a regular physician or that going to the doctor is expensive. Insurance policies can be another barrier, as they may not cover the treatments recommended by doctors. If time and money are barriers for you, the best thing you can do is find a way to maximize your time when you do seek help. That means educating yourself (check out healthy sexual function and when to seek help), considering free and cheap options first (check out the self-help resources), maximizing the time in your appointment (check out how to seek help), and doing your best to avoid spending time and money on unnecessary services (check out where to go for help and how to seek help).