An ob/gyn discusses sexual problems — and how to address them.
While many women enjoy a healthy sex life, many others struggle with physical and/or psychological issues that interfere with intimacy and, as a result, put a strain on their sexual relationships. Discover Rush Online recently asked Carrie Smith, MD, an ob/gyn at Rush University Medical Center, to share her insights on why women may not be in the mood and why it's important to talk openly — with your partner and your doctor — about this often sensitive subject.
Q: In your experience, is it unusual for premenopausal women to have problems related to sex?
A: It's not unusual at all. For instance, a lot of my patients in their 30s and 40s tell me they feel as if they should have a really high sex drive, but instead they have a really low sex drive. And as a result, they aren't having sex as frequently as they and/or their partners would like. It's a much more common problem than you might think, and sometimes it's a relief for women just to know that they aren't alone.
Q: What can cause a woman's libido to diminish?
A: Certain medications have the potential to cause a decrease in sex drive. A lot of antidepressants, for instance, have this effect, although there is one, bupropion (Wellbutrin), that has actually been shown to help hypoactive sexual desire disorder (when a person has a low level of sexual interest). So for my patients who are depressed and complain of low libido, I try to prescribe that specific drug. Using birth control pills for a prolonged period can also cause a decrease in a woman's sex drive. Chronic health problems — cancer, heart disease, diabetes — may affect your libido as well, because of changes in your physical health and side effects of treatments, and because you may be more stressed and exhausted than usual.
In addition, if there's pain involved with sex, or even just the fear of pain, it's likely going to affect both your desire for and your enjoyment of sex. Lack of lubrication is a common cause of painful intercourse, although it's far more common after the menopausal transition when women experience a drop in their estrogen levels. I have, however, found that the really low-dose birth control pills may decrease estrogen in the vaginal area and lead to vaginal dryness — not for everyone, of course, but for some women it happens. And a lack of foreplay or good communication with your partner may also cause vaginal dryness.
Other common causes of pain during sex include interstitial cystitis, a chronic inflammation of the bladder; vulvovaginitis, an inflammation or infection of the vulva and vagina; endometriosis, which can also produce painful menstrual periods; sexually transmitted diseases; and vaginismus, which is when the muscles around the vagina spasm involuntarily, causing the vagina to close. These conditions are most often treatable with medications, nonsurgical procedures, topical creams or ointments, estrogen or, in rare cases, surgery. I also typically prescribe pelvic floor physical therapy when there is a muscular component to the pain, and if necessary I might recommend psychotherapy to address any emotional issues that arise. But the treatment plan is always based on each patient's specific needs.
Q: Is it true that breastfeeding can also affect a woman’s desire to have sex?
A: Absolutely. I think many women experience decreased sex drive during breastfeeding because of the hormonal changes that occur; I've had to reassure more than one woman that her lack of interest in sex was likely due to all those hormones. Breastfeeding can also cause vaginal dryness, which as I mentioned before can be a factor. Then there's the fact that you’re often exhausted while breastfeeding because it burns a lot of calories and you’re up multiple times during the night doing it. And obviously, you're very emotionally invested in your infant during that first year, so it may just be that you don't have as much emotional energy leftover.
Q: If you do experience pain during sex, should you see a doctor?
A: I'd say it depends how severe and bothersome the pain is. If it's just a little bit of dryness or discomfort with a new partner, or if it's mild pain that you experience sporadically, you probably don't need to schedule an appointment. But if you experience pain every time you have sex, or even if it's not every time but it's affecting your sex life, then I'd say definitely talk to your doctor. As I mentioned earlier, many of the conditions that cause pain during sex are treatable, and you shouldn't have to suffer from chronic pain of any kind.
Q: Is the problem always physical?
A: No. Actually, for many women, there isn't a physical component at all. Self-esteem issues — how women feel about their bodies, their weight, etc. — can definitely affect both how often women are having sex and how much they enjoy it. And many women just have a lot on their minds: careers, children, spouses or partners, managing the household, social engagements. Perhaps they're caring for elderly parents as well. When you're being pulled in a million different directions and feel tired, stressed or distracted, sex can become low on your list of priorities. Unfortunately, when that happens, it can have a big impact on your relationship.
Q: How do you help women deal with these issues?
A: Well, first let me say that there is no magic pill. I wish I could say that there's a quick fix, but there isn't. That said, there are some things you can try that might work for you. I always counsel women on communicating with their partners; you should feel comfortable enough to talk to your partner about what feels good for you, what you enjoy, what you don't like, what parts of your sex life work best for you.
I also feel it's important for couples to figure out ways to create a balance in their sex life that will satisfy both partners. (Learn tips for increasing intimacy in this story from the Discover Rush Online archives.)
Finally, I talk to women about carving out time to do things that will help them feel good about themselves; women are often so busy taking care of everyone else that they forget to take care of themselves. Lots of women find that their sex drive can be improved with regular exercise, healthy eating, yoga and/or meditation. Things that relax you, energize you and make you feel good about yourself physically can help you become more interested — and invested — in intimacy.
Read part two of the interview with ob/gyn Carrie Smith, MD, in the May 2013 issue of Discover Rush Online, when she offers tips for older women on having a healthy sex life, and explains why condoms are a must — even after menopause.
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