Women's Sexual Health: Common Problems and Where to Start

Many women who come to talk to me begin with, "I don't know if this is something I should see a doctor about." The answer is yes. Sexual problems are a health matter, just like blood pressure or insomnia. They have causes, they can be assessed, and most can get better. This article is an overview map, to help you see where your symptoms probably fit and what to read next.

What is women's sexual health?

Sexual health does not mean "having sex often" or "reaching orgasm every time". The World Health Organization describes it as a state in which the physical, emotional, mental and relational aspects of sexuality are safe, pleasurable and based on consent.

So a woman who rarely has sex but feels comfortable with her life does not have a problem. A problem begins when what is happening causes you distress or pain, or affects your relationship.

Common problems in women

• Low sexual desire: rarely thinking about sex, not wanting to initiate, or feeling indifferent even when the relationship is loving. Read more in low sexual desire (HSDD).
• Difficulty with arousal: the mind may want it but the body does not respond, or mind and body are not in step. DSM-5-TR groups these together as FSIAD.
• Vaginal dryness, burning or itching: common around menopause, after childbirth, while breastfeeding or with certain medicines. Read vaginal dryness (GSM).
• Pain during sex, or being unable to have penetration: ranging from mild pain to muscles tightening so much that penetration is impossible. See painful sex and vaginismus.
• Difficulty reaching orgasm, or never having had one: see orgasm difficulties in women.
• Sexually transmitted infections: some cause no symptoms, so testing is worthwhile if you have been at risk. Read the overview in common sexually transmitted infections.

Many women have more than one of these at once. For example, dryness causes pain, and frequent pain makes you not want sex. That is why these problems should be looked at as a whole, not one piece at a time.

Why it happens: looking at all three sides

I use a framework called the biopsychosocial model, the main approach of women's sexual health organisations such as ISSWSH (the International Society for the Study of Women's Sexual Health).

If you take an antidepressant and feel your sex life has changed, do not stop the medicine yourself. Read antidepressants and sex and talk to the doctor who prescribed it; there are several options that can help.

Where to start looking after yourself

1. Notice and jot down a few notes: when the problem started, whether it happens every time or only sometimes, and whether it happens only with a partner or also on your own.
2. Look after the basics: enough sleep, moving your body, less alcohol and managing stress. These small things genuinely affect sexual desire.
3. Use a lubricant if you are dry: simple and safe. Choose a water-based or silicone-based one without fragrance.
4. Talk with your partner without blame: use "I feel..." rather than "You make me...". If talking is hard, couples counselling helps a lot.

What treatments are available?

Treatment depends on the cause and usually combines several approaches.

• Physical: treating other conditions, adjusting medicines that affect sexual function, local hormone treatment for vaginal dryness, or menopausal hormone therapy for women for whom it is suitable. See menopausal hormone therapy.
• Psychological: cognitive behavioural therapy (CBT) and mindfulness, both supported by research in women with desire and arousal problems.
• Relationship: couples therapy and exercises such as sensate focus, which help reduce the pressure to "perform".
• Pelvic floor physiotherapy: for women with tight or painful muscles.

When to see a doctor

• Pain every time there is penetration, or penetration is not possible at all
• Bleeding after sex, or bleeding after your periods have stopped at menopause (get checked promptly)
• Unusual discharge, sores, lumps or severe itching
• The problem has caused distress or strained your relationship for several months
• Low mood or thoughts of harming yourself: call 1323, Thailand's free 24-hour mental-health hotline (Thai language; ask for English support)

At Dr. Kris Clinic, I provide care as a family physician who looks after sexual health and as a clinical sexologist. We talk privately and without judgement, assess your body, hormones, mind and relationship, and plan together step by step. English-speaking consultations are available, at the clinic in Surat Thani or online.