This disorder manifests itself in a lack of sexual desire and reduced pleasure during sex. While in men sexuality takes place more on the physical level and orgasm is the goal, in women sexuality takes place mainly in the head. Therefore, psyche, mind and body have to be in harmony if sexual experience is to be enjoyable.
In every phase of life sexual activity and sexual need can be affected. One should distinguish between reduced appetite, i.e. less desire, sexual arousal disorders, orgasm disorders and other dysfunctions. Only in about two percent of women are sexual problems due to purely physical causes.
Women with this disorder have few or no sexual fantasies or needs. In some cases, these women even develop a real aversion to the sexual part in a relationship. Disorders of sexual appetite do not rule out sexual arousal or satisfaction, but mean that sexual activities are less often initiated.
Despite sexual stimulation, little or no vaginal fluid is formed, so that sexual intercourse is often painful. In addition to these physical symptoms, women also subjectively feel a lack of excitement and pleasure.
After the arousal phase, the affected women have no or only a delayed orgasm. In sexual medicine it is not yet completely clear whether this is a real disorder. It can also be a variant of female sexuality. The women often do not suffer from the lack of orgasm, but enjoy the form of sexual affection and tenderness and do not feel unsatisfied. They are normally excitable.
There are two different forms: the first is dyspareunia, which is pain in the vagina or lower abdomen that occurs during normal arousal during or after sexual intercourse. The other symptom is vaginismus, which causes involuntary cramping of the vaginal muscles when the man wants to insert the penis or a finger into the vagina. Sexual intercourse is impossible or painful.
Sexual disorders are caused by a combination of psychological and physical causes. Basically, the affected women seem to be under a certain pressure to perform or are very critical in their self-observation. The pressure to perform is influenced by this:
During upbringing, the parents impart values that can affect later sexual behaviour. If sex is considered immoral in a strictly conservative upbringing, it is unlikely that sex can be enjoyed in adulthood.
Many women have problems in partnership. It can be the daily quarrel or the lack of communication about sexual needs that stands in the way of sexual pleasure.
If previous sexual activities have been experienced as frightening or humiliating, the later pleasurable experience of sexuality is made more difficult. Experiences of abuse play a serious role in this respect.
If you have no experience with your own body, e.g. during masturbation, or no knowledge of the physical processes during sexual arousal, this can lead to self insecurity and thus to an impairment of sexual togetherness.
Pain during sexual intercourse often also occurs when the external genitals change, e.g. due to inflammation, scars, etc. The pain is often caused by the sexual intercourse. The dryness of the vaginal entrance can also be a cause of pain. A vagina that is too dry can be traced back, for example, to insufficient excitation or an estrogen deficiency after the menopause.
Inadequate contraception and the fear of pregnancy influence sexual feelings. In the same way, the fear of sexually transmitted diseases can lead to tension during sex.
Another factor is that many women are unable to free themselves from traditional social ideas about female sexuality. They behave passively, do not themselves make any demands on sex as a partnership and therefore do not express any wishes of their own.
In principle, a partner therapy (separate sessions) should take place, the prerequisite for this is the agreement of both partners. If the causes of the disorders lie in the relationship itself, a couple therapy (joint sessions) should be considered.
The aim of a therapy is for both partners to learn to enjoy intimacy and sexuality. The aim is to deal with each other in a more relaxed way and to reduce any pressure to perform. Both partners should learn that not every tenderness has to end with sexual intercourse. The sexual needs and preferences should be researched.
Similar to the therapy for premature ejaculation, there is a step program in which the partners "learn" to meet each other tenderly.
Parallel to the "exercises" in partnership, it is important that the partners inform each other about sexuality, e.g. about sexual practices and positions. They should learn to express their own wishes and resolve any conflicts. It is particularly recommended that women - if they have no experience with it - get to know their body better through masturbation. This can also be well integrated into the partnership exercises already mentioned.
In addition, it is necessary to treat any physical difficulties that may exist - e.g. estrogen deficiency can be well treated with creams or the lack of moisture can be compensated by water-soluble lubricants.
Written by Mark Riegel, MD
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