If only it were as easy as saying “hop on Pop!” Unfortunately for many women, female sexual dysfunction has no simple cure. In fact, it is the farthest thing from a simple disorder. It embodies hundreds or even thousands of possible problems and symptoms. For sufferers, it can make daily life unbearable, affect their romantic relationships and lead to other issues, such as depression and anxiety. It’s a disorder about which little is known and for which even fewer solutions are available.
In order to explore female sexual dysfunction, it must first be defined. Currently, there are at least three main areas in which health care workers diagnose women: Female Orgasmic Disorder, Female Sexual Interest/Arousal Disorder and Genito-Pelvic Pain/Penetration Disorder. To complicate matters even further, a sub-set of the genito-pelvic pain disorder is a disorder called chronic genital arousal. This is a disorder in which the sufferer has persistent, unwanted sensations in the genital region that are either not relieved or are only partially relieved by orgasm.
According to Licensed Social Worker Gina Buckman, Female Orgasmic disorder is defined as the woman having delayed orgasm or no orgasm in 75-100% of the time for at least six months. Female Sexual Interest/Arousal Disorder is defined as a lack of interest in sex including sexual fantasies and thoughts; reduced arousal or sensation and a reduction in the amount of times the woman initiates sex. The symptoms must cause the woman to feel distressed and can’t be explained by the presence of any other health concerns. Genito-Pelvic Pain/Penetration Disorder, according to the official guidelines provided by Buckman, include:
Recurrent or persistent difficulties with vaginal penetration during intercourse, marked pain during vaginal intercourse or penetration attempts, marked fear or anxiety about the possibility of pain during intercourse, Marked tensing and tightening of the pelvic floor muscles during attempted penetration. Again the duration must be at least six months and not otherwise explained by other medical/ behavioral health causes. Prevalence is about 15 %.
Buckman says sometimes there are other physical or psychological causes can sometimes present as sexual dysfunction:
As a social worker counseling someone who is presenting with these issues one would want to be very careful about ruling out other physical or mental health causes. Depression, for example, can cause a reduction in sexual interest and arousal. Even if the cause of the sexual dysfunction is not one attributable to one of these mental health diagnosis; if the person is distressed by the situation or if there are resultant relationship problems the counselor should focus on those feelings and issues.
While there are certainly many women who suffer from female sexual dysfunction due to psychological problems, some women feel confident that their issues stem not from their minds, but from their bodies. Violet Masterman, a 43 year old professional, says she began having problems she believes are largely hormonal. She has been frustrated, she says, by the doctors’ persistent focus on the psychological aspect of what she feels is a completely physical problem. She explains:
I think my problem is hormonal, but they keep saying it’s a sexual dysfunction and they can’t figure out how to help me. Now that I look at the history of it, the big picture seems like all of it can be directly or indirectly related to hormonal changes because of approaching menopause. But I’m not getting the answers I want. There’s nothing they can do about so they turn it into a psychological thing.
Masterman says all of her problems started when she found an endometrial polyp growing which got so large it began protruding into her vagina. She says the doctors kept insisting that the polyp would not or should not cause pain, but she began to experience severe discomfort with intercourse. She explains:
It started two years ago. I went to get an exam, and they told me I had a polyp that was basically an endometrial polyp that grew through my cervix into my vagina. At that time it was not bothering me so we decided to leave it alone. She said if it started causing symptoms it would have to come out. Months passed and I had no problems with it. I remember my husband and I were on vacation. I bled from sex and I bled a lot. It was clearly from the intercourse. It started to be an issue, so I went and I scheduled the surgery. I was concerned about it because I’d never been put under, but it wasn’t consuming me. I was having manual stimulation; we weren’t having intercourse because we didn’t want the bleeding. As I started to climax, the sensation was not a pleasant sensation. Once the contraction of the orgasm happened, it was painful. It was almost as though the feeling of the pleasant orgasm was replaced by pain. Like my brain was getting confused. To me, it seemed that it was because of the polyp. They were saying it wasn’t because of the polyp, but I really felt it was. They didn’t know or understand why the pain was happening.
Some people I talked to seemed to think it was hormonal. Then I had the surgery. And then I waited and when we again had manual stimulation, not intercourse, I was again getting pain upon orgasm. Then I started getting to the point where upon the first contraction of the orgasm, I would feel numbness. I went back to the surgeon and it seemed that all they were concerned about was liability. I just wanted somebody to help me and no one would help me. He didn’t even do a physical exam on me. Then I went to the doctor and she didn’t want to examine me either. They were both saying my pain had nothing to do with the polyp or the surgery. So I went to the neurologist and she said “of course it was from the polyp and the surgery!” She said the sensation would eventually come back. So then, over time, it was getting better, but now I’ve started having a problem with lack of arousal.
After the pain from the surgical removal of the polyp began to subside, Masterman says she began to have multiple issues like extreme sensitivity inside the vaginal canal upon penetration and lack of arousal and feeling in the vaginal area and clitoris. She is not alone. Bernadette Gallo, 42, says she began experiencing pain with intercourse after she hit 40. Like Masterman, she says she sought out medical help and received only unhelpful and even what she felt were ridiculous suggestions. She explains:
I started having pain during sex-real pain. Penetration is difficult to impossible. I am very sensitive and even bleed with finger penetration. Sometimes it’s like I’m a virgin, where it tightens up so much that it’s impossible to get in. I’m not consciously doing it. I had had some hormonal work done months ago, and when I first started reporting the problem she said ok, let’s see if you’re approaching menopause. It didn’t seem to be a lubrication issue. She did hormonal work and said my hormones were fine. She said I wasn’t going through menopause. I was also having in-between period bleeding. She said it could be cancer. I finally went and got a biopsy and I don’t have cancer. I told her I was having hot flashes and she acted like I was lying. She discounted the hot flashes. Now she sends me to a life coach because she thinks it’s all in my mind. So I give this life coach my whole history and the life coach says “the doctor says your blood work is totally fine.”
So then she asked me “are you having hot flashes on the nights your husband wants to have sex with you?” I said “no, I am waking up drenched with sweat in the middle of the night.” They only ever took one blood test and keep blaming my problem on sexual positions. My husband can’t get in because it’s clenched so tight. She’s trying to act like I’m a traumatized person. Telling me my husband is causing my nights sweats is the dumbest thing I ever heard. I feel like yelling “I have been f****** people for over 25 years and with my husband for 15 years! I am not afraid of sex! It’s a physical problem!” And all they tell me is “try the wheelbarrow position.”
Sally McGuire, 45, says she also has experienced a lack of attention when seeking medical advice for her problem, which comes in waves and bothers her on and off. She also feels her issues are physical, but is having a difficult time convincing her physicians of this. McGuire says she feels that her doctor doesn’t listen to her at all:
I have lack of sexual response and a lack of feeling in my clitoris. The problems are multiple and they happen at different times. There are times when I can’t get stimulated. I have the drive but it’s the response that’s not there. I’ve never had any problems like this up until the past few years. It was never a problem and now they’re telling me it’s in my mind. It’s not in my mind, it’s in my body. I feel like they’re saying it’s my fault, and they’re acting like it’s psychological. I don’t feel it stems from that. It’s physical. My problem is that my body is not responding the way that it used to. I want to be validated by my doctor and I feel like my doctor is not listening to me. It’s a lot harder to get aroused. It’s not just merely tight, it’s tight and sensitive. It just doesn’t feel the same inside. Your body changes, the sensation changes. I feel very frustrated that there really don’t seem to be any good suggestions.
Another complaint all of the woman have is that there are no solutions to the problems they are experiencing. Indeed, upon researching this article, two main results kept cropping up: “We don’t know much about it,” and “there is no cure and few treatments.” Masterman says that reality is because female sexual dysfunction is specifically a woman’s issue. “If men had this problem they would find ways for them to deal with it,” she says, “but there is nothing out there for us. They have no answers.”
All of the woman interviewed said that their problems have affected their romantic relationships. “It has impacted my relationship with my husband,” says McGuire. “I feel as though sex is a part of the intimate relationship. It’s not the only part, but feeling desirable is very important to me and feeling desire is important to me. I’m not getting any younger and I don’t want to abandon my relationship.”
Gallo echoes this sentiment and says she has also experienced problems in her relationship brought on by her physical issues, but that part of the problem is also compounded by her husband’s waning sex drive. “I know that some of it has to do with not feeling desired by him,” she says, “Yeah I know he thinks I’m attractive but he’s not pursuing me. It’s just not the same, and so my response is different. I need to be desired in that way. It’s fine to have a comfort level but it’s like snuggling the cat sometimes.”
Gallo says the resulting pressure has taken a toll on her and exacerbated the situation. “I feel pressure because I know we don’t have sex as often,” she says. “Before, if it wasn’t the ideal, it wasn’t the end of the world but now, it’s such pressure because the times we have sex are so few and far between. He doesn’t have the drive like he used to, so I have to contend with his lowered drive as well.”
Sometimes, physicians give the suggestion to use vibrators, but not all women like them and they are not helpful for some women with sexual dysfunction. McGuire says she can’t use them at all. “I can’t use vibrators because it’s too much stimulation. It’s the opposite of sex for me,” she says. “It makes me numb. It does not make me feel more pleasure. None of the things that used to work, work anymore. Fantasy is not enough anymore. I need more. It’s never enough to get me going. I need real human drama.”
In addition to all of the problems described by the women interviewed for this article, there are myriad health concerns that can cause all of these, plus additional, symptoms. Yet, when women approach the doctor with these problems, they get treated like “it’s all in their heads.” Why are medical professionals so quick to blame the physical symptoms these women are experiencing on psychological issues when the women insist they are not experiencing any mental concerns, and why are no real solutions available?
A search of the Mayo clinic website reveals that medicines are only available for women whose sexual dysfunction is caused by a hormonal imbalance; but what about the women who the physicians insist are not suffering hormonal problems? The advice from the Mayo clinic is the same as the advice given to the women in this article by their physicians: “try a device,” and “use a lubricant.” There are some lifestyle suggestions like “relaxation” and of course: “maximize treatment for depression and anxiety.” The only other actual medicines mentioned are marked as “needing more research.”
When it comes to female sexual dysfunction, it’s abundantly clear that telling women to hop on Pop isn’t going to cut it. There is much more work and research needs to be done to bring some relief to millions of women who suffer from this affliction.
An Editorial by: Rebecca Savastio
*Names have been changed to protect the participants’ privacy.