Sexual Dysfunction: When To See A Specialist

What is sexual dysfunction?

Sexual dysfunction is a general term that refers to a problem during sexual activity that interferes with an individual’s ability to enjoy the sexual experience. Sexual problems typically fall into one of four categories:

  1. Desire disorders
  2. Arousal disorders
  3. Orgasm disorders
  4. Pain disorders

What causes sexual dysfunction in women?

Many things, including physical or medical conditions as well as psychological causes, can contribute to sexual dysfunction. Some examples may include:

  • Medical problems, such as depression
  • Medications
  • Smoking, alcohol, and drugs
  • Stress and anxiety
  • Relationship problems
  • Prior negative sexual experiences
  • Hormone changes/menopause

What’s the link between sexual function and menopause?

Sexual function can affect both men and women of all ages. However, there are specific changes that occur around menopause that can impact a woman’s sexual experience. During menopause, declining hormone levels cause changes in our body that may affect our sexual function. For example, lower hormone levels may decrease your sex drive or cause changes in the vagina that may make intercourse uncomfortable.

What causes sex to be painful?

There are many reasons why sex may be painful. Some of the more common reasons include:

  • Vaginal atrophy: Loss of estrogen after menopause causes the vaginal lining to become thin and dry. We call this vaginal atrophy. Vaginal atrophy can make sexual intercourse uncomfortable or even painful. Although this is most commonly associated with menopause, a woman might also experience vaginal atrophy after surgical removal of her ovaries. Your doctor may treat this condition with vaginal estrogen in a cream, tablet, or ring form. Vaginal lubricants and moisturizers can also help.
  • Pelvic floor muscle spasms: Similar to a “Charley horse,” women can also develop muscle spasms or “trigger points” in their pelvic floor muscles. When this happens, it can make penetration difficult and painful. Treatment involves working with a pelvic floor physical therapist to help you rehab and appropriately relax these muscles.
  • Infections
  • Cysts
  • Endometriosis

When should you see a specialist about sexual dysfunction?

Most conditions can be managed with the help of your gynecologist or primary care physician. However, there are some conditions, like the ones listed below, that may require consultation with a specialist known as a urogynecologist, who has advanced training in these areas.

  • Pelvic organ prolapse: Pelvic organ prolapse is a weakening of the pelvic floor, which allows the vaginal walls along with some of your pelvic organs to herniate through the vaginal opening. This often presents as a vaginal bulge or an appearance that something is protruding outside of the vagina. Sometimes women describe a sensation of feeling like they are sitting on an egg. Although prolapse should not cause pain per se, the vaginal bulge may interfere with one’s ability to experience penetration and may cause discomfort during intercourse.
  • Previous surgeries: Sometimes women experience pain with intercourse after having undergone previous surgeries. This may be due to a complication of the surgery, distorted anatomy, or perhaps a residual foreign body in the vagina such as suture or mesh.

Talk to your health care provider

The good news is that most causes of sexual pain and sexual dysfunction are treatable. Treatment will depend on the underlying etiology and often requires a team approach including your partner, doctors, physical therapist and psychologists. Remember, communication is key. Talk to your health care providers today to see how they can help you with any concerns you are having.

About Kristie Greene, MD

Kristie Greene, MDKristie Greene, MD, is an Assistant Professor in the Department of Gynecology and Obstetrics at Emory University School of Medicine. She is a member of the Female Pelvic Medicine and Reconstructive Surgery division, also known as urogynecology. Dr. Greene sees patients at the Emory Clinic at 1365 Clifton Road, in Building A on the 4th floor. She completed medical school at Loyola University’s Stritch School of Medicine and went on to complete both her residency and her fellowship in Female Pelvic Medicine and Reconstructive Surgery at the University of South Florida. To make an appointment with Dr. Greene or any of our urogynecologists, please call 404-778-3401.

Tags: , , , , , , , , , , , , , , , , ,

  • Laurie

    This article was very insightful and described some issues I’ve faced my whole life. I’d be interested in speaking with someone further or setting up an appointment to talk with Dr. Greene and see if she may can be of some help.
    Could someone please email me at the above address.
    Thank you so much!