How to Handle Different Sexual Concerns

Sexy woman

Decreased sexual desire

Sexual desire is that which cause one to be receptive to or initiate sexual activity. For women, the quality of the relationship and the emotional and the physical satisfaction she receives from that relationship appear to be critical elements.

Desire requires androgens such as testosterone and DHEAs, neurotransmitters, and the sensory system. Starting in the twenties, there is a progressive decline of physiologically available androgens for both men and women, which can contribute to decreased sexual interest. Interest in sexual activity can be disrupted by psychosocial, physiological, physical, environmental, cultural factors. Fatigue, depression, side effects from medications, self-esteem, and body image concerns can all interfere with sexual interest. Addressing relationship issues through counseling, supplementing androgens, treating depression, and assessing medication side effects are all important. More important for good sexual desire is attending to scheduling the time and setting the environment for sexual activity, using the senses to the fullest, and incorporating seduction.

Decreased arousal

Arousal difficulties leading to delayed vaginal engorgement, reduced vaginal lubrication, pain with intercourse, and decreased vaginal, clitoral, and orgasmic sensation can be caused by or exacerbated by atherosclerotic disease. Screening laboratory testing should include lipid profile, glucose with or without insulin levels, thyroid stimulating hormone (TSH) and androgen levels (DHEAs and free testosterone).

Lifestyle changes are critical and should include moderation of alcohol intake, exercise, smoking cessation, weight loss, and stress management. Medications that can be discontinued or reduced in dosages should be changed. Additionally, just as psychotropic agents can significantly reduce sexual interest, they can produce a secondary effect on arousal.

Many excellent sexual lubrications are available over the counter. They can offset changes in vaginal lubrication brought about by age or chronic illnesses and/or their medical treatment and can enhance sensuality in general.

Difficulties with orgasm

Difficulties with orgasm are related most often to lack of understanding of what sort of sexual stimulation is required, difficulty communicating this needs to one’s partner or lack of the partner’s initiative to provide this stimulation. Additionally, medications, most notably psychotropic agents, can prolong arousal, making orgasm very difficult to attain. Androgen deficiency is believed to contribute to the higher threshold required for orgasm and the intensity of orgasm.

Exploring the woman’s desire and arousal phases, including quality of her relationship, is important because sexual health comorbidities are likely. Supplementation of androgens should be undertaken if needed. The woman should be encouraged to enhance her self-awareness about what sensual and physical stimulation she requires for orgasm through self-stimulation.

  1. Butcher, J. ABC of sexual health: female sexual problems II: sexual pain and sexual fears. Br. Med. J. 1999 
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