Sexuality is complex. For women, sexuality can feel like a mosaic of complicated physical and emotional tiles that sometimes don’t fit all neatly together. When you have sexual dysfunction, whether that is pain or even loss of desire, it can impact nearly every aspect of your life. For that reason, sexual issues of any kind can feel incredibly isolating and confusing.
According to studies, sexual dysfunction in women is very common. In fact, about 12% of women in the United States report distressing sexual health concerns, although as many as 44% report sexual concerns overall.
From Female Orgasmic Disorder to Vaginismus, to Hypoactive Sexual Desire Disorder (HSDD), there are a variety of sexual dysfunctions that women all over the country deal with every day.
The most common types of sexual dysfunction in women are:
- Female Orgasmic Disorder (FOD)
- Sexual Aversion Disorder (SAD)
- Hypoactive Sexual Desire Disorder (HSDD)
Female Orgasmic Disorder (FOD)
It’s no secret that there is a perceived orgasm gap between men and women. In a 2009 Survey of Sexual Health and Behavior at Indiana University, they found that 85% of men had reported that their partner had an orgasm in their most recent sexual encounter. Comparatively, in that same survey, only 64% of women reported having had an orgasm at their most recent sexual encounter. That is a big gap, even when accounting for men that had male sexual partners. That being said, sometimes not reaching orgasm isn’t just about communication, it could be due to not being able to orgasm in sexual encounters at all, no matter what the situation.
Female Orgasmic Disorder refers to the inability to orgasm, even after enough stimulation and arousal, which leads to personal distress. According to the International Society for Sexual Medicine, it is one of the more common type of sexual dysfunction in women. FOD “is estimated to affect 16% to 28% of women in the United States, Europe, and Central and South America. In Asia, the rates range from 30% to 46%.”
While many women may have the ability to orgasm, factors like depression, anxiety, and medications could factor into difficulty with reaching orgasm. This can often be resolved by learning how your body responds, how to ensure the stimulation you need, and getting therapy to overcome inhibitions or anxieties around sexual encounters.
Sexual Aversion Disorder (SAD)
Some people have aversion to all sexual acts. From the act of kissing to the idea of touching genitals, sexual contact of any kind is incredibly stressful for those suffering from Sexual Aversion Disorder (SAD). According to the Diagnostic and Statistical Manual of Mental Disorders, it is defined as a ‘‘persistent or recurrent extreme aversion to, and avoidance of, all or almost all, genital sexual contact with a sexual partner.”
That doesn’t mean, however, that orgasms and desire don’t happen. As reported in The DSM Diagnostic Criteria for Sexual Aversion Disorder, those with SAD can “continue to experience normal sexual desire, fantasize, and often masturbate to orgasm” while still having anxiety about sexual encounters.
Though it is classified as sexual dysfunction, it also falls under sexual phobias and panic disorders as well. As the DSM paper reports, there is “overlap between SAD and panic states” and because of that “those that are dealing with it should seek out psychiatric help in order to help deal with their aversion.”
There are also other factors including sexual pressure, anxiety, depression, and even other types of sexual dysfunction that are a part of suffering from SAD. For those dealing with it, the first step is talking to your healthcare provider to figure out the right course of treatment to move forward sexually.
Having any kind of sexual dysfunction can feel isolating, but when pain is involved, it can bring it to a whole other level of frustration. Vaginismus is a condition in which the levator ani muscles around the opening of the vagina involuntarily contract whenever anything is introduced.
According to one study about the condition, Vaginismus can potentially lead to a general avoidance of sex, and/or more pain. “Psychosexual factors such as loss of libido and arousal disorders may be present in sexual pain-related disorders. These may contribute to the worsening of coital pain over time.” Vaginismus can affect fertility as women with the condition often avoid penetrative intercourse.
Due to how many cases are likely unreported, it’s hard to find any official data confirming how common it is. As Rosemary Basson details in the CMAJ Journal, “A population-based assessment of 5000 women aged 18–65 recently identified about 16% reporting histories of unexplained chronic, burning, knife-like vulvar pain lasting longer than 3 months, including 8% experiencing the problem at the time of the survey.”
Treatment of vaginismus varies between using dilators to train vaginal muscles and taking part in physical therapy to alleviate the symptoms.
Dyspareunia is best described as pain during attempted or actual penetrative intercourse. Pain during sex can also be caused by medications, hormonal changes, and/or a lack of vaginal lubrication. Deep pain from sex could be a sign that something else could be wrong: endometriosis, infection, constipation, or ovarian cysts.
Dyspareunia affects approximately 10% to 20% of women in the United States. Dealing with this kind of pain can impact a woman’s mental health, body image, relationships, and even fertility efforts.
For some that suffer from dyspareunia, it can be linked to past trauma including rape and assault. Because of that, it is important to take steps with your doctor to deal with both mental and physical aspects. It can be caused by a variety of sexual issues including the aforementioned vaginitis, interstitial cystitis, endometriosis, and could simply be caused by inadequate lubrication. No matter what, if you’re experiencing pain during sex you should talk about it with your healthcare provider to figure out the next steps.
Hypoactive Sexual Desire Disorder (HSDD)
For some women, the problem isn’t the inability to orgasm or pain during sex, it’s the loss of desire. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM–4), HSDD is defined as “the absence of sexual fantasies and thoughts, and/or desire for or receptivity to, sexual activity that causes the personal distress.”
The distress that women feel from their low desire is key to understanding this condition. Some women may experience low desire but aren’t actually upset or worried about it. In that case, it may not be HSDD.
It’s estimated that 1 in 10 women have HSDD, which makes the most common sexual dysfunction in females. Low sexual desire and related distress can negatively impact personal attitudes, such as body image and self-confidence, and can lead to relationship difficulties, such as feeling less connected to a partner.
If you think you could be suffering from HSDD, we encourage you to talk about your experience with your own healthcare provider.
One of the best ways to open the dialogue is to take Right to Desire’s sexual desire quiz and bring up your results at your appointment.