Story highlights
- Study: Over 40% of women have experienced sexual dysfunction
- Problems can be biological, psychological, pharmacological and physiological
- Testosterone and estrogen play a role in sexual response
(CNN)Ask me about the most significant moments in sexual medicine history, and I'll name two: the creation of the birth control pill in the 1960s, and the introduction of Viagra in 1998.
When Viagra hit the market, it changed the face of sexuality for men, young and old, forever. It took sexual dysfunction from behind closed doors and brought it out into the open.
It also, however, highlighted the fact that research on women's sexual functioning and treatment was significantly lagging -- even though studies report that 43% of women have experienced, or are experiencing, some form of sexual dysfunction.
Three-hour orgasm sends woman to ER 01:46
Photos: Birth control methods
Photos: Birth control methods
A woman's choice – Women have many choices when it comes to avoiding pregnancy, but men have only two. According to the Centers for Disease Control and Prevention, 99% of sexually active women used at least one contraceptive method at some point between 2006 and 2010. Here's a look at a variety of birth control methods and how they each work.
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Photos: Birth control methods
A male condom is a thin covering worn on the penis during intercourse. It can prevent sexually transmitted diseases, and is about 82% effective at preventing pregnancy.
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Photos: Birth control methods
During a vasectomy, a surgeon cuts the vas deferens, the tubes that carry sperm from the testicles. It has a failure rate of about 0.15% and can be reversed, but the procedure is complicated.
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IUD – An intrauterine device, or IUD, is a flexible T-shaped device that's inserted by a doctor into a woman's uterus. The devices block sperm and change the lining of the uterus, which may keep a fertilized egg from attaching. Pregnancy is prevented from three to 12 years, depending on the type.
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The pill – Approved in 1960 by the Food and Drug Administration, oral contraceptives involve taking a daily pill with a combination of estrogen and a progestin. The hormones prevent ovulation and thicken a woman's cervical mucus, blocking sperm from fertilizing an egg.
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Female condom – Condoms aren't just for men. The female condom fits inside the vagina with a ring at one end that covers the cervix. When used correctly all of the time, the National Institutes of Health says, it's 95% effective, with bonus protection from sexually transmitted infections.
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Diaphragm – The diaphragm also fits inside the vagina but covers only the cervix, where it blocks sperm from entering the uterus. It is made of silicone and can last up to two years. A spermicide must also be used for greatest effectiveness.
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Cervical cap – The cervical cap is similar to a diaphragm but smaller in size and made of rubber instead of silicone. It is useful for women who find it hard to keep a diaphragm in place.
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Implant – Implants are flexible matchstick-size devices that are surgically inserted into a woman's arm. They slowly release the hormone progestin into the body, preventing a woman's ovaries from releasing eggs. The protection can last several years.
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The patch – For women who don't want to take a pill or insert a device, the Ortho Evra birth control patch sticks to the body and releases pregnancy-preventing hormones through the skin. A woman must change her patch once a week for three weeks in a row. No patch is used in the fourth week, and then the cycle starts again.
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Vaginal ring – NuvaRing, approved for use in the United States in 2001, is a small, flexible ring inserted into the vagina. It releases estrogen and progestin, the same pregnancy-preventing hormones found in most variations of the birth-control pill.
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Vaginal sponge – Introduced in 1983, the Today Sponge was pulled from the market after fears of toxic shock but returned in 2005 following design changes. The sponge contains spermicide and can be inserted into the vagina before sex, like a diaphragm, to prevent pregnancy.
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The shot – Depo-Provera, an injection form of birth control, provides protection for three months with hormones that prevent ovulation and block sperm. It doesn't contain estrogen, as do some other forms of birth control. As a result, it is a popular option for women who can't take estrogen or who are breastfeeding.
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Morning-after pill – Emergency contraception, frequently referred to as the morning-after pill, can be taken to prevent pregnancy up to five days after unprotected sex. It can prevent the ovaries from releasing eggs and thickens a woman's cervical mucus. The morning-after pill can also thin the uterus lining, which could prevent a fertilized egg from attaching.
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In 2004, the American Foundation of Urological Disorders identified distinct diagnostic categories for the most common women's sexual function complaints: hypoactive sexual desire disorder, sexual arousal disorder, orgasm disorder and pain disorders such as dyspareunia and vaginismus.
Here's what you should know about each:
Hypoactive sexual desire disorder
Hypoactive sexual desire disorder is defined as the absence of sexual thoughts or feelings. This is one of the most prevalent issues seen in female patients. For women, it can be stressful and negatively impact their relationships.
Causes include sexual trauma history, the quality of a woman's current relationship (I'm just not that into you ... ), hormonal imbalance and depression or anxiety.
When patients come to see me for this issue, I usually ask whether they fantasize about actors, models or even the pool boy. If they answer yes, then more than likely it is a relationship issue, not a psychological and/or biological issue. For women, it is hard to turn off the fight you had with your spouse earlier in the day or the fact that he constantly irritates you with something you don't like.
Most times the fix is communication and spending quality time together. A sex date is usually my prescription. Try it, you might like it!
Sexual arousal disorder
Sexual arousal disorder is defined as the inability to achieve or maintain adequate lubrication after sufficient stimulation. It oftentimes overlaps with sexual desire disorder. It can also be dependent on the stage of life a woman is in.
Menopause, for example, which is categorized by a significant loss of estrogen, can have a huge impact on a women's sexual activity. The loss of estrogen can lead to the loss of vaginal lubrication and cause vaginal atrophy, which can be painful.
For women who are not in menopause, sexual arousal can also be caused by a lack of blood flow to the labia, poor partner ability, hormones and other factors. Viagra has been prescribed for women to help increase arousal to the vulva, but it is not FDA-approved for use in women.
Arousal and desire at times go hand-in-hand. Men tend to forget that women need longer foreplay; it takes about 15 minutes or more to become fully aroused.
Foreplay for women is not only physical, but also mental -- it starts way before you get to the bedroom. So start the foreplay before you hit the bed. E-mails, text messages and even taking out the garbage go a long way.
Orgasm disorder
Orgasm disorder is defined as the inability to achieve orgasm. Being able to be aroused, either physically and/or mentally, is necessary in order to achieve orgasm.
For many women, orgasms are elusive because they are unable to stay in the moment. They are thinking about a host of other things which distract them from feeling and being present.
In addition, a lot of women do not know their bodies and/or have difficulty talking about what makes them feel good. How can you advocate for improvement if you don't understand what you are trying to improve?
Sometimes improving orgasm can be as easy as changing your sexual position. Switching a woman from the missionary position to being on top can help give her increased clitoral stimulation as well as control of the depth of penetration and rate of thrusting.
Pain disorders
Pain disorders in women are common place. At some point in a woman's life, many will experience painful sex.
Dyspereunia is defined as persistent or recurrent genital pain that occurs before, during or after intercourse. Vaginismus is the involuntary spasm of the muscles of the vaginal walls. There is a range of causes for these pain disorders that include insufficient lubrication, trauma, surgeries, irritation and emotional factors.
Earlier this year, Osphena was brought to market and has changed the lives of some women with pain disorders caused by menopausal symptoms. Vaginismus, on the other hand, is treated by using varying and increasing sizes of vaginal dilators, usually in conjunction with therapy.
When a patient comes about this issue I always want to know whether they use latex, as there may be an allergy, or if water-based lubricant is being used. Water-based lubricants tend to dry faster, needing repeated application. The drying out can lead to small vaginal tears due to friction. Silicone-based lubricants tend to be more slippery and need less reapplication, which often means less tearing.
Hormone issues
Biologically, women and men are quite different in their hormonal makeup, yet we share some of the same hormones in differing amounts. Testosterone and estrogen are our main hormones and have been found to play a significant role in our sexual response.
Testosterone, when it is at a low level in men, can lead to decreased desire and erections that are less firm. Women also need testosterone for desire. Research has shown that birth control pills tend to bind to the free testosterone in women's blood, leaving little to fuel desire.
There has been much conversation about testosterone being prescribed to women in order to improve sexual functioning. Despite the controversy, by 2006, over 1.3 million testosterone prescriptions were written for women. Women clearly are ready to change the status quo and reclaim their right to good sex.
Just start by asking, "Where's my orgasm?"
