|
|
DIAGNOSIS
If you're having sexual problems, your health care professional will try to rule out medical causes first by conducting a thorough medical history and exam, including a pelvic exam and blood tests. If there is no physical or biological cause, you may be referred for psychological counseling. Ask for a referral to a sex therapist. These specialists are specially trained to provide the type of therapy you need and, with your input, make a diagnosis and recommend treatment. When possible, your partner should be included in this therapy with you. To find a certified, trained sex therapist contact the American Association of Sexuality Educators, Counselors and Therapists at http://www.aasect.org.
Be sure to tell your health care professional if you have any of the following conditions that can have a significant impact on sexual functioning, both physically and psychologically:
-
Chronic illness, such as diabetes, heart disease and kidney or liver disease.
These conditions can lead to nerve damage and affect blood flow to the pelvic organs, affecting arousal and decreasing vaginal lubrication. Additionally, having a lifelong illness can hurt a woman's self-image and make her feel less sexual, affecting desire.
-
Cancer.
Radiation treatment, as well as certain medications used to treat cancer, may result in lubrication problems, and, in turn, painful sex. Anti-estrogen hormonal medications for breast cancer or drugs used to prevent recurrence of breast cancer, such as tamoxifen (Nolvadex), may also produce low desire, vaginal dryness and difficulties with vaginal penetration. Chemotherapy for cancer can affect many physical functions and responses, including sexual desire and arousal. Additionally, cancer treatment can produce fatigue, decreased self-esteem, fear of death, disfigurement and/or rejection that can affect a woman's sexual feelings.
-
Pregnancy.
Women differ in their sexual activity patterns during pregnancy. Some curb their activity in the first three months, and again near the end of pregnancy when physical discomfort can lead to decreased desire. Some have an increase in activity when the initial discomfort wanes. Generally, however, sexual activity doesn't have to stop because of pregnancy. Sex won't hurt the fetus. However, if you are at risk for a pre-term birth your health care professional may advise against sex during pregnancy.
Some pregnant women find sexual interest decreases steadily over the course of the pregnancy. After the baby is born, changing hormone levels, fatigue and/or a healing episiotomy may lead to reduced sexual desire. Additionally, it is common for women who breastfeed to notice a lack of vaginal lubrication. This is caused by high levels of the hormone prolactin, which is stimulated by nursing. Also, as prolactin increases, testosterone, a hormone that contributes to sexual desire, decreases, another reason for declining sexual desire.
-
Menopause.
Low estrogen levels can cause vaginal dryness, thinning of vaginal tissues, reduced blood flow to the genital area and reduced vaginal sensitivity that may contribute to arousal and, in turn, orgasm problems. Postmenopausal women often find that the arousal phase of the sexual response cycle takes longer or is less intense. Changing hormone levels also can produce mood swings that make some women nearing menopause feel less interested in sex.
-
Substance abuse.
Alcohol affects the arousal states and inhibits orgasm. Chronic alcohol use reduces desire. Abusing drugs, especially narcotics such as morphine, codeine and heroin, impairs sexual function and reduces desire.
If you are having a sexual problem, make sure you tell your health care professional about any medications you're taking. Blood pressure medications, antipsychotics and antidepressants are commonly prescribed drugs that can interfere with the sexual response. Selective serotonin reuptake inhibitors (SSRI) such as paroxetine (Paxil) and fluoxetine (Prozac) frequently produce side effects that inhibit or prevent orgasm. Anticonvulsants for seizures also can cause sexual problems.
A change in dosage or medication may help resolve your sexual problem.
If you have pain associated with sexual activity, it's important to accurately describe where the pain is located so your health care professional can determine its cause. The types of pain associated with sex include:
-
Vulvar pain.
This type of pain is felt on the outside of the vagina and often occurs when some part of the vulva is touched. It can be caused by irritation from soaps, feminine hygiene sprays or douches, scars, cysts or infections.
-
Vaginal pain.
This type of pain is felt inside the vagina. The most common cause is a lack of lubrication from inadequate arousal, medications, medical conditions, pregnancy, breastfeeding or menopause. Vaginal pain also can be caused by an inflammation of the vagina, known as vaginitis. Additional symptoms of vaginitis are a vaginal discharge, itching and burning of the vagina and vulva. It can be caused by a yeast or bacterial infection or a sexually transmitted disease.
Vaginal pain also can be caused by vaginismus. This pain occurs when anything attempts to enter the vagina, including tampons or even during a pelvic examination. It can be caused by irritation from douches, spermicides or latex in condoms, infections, scars from an injury, childbirth, surgery or psychological problems from sexual trauma or abuse.
-
Deep pain.
Pain that is felt deep inside the vagina, lower back, pelvic area, uterus or bladder can be a sign of an internal medical problem. It can be caused by:
-
pelvic inflammatory disease
-
endometriosis, a condition in which the tissue that lines the uterus grows outside the uterus
-
pelvic tumor
-
bowel or bladder disease, such as interstitial cystitis
-
scar tissue
-
ovarian cysts
-
If you are experiencing deep pain during sex, your health care professional may recommend a variety of tests including but not limited to blood tests, urine tests and scans to check for possible causes.
