CausesBy Mayo Clinic staff
Several factors contribute to sexual dissatisfaction or dysfunction. These factors tend to be interrelated.
- Physical. Examples of physical conditions that may contribute to sexual problems include arthritis, urinary or bowel difficulties, pelvic surgery, fatigue, headaches, other pain problems, and neurological disorders such as multiple sclerosis. Certain medications, including some antidepressants, blood pressure medications, antihistamines and chemotherapy drugs, can decrease your sex drive and your body's ability to experience orgasm.
Hormonal. Lower estrogen levels after menopause may lead to changes in your genital tissues and sexual responsiveness. The folds of skin that cover your genital area (labia) become thinner, exposing more of the clitoris. This increased exposure sometimes reduces the sensitivity of the clitoris.
The vaginal lining also becomes thinner and less elastic, particularly if you're not sexually active, causing a need for more stimulation to relax and lubricate before intercourse. These factors can lead to painful intercourse (dyspareunia), and it may take longer to experience orgasm.
Your body's hormone levels also shift after giving birth and during breast-feeding, which can lead to vaginal dryness and can affect your desire to have sex.
Psychological and social. Untreated anxiety or depression can cause or contribute to sexual dysfunction, as can long-term stress. The worries of pregnancy and demands of being a new mother may have similar effects. Longstanding conflicts with your partner — about sex or other aspects of your relationship — can diminish your sexual responsiveness as well. Cultural and religious issues and problems with body image also may contribute.
Emotional distress can be both a cause and a result of sexual dysfunction. Regardless of where the cycle began, you usually need to address relationship issues for treatment to be effective.
- Longo DL, et al. Harrison's Online. 18th ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=4. Accessed Aug. 20, 2012.
- Brotto LA, et al. Women's sexual desire and arousal disorders. Journal of Sexual Medicine. 2010;7:586.
- Shifren JL. Sexual dysfunction in women: Epidemiology, risk factors, and evaluation. http://www.uptodate.com/index. Accessed Aug. 20, 2012.
- Shifren JL. Sexual dysfunction in women: Management. http://www.uptodate.com/index. Accessed Aug. 20, 2012.
- Lentz GM, et al. Comprehensive Gynecology. 6th ed. Philadelphia, Pa.: Mosby Elsevier; 2012. http://www.mdconsult.com/books/linkTo?type=bookPage&isbn=978-0-323-06986-1&eid=4-u1.0-B978-0-323-06986-1..C2009-0-48752-X--TOP. Accessed Aug. 23, 2012.
- Clayton AH, et al. Female sexual dysfunction. Psychiatric Clinics of North America. 2010;33:323.
- Schoen C, et al. Sildenafil citrate for female sexual arousal disorder: A future possibility? Nature Reviews Urology. 2009;6:216.
- Nurnberg HG, et al. Sildenafil treatment of women with antidepressant-associated sexual dysfunction. Journal of the American Medical Association. 2008;300:395.
- Nijland EA, et al. Tibolone and transdermal E2/NETA for the treatment of female sexual dysfunction in naturally menopausal women. Journal of Sexual Medicine. 2008;5:646.
- Kammerer-Doak D, et al. Female sexual function and dysfunction. Obstetrics and Gynecology Clinics of North America. 2008;35:169.
- Brotto LA, et al. A mindfulness-based group psychoeducational intervention targeting sexual arousal disorder in women. Journal of Sexual Medicine. 2008;5:1646.
- Brotto LA, et al. Eastern approaches for enhancing women's sexuality: Mindfulness, acupuncture, and yoga. Journal of Sexual Medicine. 2008;5:2741.
- Swanson JB (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 11, 2012.