Monique Rainford

ON MANY occasions, women visit my office with various complaints related to sexual intercourse. These complaints include pain with intercourse, low sexual desire, lack of enjoyment of intercourse or failure to achieve an orgasm.

They may be embarrassed to discuss these concerns and this may leave them feeling isolated and frustrated. However, these women are by no means alone. About 35-45 per cent of women believe they have some type of problem and many more women have concerns about sexual issues.

What is normal for women?

For many years it was thought that, like men, the sexual response cycle in women followed a linear progression of desire, arousal, plateau, orgasm, possible repeat orgasms and resolution. However, in the past few years a more circular model, which better reflects the differences between men and women, has been developed.

There are multiple reasons why women choose to be sexual and their response is very complex and influenced by psychological, physiological and relationship factors. In this model, as opposed to traditional models,normal women may not have spontaneous sexual desires (that is, she may not have sexual thoughts or fantasies) and this may not occur until she is stimulated sexually. Her decision to have sex may be based on different reasons such as a desire for commitment, closeness, intimacy and to show caring. The model emphasised that not only biological but psychological factors affect women's ability to be aroused. A woman, therefore, may not necessarily be aroused even if she is being sexually stimulated.

Satisfaction without orgasm

Other factors such as a history of abuse, poor self image or past negative experiences may also influence women's ability to be excited or aroused. Conversely, pleasant sexual experiences increase women's desire for sex. Enjoyable sexual experiences may lead to emotional intimacy and well being. With this model it is possible for women to achieve sexual satisfaction without orgasm.

Another allowance of this model is that, unlike men, women may have physical signs of sexual arousal such as vaginal lubrication or wetness and swelling in the vaginal area, without being aware of any sexual excitement. Men are aware of when they are getting an erection and they find it stimulating.

So what about the problems? There are about four different categories of female sexual problems or dysfunction. These are desire, arousal, pain and orgasm and any of these may overlap. A woman has a sexual problem or dysfunction only if a specific symptom is upsetting to her or affects her relationship. For example, a woman may have a low sexual drive or libido but if it does not present a problem to her or her relationship it is not a sexual dysfunction. As women get older, except for problems with vaginal dryness, they tend to have less sexual problems.

Women usually have sexual desire for their partners when a relationship begins but this often decreases as the length of time in the relationship increases. Low sexual drive or hypoactive sexual desire disorder is the most common sexual problem in women. Women with this condition are lacking in sexual fantasies and a desire for sex. There are a number of reasons why a woman may have a low sexual drive. These include difficulties in the relationship, stress, preoccupation in work or studies and a history of childhood sexual abuse.

Medical illness such as depression or kidney failure can lower a woman's libido. Certain medications such as those for high blood pressure, mental illness and even birth control pills may also cause a sudden decrease in sex drive.

I will continue this discussion in my next article.