We all want to have a very healthy sexual relationship with our partner as part of our growing intimacy in our relationships and marriage.  In my last segment we reviewed normal sexual health and function.  In this segment we will address common questions regarding female sexual dysfunction.  

Question: When does female sexual dysfunction occur?  

Answer:
Female sexual dysfunction occurs when:
we have pain during sexual contact,
when desire is absent or low,
if we don't experience an orgasm, or
cannot maintain or experience arousal, despite desire,
and the key thing is, if it bothers us, or if we experience personal distress because of it.    

Question: Can you describe situations which women may have pain during sexual contact?  

Answer:
A woman may have something called dyspareunia, which is pain during sexual contact, and she can have it where it is painful upon entering in the vagina, vulvodynia, or with penetration or deep thrusting.
Different reasons, different causes. Some women have irritation/inflammation on the outside of the vagina, and as we get older, that skin can become dry and thin, and more easily irritated and prone to infection, as well as the vaginal walls themselves lose their pliability and the elasticity, if the hormones are out of balance.
Women can also have vaginal muscle spasms, something called vaginismus, and that may be traced back to issues of sexual abuse, and needs to be handled very carefully. In patients with vaginismus, I recommend using progressive dilators or start with the smallest size vibrator that is tolerable, and then gradually increase in size, to enable her to have intercourse with her partner.
Other reasons for dyspareunia are again, vaginal and pelvic infections.  Inflammation of the bladder, called interstitial cystitis, conditions of the pelvis and the uterus called endometriosis, uterine fibroids, ovarian cysts, trauma, and pain after surgery.    

Question: What are the types of orgasm?  

Answer:
Orgasm can be stimulated by clitoral stimulation or by penetration during intercourse.  The orgasm can be vaginal contraction and or uterine contraction/uterine orgasms.  

Some women have primary anorgasmia, in other words, have never experienced an orgasm.  More often, however, women who have been used to experience orgasms may find that it now takes them a lot longer or they are unable to experience them any longer.

Most women will experience orgasm from clitoral stimulation, so really, taking control in the relationship during intercourse, by foreplay, being able to stimulate the clitoris enhances a woman's sexual experience.  With orgasm, the brain releases oxytocin, which gives us that calm after orgasm and nurtures the bonding that we experience with our partner.    

In my next blog I will continue this discussion and respond to your questions and discuss the topic of decreased sex drive, that is, a low libido.
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