Health and Sexuality in Women

Female sexuality is complex. It also has been poorly studied. Since the creation of Viagra, healthy sexuality is more openly discussed - but mostly that of men. This is in part due to the strong correlation between erectile dysfunction and heart disease. What about women in midlife and older? Little research has been devoted to this area of a woman's health.

Data from the National Health and Social Life Survey (NHSLS) suggests that sexual problems affect 43 percent of women in the United States (compared with 31 percent of men).[1] This has spawned an interest from the pharmaceutical companies to develop medication to treat female sexual dysfunction. But where would they begin? The problem is that sexual dysfunction in women is poorly defined. What actually constitutes "sexual dysfunction" for a woman?

Erections are measurable. Discomfort during sex, female orgasm and sexual performance anxiety for women are not so easily measured. In other words, these are not physical events, as is an erection, making research more difficult. Medical researchers realize the inequity and are starting to shift their focus more toward women's sexual health issues. The medical community seems very clear that a woman's sexuality is complex and involves psychosocial and physical aspects.

Here are some views that have been challenged by experts:

• A woman's physical and psychological problems can be separated - the challenge here is that a woman's sexuality involves complex issues - psychological, physical, biological and personal.

• Women desire sex because they fantasize about it and are aware of sexual desire - This may not be entirely correct. Women in new relationships are most likely to feel a spontaneous desire for sex but women in established relationships think about sex infrequently: women desire sex for more complex reasons than men.

• A woman desires sex before she becomes aroused - It is now recognized that sexual arousal often occurs before the desire or at the same time. Women have sex because they desire intimacy with their partners as well as a variety of other reasons that still need to be studied.

• A woman's sexual arousal is characterized by vaginal lubrication and swelling - The fact is most women aren't aware, or don't correlate these bodily responses with sexual arousal (this has been measured). In addition, women experience vaginal lubrication even when they are not sexually stimulated.

• A woman's sexual response doesn't change much throughout life - More accurately, a woman's sexual response changes, depending on a multitude of factors: interpersonal relationship, the context of sexual interaction, pregnancy, medical conditions, menopause, and the natural decline that occurs with age.

• Women become distressed when their sexual response changes - Most women really don't seem to get upset, making no treatment necessary, especially if both partners are accepting.

It will be interesting to see what positive changes a new focus will bring to women's sexual health issues.

Speak with your doctor about medications that can interfere with libido. Exercise regularly to maintain overall health. Speak with your partner about feelings related to intimacy. Remember that female sexual health really is complex. There are no simple answers to a woman's psychological and physical desire for sex.

(1)Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA. 1999; 281:537-544, 1174.