Many of us may think we talk openly about sex but far too often I have patients who come to see me for sexual health concerns they have never discussed with other healthcare providers. I am glad that my patients feel comfortable asking me about a wide variety of issues related to sex practices: how to avoid giving and getting sexually transmitted infections, how to get or not get pregnant, and how to improve sexual function. Dissatisfaction with one’s sex life, sometimes called sexual dysfunction, is a rather common concern.

Drugs like Viagra and Cialis have brought men’s sexual (dys)function to the examining table in the past decade or so. Nonetheless, women’s sexual (dys)function has historically, and currently, been relegated to the domain of psychiatry, most recently referred to as female sexual interest/arousal disorder. Medical discussions about women’s sexual function continue to be fraught with debate and criticism, in part because the history of medicine has a long and sordid past in terms of its approach to women’s sexual health. The pathologization of female reproductive and sexual function or sexuality has a long history in medicine, psychiatry in particular. I highly recommend reading Michel Foucault, Susan Bordo, Luce Irigary, Judith Butler, and Sara Ahmed for starters. You could also read a brief history of “female sexual dysfunction” as a mental disorder. But I digress…

Sociocultural issues around pathologization aside, researchers suggest about one in three adult women in the United States experience some form of sexual dysfunction. In other words, many women aren’t happy with their sex lives. Unfortunately, sexual function is rarely asked about in standard, general health screens or medical intakes. I’ve been including a question about sex life satisfaction on my intake forms since I started private practice. It has been a great way to allow for space to talk about sexual health and function with my patients, including the sociocultural aspects of sex and sexuality.

So, why aren’t women, and people in general, happy with their sex life?

The 5Ws

Sometimes, people are unhappy about how much or how often they have or want to have sex. Other times it is about other questions like the when, how, where, who, why and what of sex (ie. when sex happens, how it happens, where it happens, who it happens with, why or what precipitates it happening, and/or what exactly happens). The five Ws can also be related to other issues in a sexual relationship, such as miscommunication or a discrepancy between the sexual interests or appetites of different sexual partners.

Desire, arousal, interest

Again, misinformation has informed too many people’s ideas of what is the right, or healthy, amount of sexual function. The truth is, there is no “right” sexual function. Sex as a component of health, is completely individualized. Many expect that desire comes before arousal but that isn’t true for everyone, especially women. Having no interest in sex may be just as healthy as having lots of interest in sex, depending on the person. That isn’t to say that decreased sexual desire and arousal or hypersexual behaviour and addiction aren’t problems in their own right. But no one can really define what a healthy sexual function is better than you. Changes in arousal or desire may be physical or mental-emotional in origin but may also be related to other health concerns or caused by certain medications, most notably antidepressants. Psychotherapy, medication adjustments, osteopathy, pelvic physiotherapy, and a variety of naturopathic treatments to address support blood circulation, mood, hormones, stress management and other factors may be helpful.

Vaginal dryness

Some people have adopted the false idea that lubrication should always be present naturally and that using a lubricant somehow indicates that something isn’t working as it should. Vaginal lubrication is dependent on many different factors (arousal, menstrual cycle, hormonal regulation, menopause, drugs, etc…). Normalizing the use of lubricants, adjusting medications as needed, using diet, herbs and supplements to regulate hormones and increase vaginal lubrication, or taking hormone replacement therapy, are all potential options.

Self-love

Start loving your body, no matter what it looks like, or what you think it “should” look like. Love yourself for who you are in body, mind, and spirit. Practice overall self-care. When you feel good and healthy in other ways, you will likely also feel sexy.

Communication

Talking may not be easy. It may make you feel vulnerable but it’s important. Be honest and honour your physical sensations and emotional feelings. Do what feels right rather than what you think is expected of you. This is just as important in your teens as when you are past menopause. Talk to your friends, talk to your sexual partners, talk to your healthcare providers.