Ask the Doctors: Woman Suffering from Sexual Dysfunction

Our staff doctors Carol Queen, Ph. D and Charlie Glickman, Ph. D answer questions from our customers. Do you have a question for the doctors? Here, Carol responds to a question about sexual dysfunction. – ed

Question: Hello. I am twenty years old and unfortunately suffer from sexual dysfunction. Before seeing your blog on Good Vibration’s website I had no idea this was an issue with other woman. I was wondering if you knew where I can find help, any kind of help with this issue. I didn’t know there were people who studied this or that I could talk to. So if you can, please help me out. Thank you so much.

Dr. Carol Queen: You saw my reference to pharmaceuticals that are supposed to assist women with sexual issues. First, though: it is really pretty common for young women to have sexual issues that might be called “dysfunctions.” Keep in mind that it is only a dysfunction if you are unhappy about it. If you have low libido, or have a hard time getting aroused, and you don’t have or want much sex and don’t feel troubled by this, it is simply the way you are, not a dysfunction. If, however, you are concerned about it, then that language might be appropriate. Now let me get back to why I said it’s common for *young* women, in particular. There are two big reasons. The first is that younger women have had less sexual experience, on the whole, than many older women, so have had less time to settle into their own unique sexual preferences — when I use that term here, I don’t mean it as synonymous with “sexual orientation,” but rather to describe a person’s sexual individuality: what kind of sex you like best, how long it takes to get turned on, how long you like it to last, what you fantasize about, *everything* that might make a difference to your experience. The more times you have sex, the more you come to learn those kinds of things about yourself. Even less-than-pleasurable sexual experiences give you at least one thing — they give you knowledge about what you *don’t* like.

The other reason: Younger women (and the younger men they may be having sex with) have often had terrible sex education. School-based sex ed does not give people the information they need to have sex, certainly not *pleasurable* sex. At least when you take driver ed, it’s assumed you’re going to have a chance to drive a car before the end of the semester! Many young people go on to college and take sex ed classes that give more useful detail about actual sexual functioning. When you’re over 18 you can take classes, read books to help you learn more (check out The Guide to Getting It On, or the wonderful book I Love Female Orgasm by Marshall Miller and Dorian Solot), and access explicit information on the Internet. Too many people can’t tell the difference between explicit information and porn — porn, while sometimes useful, also tends to present incorrect or at least incomplete information about many elements of sex, so it’s of limited usefulness as basic sex ed. And it’s not designed to be used for that — it’s designed to entertain and turn people on.

In short, unless you have really gone on a hunt to get good information, the schools and the culture have not made sure you learned enough about sex to have *good* sex. And this does not make YOU dysfunctional — if anything, it means our society is dysfunctional! People are not born being good at sex. We *learn* that, just as we learn everything else. And we live in a society which does not want people under 18 to have access to information about how to have sex. Having said that, now that you’re over 18, it’s up to you to add to the information you have. Check out those books, classes at Good Vibrations and the Center for Sex & Culture, and gather useful knowledge in other ways that appeal to you.

So far I haven’t really said anything about sexual dysfunction itself; I’ll do that now. It’s possible that in spite of what I said above, you *do* have some sort of sexual dysfunction, but it’s likely that it is something that can be helped via knowledge. It’s not as likely that you need some sort of medication, which is good, because so far, the pharmacological remedies available to women to help us with our sexual problems are, at best, untested and insufficiently understood. But let’s look at women’s most common sexual problems. Here I am leaving aside my discussion about young women’s particular set of circumstances and will talk more generally.

Can’t have an orgasm during intercourse:
In a way, this is really not a sexual dysfunction — in fact, it is practically the norm. At least 40% of women don’t regularly — or ever — come during intercourse with a male partner. Very often this is considered a dysfunction because people believe that intercourse IS the way people have sex (and pleasure), and of course most men do come this way… but not ALL men do, and it is not well-understood that some guys prefer and respond better to other kinds of sexual stimulation, just as so many women do.

Women who are concerned about this should start by paying attention to what *does* make them come. Generally, when a woman isn’t coming via intercourse, it may be because she isn’t aroused enough or because she isn’t very orgasmic in general. (See below for more about these.) When it’s hard to come at all, it might be extra-hard to come during intercourse, when a woman isn’t getting direct clitoral stimulation. This is the other culprit when women can’t come this way: intercourse does not stimulate the clitoris directly enough. The very easiest way to remedy this is to give the clit extra stimulation: via your own fingers, your partner’s hand, or a toy, either a vibrator or a cock ring with a clitoral stimulator built in. But starting intercourse before she’s aroused enough is another way to make it too hard for a woman to come. Other kinds of stimulation (our culture often calls them “foreplay”) can help a women get optimally turned on. Intercourse that begins before she’s turned on enough may be uninspiring and non-orgasmic, or even downright painful and unpleasant.

Can’t have an orgasm at all:
Most women are able to orgasm; it is rare to find one who can’t have an orgasm at all. But plenty of women do not take the time to get stimulated enough for orgasm, or don’t know what will appropriately stimulate them. Put another way, plenty of women *and their partners* do not take the time and do not know what will work. But if sex with a partner is not resulting in orgasm, I would always recommend that a woman learn about her own body on her own, through self-exploration and self-stimulation. There are two good reasons to do this. First, when you stimulate yourself, you learn which types of touch feel the best and how long it takes to feel really good. Second, you aren’t distracted by a partner’s presence. Having a lover in bed with you is a nice distraction! But it IS a distraction nonetheless, and many women do not focus on themselves and their pleasure very well when there’s someone else with them. Masturbation means you can take your time and learn your body and your responses. Then you can share what you learn with a partner.

Sometimes the amount of stimulation it takes to get aroused enough for an orgasm is greater than the amount we get during partner sex, or even alone, using our hands. Using a vibrator may make the difference between “almost came” and “definitely came!” Vibrators offer strong and consistent stimulation. Many people think a vibrator is supposed to be used vaginally, to stimulate the way intercourse does. But optimally, most women prefer clitoral vibration, or a vibrator on (or near) the clit and a vibe or dildo used vaginally or anally at the same time. Using two toys like this has the advantage of accustoming you to penetration while being erotically stimulated and coming to orgasm — so it might make it somewhat more likely, over time, that you’ll learn to come during intercourse, if you don’t already.

If solo stimulation with a vibrator doesn’t result in orgasm (and don’t just try it once for a few minutes, take some time to devote to it; it is a learning process, and does not always happen the first time), it might be time to see a doctor. The final three dysfunctions, too (below), may get in the way of a woman’s ability to come.

Doesn’t get aroused enough for pleasurable sex:
If sexual stimulation doesn’t feel good, it’s not likely that arousal will increase and result in orgasm. Some women who don’t have orgasms still like the way sex feels — but low-arousal sex can be anything from boring to irritating to painful, and sex should not feel that way. If erotic stimulation like kissing, caressing, and genital touch feels good and erotic, but penetration doesn’t, extend the non-penetration forms of stimulation until penetration *does* feel nice. (For some women, this will take a long time — but it’s a long *enjoyable* time!) If she isn’t wet enough for pleasurable sex, a woman can try using some water-based lubricant — but still, using lube doesn’t mean you can skip getting aroused, if you want to have a good sexual experience.

Not getting aroused is also sometimes a signal that what you’re doing is not erotic on a fundamental level — having sex with a man when a woman really desires other women, for instance. Also, it can be an indication that a woman has unresolved issues about sex — she is unusually fearful, or she has had bad sexual experiences in the past that have left her unable to relax and have good, arousing experiences today.

Isn’t interested in having sex (low or no libido):
This is fairly common during menopause, at least for temporary periods of time, as women’s hormonal levels change rather radically. It is sometimes true of pregnant women (though some women’s interest in sex *increases* when they get pregnant), or new moms whose babies keep them awake all the time. Depression and stress are fairly common culprits for low libido. Sometimes a woman in a long-term relationship will find her libido gets lower over time, though that is by no means always true. It is really important to remember that we are not all the same, and one woman’s low libido is another woman’s norm, and vice versa.

And some physicians think that low libido that is not associated with any other psychological, health or similar issue can be treated with hormones (or possibly newer pharmaceuticals like the most recently-announced one, Flibanserin).

Even when a woman is not actively interested in sex, if she chooses to engage in sex with a partner, she might find it’s a pleasurable experience despite her initial low level of desire. In this case, she and her partner should definitely make sure she has enough stimulation to become aroused, because low libido is not always the same thing as an inability to be aroused — it might have to do with her drive but NOT her responsiveness.

Pain during arousal, penetration, or orgasm:
This one is much less common, but should be checked out by a physician who is informed about women’s sexuality. In some cases, pain with penetration is associated with bad past experiences (survivors of rape or sexual abuse) and/or inordinate fear of sex. Other times it is a sign that something’s wrong with a woman’s health. Pelvic Inflammatory Disease (PID) and other conditions can result in pain with penetration, so this is definitely a kind of dysfunction that may need to be addressed with professional help.

One last thing. IF a woman has a history of comfortable, sufficiently-aroused, orgasmic sex, and something changes, that might be a signal that there is a problem in her relationship (of course, relationship problems can also be troublesome for a women who has *never* had good sex). When trust is lost in a relationship or anger and bad communication become issues, sex can definitely suffer. The other things that can cause a change may be physical: temporary and natural changes, like the hormonal changes that come with pregnancy and menopause, can do it, but the other thing that can cause such change is the onset of serious illness. Major sexual changes should be considered a reason to get a check-up — not necessarily a prescription for a sex pill, but an evaluation to make sure you’re healthy.

What about sex pills? I’ll write more about that later this week!
Hope this is useful — back at you soon, OK?
Best–CQ

Dr. Carol Queen

Carol Queen has a PhD in sexology; she calls herself a "cultural sexologist" because her earlier academic degree is in sociology: while she addresses individual issues and couple's sexual concerns, her overarching interest is in cultural issues (gender, shame, access to education, etc.). Queen has worked at Good Vibrations, the woman-founded sexuality company based in San Francisco that turned 35 years old in 2012, since 1990. Her current position is Staff Sexologist and Good Vibrations Historian; her roles include representing the company to the press and the public; overseeing educational programming for staff and others; and scripting/hosting a line of sex education videos, the Pleasure-Ed series, for GV’s sister company Good Releasing. She also curates the company's Antique Vibrator Museum. She is also the founding director of the Center for Sex & Culture, a non-profit sex ed and arts center San Francisco, and is a frequent lecturer at colleges, universities, and community-based organizations. Her dozen books include a Lambda Literary Award winner, PoMoSexuals, and Real Live Nude Girl: Chronicles of Sex-Positive Culture, which are used as texts in some college classes. She blogs at the Good Vibes Magazine and at SFGate's City Brights bloggers page and contributes to the Boston Dig. For more about her at carolqueen.com.

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