FEMALE SEXUAL HEALTH
Barriers to Sexual Fulfillment
Achieving and maintaining sexual health allows for healthy relationships, family planning, and the avoidance of disease. At any age, it is important to considersome factors that can impede sexual fulfillment, including depression, anxiety, physical changes such as vaginal atrophy or erectile dysfunction in men, and issues with body image. Further, our increasingly busy schedules can often leave little time for intimacy, subsequently interfering with sexual enjoyment.
Sexual dysfunction is not uncommon. For women, the majority of sexual problems are often the result of significant hormonal changes such as duringpregnancy or menopause, physical changes such as incontinence, vaginal atrophy, arthritis, injury, or the use of certain medications, or psychosocial changes including conflict with a partner, becoming a parent, or issues with body image (1). To some degree, all of these can act as barriers, alone or in concert, to achieving optimal sexual health.
Sex and Pregnancy
Most women experience changes in sex drive during pregnancy due to the unique physical demands of carrying a child. Hormonal changes often bring about reduced sex drive, mood swings, depression, and fatigue (2). Other issues associated with pregnancy and childbirth can also alter sexual health, such as postnatal vaginal discomfort, vaginal dryness due to decreased estrogen levels, C-section recovery, or just feeling disinterested in being sexual as a new parent.
Many pregnant women and new parents are often concerned with sex during pregnancy. Numerous expectant parents wonder if vaginal intercourse is safe, or if sex is somehow related to miscarriage. According to Dr. Lisa Oldson, an internist at Northwestern Univrsity, sex during pregnancy is absolutely safe, and unrelated to miscarriage or complications with fetal development (2). In some specific cases, however, concern is validated, such as during high-risk pregnancies, or if a woman is experiencing "vaginal bleeding, preterm labor, or ruptured membranes" (3). In these cases, it is recommended that intercourse and orgasm be avoided.
Sex and Menopause
The body undergoes many changes during menopausal years. Estrogen levels drop significantly, and for many women, this results in reduced sexual desire, less natural lubrication, painful intercourse, and vaginal atrophy. The North American Menopause Society (NAMS) states that usually a variety of problems are often interrelated, and therefore are affected by one another. For example, emotional change arising from depression or anxiety can be both a cause and a result of sexual dysfunction such as inhibited desire. Further, antidepressants such as SSRIs (selective serotonin reuptake inhibitors) come with side effects that include "diminished sexual desire, trouble achieving and maintaining arousal, and difficulty achieving orgasm" (5).
Recently, the IWHR hosted Dr. Lauren Streicher, an expert on sexual issues as they relate to women of menopausal or post-menopausal age. She discussed vaginal atrophy and the effects of reduced estrogen levels on sex. For many of her patients, maintaining sexual health is important, but becomes increasingly difficult with the passage of time and the onset of menopause. Vaginal atrophy-the thinning of mucosa and labial folds that results in low natural lubrication and painful intercourse-is common, but treatable with moisturizers or estrogen rings that reintroduce the hormone internally. To read more about sex during and after menopause, see the most recent Lecture Notes from Dr. Streicher's lecture on the IWHR website.
Achieving and Maintaining Sexual Health
Sexual health is possible with the myriad of resources available today. If sexual dysfunction is an issue, there are many options for treatment. For women of menopausal age who may be experiencing issues such as lack of desire or vaginal atrophy, there are a variety of treatment options including estrogen tablets, vaginal moisturizers, lubricants, and creams.
For some, maintaining their sexual health could mean simply finding more time to spend with a partner, figuring out new ways to experience pleasure, or learning to enjoy sex in a different way during or after pregnancy, or post-menopause. Overall, it is imperative that we understand our bodies and learn to communicate our sexual needs to our partners, our healthcare professionals, and ourselves. If you have access to healthcare, getting regular check-ups, communicating with your doctor, and being screened for sexually transmitted infections are a few ways to maintain sexual health.
It is also important to remember that sexual health does not mean having a very high sex drive or desiring sex often. Sexual desire is relative-some may be more sexual than others, desiring a fuller sexual life, while others may find sexual enjoyment to be less of a priority. Sex drive and sexual interest can vary significantly from person to person, but becoming acquainted with what is sexually important to us as individuals and in our relationships will allow for achievement of sexual health.
(5) North American Menopause Society
Contributing Author: Heather Pieske, BA