From a scientific perspective, a woman’s sexual life (as well as a man’s) is a combination of biological, psychophysiological, psychological, and emotional reactions, experiences, and behaviors related to the expression and satisfaction of sexual desire. Sexuality is an innate need and function of the human body, similar to processes like breathing and digestion. A person is born with a certain physiological sexual potential, and sexuality is further shaped within the framework of individual life experiences.
From a practical point of view, sexuality represents a driving force of social activity for individuals, as it aims not only for sexual satisfaction but also for a socio-psychological state referred to as “happiness” and an improved quality of life. It is no coincidence that the renowned German scientist Wilhelm Reich considered sexuality and orgasm as the primary regulating mechanisms of human life. He developed a naturalistic theory about “orgone energy” (freely flowing sexualized “life energy”) and worked on devices for its accumulation.
From a historical perspective, researchers identify several cultural types of women’s sexual life:
- Apollo type, characteristic of ancient societies and, in the modern era, found in Japan and some Pacific islands. Sexuality within this type is viewed on par with other human needs (such as food, sleep, etc.), without taboos or restrictions.
- Liberal type, characterized by tolerance towards various manifestations of sexuality and the absence of coercion towards specific forms of sexual behavior. It was prevalent in the sexual lives of women from the upper classes during the periods of the Renaissance and Enlightenment.
- “Cultures of poverty” influenced by patriarchal traditions. This type is characterized by a low level of awareness regarding sexuality, the absence of an organized system of sexual education, including within families, notions of male dominance and female subordination, and acceptance of violence in sexual and family life. It was primarily prevalent among women from the poorest and middle-income segments of the population until World War II.
- “Culture of lovers” –– characterized by double moral standards that condemn open displays of sexuality but allow for discreet expressions of sexual freedom, including marital infidelity.
- Orgiastic culture. It is based on the pursuit of pleasure as a result of sexual relations, allowing for all forms of sexual activity. This type of sexual life has been recorded in historical records since ancient Egypt.
- Mystical culture, in which sexual life serves as a means of implementing religious and philosophical principles.
- Repressive culture, characterized by a tendency towards almost complete suppression of sexuality, strict prohibitions on extramarital and premarital relationships, the absence of a system of sexual education, and a limitation on the role of sexual relations in marriage and procreation. This type was mainly associated with women living under authoritarian or totalitarian regimes throughout the 20th century.
- Puritan culture, representing the extreme expression of Christianity’s religious disposition to abstain from earthly pleasures, including sexual ones. The puritan culture also exists within medical circles, promoting false beliefs about the harmful effects of sexual expressions (e.g., “masturbation causes impotence, blindness, and hair growth on palms”). This culture gained significant prevalence in the early 16th century as a reaction to the licentious behavior of the aristocracy. It still maintains its influence on certain segments of the population, such as the Amish in the United States.
- Prior to the 20th century women’s sexual life in developed European countries mainly consisted of a combination of the liberal type and the “culture of poverty.” After World War I, due to the catastrophic shortage of men in Europe, extramarital motherhood and extramarital sexual life became common practices. However, the state, official institutions, and ideology either ignored sexuality (resulting in insufficient provision for reproductive and sexual health, lack of contraception, expert information, education, etc.) or regarded sexual relations within marriage as the only norm of life. This manner of organizing the sexual sphere was labeled as “hypocritical”.
The main shifts in sexual culture in the mid-20th century were centered around women taking control and planning their own sexual lives, a responsible attitude towards reproductive health, increased activity in sexual relationships, positioning themselves as subjects of sexual desire and pleasure, the spread of responsible attitudes of both men and women towards sexual practices, and an orientation towards partnership in sexual relationships. These changes form the basis of the “sexual revolution,” which prompted efforts to study sexual disorders. New terms became widely used, including sexual desire (libido) – the individual’s drive to satisfy their sexual needs; sexual arousal – the activation of a complex system of nervous reflexes involving the genital organs, nervous system, and the body as a whole; orgasm – the culmination of sexual arousal associated with intense pleasure and satisfaction; lubrication – the moistening of a woman’s genital tract due to erotic stimulation, among others.
In the subsequent decades, researchers identified the most common sexual problems experienced by women, including sexual interest/arousal disorder, orgasmic disorder, and genito-pelvic pain/penetration disorder.
According to research published in the scientific journal “National Health and Social Life Survey,” women experience orgasms much less frequently than men. For example, 75 % of men have orgasms during sexual intercourse, while only 29 % of women always experience sexual satisfaction. Additionally, the majority of women do not experience vaginal orgasms and require clitoral stimulation.
Currently, there is no unified theory regarding the origins of sexual disorders. Both physical and psychological aspects play a predominant role. With age, somatic causes become increasingly significant, such as conditions like diabetes, obesity, and alcohol dependence, as well as the side effects of medications such as selective serotonin reuptake inhibitors (SSRIs) and antihistamines. Psychological factors, such as conflicts with partners, psychological traumas, and occupational stress, also play an important role. Frequently, deviations in sexual behavior are symptoms of unresolved conflicts from childhood.
In the modern world, there is rapid progress in the development and implementation of numerous medications in practical healthcare. While these medications have the potential to improve a patient’s condition, they can also have negative effects on their health. The desire to help patients recover from all their developed illnesses leads to the prescription of a large number of medications, a phenomenon known as polypharmacy.
Currently, polypharmacy poses a significant problem in healthcare. When treating sexual disorders in women, doctors often prescribe medications that can suppress the patients’ sexual function. Hormonal contraceptives, particularly those containing progestin, including oral contraceptives, are among the primary culprits. They reduce the levels of estradiol and progesterone in the blood, leading to ovulation disturbances. Antiestrogens can cause vaginal dryness. Antihypertensive medications can decrease libido and vaginal lubrication. Antihistamines (such as diphenhydramine, mebhydrolin, promethazine, among others) can cause vaginal dryness. Neuroleptics (medications from the phenothiazine, butyrophenone, thioxanthene groups, etc.) can reduce sexual desire and disrupt sexual function. Alcohol and other addictive substances (heroin, methadone, morphine, cocaine, phenamine, barbiturates) present separate issues.
However, some medications have a positive influence on a woman’s sexual life. For example, estradiol enhances the ability to experience sexual satisfaction and sexual desire, increases blood flow to the brain, and sensitivity in erogenous zones. Additionally, estradiol intensifies sexual pleasure and orgasm by acting on receptors in the brain.
According to the clinical recommendations of the International Society for the Study of Women’s Sexual Health, healthcare providers should suspect sexual dysfunction if the following symptoms persist for six months or longer and bother the patient:
- Lack of sexual interest or desire
- Absence of sexual thoughts or fantasies
- Loss of desire to engage in sexual activity
- Frequent feelings of disappointment, grief, guilt, sadness, or anxiety
- The optimal strategy for a healthcare provider to detect sexual issues is to directly ask, “Are you sexually active?” If the patient avoids answering, it is better to specify the question: “Are there any sexual problems you would like to discuss?” or “Many women nowadays are concerned about issues of sexuality and the quality of their sexual lives, what about you?”
Creating a comfortable environment for conversation with the patient and establishing a trusting relationship are of utmost importance. Despite the frequency of these disorders, women often feel hesitant to discuss the topic and reluctantly initiate conversations about their problems.
Assessing sexual dysfunction in women in the absence of organic causes involves a thorough physical examination, including an examination of the pelvic organs, psychological and psychosocial assessment, laboratory and hormonal testing, and monitoring of sexual arousal. A patient’s examination on a chair in relation to complaints of sexual dysfunction is mandatory! According to the recommendations of the International Society for the Study of Women’s Sexual Health, attention should be paid to a visual examination of the external genitalia, assessing sensitivity to pressure with a cotton swab around the introitus of the vagina, manual examination, palpation of the hip joint, evaluation of vaginal atrophy, pelvic floor muscle tone, and the condition of the lumbosacral joint.
Hormonal medications are considered the main provocateurs of sexual disorders in women of reproductive age. There is a suggestion that libido decreases due to the influence of oral contraceptives. Therefore, one of the first steps a physician should take when complaints of sexual dysfunction arise is to consider replacing hormonal contraception.
Many causes of female sexual dysfunction still elude diagnosis. This is due to insufficient knowledge and the imperfection of modern diagnostic methods in this field. However, if women do not hesitate to discuss their problems with a doctor, in most cases, they can be addressed at an early stage and prevent their exacerbation. Prolonged sexual disorders lead to neuroticism, depression, the breakdown of family relationships, and marriage. Most sexual disorders do not hinder a woman’s sexual intimacy. This is further evidence that psychological factors play a leading role in the structure of female sexuality.
An important point when discussing the correction of sexual dysfunction is the influence of placebo treatment. According to an analysis of 605 scientific articles on this topic, the treatment of female sexual dysfunction using a placebo was successful in 67,7 % of cases. Therefore, it is important to emphasize once again the importance of establishing trusting relationships between women and their treating physicians.
Discussions on such topics can be difficult and uncomfortable, but it is important to understand that sexual life is an essential part of our existence, and problems in it can undermine not only self-confidence and relationships with our partners but also have a serious impact on health.
Sexual discomfort in women can be a result of physiological disturbances, but more often it is based on personal problems. Sexual activity is adversely affected by stress, emotional disorders, and often such disorders are accompanied by persistent anxiety.
Such conditions are often associated with chronic anxiety, depression, various interpersonal conflicts (such as marital discord), and require the assistance of a professional sexologist since “decreased libido” is a characteristic symptom of many anxiety and depressive disorders.
In such cases, sexologists are effective in providing assistance. Sexology is closely related to psychotherapy, as the cause of most sexological disorders lies in disturbances of the psychoemotional sphere.
Persistent or regularly recurring painful sensations in the genitals associated with sexual intercourse (such as vaginismus) trouble many women. While such occurrences can also be found in men, they are usually of a physiological nature and require consultation with a urologist. In women, however, such sensations are often psychogenic in nature. There can be numerous causes, including various sexual traumas (including sexual violence), excessively strict upbringing (leading to a perception of sex as sinful impulses), and emotional rejection of the sexual partner. These internal conflicts prevent women from enjoying their sexual lives, which, under normal circumstances, should only bring pleasure.
The inability to surrender to passion and achieve the peak of sexual satisfaction (anorgasmia) may indicate high levels of anxiety. More often than not, marital conflicts, feelings of guilt about one’s own sexuality, low self-esteem, fear of pregnancy in women, and concerns about one’s ability to satisfy one’s partner in men are the primary causes of such phenomena. All of these factors indicate evident psychoemotional disorders and require appropriate therapy.
The inability to relax in bed is a fairly common problem among women. Women constantly control their actions and emotional expressions, not allowing themselves to fully enjoy sex. In other words, their constant tension prevents them from deriving complete satisfaction from their sexual lives. This state is a clear sign of an anxiety-depressive spectrum disorder. One should not take this problem lightly; seeking medical assistance is essential.
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