4 signs you might have sexual dysfunction

The Cleveland Clinic estimates that 43 percent of women and 31 percent of men report having sexual difficulties—also known as sexual dysfunction—at some time or another.

In short, sexual dysfunction is a problem that causes you to avoid sex or to have unsatisfying sex. It’s influenced by biology and psychology, and can get worse with age, especially after 40. There are many different types of sexual dysfunction. Your symptoms can help your healthcare provider (HCP) determine your particular issues and help you move toward a more fulfilling sex life.

Here are signs to watch for and what you should know about getting diagnosed.

Low libido, or sexual desire, is often the first clue a patient has sexual dysfunction, says Samantha Tojino, DNC, a doctorate nurse practitioner and sexual health specialist in Augusta, Georgia. “When a woman experiences a marked deficiency or absence of spontaneous or erotic thoughts and desire, this could mean something is off-balance,” she explains. 

This can be due to a hormonal or neurochemical imbalance. If you’re not interested in sex at all, your drive is weaker than it used to be, or your disinterest causes you distress, it could be due to decreased libido, also known as hypoactive sexual desire disorder (HSDD).

Having HSDD doesn’t mean you don’t love your partner or find them unattractive. Rather, there’s an underlying issue affecting your desire and drive. A nonexistent or low sex drive could be caused by a variety of things, including:

• Medical conditions like arthritis, cancer, diabetes, heart disease, or neurological issues
• Anti-depressants or anti-seizure medications
• Alcohol and nicotine
• Hormonal changes during stages of life like menopause and pregnancy
• Anxiety or depression
• Negative sexual experiences in the past

Talk with your OBGYN, a sexual health specialist, or another HCP if you feel like your libido is waning. And make sure you’re communicating with your partner about these changes so they’re aware, too.

If intercourse is causing you pain, the reason could be as simple as not using lubrication. A water-based lubricant can help, and ample stimulation through foreplay may also increase comfort. Hormonal changes related to menopause can cause the vagina to become dry or irritated as well. In this case, an HCP may recommend hormone-based creams, tablets, or a ring to provide lubrication.

Painful sex could also indicate you have another issue that needs attention. Some medical conditions that may also cause this sexual dysfunction:

• Bacterial vaginosis and herpes
• Bladder infections
• Yeast infections
• Fibroids
• Endometriosis
• Contact dermatitis
• Tearing during childbirth
• Vulvar vestibulitis
• You’ve recently come off birth control

Uncomfortable sex that you can’t take care of with at-home remedies means it’s time to see an HCP. They can help you determine the cause and develop a treatment plan.

Sexual complications can also be a result of what’s happening in the bedroom. “If your partner is finishing before you or is unable to achieve erection, this can leave you dissatisfied,” says Tojino. "This may also be an indicator of health issues with your partner."

Communication can help. Talk to your partner about what feels good and what doesn’t. Openly discuss things like when you’d like to have sex, how often you want to do it, and new positions to explore. You may even consider a "fantasy box" with mutually agreed-upon fantasies or positions to try. Pull out a fantasy at the beginning of the week and you’ll have something to look forward to for the days ahead.

Still not feeling comfortable sharing your desires? Sex therapy can help you open up to your partner. Describe the problems you’re having. Saying things like “I do not enjoy sex like I used to” or “I’m not interested in sex” can give your therapist a starting point.

Sex can boost your mood and reduce your stress levels. But if you're stressed about work, money, or your schedule, you might have a hard time focusing on being intimate in the moment. When anxiety or stress is affecting how often you want to have sex or your mindset when you do try to have sex, relaxation techniques can help. At-home exercises that may reduce stress include:

• Meditation
• Deep breathing
• Workouts like yoga and tai chi
• Music and art therapy
• Aromatherapy
• Progressive muscle relaxation

And remember: If you’re having trouble managing your stress levels on your own, see your HCP to talk through other things that can help.

“When a patient first comes to me with sexual dysfunction symptoms, we typically go through a series of tests, surveys, and screenings to diagnose what may be causing it,” says Tojino. These include a pelvic exam, a sexual dysfunction screener, and a menopausal questionnaire, which, when combined, help a patient understand their symptoms a bit better. 

Your HCP may also suggest blood tests to measure hormone levels and check for diabetes or thyroid, kidney, or liver problems. If you have any symptoms of sexual dysfunction, see your provider so they can help you get to the root of the problem.

Tojino wants everyone to know you don’t have to live with sexual dysfunction. Many treatments can significantly improve your symptoms so you can enjoy sex again.  

When it comes down to it, sexual dysfunction usually involves issues with desire, arousal, lubrication, pain, orgasm, or overall satisfaction, says Tojino. Once you get to the bottom of these symptoms and why you’re experiencing them, your treatment plan can help improve your experience of sex.

Once you’ve addressed any underlying health issues that may be interfering with sex, it’s time to make sex a priority (in whatever capacity you desire). Here are some ways to get started:

Set aside time for sex: In order to have sex, you have to make time for it. Try putting time on your calendar like you would do for a dinner reservation to ensure you have regular sex.

Communicate with your partner: Ask them how they like to be touched and what feels best to them—and have them do the same for you. Talk about any sexual desires, fantasies, or role-playing scenarios either of you want to try, too.

Show affection outside the bedroom: A simple “I love you” text in the middle of the day, or a sticky note on the mirror that says “I’ll be thinking of you all day” is one way to let you partner know they’re on your mind.

Arm yourself with lube: If you’re dealing with vaginal dryness or pain during sex, lube can help ease the discomfort. But even if you’re not having such issues, adding lube can make sex feel better. Experiment with different gels and liquids until you find one that works for you. Water-based lubes are generally safe, even for those with sensitive skin.

Sex is an intimate part of any relationship, which means it’s individualized and personal. Your sex life may look different than someone else's, and that’s okay. It's all about what you want and need.