Decreased sexual desire
Sexual desire is that which cause one to be receptive to or
initiate sexual activity. For women, the quality of the relationship and the
emotional and the physical satisfaction she receives from that relationship
appear to be critical elements.
Desire requires androgens such as testosterone and DHEAs,
neurotransmitters, and the sensory system. Starting in the twenties, there is a
progressive decline of physiologically available androgens for both men and
women, which can contribute to decreased sexual interest. Interest in sexual
activity can be disrupted by psychosocial, physiological, physical,
environmental, cultural factors. Fatigue, depression, side effects from
medications, self-esteem, and body image concerns can all interfere with sexual
interest. Addressing relationship issues through counseling, supplementing
androgens, treating depression, and assessing medication side effects are all
important. More important for good sexual desire is attending to scheduling the
time and setting the environment for sexual activity, using the senses to the
fullest, and incorporating seduction.
Decreased arousal
Arousal difficulties leading to delayed vaginal engorgement,
reduced vaginal lubrication, pain with intercourse, and decreased vaginal,
clitoral, and orgasmic sensation can be caused by or exacerbated by
atherosclerotic disease. Screening laboratory testing should include lipid
profile, glucose with or without insulin levels, thyroid stimulating hormone
(TSH) and androgen levels (DHEAs and free testosterone).
Lifestyle changes are critical and should include moderation
of alcohol intake, exercise, smoking cessation, weight loss, and stress
management. Medications that can be discontinued or reduced in dosages should
be changed. Additionally, just as psychotropic agents can significantly reduce
sexual interest, they can produce a secondary effect on arousal.
Many excellent sexual lubrication are available over the
counter. They can offset changes in vaginal lubrication brought about by age or
chronic illnesses and/or their medical treatment and can enhance sensuality in
general.
Difficulties with orgasm
Difficulties with orgasm are related most often to lack of
understanding of what sort of sexual stimulation is required, difficulty
communicating this needs to one’s partner, or lack of the partner’s initiative
to provide this stimulation. Additionally medications, most notably
psychotropic agents, can prolong arousal, making orgasm very difficult to
attain. Androgen deficiency is believed to contribute to the higher threshold
required for orgasm and the intensity for orgasm.
Exploring the woman’s desire and arousal phases, including
quality of her relationship, is important because sexual health comorbidities
are likely. Supplementation of androgens should be undertaken if needed. The
woman should be encouraged to enhance her self-awareness about what sensual and
physical stimulation she requires for orgasm through self-stimulation.
Reference
- Butcher, J. ABC of sexual health: female sexual problems II: sexual pain and sexual fears. Br. Med. J. 1999