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RISK FACTORS FOR SEXUAL PROBLEMS



RISK FACTORS FOR SEXUAL PROBLEMS
There are a number of risk factors that may contribute to sexual problems in women. A risk factor is not necessarily the cause of a problem, but rather something that makes the problem more likely.
Personal well-being — A woman's sense of personal well being is important to sexual interest and activity. A woman who does not feel her best physically or emotionally may experience a decrease in sexual interest or response.

Relationship issues — An emotionally healthy relationship with current and past sexual partners is the most important factor in sexual satisfaction. Stress or conflict between a woman and her partner, and current or past emotional, physical, or sexual abuse often influence a women's sexual satisfaction. In addition, even good relationships can become less exciting sexually over time.

Male sexual problems — For women with a male sexual partner, midlife changes in the partner can affect her sexual response. Male sexual problems, (erectile dysfunction, diminished libido, or abnormal ejaculation), can occur at any time, but become more common with advancing age. In addition, women tend to live longer than men, resulting in a shortage of healthy, sexually functional partners for older women.

Gynecologic issues

Childbirth — After childbirth, physical recovery and breastfeeding, as well as the demands of parenting, may decrease sexual desire or result in vaginal pain during intercourse. In most cases, these issues improve with time.

Menopause — Estrogen is a female hormone produced by the ovaries. During the several years before menopause, estrogen levels begin to fluctuate. After menopause, estrogen levels decline dramatically. This may lead to changes in a woman's libido and ability to become aroused. Hot flashes, night sweats, sleep interruptions, and fatigue may also contribute to sexual problems.

In addition, some women experience vaginal narrowing, dryness, and a decrease in elasticity of the vaginal wall after menopause, which can lead to discomfort or pain during sex.

Hysterectomy — In general, hysterectomy does not cause sexual dysfunction. Most studies actually show in improvement in sexual function after hysterectomy, likely due to an improvement in symptoms that interfere with sex, such as heavy bleeding. Removal of the cervix at the time of hysterectomy also has no negative effect on sexuality. Removal of the ovaries at the time of hysterectomy reduces estrogen and androgen levels, which may impact sexual function for some women.

Vaginal or pelvic pain — Women who have vaginal or pelvic pain often have difficulty with sexual activity. Pain may lead to fear of further pain during sex and can diminish lubrication and cause involuntary tightening of the vaginal muscles, causing further pain.

Pain may be caused by endometriosis, prior surgeries, infection, or scar tissue. In postmenopausal women, a lack of estrogen often causes discomfort with intercourse. (See "Patient information: Chronic pelvic pain in women".)

Bladder and pelvic support issues — Changes in the bladder or loss of pelvic support (pelvic organ prolapse) can lead to loss of urine (incontinence) or sensations of vaginal pressure. These symptoms may interfere with sexual desire or activity in some women. (See "Patient information: Urinary incontinence in women".)

Medical issues — Almost any serious or chronic medical problem can impact a woman's sexual desire and responsiveness. Problems such as coronary artery disease and arthritis can affect a woman's physical ability to have sex. Indeed, arthritis has been identified in some studies as a common cause of sexual inactivity in the United States.

Women with cancer experience can discomfort and fatigue, due to both the disease and its treatments, which impacts sexual function. Changes in body image, especially after surgery on the breasts or other intimate areas, can contribute to sexual problems in women with cancer.

Other conditions such as Parkinson disease, complications of diabetes, or alcohol and drug abuse can impair arousal and ability to experience orgasm.

Psychiatric or emotional problems may also impact sexual function, either due to the disease itself or its treatment (see below). Depression is one of the most common causes of decreased libido and other sexual disorders in women.

Medications — Both prescription and nonprescription medications can alter sexual desire, arousal, and orgasm. This may include:

Beta blockers (used to treat high blood pressure)
Many antidepressants (especially selective serotonin reuptake inhibitors)
Some antipsychotic medications (used for psychiatric problems as well as sleep disorders and other conditions)
It is not clear if hormonal medications, such as birth control pills and menopausal hormone therapy, affect sexuality. Studies have shown mixed results, with some studies showing that hormonal medications have no effect while others showing worsening or improvement of sexual problems in women who take hormonal medications.

Surgery — Certain surgeries can affect a woman's sexual response. In particular, surgeries of the breast or the reproductive organs can change how a woman feels about her body, particularly if there is an underlying diagnosis such as cancer that led to the surgery.

Hysterectomy, with or without removal of the cervix should not negatively impact sexual function. However, some women experience sexual problems after both ovaries are removed due to decreased estrogen levels.