Sexuality is a complex interplay of emotional and physical factors. Women at any age can struggle with issues of sexuality, from basic concerns about intimacy to sexual dysfunction. Women are often hesitant to discuss their concerns about sexuality with their physicians.
It is important to remember that both physical and psychological factors can contribute to sexual dysfunction. Some medical conditions or side effects of medications can interfere with sexual function. Conditions such as depression or anxiety, or past experiences that may have been traumatic, can inform a woman’s sense of her sexuality.
Sex therapy often begins with an educational phase, as a person’s uncomfortable feelings may be due to needing more information on the subject. Literature on sexuality (please see resources page) and closed facebook groups can help with this, in addition to counseling. Secondly, there is the “permission” stage of sex therapy counseling, which involves resolving insecurities/questions about whether or not it is ok to feel the way you do or want what you want. In this stage it is important to realize that there is a *very* wide spectrum or degrees of interest in sex.
Finally, the process of unpacking one’s sexual history (even if you hadn’t had sex until your spouse, ever since you were a kid you likely received messages about sex and positive/negative attributions about it). A history of abuse is critical to disclose to your therapist for progress to be made, as trauma impacts one’s sex life, even if it happened decades ago. If one has not had an abusive sexual past, writing down one’s sex history for deeper insight and mindfulness can be therapeutic before counseling begins, or to share with your partner if you feel they are a safe person and you want to communicate this history to them for greater understanding (be cautious, however, as this is a very vulnerable act and you must be sure you can trust them).
Sexual disorders (as diagnosed in the DSM) can occur at the desire, orgasm, or resolution phase. Inorgasmia (inability to experience orgasm) is quite common in women, most studies report 1 in 3 women have trouble reaching orgasm during sex, and as many as 80% have difficulty reaching orgasm through intercourse alone. Vaginismus (pain during intercourse) is also common. If you are experiencing these and they are interfering with your life, counseling is highly recommended. You can speak to your OBGYN or doctor for a referral to a psychologist or psychiatrist, preferably a licensed sex therapist or therapist that specializes in women’s issues.