navigation Menu
flower bullet

Sexual Dysfunction: An Overview

July 19, 2016 | Mary South, MD, MHA

Sexual dysfunction can be a lifelong problem. For some women, it shows up only in certain situations, or develops after a period of normal sexual function. The causes can be psychological, physical, or both, and take a toll on health and relationships.

Fortunately, there’s a lot that can be done to treat sexual dysfunction, but first you have to identify the cause. In this article, we talk about how orgasms work and provide an overview of most common causes of sexual dysfunction.

How do women orgasm?

The muscles of the pelvic floor are an integral part of the orgasmic mechanism. At the moment of climax, the muscles contract in rhythmic waves creating the pulsating nature of the orgasm. The stronger the muscles, the stronger the orgasm. When a woman’s pelvic floor muscles weaken, so do the strength of her orgasms. Weakened pelvic floor muscles can go into spasm, causing pain, which is often the starting point for many physical causes related to sexual dysfunction.

Whether you are struggling with some form of sexual dysfunction or just want to have better orgasms, regular kegel exercises can strengthen your pelvic floor muscles for results that both you and your partner will appreciate. Learn more about how to kegel.

Sex and Bladder Control

For women with bladder-control issues, the feeling of desire is often overcome by the instinct to avoid intimacy. But avoid what? You don’t need it spelled out for you. And you know why: the unexpected leaking and embarrassment or the feeling of a need to urinate during intercourse. Women in these situations may have lost something very dear: the spontaneity – the freedom to abandon herself to the pleasure of sexual intimacy without anxiety.

Occasionally, merely emptying your bladder beforehand may be all you need to do, but the problem is more complex for some women.


Some women are unable to achieve an orgasm during sexual intercourse, a condition called anorgasmia.  The causes of anorgasmia vary, but are often related to pelvic floor dysfunction.  If a woman suffers from urinary incontinence, pelvic organ prolapse or vaginal atrophy (dryness and discomfort), she may have a decreased body image or feel anxious during intercourse, making release difficult.  Pain during intercourse can also result in the inability to climax.  Pelvic floor dysfunction aside, the day-to-day stresses of life – raising kids, work and fatigue – can make orgasm difficult.

Discussing your situation with a doctor or sex counselor can help you identify the cause and treatment options.  Pelvic floor physical therapy, counseling, relaxation techniques, vaginal estrogen cream or vaginal laser (or a combination of these treatment options) may prove helpful.

Pain with Sex

There are a number of different reasons why women may have pain with sex, all of which can be treated for a healthy, more enjoyable experience.

  • Vaginal dryness and atrophy often occurs during and after menopause when the walls of the vaginas atrophy, or grow thinner.  With atrophy, sex becomes uncomfortable and sometimes discomfort can be eased with personal lubricants. Your gynecologist may also recommend or prescribe estrogen creams or insertable tablets. New non-hormonal therapies are available, such as Mona Lisa Touch vaginal laser therapy, which has been shown to restore the vaginal tissues almost to their premenopausal state with three quick in-office treatments.
  • Pelvic floor myalgia or vaginismus is the involuntary spasm or constant tension of the muscles surrounding the opening of the vagina. When a woman suffers from pelvic floor myalgia, pain can occur with intercourse or she may even experience pain with sitting.  Some women describe pelvic or vaginal pressure and sharp shooting pains in the vagina. Exercise therapy and pelvic floor physical therapy can help. By exercising the muscles of the pelvic floor, they become stronger and more flexible. Intercourse will become more comfortable over time as the exercises are continued. If pelvic floor physical therapy is not effective, pelvic floor trigger point injections with steroids may be an option. In some cases, botulinum toxin has proven an effective therapy as well.

Beyond the physical realm, psychological causes for sexual dysfunction can be just as challenging: conflicts with a partner, worry about sexual performance and self-esteem, stress or anxiety, depression or a history of rape or sexual abuse. Sex therapy is often recommended for sexual dysfunctions that stem from psychological or relationship issues.

On the other hand, problems resulting from physical causes respond to medical treatment and physical therapy. And for women with both physical and psychological causes at play, they may find that resolving the physical issues can help overcome the accompanying emotional issues.

Find more information about Leaking During Sex.

Find more articles on Sex and Your Pelvic Floor