After being considered a taboo topic, women’s sexuality is now openly discussed and portrayed on television, in magazines, and on the Internet. From hushed whispers and cryptic phrases to in-depth scientific conversations, this subject is no longer a secret. Opening up to it has unveiled several sex problems faced by women that were for long kept confidential. So what is are sex issues, what are the causes and how to deal with them effectively?

In conversation with TC46, Dr Sanjay Kumawat, Consultant Psychiatrist and Sexologist, at Fortis Hospital in Mumbai, shares the changes that occur in women during arousal, the need for sexual satisfaction and the diagnosis of sex problems.

1. What happens when a woman gets excited sexually?

The sexual response cycle has four phases: excitement, plateau, orgasm, and resolution. 

Phase 1 – Excitement

General characteristics of the excitement phase, which can last from a few minutes to several hours, include the following:

  • Muscle tension increases
  • Heart rate quickens and breathing is accelerated
  • The skin may become flushed (blotches of redness appear on the chest and back)
  • Nipples become hardened or erect
  • Blood flow to the genitals increases, resulting in swelling of the woman’s clitoris and labia minora (inner lips)
  • Vaginal lubrication begins
  • The woman’s breasts become fuller and the vaginal walls begin to swell

Phase 2- Plateau

General characteristics of the plateau phase, which extends to the brink of orgasm, include the following:

  • The changes begun in phase 1 are intensified
  • The vagina continues to swell from increased blood flow, and the vaginal walls turn a dark purple
  • The woman’s clitoris becomes highly sensitive (may even be painful to touch) and retracts under the clitoral hood to avoid direct stimulation from the penis
  • Breathing, heart rate, and blood pressure continues to increase
  • Muscles spasms may begin in the feet, face, and hands
  • Muscle tension increases

Phase 3 – Orgasm

Orgasm is the climax of the sexual response cycle. It is the shortest of the phases and generally lasts only a few seconds. In men, rhythmic contractions of the muscles at the base of the penis result in the ejaculation of semen. General characteristics of this phase include the following:

  • Involuntary muscle contractions begin
  • Blood pressure, heart rate, and breathing are at their highest rates, with a rapid intake of oxygen
  • Muscles in the feet spasm
  • There is a sudden, forceful release of sexual tension
  • In women, the muscles of the vagina contract; the uterus also undergoes rhythmic contractions
  • A rash, or ‘sex flush’ may appear over the entire body

Phase 4 – Resolution

During resolution, the body slowly returns to its normal level of functioning, and swollen and erect body parts return to their previous size and colour. This phase is marked by a general sense of well-being, enhanced intimacy and, often, fatigue. Some women are capable of a rapid return to the orgasm phase with further sexual stimulation and may experience multiple orgasms.

2. What’s sexual satisfaction for a woman?

Psychological, interpersonal and sociocultural factors play a significant role in deciding sexual satisfaction in women. The importance of sexual satisfaction in a healthy romantic relationship is clear. It tends to be associated with higher levels of love, commitment, and stability in the relationship. A number of factors influence sexual satisfaction in women. While age can somewhat work against it, high sexual desire and satisfaction with work and satisfaction with romantic relationships for a woman promote sexual satisfaction. Sexually satisfied women tend to have levels of sexual desire that are closely matched with those of their partner. There is some evidence that while penis length does not tend to be a factor for sexual satisfaction, penis width may very well be. Women who self-stimulate are also more likely to feel sexually satisfied. The theory here is that women who self-stimulate are more aware of their sexual wants and needs.

Communication, both generally and about one’s sexual needs, is thought to be the strongest factor in achieving sexual satisfaction. Women who tend to be highly sexually assertive tend to have higher levels of desire, orgasm ability, and sexual satisfaction compared to their non-assertive counterparts. The more often couples tend to be affectionate, both sexually and otherwise, the higher their sexual satisfaction tends to be. Interestingly, even the form of communication can have an impact on sexual satisfaction. For example, non-verbal communication during sex is thought to be more likely associated with sexual satisfaction than verbal communication during sex

Given the importance of sexual satisfaction in maintaining health and happiness, as well as the multiple factors involved in female sexual satisfaction, women and their partners would be well advised to protect their emotional and physical health. Be affectionate in all aspects of their relationship, get to know their sexual needs, and communicate those needs openly and kindly to their partners.

3. What are some of the common sex issues in women and how to tackle them?

1. Lack Of Desire 

It may be persistent or temporary, which involves a lack of desire for fantasy or actual sexual activity. The first thing is to have a biological, psychological or social approach to this issue. Biologically rule out any general and local pathologies and any drugs that the woman is taking for various medical and psychological issues. Her psychological get-up and mood in general is most important. Interpersonal relationships matter most. Her social background needs to be explored and her value system needs to be understood. Her lifestyle adds vital input. Combining medical and psychotherapeutic interventions is the natural extension of the biopsychosocial model. Psychotherapeutic interventions namely counselling, Behavior Therapy, marital counselling to sort out interpersonal relationships, and most importantly psychosexual education to understand the importance of love talk, foreplay and understanding the female psyche and sexual cycle, can help come over the issue. Therefore, focusing on improving the intimate relationship would be an important first step for a woman with low sexual desire and associated low relationship quality

2. Painful Intercourse

The medical term for painful intercourse is Dyspareunia, defined as persistent or recurrent genital pain that occurs just before, during or after intercourse. It can be because of menopause, painful area or over-sensitivity around the wall of the vagina with unexplained aetiology, or because of Vaginismus (a kind of voluntary contracting of muscles around the vagina) leading to pain during intercourse. It can also happen during infection, lubrication issues, any injury or trauma at the local area. Psychologically emotional stress, any trauma can also cause this kind of problem.

3. Management

Management of physical factors and issues about a dry vagina with help of your Gynecologist is crucial. Psychological counselling is of help for emotional trauma, stress and more.

4. Difficulty In Reaching Orgasm

It can be because of a variety of reasons like gynecological issues, medical illnesses, psychological factors, alcohol, smoking and ageing. Management is also cause-specific. There may be relationship issues and breach of confidence which needs to be addressed by counselling and marital therapy.

4. How are sexual problems in women diagnosed?

Diagnosis of sexual problems in women is done through:

  • Proper medical history
  • Pelvic examination to rule out local issues
  • Self-reporting questionnaire for sexual satisfaction
  • Sexual history
  • Information about lifestyle, morals, values, drug and alcohol taking behaviour, modes of sexual satisfaction are important for diagnosing female sexual dysfunction.

5. What are some of the factors associated with higher sexual satisfaction in women?

Important factors for higher sexual satisfaction in women are visual:

  • Sexual stimulation
  • Intimacy
  • Security in relationships
  • Quality of life 
  • Stable mental status

Disclaimer: This is for the general information of the readers. Always consult a doctor for specific health-related concerns.