Private Problems: Addressing Women’s Sexual Health

According to the American College of Obstetricians and Gynecologists, approximately four out of 10 women have problems with sex at some point during their lives. It can be uncomfortable or awkward for many women to talk with their healthcare provider about these problems. However, addressing women’s sexual health is a crucial element in overall health.  

Experiencing painful sex

Pain during sex is common for nearly three out of four women at some time in their lives, according to the ACOG. One of the primary causes for this is vaginal dryness. According to a 2018 study, 19.4% of all women ages 42 to 52 experience vaginal dryness. That number increases to 34% for women ages 57 to 69. When women are younger, the vaginal mucosa — the skin that lines the vaginal tract — is pink and well-hydrated. 

“The biggest thing is, as we get older, our skin on the outside of our body loses its elasticity; it loses its moisture,” says Sabrina, founder and owner of Immunity Health in The Villages. “[Women] get little micro-tears when they’re having sex because the skin integrity is not the same as it used to be.” 

One reason there’s decreased moisture is a decrease in blood flow to the area. 

“The genital areas for men and women [contain] the tiniest little blood vessels than any other part of our body,” Sabrina says. “They’re the smallest blood vessels in that area. Over time, there’s not enough circulation, which is not enough hydration, not enough elasticity.”

Other causes for pain during sex include yeast infection, endometriosis, adhesions, tears resulting from childbirth, tightening of the vaginal muscle and hormonal changes. 

In addition, past trauma, negative experiences or relationship problems with your partner can lead to difficulties with your sexual health. In those cases, consider seeking professional counseling to help remove any emotional or mental roadblocks interfering with your sexual health.  

Treatment for painful sex

Many women think pain during sex is just a sign of getting older, so they don’t seek out help to alleviate the discomfort. 

“Women almost become resolved to the fact that it can’t be better,” says Lori Esarey, MS, APRN, CS, founder and owner of Total Nutrition and Therapeutics in Lady Lake. “The reality is that’s an untruth. It is easily treatable, and it is important to treat it. It’s not just for sexual pleasure; it should be treated because, if not, this same vaginal dryness can open the door to having frequent urinary tract infections and yeast infections. So there are other reasons beyond sexual pleasure to make sure that the vaginal tract is plush and pink and hydrated.”

Some at-home treatments include using a lubricant during sex or taking an over-the-counter pain reliever before sex. If the condition persists, seek professional evaluation and treatment. If necessary, there are treatments to help alleviate pain during sex. One such treatment is shockwave therapy, such as GAINSWave. 

“It’s about a 15-minute procedure on the outside of the skin,” Sabrina says. “It’s not intravaginally, but it’s across on the top of the pubic bone area down along the side of the outer labia. We do use a numbing cream, and it might sting a little but it’s nothing that’s unbearable.” 

Shock waves are sent into the area to loosen it up and promote blood flow. 

“Getting a series of treatments opens up and expands those vessels and gets the blood flow going there,” Sabrina says. “It’s miraculous how things bounce back.”

Another possible solution is an O-Shot, a non-surgical treatment that starts with a blood draw. The platelet rich plasma is removed from the blood and inserted into an area by the clitoris and upper vagina. 

“The clitoris gets very thin and very dry and very tiny as we get older as well,” Lori says. “It’s lack of estrogen causes cells to die. So when that happens, the clitoris does the same thing; it gets quite small. Because it’s also thin and dry at the same time, you lose feeling. It becomes less sensitive, and the clitoris is very, very important with sexual satisfaction.”

The O-Shot can reduce vaginal dryness and lead to increased sensitivity and increased desire. Some women experience results right away, but more than one shot may be needed. 

With shockwave therapy, it could take between six and 12 treatments for ultimate therapy. 

“You can get some benefit, of course, any time you’re going to increase flow, but there is a sweet spot with getting six treatments,” Sabrina says. 

Additional, future treatments may be needed to maintain blood flow and hydration in and around the vagina. 

“They suggest about every 18 months to two years, it’d be good to have a single session to optimize yourself down there and just keep the blood flow going,” Sabrina says. “What happens over time, it’ll start closing up again.”

It’s important to note that health insurance does not cover these treatments. And the price can be a heavy lift. Shockwave therapy can range from $500 to $700 per treatment, and the O-Shot can cost between $1,500 and $2,200 for a single shot. 

Balancing bacteria 

Much has been written about gut bacteria and how the right balance can improve your overall health. The same holds true with vaginal bacteria. 

“We need the right bacteria in the vaginal tract,” Lori says. “When we have an overpopulation of things that don’t belong there, it can cause inflammation and that inflammation can cause irritation.”

As with gut bacteria, eating the right foods (like those rich in fiber) can help promote the right balance for vaginal bacteria. 

“There are times when my female patients have repetitive vaginal infections because of multiple different reasons,” Lori says. “And usually it’s a result of a lack of the proper pH balance of the vaginal tract. Unfortunately, again, with hormone balance and when that pH changes in the vaginal tract, we’re more apt to get infections. So, when I have patients that have repetitive vaginal infections, I will often recommend probiotics inserted intravaginally.”

Over-the-counter probiotics are available as suppositories, gummies and capsules, but it’s important to see a healthcare provider and undergo an examination before taking any probiotics. 

“If you’re experiencing symptoms and they have not been evaluated, they need to be evaluated first because that product’s not going to clean up an infection,” Lori says.

Treating pelvic organ prolapse

If your vagina, bladder, uterus, urethra or rectum start to drop from their original location, they could move and make a bulge in the vagina. This is known as a prolapse. These organs drop because the muscles and tissues of the pelvic floor grow weak due to pregnancy, childbirth or menopause. Symptoms of a pelvic organ prolapse include pain during sex, lower back pain, feeling a bulge at the opening of the vagina, and urinary changes such as an urgent need to urinate. 

While the most common cause is giving birth vaginally, risk factors for pelvic organ prolapse also include getting older, being obese, straining from an ongoing cough and having a family history of pelvic organ prolapse. 

To treat the condition, your healthcare provider may prescribe estrogen to help strengthen vaginal tissue. Another option is pelvic floor therapy, including shockwave therapy and the O-Shot mentioned above. Physical therapy incorporating exercises to strengthen pelvic floor muscles may also be prescribed. 

Reconstructive surgery to move the pelvic organs back in place also is possible. The goal is to eliminate the vaginal bulge and improve some symptoms. However, it won’t strengthen weak pelvic muscles, so the prolapse could recur. 

Identifying a submucosal uterine fibroid 

A submucosal uterine fibroid is a benign growth that appears in the inner lining of the uterus. It may just be one fibroid or develop in clusters. Symptoms of a submucosal uterine fibroid include heaving bleeding during or between periods, anemia, lower back pain, pain in the pelvis, passing large blood clots, fatigue, and dizziness. 

There are several treatments available to treat a submucosal uterine fibroid, including shrinking by using uterine fibroid embolization (UFE), which is a minimally invasive, non-surgical procedure. Surgery to remove the fibroid is another option. Endometrial ablation may also be used to decrease heavy menstrual bleeding. 

Your doctor will discuss which treatment option would best address your submucosal uterine fibroid. 

Testosterone therapy for women: Can it improve your sex life?

As previously mentioned, hormone balance is a key element in good sexual health. That includes the right balance of estrogen and testosterone. It’s true that testosterone could have a positive impact on a woman’s sexual health. 

“Testosterone is absolutely going to increase libido and drive and making you feel sexy again,” Lori says. “But we need the right testing to identify truly where the imbalances lie, so we can correct appropriately.” 

Studies in women of all ages have failed to identify a clear link between testosterone and sexual desire and satisfaction. In addition, the long-term safety of testosterone in women has not been proven, making it less likely to be a recommended treatment. Plus, taking testosterone can cause side effects such as acne, weight gain, hair growth on the face and body, and hair loss on the head. 

Therefore, it’s important to consider other treatment options before turning to testosterone therapy. Talk with your healthcare provider to determine your options and see if testosterone is included. 

Having “the” talk 

Discussing sexual health is not always an easy conversation —not with a partner, and not with a healthcare provider. But it’s important for these conversations to take place. 

Whether it’s asking a new partner to get tested for sexually transmitted diseases (STDs), talking about pain with sex or explaining why you have no sexual desire, bringing up the subject of sexual health is no easy task for most women. When planning this conversation, it’s important to consider timing. Waiting until you’re in the bedroom is definitely not the right time. Instead, you should set aside a time when you both are able to listen and consider what is being said. 

Also, be prepared for your partner to be defensive. It’s natural for your partner to wonder why they aren’t pleasing you. It’s important to make them understand this is not their fault. Instead, make sure they know it has to do with you and changes occurring in your body. Lori suggests keeping the conversation focused on what’s happening within your body, sharing what changes you’re feeling, how your body is behaving right now and discussing possible treatment options. 

She also says to reassure your partner. Tell them you love them and you want them to understand what is going on with your body. By all means, avoid abstinence. If you forgo sex, your partner will automatically assume they did something wrong. 

“Abstaining and pulling away is one of the worst things we can do without talking about it,” Lori says. 

Talking sex

It’s equally important to talk with your healthcare provider about your sexual health. Women usually have no trouble bringing up hot flashes and night sweats with their doctors but are more reluctant to do so when it comes to painful sex or a loss of sexual desire. 

“I think they seek out help for things they have like hot flashes that are disruptive during the day,” Lori says. “They’re less likely to seek out attention for things that intermittently are occurring and they can just avoid. They avoid sex, and then think, ‘I’m fine.’ I’m like, ‘No, we have to fix this.’ I wish more women were speaking up.”

Sabrina agrees, pointing out that our entire body is supposed to function throughout our lives. 

“We feel that God did not make us for any one part of our body to all of a sudden stop working,” she says. “You should be able to walk and talk and hear and all these things at a proficient level all the way until we drop dead. We want to send hope that you can age gracefully in some things. But please don’t think that that part of your life just falls off. It doesn’t have to; that’s not the way we were made.”

To help encourage these conversations, find a healthcare provider that puts you at ease. Also, look for one who takes time to listen to your questions and concerns. Remember, your healthcare provider is experienced in all areas of health — including sexual health — so he or she should be ready for a conversation on this topic. To make it easier, bring a list of questions to your appointment. If you have trouble discussing the topic, just tell your healthcare provider that you have something you want to discuss and hand over the list of questions. In this way, the healthcare provider can see your concerns and start the conversation. This allows you to relax as you go over your questions. 

Final thoughts 

Sexual health is a vital component of your overall well-being, so don’t be afraid to talk about it. 

“Sexual wellness is a very important part of living well and living optimally, just like financial wellness and emotional wellness,” Lori says. “I really want people to understand that healthy sexual relationships are pivotal for overall health and well-being.” 

Talk with your partner and your healthcare provider if you are experiencing problems with your sexual health. You can find solutions that restore your sexual health and get you back in sync with your partner.