7 sexual dysfunctions that could explain why many women don't really enjoy making love

The vagina has to be one of the universe’s greatest and most intelligent creations. It holds within it both the power button of female pleasure and the gateway to the miracle of procreation. This strong independent woman *scratch that* organ’s a self-cleaning oven with a whole microbiome of good bacteria (like our gut) in the form of lactobacilli, and glands that produce mucus to clean out the house and kick out dead cells and unwanted particles if and when the need arises. 

But like any good character arc, things also get a bit complex. Trying to fully understand the inner workings of female genitalia can feel like trying to navigate a new city without Google maps. Merely saying the word out loud makes eyebrows and blood pressure shoot up. It explains why so many grown women aren’t sure if they have one hole or two “down there”, despite having owned a vagina since birth.

Misconceptions and myths help perpetuate this air of mystery. Bleeding vaginas can ruin your pickles, destroy crops, cause earthquakes, communicate with aliens… our lady bits were victims of fake news centuries before Whatsapp was invented. We grew up fearing our own genitalia, and the repercussions and judgement that talking about it brought. We’re intimately familiar with the furrowed brow of the gynaecologist who finds out we are unmarried but still inquiring about safe sex, STDs and abortions. So we stayed clear of the clinics, lest we have to face the scowls and judgement of the professionals meant to guide us.

But there’s been a change in the tides of female sexual and reproduction health. That may have to do with growing conversations and awareness among women about their own bodies, and also the creation of telemedicine websites and apps, according to Practo’s 2020 report. The distance between patient and doctor provided a kind of safety wall and through the lockdown, queries about rare sexual dysfunctions and sexual health shot up by 184%.

“Sexual health needs were largely unmet in the past due to shame and stigma people attach to it. Patients were embarrassed to be seen going to doctors with sexual problems. Teleconsultations have given more power to patients to discuss and get advice at their own pace without being rushed by the doctor to undergo a battery of tests for disorders and symptoms that might not be related to their sexual health issues,” says Dr Vinod Chebbi, a psychosexual and relationship therapist at Medisex Foundation.

Concerns about unusual and rarely discussed sexual dysfunctions became hot topics during consultations with young Indians. An itch here, some unusual discharge there and a funky smell all-around – sometimes it’s obvious that things aren’t alright down under. But these sexual dysfunctions that are so unknown to the larger population that they end up silently suffering.

“Most of the time, the symptoms are pushed aside or just accepted in a ‘this is just how it is’ manner,” says Dr Rukhsana Hashim, OBGYN. “Because there is so little discussion over what sex should be like and feel like, women assume that their discomfort is just part of being sexually active.” With few coming forward to seek help, Hashim adds that the statistics regarding those who deal with such sexual dysfunctions are also skewed. “It’s a lot more common than people think, women just aren’t aware that what they’re experiencing isn’t normal.”

Sexual dysfunctions include persistent and recurring difficulties with arousal, orgasm and even pain during and after sex. Sometimes these can be linked to temporary stressors, a poor lifestyle and turbulent emotions in a bad relationship. But when the stressors pass or relationships factors normalise, and you are still experiencing severe symptoms, then Hashim says it may not be temporary but a disorder that requires medical attention and treatment.

Most sexual dysfunctions can be managed and treated with a combination of medications and counselling with a gynaecologist and/or sexologist.

7 sexual dysfunctions you may be suffering from but unaware of

Hypoactive sexual desire disorder (HSDD)

Hashim says that this sexual dysfunction is more common than people think. It’s more commonly referred to as female sexual interest/arousal disorder which causes a lowered sex drive in women. Women just don’t pay much heed to it, brushing a low sex drive aside as a sign of ageing. But HSDD can affect women of all ages.

It’s characterised by little to no interest in sex, a lack of arousal or pleasure when parts of the body and genitals are stimulated, little to no sexual fantasies or thoughts, and a complete disinterest in initiating any intimate acts. A professional will assess the possible causes for every patient and find a course of treatment and psychological counselling that best caters to them.

The cause of HSDD is best determined by a professional, but Hashim says it can be a combination of emotional and physical conditions. Health ailments like heart disease, hormonal fluxes, diabetes, fatigue and tiredness can contribute to it. A history of mental illness and related medications can also severely lower your sex drive. HSDD could be caused because of past traumas, interpersonal issues or even emotional matters with a partner, like trust issues and past infidelities.

Anorgasmia

Anorgasmia is far more common in women than men, a sexual dysfunction where you are unable to reach an orgasm despite adequate stimulation. In some cases, orgasm can be achieved but it takes so long that it becomes distressing rather than an enjoyable process.

Orgasms are already pretty scarce for womenkind, but this makes it even more of a unicorn. There are different types of anorgasmia. Lifelong, where there’s never been an orgasm; acquired anorgasmia is when a woman could orgasm in the past but later has difficulty; situational refers to the ability to reach orgasm only in certain circumstances, with a specific type of stimulation or partner. With generalised anorgasmia, a person isn’t able to orgasm at all, regardless of situation, masturbation or partner.

Orgasms are complex to achieve in normal circumstances. A mix of physical ailments, medications, gynaecological issues, interpersonal and psychological causes can combine to cause anorgasmia. Medications for blood pressure, antihistamines and antidepressants can delay orgasms. Too much alcohol consumption can be a contributing factor, along with more psychological factors based on cultural beliefs.

“There is an embarrassment associated with sex, and especially for women to enjoy sex. That has been ingrained from a young age. Some people can feel guilty about it being a pleasurable experience and that psychology can have a physical impact on the inability to orgasm,” says Hashim.

Persistent genital arousal disorder (PGAD)

PGAD can be an incredibly distressing experience. It includes involuntary and uncontrollable genital arousal and spontaneous orgasms, which do not fully relieve the intense arousal since in most cases it’s not linked to sexual desire in any way. PGAD can be incredibly physically painful, stressful and psychologically taxing. We saw this in the highly-publicised case of Cara Anaya-Carlis, a woman who came forward about her condition of sometimes having to endure a painful six hours of sexual arousal a day.

Unfortunately, this rare sexual dysfunction has no definitive cause or treatment. But some researchers have found a link between stress-triggering PGAD episodes, which would indicate that it could be psychological in nature. Others found a connection between PGAD and hormones, veins, the nervous system and chemical changes after the use of certain medications. Some cases of women with PGAD also had Tarlov cysts, which researchers theorise may also contribute to the condition.

The treatment of this perplexing condition comes down to the identification of possible triggers and management with topical painkillers and cognitive behavioural therapy to help cope. Each cause is different and takes a process of elimination to recognise possible causes and a treatment path to cater to each.

Post-orgasmic illness syndrome (POIS)

Most bask in the warm after-sex glow, but there are those for whom orgasm/ejaculation means feeling sick to their stomach. POIS is more common in men but afflicts some women too, where you experience flu-like symptoms after orgasm. This can happen a couple of minutes or even hours afterwards and can last for many days.

The thought of falling ill every time you have sex is enough to make people stay clear. It can be incredibly exhausting, even embarrassing while trying to sustain a healthy relationship. POIS takes a toll on your mental health and can be incredibly isolating. Even when you’ve managed to plan, pick a day that gives you enough time to recover afterwards, having to do it every single time, while maintaining a healthy social and professional life can really bring you down.

Most people manage to link having an orgasm to falling sick afterwards late in their life. Many don’t come forward to seek help, which had made quantifying how common or rare it is difficult, according to Hashim.

Researchers haven’t been able to find a cause for this sexual dysfunction. Some believe it could be an autoimmune disorder or allergy to semen, most likely in the case of men. Others think it could be a chemical imbalance that triggers the feeling of being unwell.

There are no well-studied recognised treatments but a combination of antihistamines, SSRIs (typically used as antidepressants) and benzodiazepines has given some relief to patients who have sought treatment. Others manage the condition by treating the illness that follows.

Sexsomnia

You may be familiar with sleepwalking and sleep talking episodes, but sleep sex, or sexsomnia is a relatively unheard of type of parasomnia. It’s like sleepwalking, instead, the person is indulging in sexual acts or sexual behaviours while their brain is stuck between two stages of sleep. A person may not even realise they have this condition, especially if they sleep alone.

Even a partner may not catch on to the fact that it’s sexsomnia because your eyes are open and you seem conscious. Sexsomnia involves amnesia during these sexual episodes, which helps in diagnosing the condition.

Underlying sleep disorders and ailments like restless leg syndrome, migraines, sleep apnea and head injuries can trigger sexsomnia. Sleep studies are conducted by professionals to observe and diagnose the condition and treatment focuses on possible causes of sexsomnia. These include sleep deprivation, irregular sleep patterns, high levels of stress, anxiety, fatigue, some prescription medications and alcohol and drug abuse.

In severe cases, this sexual dysfunction can be dangerous for partners because it can cause the person to be more assertive and aggressive. Because the person is actually unconscious, they don’t register the denial of consent, leading to possible instances of molestation and sexual assault.

Vaginismus

The exact cause of vaginismus isn’t clear at the moment, but it involves the pelvic floor muscles spasming and contracting uncontrollably during penetration. This makes it difficult, even painful, to have sex, insert tampons and even get gynaecological examinations. Your vagina pretty much shuts shop, in a way.

It is believed to be a psychological condition resulting from a fear of physical penetration. This could stem from a history of sexual abuse, past experiences of painful sex, a fear of sex and even anxiety. According to Dr Ashok Koparday, “Treatment of painful sex requires sensitivity and experience on the part of the health care professional.”

He doesn’t recommend surgical intervention or pills in cases of secondary vaginismus— where the patient has had non-painful penetrative intercourse before — but consultations with a sexologist to treat the problem. A study published in the Indian Journal Of Psychiatry found that kegel exercises could also help control the pubococcygeus muscle which surrounds the entrance to the vagina.

You know when you really have to go to the bathroom but are squeezing hard to hold it in? Those are the muscles you want to engage during Kegels. Contract the muscles, hold them for 5-10 seconds and relax. Take a break for 3-5 seconds and repeat.

Dyspareunia

Dyspareunia is an ailment that causes deep pain in the pelvic and genital area during and after intercourse. It’s a common cause for women to have painful sex, according to Hashim, and usually indicates a physical problem that needs attention.

Many conditions can cause dyspareunia. These include vaginal dryness after menopause, infections, yeast and urinary tract infections, vaginismus, vaginitis (swelling of vaginal walls), endometriosis, pelvic inflammatory disease and uterine fibroids.

The underlying conditions are identified and diagnosed through pelvic examinations and pap smears, and treatment can include antifungals, a course of antibiotics, topical ointments and more.

Hashim says, “more women need to know that sex isn’t supposed to be painful or uncomfortable. It can point to the existence of an infection that needs quick treatment before it spreads and causes more long-term damage to our bodies.”

A note of caution: The information regarding sexual dysfunctions is in consultation with trained medical professionals. Please consult your healthcare provider for more information and find what works best for your personal needs.

WATCH NEXT – Awkward questions you’re too embarrassed to ask your gynaecologist