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You may remember the joke email trail Mum sends me regularly. One of my most favourite was titled Zen Teachings and the blog I wrote back in November was Zen Teachings No 3 ‘No one is listening until you pass wind’. Now it s time for more Zen Wisdom. (Sincere apologies to the real Zen philosophies.)
Zen Teachings No 2…….‘Sex is like air. It’s not that important unless you aren’t getting any.’
 I have been wanting to write about this for a long time as I am seeing more and more patients with sexual dysfunction. It’s a touchy subject – and a cause of significant angst between couples and puts tremendous strain on relationships. It’s also quite difficult for women (and men) to open up about the problems that are occurring with their sex life. (Mum you can skip reading this blog if you prefer….)
This month, Dorothy Kammerer-Doak wrote an article on sexual dysfunction in the official newsletter of IUGA, The International Urogynaecological Association.  In it she states the prevalence of female sexual dysfunction (FSD) ranges from 25% to 63%. Sexual dysfunction for women includes low libido, problems with arousal and orgasm and of course pain disorders such as vulvodynia. Of course male sexual dysfunction is also common with erectile dysfunction occurring with certain medications such as anti- depressants, following prostate cancer surgery and for other medical reasons. (Beware smoking causes a lack of blood flow to the peripheries …..including the penis).
The wide variance in the figures with FSD indicates there may be inconsistencies with the incidence reporting by patients. And of course it goes without saying if you don’t ask the question directly, patients will rarely volunteer information about this very personal area ( like bowel function). There are also some parts of the female lifespan that it becomes almost ‘a given’ that there is no or very little sex happening:
Post baby….it can be a perfectly reasonable 3-6 weeks depending on the level of trauma involved with the delivery or a somewhat more unreasonable 12 months plus post natal ‘because the baby never sleeps, I’m too fat, we’re both too tired, zilch libido’.
Post menopause …… The lack of libido at this time is again something that is talked about in women’s magazines, becomes an expectation and a great excuse to give up on sex. This is despite the fact that the opportunity for sexual activity being vastly increased by the fact that (hopefully) the offspring have departed the house. Don’t get me wrong the hormonal changes for many women with menopause are significant and your libido may be in your boots. But I do love Bettina Arndt’s saying….’just put the canoe in and start paddling’. She is definitely not saying force the issue, but sometimes making the time for intimacy including kissing, cuddling – and a bit more – can lead to a pleasurable experience for the couple. Asking you doctor about local oestrogen twice weekly and always using a lubricant can help any discomfort postmenopause.
Research in America tells us that many women can have virtually no libido but decide for whatever reason to have some attempt at sexual intercourse…initially there is very little arousal, they then start to enjoy things with arousal increasing, they then can orgasm and ultimately report that they have found the experience pleasurable.
So what is my message from this blog… Don’t have preconceived ideas about what should and shouldn’t happen during the female life-stages; don’t be afraid to be affectionate and intimate, thinking that this always must lead to intercourse – and have a conversation with your partner to this effect – it will take the pressure off you and often improve difficulties arising in the relationship from a lack of intimacy; sexual dysfunction is more common than you think and it is important to seek help earlier rather than later as it can severely affect your relationship.
Next time I am going to discuss some pelvic pain issues and treatment strategies for these conditions.