Response cycle

To understand why sexual problems occur, it is important to understand the sexual response cycle. This cycle is the same in both men and women, although at different rates and, obviously, with different physical changes. The cycle has 4 steps.

* Desire (excitement phase) - Desire is a sexual "charge" that increases interest in and responsiveness to sexual activity. You feel "in the mood." Your heartbeat and breathing quicken, and your skin becomes reddened (flushes).

* Arousal (plateau phase) - Sexual stimulation--touch, vision, hearing, taste, smell, or imagination--brings about further physical changes. Fluids are secreted within the vagina, moistening the vagina, labia, and vulva. These fluids provide lubrication for intercourse. The vagina expands, and the clitoris enlarges. The nipples become hardened or erect.

* Orgasm (climax) - At the peak of arousal, the muscles surrounding the vagina contract rhythmically, causing a pleasurable sensation. This is often referred to as the sexual climax.

* Resolution - The vagina, clitoris, and surrounding areas return to their unaroused states. You feel content, relaxed, possibly sleepy.

Every woman progresses through the cycle at her own rate, which is normal for her. A sexual problem may occur if any of these stages does not occur.

Sexual problems

The types of sexual problems in women correspond to the stages of the sexual response cycle. Inability to achieve any of the stages can interfere with sexual satisfaction and thus create a problem. Any of these can be very distressing for a woman, because everyone deserves a satisfying sex life. They can be distressing for her partner, too, and can lead to problems in the relationship.

* The sexual problems reported by women in the JAMA study comprised 3 types:

o Lack of sexual desire (22%) - Lack of interest in sex, or desire for sex, is a common problem in both men and women, but especially in women. Lack of desire stops the sexual response cycle before it starts. Lack of desire is temporary in some people and an ongoing problem in others.

o Difficulties becoming sexually aroused or achieving orgasm (14%) - Inability to become sexually aroused is sometimes related to lack of desire. In other cases, the woman feels sexual desire but cannot become aroused. Orgasm may be delayed or not occur at all (anorgasmia). This can be very distressing for a woman who feels desire and becomes aroused. It can create a vicious cycle in which the woman loses interest in sex because she does not have an orgasm.

o Pain during intercourse (7%) - Pain during intercourse (dyspareunia) is not uncommon. Like other sexual problems, it can cause a woman to lose interest in sex.