Women may not be in the mood for sex for many reasons--they're too tired, too stressed, too resentful, or maybe just too reluctant since the kids are still awake and in an adjacent bedroom. But not wanting sex isn't always tied into what's going on in a woman's head.
"The reasons women refuse sex fall into two categories," explains Ramani Durvasula, Ph.D., professor of psychology at California State University in Los Angeles. "These include disorders of sexual desire and physical disorders."
Here are some of the most common reasons why women might refuse sex.
1. Dyspareunia is the name for a condition in which a woman has genital pain in association with sexual intercourse. "Usually it occurs during intercourse, not before or after," Durvasula says. "And since sex is painful, women with this just don't want to have sex."
In many cases, dyspareunia can be treated with a vaginal lubricant or, in women who have been through menopause, with a prescription estrogen cream or tablet. Some doctors may recommend desensitization therapy, in which a woman learns vaginal relaxation exercise that can help lessen pain during intercourse. Women with dyspareunia may also be tested for a sexually transmitted disease, Durvasula says, and treated if she testes positive for an STD.
2. Vaginismus is a relatively uncommon condition that occurs when the muscles of the vaginal wall go into an involuntary spasm. Since it happens whenever something is inserted into the vagina, whether a penis, finger or even tampon, sex becomes unpleasant. "Penetration is almost impossible and very uncomfortable," Durvasula says.
Once diagnosed, a woman may benefit from counseling, exercises that focus on pelvic floor muscle contraction and relaxation, and vaginal dilation exercises. These would be done under the supervision of a health care provider or sex therapist.
3. Female sexual arousal disorder occurs when a woman does not respond to normal stimuli and who doesn't reach orgasm. "There is little lubrication, and these women don't have the normal response in which blood flows into the genital area, and the area opens up and relaxes," Durvasula says.
4. Hypoactive sexual desire disorder causes women to just not want sex. "She may give in just to please her partner but she does not really want sex and would never initiate it," Durvasula explains. "A woman with this condition can be almost disgusted by the idea of having sex."
Treating the Problem
Besides lower estrogen levels after menopause, a variety of medical conditions can cause female sexual arousal disorder and hypoactive sexual desire disorder. Among them are pelvic surgery, urinary or bowel disorders, arthritis, and neurological conditions like multiple sclerosis. Even medications like antidepressants, blood pressure medicine and antihistamines can cause a woman's desire for sex to plummet.
Fortunately, female sexual dysfunction conditions like female sexual arousal disorder and hypoactive sexual desire disorder are treatable. Often the treatment is psychotherapy, Durvasula explains. "Many couples benefit from couples therapy where they can come in and talk about what's happening with a partner," she say. "It may involve working with the woman to help her get more comfortable with her sexuality."
Also, a therapist may recommend that the couple have physical contact but not intercourse for awhile. "The therapist may suggest alternative activities and exercises that are still very gratifying and promote physical closeness," Durvasula says. These exercises, she explains, focus less on actual intercourse and more on physical intimacy and encouraging a woman to become comfortable with her sexuality.
Sources
"Vaginismus," Medline Plus, U.S. National Library of Medicine, National Institutes of Health.
