What should a dissatisfied woman do

Dissatisfied with your love life? : Help with sexual dysfunction

Even if advertising, relevant articles in women's magazines and even more pornography may paint a different picture: Sometimes you just don't feel like having sex, you are too stressed or tired for it - as a man as well as a woman. And sometimes you may feel like it, but still remain strangely unmoved by the caresses your partner makes - especially as a woman: Experts assume that around 43 percent of all women have at least temporary sexual problems. Such phases are completely normal, do not cause concern and do not necessarily require treatment. Because mostly they pass when the stress subsides. And even if, for example, there is a permanent lack of interest in intimacy, that does not necessarily mean a problem.

"Sexuality is something very individual," says gynecologist and sex medicine specialist Annett Gauruder-Burmester. "Some women have not wanted to have sex for ten years and have therefore not slept with their partner for just as long - and they do not mind at all." Other women, on the other hand, are already after a few weeks or months when it is not so in bed going well, very unhappy. In such cases, when a woman is dissatisfied with her love life, when it affects her personal well-being and the relationship with her partner, doctors speak of sexual dysfunction.

Such dysfunctions can occur in any phase of sexual experience: in the desire for it, during arousal and during orgasm. All in all, they have met Annett Gauruder-Burmester more and more frequently in the interdisciplinary pelvic floor center she heads in Friedrichstrasse in Berlin-Mitte for a number of years. "In the meantime, young women and couples come to my practice when they are not satisfied with their love life." The main reason for this is the socially more open approach to sexuality. However, this could also have a negative effect: in a subjectively perceived pressure to optimize the love life, to have to adapt it to an assumed ideal.

This “pressure to perform” can trigger an overly critical view of their own body as well as fears and inhibitions in women - and thus significantly impair their sexual experience. "Sexual dysfunctions in women are less likely to have organic or medicinal causes, but mainly psychological ones," says Gauruder-Burmester. Because in addition to a general good physical condition, a satisfactory sexual experience requires, in particular, emotional and partnership well-being and the associated freedom from fear. For example, gynecological surgery for cancer can affect a couple's physical love in two ways. On the one hand, because sexual acts on the tissue scarred by the operation may cause pain. On the other hand, however, because many women no longer consider themselves desirable after an operation in which, for example, the uterus or a breast was removed (see page 30).

When diagnosing sexual dysfunction, in addition to a physical examination, the sexual history of an affected woman - that is, the exploration of her sexual biography - plays an important role: her possibly anti-sexual upbringing, in the physical love and the fun of it as something immoral, reprehensible were mediated; their resulting shame, which makes them shy away from masturbation, for example; their perhaps lack of knowledge about their own body and its stimulation; any traumatic experiences such as sexual abuse.

The current partnership is also of great importance. "Women have a different, more holistic approach to sex," says Gauruder-Burmester. "While men often only concentrate on the act itself, the surrounding area also plays a decisive role for them: the physical affection, the tenderness, the stimulation of the imagination." If this is missing, the sexual desire can decrease, as can the increase in pleasure the sex itself. However, women usually looked for the reason for this in themselves and not in the relationship. "In doing so, they would have to ask themselves more often why they are no longer interested in their partner, what is missing in the relationship and during sex."

However, sexual dysfunction in women is still less prevalent than their male counterparts (see page 52). "The field of sexual dysfunction is relatively clear in men," says Gauruder-Burmester. "It mainly relates to the act itself, to penetration and orgasm." With women, on the other hand, the problems are more numerous and usually less tangible. Nevertheless, overall it is more women who address sexual problems and seek professional help.

If the sexual desire is permanently absent, and therefore sexual activities are not initiated or even avoided entirely, doctors speak of a libido disorder. It is the most common sexual dysfunction in women. Young women in particular are affected: between the ages of 18 and 34, every third woman suffers from it at least temporarily, among 45 to 59 year olds it is only around one in four.

There are many reasons for a lack of interest in sex: "A loss of libido can occur on the pelvic floor after an operation, for example," says Gauruder-Burmester. Some medications such as antidepressants, antihypertensives or sedatives could also be the cause, as well as general living conditions: "After pregnancy, sexual interest often decreases." The role of women as a mother and the associated stress. In such a situation, regular relaxed evenings for two can help, in which man and woman get closer as a couple - not only physically, but also emotionally. If the causes lie not only in the current living conditions, but more deeply - in the biography of a woman or in the partnership in general - this is usually not enough. "In these cases, individual therapy or therapy for couples can help," says Gauruder-Burmester. If necessary, these could be supplemented by drugs that increase pleasure.

In general, it is true that, unlike men, women can usually sleep with their partner without sexual desire of their own, for example because they want to do him a favor. However, this can further contribute to the fact that a woman perceives sex more as a compulsory exercise than as a means of gaining her own pleasure. As a result, a lack of interest in sex can develop into a real defense against intimacy with the partner.

but even if the interest is there, something important may be missing: the pleasure. Around every fourth woman is familiar with this problem, which medical professionals refer to as a disorder of sexual arousal. "The women affected do not succeed or only with difficulty in building or maintaining arousal," says Gauruder-Burmester. Physically, this can be seen, for example, in the fact that little or no vaginal fluid is formed despite sexual stimulation. This can be caused, for example, by a hormone deficiency, which is why women are particularly often affected by vaginal dryness after the menopause. For example, lubricating creams or hormone therapy can help.

Mostly, however, there are psychological causes. For example, the arousal disorder often occurs after traumatic sexual experiences. But even a generally insecure body feeling can inhibit excitability. This often creates a vicious circle: With a strong desire to experience sexual pleasure, those affected observe themselves and their feelings closely during love play - and thereby further reduce their arousal.

For many, orgasm is the climax and therefore the goal of sexual intercourse. However, it is precisely this goal that many women often do not achieve - and some even never: According to studies, every fourth woman only occasionally or seldom achieves an orgasm during sexual intercourse, and every twentieth never even reaches an orgasm. This orgasm disorder can exist for a lifetime, but it can also appear at a later point in time or only with a specific partner. In addition, some women reach climax through masturbation and manual or oral intercourse, but not through the sexual act itself.

"In principle, women can of course have an orgasm just as much as men," says sex medicine specialist Gauruder-Burmester. For them, however, it often takes more than the mere act of penetration: "With women, orgasm occurs primarily in the head." However, this also means that psychological factors can have a negative effect on the experience of sexual ecstasy. "The main causes of orgasm disorders are inhibitions, fears and relationship problems."

However, the following also applies here: Whether it is actually a disorder that requires treatment depends above all on the woman's subjective perception. "While good sex ends with an orgasm from a male point of view, the love life for women can be fulfilled even if they do not always reach climax."

However, if a woman suffers from the lack of sexual climax, a therapy that counteracts the fears and inhibitions, for example through education and guidance on getting to know one's own body, could help. The partner should also be included if possible.

Sexual intercourse should produce positive sensations. However, penetration in particular can occasionally be associated with an uncomfortable feeling or even pain. Frequently or even permanently, this type of disorder occurs in up to 15 percent of women. In addition, she is the one for whom affected women seek medical advice particularly often.

One of their causes can be a lack of sexual arousal and the associated dryness of the vagina: Since the vagina is not sufficiently moist despite stimulation, the man's penis cannot slide gently into it. Other possible causes of pain during sex include sexually transmitted diseases, inflammation or deformities in the genital area, ovarian cysts and surgical interventions that leave scarred tissue in the genitals. "With such organic causes, the therapy depends on the respective underlying disease," says Gauruder-Burmester. In the case of pain, however, psychological blocks can also play a role. This is the case, for example, with so-called vaginismus. The muscles of the vagina and the pelvic floor involuntarily cramp as soon as something is inserted into them - be it a finger, a tampon or a penis. Possible causes for this are a repressive sexual upbringing, fear of injury or a traumatic sexual experience. In addition to psychotherapy, however, sexual medicine therapy is also appropriate, in which the woman, for example, uses gentle exercises to get her vagina used to stretching.

In old age, the desire for intimacy, tenderness and sexual satisfaction only very rarely disappears completely. However, sexuality is changing: especially after the menopause, many women feel less interested in sexual intercourse, and they more often suffer from arousal and orgasm difficulties. The causes are often primarily physical: hormonal changes after menopause, urinary incontinence, internal diseases such as diabetes, high blood pressure or rheumatism, as well as the drugs used for their therapy, cancer and the associated gynecological operations.

But here too the psyche plays an important role in many cases. For example, urinary incontinence often causes feelings of shame and fear of uncontrolled loss of urine during sexual intercourse. As a result, affected women increasingly avoid intimacy with their partner. Cancer of the breast or uterus and its treatment can also impair self-confidence as a woman, which also has a negative effect on sexuality.

It is possible to prevent malfunctions to a certain extent. Women should be examined regularly by their gynecologist, for example, in order to be able to rule out organic causes of pain. In addition, a general good physical condition and knowledge of your own body can contribute to healthy sexuality: Those who feel comfortable with themselves and their body, who know what they like and what they don't, usually have fewer problems in bed. "However, it is particularly important to speak openly with the respective partner about your own wishes and ideas so that both have a love life that is as fulfilling as possible," says sex medicine specialist Gauruder-Burmester.

If a sexual dysfunction has primarily organic causes, the main aim of therapy is to remedy it. For example, an estrogen deficiency that leads to vaginal dryness can be countered with hormone therapy. If a woman's symptoms can be traced back to certain medications, this is where therapy begins: for example, if certain antidepressants or antihypertensive and calming preparations reduce sexual desire or sensation, women affected should work with their doctor to find alternatives that do not show these side effects .

In most cases, however, it is primarily psychological factors that affect a woman's sexual experience. "For around 80 percent of sexual dysfunctions, a sexual medical treatment based on partnership is necessary," says Gauruder-Burmester. In such a therapy, couples should, for example, slowly and carefully approach each other, stimulate each other in order to get to know their own body and that of the partner better. They also learn to address problems, fears and inhibitions, as well as their wishes and preferences. Often times, however, the men would resist, says Gauruder-Burmester. "You don't see the problem in yourself - after all, you don't have erection or orgasm problems yourself."

Although, according to Gauruder-Burmester, sexual health is an essential part of a person's physical and mental health, sexual medicine measures are not yet covered by health insurance. They have to be paid privately: a 90-minute session costs an average of 90 to 120 euros. This is a serious problem: “Many of those affected cannot afford this and therefore forego treatment, even though they feel a great deal of suffering.

Advice centers
The German Society for Sexual Medicine (DGSMTW) maintains a directory of sex therapists, Tel. 0231 567 631 81, dgsmtw.de

The Center for Sexology advises on sexual problems, Tel. 030 788 16 42, Tue 9-10, Wed 12-13, Thu 2-3 p.m., csw.berlin

The family planning center Balance offers advice and medical help in the field of women's health, Tel. 030 236 236 80, Mon, Fri 9 am-2pm, Tues, Thurs 11 am-6pm, Wed 3-7pm, fpz-berlin.de

The magazine for medicine and health in Berlin: "Tagesspiegel Gesund - Berlin's best doctors for women and men".

Further topics of the edition: Fact check. Interesting facts about men and women. What to do in case of hair loss From tablets to transplants. Truth and myth. Gender stereotypes under the microscope. Porn use.Are sex films a threat to youth health? Precaution.Health check-ups at health insurance costs. Woman's anatomy.Gender medicine. When the small difference becomes vital. Breast cancer. About living with an enemy in your own body. Mammography. What speaks for the screening - and what against it. Doctor's letters.Cervical cancer, endometriosis, cysts, myomas, testicular cancer, testicular pain.Life after cancer. Why the psyche suffers. Menstrual pain. Which provides relief from menstrual cramps. Menopause.What helps with the changeover? Natural medicine.Herbalism for women and men. Man's anatomy. Sex therapy. How conversations strengthen couples' intimacy. Erectile dysfunction.The doctor helps the potency on the jumps. Premature effusion.Occasionally arriving too early is normal - but in the long run it is a problem. Prostate cancer. The navigator shows the way through the various therapy options.Interview.The twins Michael & Uli Roth had prostate cancer - now they are promoting prevention. The prostate sometimes presses on the urinary tract in old age. Testosterone. Everything about the stuff men are made of.Also: Urological and gynecological clinics and doctors - clearly arranged in tables. "Tagesspiegel Gesund" - Now in our shop

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