Communication is often the answer to many of the sex questions that women pose, and can also be at the root of a secondary problem: a low sex drive.
Doctors say that a low libido is often a reflection of problems in the relationship, especially in pre-menopausal women. While a woman's sex drive will naturally hit highs and lows throughout her life, psychological problems, like a poor body image, history of physical or sexual abuse, and anxiety and low self-esteem can all contribute to a lack of desire. Certain medications, like anti-anxiety and anti-depressant pills, can also add to a low sex drive.
Moreover, relationship problems, like unresolved conflict, lack of trust, and poor communication of sexual preferences, can all lead to a decreased desire for sex.
Surveys reveal that about 40 million Americans live in a no-sex or low-sex marriage, defined as having intercourse ten times a year of less. Whether or not this sex life is sufficient depends on the couple. But, like most things sex-related, communication is significant, with a woman's partner and with her doctor.
Of course, if a woman experiences pain during sex, it will certainly lead to a lack of sexual desire. Doctors say that it is not normal to experience pain during intercourse, but there are many treatments available, so a woman should talk to her doctor about any sort of discomfort during intercourse.
"Pain during sex … should be thoroughly evaluated to rule out physical causes, such as infection, scarring, [or] vulvodynia," said Dr. John Repke, chairman of the department of obstetrics and gynecology at Penn State College of Medicine.
Vulvodynia is defined as chronic pain in and around the opening of the vagina. Symptoms include burning, soreness, itching and throbbing in the genital area.
Doctors suggest that women who suffer from pain during sex use lubricants and get adequate foreplay into the mix before having sex. While not in the bedroom, women should avoid tight pants and underwear, stay active and use cold compresses to ease the pain.
If lifestyle and home remedies still don't ease the pain, there are several medications and treatments that a woman can discuss with her doctor.
Pain and dryness is particularly common in older women, said LaValleur. There are three layers of cells on the vagina, but, as women age, the layers decrease, getting down to two, then one. The opening of the vagina also gets smaller with age and women can lose their ability to lubricate. Intercourse can be very painful, and women can even bleed when trying to have intercourse without foreplay.
"There may also be a psycho-physiologic reason for painful intercourse that sometimes requires the intervention of a skilled sexual medicine specialist," Repke said.
About one in four women will experience some sort of domestic abuse in their lifetime. While most cases of domestic violence are never reported to the police, many physicians have started to screen for emotional and physical violence during annual gynecological appointments.
Domestic abuse is broadly defined as a pattern of behavior where one partner tries to dominate and control the other person by using fear, guilt, shame and physical or emotional intimidation to wear the other person down. Both physical and emotional abuse threaten the livelihood and well-being of the person involved.