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One "underreported” issue may be ruining the sex lives of almost half the population

"This is a wake-up call."

A study involving 6,986 women in Australia reveals one of the most intimate aspects of their lives may be causing the majority significantly more distress than joy.

More than half of study participants revealed that they feel significant distress about sex, while one in five experienced sexual dysfunction, from trouble orgasming to pain during sex. But this is not a solo problem. The worrying findings also highlight how couples can work together to move past some of these issues and improve their sex lives.

The new study was published on Monday in the journal Fertility and Sterility.

The findings suggest female sexual dysfunction, an under-researched and under-reported problem, may be far more common among women than previously thought.

"Sexual wellbeing is recognized as a fundamental human right,” Susan Davis, senior author of the study and researcher at Monash University, said in a statement accompanying the study.

"This is a wake-up call to the community and signals the importance of health professionals being open and adequately prepared to discuss young women's sexual health concerns."

Female sexual dysfunction: Behind closed doors

Female sexual disfunction is “highly prevalent but not well defined or understood,” the new study’s authors write. To paint a more accurate picture of the sex lives of young women, Davis and her colleagues recruited a group of 6986 women between 18 and 39 years old, living in Victoria, New South Wales, and Queensland, Australia.

In questionnaires, the participants reported dimensions of their sexual wellbeing in terms of desire, arousal, responsiveness, orgasm, and self-image. They also evaluated whether they had personal distress associated with sex and provided extensive demographic information.

About a third of the group described themselves as single, and nearly 70 percent had reported being sexually active in the 30 days preceding the study.

After analyzing the data, the results were staggering: 50.2 percent of the young women experienced some form of sexually-related personal distress. Distress included feeling guilty, embarrassed, stressed, or unhappy about their sex lives.

About 30 percent of the group experienced sexually-related personal distress without dysfunction, while 20.6 percent had at least one symptom that smacked of sexual dysfunction.

"The determinants of sexual function in women are likely to be very complex, involving physical, psychological, socioeconomic and relationship issues and even past experiences that women have had which might impact their current sexual function," Robin Bell, professor at Monash University, Australia, and co-author on the study, tells Inverse.

When the researchers broke down the cohort by specific sexual issues, they found that the most common problem was low sexual self-image, which caused distress for 11 percent of study participants.

Arousal issues were the biggest source of distress for 9 percent of participants, while 8 percent experienced desire or orgasm problems. Sexual responsiveness was a problem for 3.5 percent of participants.

Women whose appearance determined their level of physical self-worth, or who monitored their appearance habitually, reported being less sexually assertive and more self-conscious during intimacy and experienced lower sexual satisfaction.

This suggests that people who worry more frequently about how they look may have more trouble asking for or getting what they want in bed.

One of the biggest factors in women's sexual function appears to be medication use, particularly psychotropic medications like antidepressants. People who took these drugs were at highest risk of experiencing sexual problems, the study finds.

However it is impossible to say whether taking psychotropic medications cause sexual dysfunction, Bell says. Instead, it may be that the underlying reason for using the medication — depression — is associated with sexual dysfunction, she says.

If left untreated, sexually-related personal distress and female sexual dysfunction could impact relationships and overall quality of life as women aged, Davis said. And that matters for everyone's sex lives.

Better sex for everyone

Female sexual dysfunction is diagnosed from a detailed medical and sexual history, pelvic exam, and blood tests. And while it may be an embarrassing subject, in the United States, some 43 percent of women (both pre and post-menopause) deal with sexual dysfunction.

Compared to male sexual dysfunction, especially erectile dysfunction, the female variety is relatively understudied and has few effective treatments, researchers say. Many women are still waiting for an effective “female Viagra.”

But experiencing female sexual dysfunction does not mean a lifetime of bad sex, and it is by no means a one-person problem, experts say.

Treating female sexual dysfunction is complicated. There aren’t any “one-size-fits-all” solutions, researchers say.

Instead, it involves exploring the constellation of psychological, social, hormonal, biological, and environmental factors influencing sexual health. Current treatment options include counseling, education, medication, and various tools like sexual stimulation devices such as a vibrator, lubricants, erotic materials, among others.

"Given the complexity, the determinants of sexual dysfunction are likely to be unique to each woman and so need to be explored on a case by case basis," Bell says.

There are also strategies women and their partners can take to overcome these intimacy issues. Engaging in self-care, upping physical activity, and talking openly with others can help. Sexual partners can help by being "compassionate and nonjudgmental listeners,” Katherine Rowland, a public health researcher and author of The Pleasure Gap, told NPR.

The research highlights the need for doctors to talk to young female patients openly about their sex lives, the researchers say.

"One of the benefits of our study is to show women that these feelings of sexual distress are not uncommon, so if they have such feelings they are not alone," Bell says.

Objective: To document the prevalence of female sexual dysfunctions (FSDs) and factors associated with FSDs and sexually related personal distress in premenopausal women.Design: Community-based cross-sectional study. Setting: Eastern states of Australia. Participants: Women aged 18–39 years.
Interventions(s): Not applicable.Main Outcome Measure(s): Women were classified as having sexually related personal distress if they had a Female Sexual Distress Scale–Revised score of R11, and as having an FSD if they had a low Profile of Female Sexual Function desire, arousal, orgasmic function, responsiveness, or sexual self-image domain score plus sexually related personal distress. Sociodemographic factors associated with an FSD were examined by means of multivariable logistic regression.
Q1 Result(s): The prevalence of sexually related personal distress was 50.2%. Sexually related personal distress without dysfunction affected 29.6%, and 20.6% had at least one FSD. The proportions of women with self-image, arousal, desire, orgasm, and responsiveness dysfunction were 11.1%, 9%, 8%, 7.9%, and 3.4% respectively. Sexual self-image dysfunction was associated with being overweight, obese, living together, not married, married, breastfeeding, and taking a psychotropic medication. Psychotropic medication was significantly associated with all FSDs. Independent risk factors for nonspecific sexually related personal distress included psychotropic medication., sexual inactivity, and infertility treatment. Conclusion(s): That one-half of young Australian women have sexually related personal distress and one in five women have at least an FSD, with sexual self-image predominating, is concerning. The high prevalence of distress signals the importance of health professionals being adequately prepared to discuss sexual health concerns.

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