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What constitutes a sexual problem or dysfunction for women? How frequently do such problems occur?

What constitutes a sexual problem or dysfunction for women? How frequently do such problems occur?

hese issues are currently topics of vigorous debate among researchers. Some scholars have defined anything interfering with orgasm as a sexual problem. Others, however, argue that emphasizing orgasm reflects the male perspective that sex ends with ejaculation, whereas for many women, orgasm is not the goal or the most important part of sexual activity (Fassinger & Arseneau, 2008; Tolman et al., 2003). In this section, we examine changing views of women’s sexual problems.

Researchers who study sexual problems have typically employed the widely used system for classifying sexual dysfunction from the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) of the American Psychiatric Association (1994). Four categories are recognized: sexual desire disorders, sexual arousal disorders, orgasmic disorders, and sexual pain disorders. Feminist scholars have criticized this categorization, as we shall see shortly, because it is overly genital and neglects issues of relationships and social context (Tiefer, 2008).

Large-scale studies have used the DSM-IV categories to examine sexual problems in U.S. adults ages 18–85 (Laumann et al., 1999, 2008). These studies have found that the most frequently reported sexual problem among women is a lack of desire for sexual activity, or inhibited sexual desire. About 25 percent of younger women and up to 40 percent of older women report having this problem. (Persons who have little interest in sex, but are not concerned by it, are not considered to have the disorder.) About one in seven younger women and over one in three older women report sexual arousal disorder, which involves insufficient lubrication or a failure to be aroused. Nearly one in four younger women and one in three older women report female orgasmic disorder, defined as experiencing the excitement phase of the sexual response cycle but not achieving orgasm. (If a woman is satisfied with this situation, she is not considered to have an orgasmic disorder.) About 7 percent of younger woman and 18 percent of older women report dyspareunia, or painful intercourse. Often a physical condition, such as a sexually transmitted infection (STI), lack of lubrication, or a structural problem, is involved. Psychological factors such as anxiety about sex or prior sexual trauma may also be responsible (Rathus et al., 2010). Another sexual pain disorder documented by Laumann and his colleagues is vaginismus, the involuntary contraction of vaginal muscles, making intercourse painful or impossible. Vaginismus is often caused by factors such as childhood sexual abuse, rape, a family upbringing that included negative attitudes toward sex, and a history of painful intercourse (Rathus et al., 2010).

Laumann and his colleagues (2008) also found that factors such as age, marital status, ethnicity, education, and economic status were related to the incidence of sexual dysfunction. For women, the prevalence of sexual problems declined until about age 60 and then leveled off, except for those who reported trouble

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lubricating. Men, on the other hand, had more problems with age, particularly erectile dysfunction and inability to achieve orgasm. Single, divorced, separated, and widowed individuals showed an elevated risk of sexual problems. Ethnicity also was associated with sexual problems. For example, among younger women, White women were more likely to report sexual pain, whereas Black women more often experienced low levels of desire and pleasure. Latinas, on the other hand, reported lower rates of sexual problems than other women.

Women and men with less education and lower income reported more sexual problems than more highly educated and affluent individuals. What might account for this social class difference in sexual problems? Poorer physical and mental health in individuals of lower social status may be a factor because diminished health is related to problems with sex (Laumann et al., 2008). Underlying physical conditions that can cause sexual dysfunction include diabetes, heart disease, neurological disorders, side effects of medications, alcoholism, drug abuse, and heavy smoking. Psychological causes of sexual problems include stress or anxiety from work, concern about poor sexual performance, marital discord, or depression. Some of these problems are all too common in the lives of poor women and men (Heiman, 2008). Unfortunately, the sociocultural predictors of sexual problems studied by Laumann and his associates have often been given little attention in the popular and professional media. Instead, media focus on the high incidence of physiological problems, and the need for drug companies to develop medical treatments, such as female Viagra, to treat women’s sexual “illnesses” (IsHak et al., 2010; Moynihan & Mintzes, 2010; Singer, 2010).

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