A satisfying sex life can be a source of comfort and joy. When it's neither comfortable nor joyful, however, don't automatically blame your mate. Maybe your body is trying to tell you something.
"Sex and health do reflect each other," says research scientist Debby Herbenick, associate director at the Center for Sexual Health Promotion at the University of Indiana and author of Because It Feels Good: A Woman's Guide to Sexual Pleasure and Satisfaction. "But because sex is still often seen as taboo, as something we don't talk openly about, people often separate the two in their lives."
Here are seven physical problems that can tiptoe into a woman's bed -- affecting the quality and quantity of sexual relations. (Of course, it takes two: Sexual clues can also reveal what your sex life says about his health.)
Sex scene #1: You've been avoiding sex because, well, it hurts.
It might be: Vulvodynia (pain syndrome)
In 2010, in the largest nationally representative survey of American sex lives in 20 years, Indiana University's Center for Sexual Health Promotion found that 30 percent of women reported mild to moderate pain during their most recent sexual encounter. "That's a striking number -- we didn't expect it would be that big," notes Herbenick.
Fleeting causes of painful sex can include insufficient foreplay and the penis striking the cervix. But for many women, the pain is more generalized, often described as burning, stinging, or knife-like and showing up even when they're not having sex -- hallmarks of a mysterious pain syndrome known as vulvodynia. Almost one in five women experiences vulvodynia at some point, according to the National Vulvodynia Association, and six million women have it.
What to do: See a gynecologist. The cause of vulvodynia is unknown, but a thorough medical workup can rule out other possible causes, such as skin diseases or infections. (Top theories include nerve stimulation or inflammation.) Be persistent if you don't get help: One Harvard University study found that women with vulvodynia see an average of three doctors in seeking diagnosis, after which 40 percent still remain undiagnosed. Try looking for a doctor with a vulvovaginal specialty. Treatment includes a range of therapies, including drug therapy to block pain signals, physical therapy, and biofeedback.
Sex scene #2: You take forever to climax, if at all.
It might be: Diabetes
Many things can contribute to difficulty achieving orgasm, including pain or medication side effects. But one fast-growing factor is complications from diabetes. In a 2010 study of 2,000 adults ages 57 to 85, University of Chicago researchers found that both women and men with diabetes reported difficulty attaining orgasm, even though male erectile dysfunction gets most of the attention.
Diabetes can damage nerves and small blood vessels, including autonomic nerves, the kind the brain uses to send unconscious signals for involuntary responses, such as sexual stimulation. The reduced blood flow caused by damage to blood vessels contributes to the problem.
What to do: If you've never been diagnosed with diabetes but you're also having other possible signs of diabetes, have a medical check-up and mention all worrisome symptoms. If you're a known diabetic, don't be shy about mentioning this sexual effect to your doctor. Only 19 percent of the women in the Chicago study discussed sexual problems with a doctor, compared to 47 percent of the men. Better glucose control can improve responsiveness, and your doctor may refer you to a gynecologist to help pinpoint and control other contributing factors.
Women: What Your Sex Life Says About Your Health
Sex scene #3: You don't lubricate much when aroused -- and you're not even menopausal.
It might be: A sign of an unhealthy heart
Most women have heard that vaginal dryness is a common side effect of the shifting hormones at perimenopause and after menopause. But if you're under 45 and affected by dryness, one possible cause is your heart health.
"Lubrication comes from hormones but also from fluid in your bloodstream," Herbenick says. "If there's impaired blood flow for any reason, it could reflect early signs of a cardiovascular issue." Men experience this surprising sign of an unhealthy heart more noticeably in the form of erectile dysfunction.
Interestingly, longtime smokers can also develop vaginal dryness. In lab studies, women who chewed nicotine gum experienced less blood flow to the genitals than those chewing a placebo gum, Herbenick says.
What to do: Consider whether you have other signs of heart trouble, which can include fatigue, shortness of breath, or heartburn. Get a thorough checkup if you haven't had one lately. There are other causes of vaginal dryness, of course, including early menopause (in women under ages 40 to 45), perimenopause (which can begin at 40), and medication side effects.
Meanwhile, over-the-counter vaginal lubricants can replace what nature isn't producing. Water-based lubricants were shown in a 2010 University of Indiana study to reduce discomfort better than silicone-based types.
Sex scene #4: You're hardly ever in the mood.
It might be: Low testosterone
There's no male monopoly on the hormone testosterone (although guys have more of it). In both men and women, testosterone is linked to desire. In the years before menopause, testosterone levels fall to about half what they were when women were in their 20s. Sometimes this corresponds to a dip in libido.
What to do: If a woman's general health is good and the relationship is good, doctors often check hormone levels, says Elizabeth G. Stewart, a vulvovaginal specialist in Boston and coauthor of The V Book. Many women have effective results with supplemental testosterone when the problem is mainly hormonal, she says. Long-term consequences of testosterone-replacement therapies aren't yet well studied, however, and there are no FDA-approved testosterone treatments for women. (A topical gel, LibiGel, is in clinical trials.)
An adrenal substance called DHEA is often sold over the counter as a cure for low desire, but it isn't regulated by the FDA. There's little data on its effectiveness, and it can cause liver damage when used in excess.
Part of the challenge is that desire is influenced by many factors, both mental and physical. Perimenopause alone may not explain a loss of desire. Stress, fatigue, boredom, and relationship woes can all contribute.
Sex scene #5: You're never in the mood -- for sex, or much else.
It might be: Depression -- or medication for depression
Loss of interest in activities that once brought you pleasure -- especially sex -- is a classic sign of clinical depression. Ironically, the treatment for depression, antidepressant medications, can produce the same effect or worsen already dormant desire. An estimated 30 to 70 percent of those taking antidepressants report difficulty with arousal or climax. The most common culprits: drugs in the SSRI family of antidepressants (including Prozac, Paxil, and Zoloft). In women, SSRIs can numb both desire and sensation, including the ability to climax.
What to do: Women often don't link sexual ennui to depression. But if you're feeling low and have also experienced other common symptoms of depression, mention it to a doctor. Clinical depression is highly treatable with talk therapy and medication.
If you're being treated with an antidepressant and are troubled by low libido, ask your prescribing doctor about switching to a class of drugs less associated with sexual side effects, such as bupropion (Wellbutrin). Ask, too, about reducing the dosage slightly or taking a "drug holiday" from an SSRI if you're on one; some doctors endorse quitting these meds for a day or two at a time in order to allow libido to bloom without raising the risk of depression symptoms returning.
Women: What Your Sex Life Says About Your Health
Sex scene #6: You've begun making excuses because you're embarrassed about a weird vaginal odor.
It might be: Bacterial vaginosis (BV) Bacterial vaginosis is the leading cause of vaginal complaints in the United States, says gynecologist Elizabeth G. Stewart. "It's often mistaken for a yeast infection," she says. "It's not an infection, but an imbalance in the bacteria normally found in the vagina." Lactobacilli, normally the predominant bacteria found in the vagina, disappear for reasons that aren't yet well understood, and other types of bacteria overgrow. This changes the acid-base balance of the vagina to an alkaline one, and the elevated pH is accompanied by protein concentrations that, well, smell. "A mild form smells like ammonia," Stewart says. "A bad case smells like dead fish." Yeast infections can also cause an off-smelling discharge, but this is less common. In addition, combo yeast-BV infections can occur.
What to do: Report the symptom to your gynecologist. In fact, it's usually wiser to get a suspected yeast infection checked by a doctor, too, rather than self-treating with over-the-counter products, Stewart says, since the two conditions are often mixed up and OTC yeast cures won't affect BV. Untreated BV can lead to complications, such as pelvic inflammatory disease and preterm delivery in pregnant women. The usual treatment -- prescription antibiotics that come in both oral and vaginal forms -- seems to be equally effective, Stewart says. But even when treated, BV can return in up to a third of women, who will need retreatment.
Sex scene #7: Urine leaks out when you have sex.
It might be: Stress incontinence, caused by weakened or damaged muscles Some women wet themselves a little at orgasm -- and wonder sheepishly if this isn't just part of the excitement run amok. It's not. "Peeing at any point during sex, whether foreplay, intercourse, or climax, is not normal," Herbenick says. Leaking is a form of stress incontinence, the most common form of incontinence in women. It's caused by a weakened or damaged pelvic structure. Childbirth, especially multiple pregnancies and vaginal deliveries, is a leading risk factor. Other risk factors include getting older, smoking, obesity, and having COPD (chronic obstructive pulmonary disease) or asthma, which cause chronic coughing. For as many as one in three women with stress incontinence, anxiety about future episodes is enough to make them avoid having sex altogether.
What to do: Fortunately, there are many ways to stop urinary incontinence from sabotaging your sex life. The simplest include avoiding liquids for several hours before sex and voiding both immediately before and during sex play. Sexual positions can also make a difference, as rear or side entry, for example, take pressure off a woman's bladder and urethra. A urologist who specializes in incontinence can guide you to pelvic floor exercises and medications, or possibly a surgical fix.