If you are a man, let me
suggest that you beg you to go read something else. Anything else. Seriously. You just don’t want to read this. Really, you don’t. And I don’t want you to read this, either.
Okay, now that the men are out of the room, I can relax.
Are you ready for some irony? Here it is:
I, a female sex blogger, have been diagnosed with Female Sexual Dysfunction (FSD).
My specific diagnosis includes the following:
- Vulvar disorder
- Vulvar atrophy
- Vaginal atrophy
- Sexual arousal disorder
- Female orgasmic disorder
This shouldn’t be embarrassing to talk about. It’s all a result of hormonal changes related to menopause. Menopause is a natural part of a woman’s life. God made me this way. Plenty of women experience the same thing. Plus, I’m pretty comfortable with conversations about sex. I write about sex. I talk about sex on the podcast.
Nonetheless, I still feel a little embarrassed and shy about this.
I’m going to write about it anyway, for two reasons.
First, FSD is common, affecting approximately 40% of women.* It even affects women who enjoy sex. Although frequent sexual activity can help alleviate some of the symptoms for a time, it is not a prevention. (Case in point: me.) This post will probably help a few women be more prepared to address their own FSD.
Second, writing about it models something super important: In order to deal with female sexual dysfunction, we have to push past the embarrassment and talk about it. Yes, it’s a little embarrassing. Yes, it’s weird to tell people about your sexual struggles. But if you don’t talk about it, you can’t fix it. It’s that simple.
So. Gulp. Here I am.
I want to share my experience with my diagnosis. My experience doesn’t speak for everyone, but it does suggest some things you can pay attention to for yourself, and it gives you an idea what to expect when you speak with a doctor.
My Sexual Response? Meh.
Over the past several years, I’ve seen an increase in the amount of time I need for arousal, and orgasm has become more difficult. A year and a half ago, I briefly mentioned it to my primary care physician. She suggested that I talk with a gynecologist about it and mentioned that I might also want to visit the local Women’s Health Center specialists in sexual health.
Now, instead of thinking, Awesome! I’ll go call right now! I put it off. We’d been dealing with some stresses, and I figured that my difficulties were probably a result of stress and not being able to relax my mind. But then we faced some new stresses, and it didn’t get any better.
Then it got worse. I’d been experiencing vaginal dryness ever since my hysterectomy nine years ago, but it seemed that we were needing to use more artificial lubricant than we had in the past. More than that, arousal and orgasm were becoming increasingly difficult. I realized that I was starting to slip into an attitude of “Let’s just get this over with” because of my constant frustration that no matter how hard we tried, sex wouldn’t be good for me.
At some point, it occurred to me that maybe this was all related to hormones and menopause. My symptoms are typical of women in menopause: vulvar and vaginal dryness along with increasing difficulty with arousal and orgasm. These are normal symptoms of menopause—and if even one woman reads this and feels relief that she isn’t alone, my own embarrassment is worth it.
When I got an email several months ago about an upcoming sexual wellness class offered by a local health care organization, I figured I should go and see if there was any hope for changing things for me. (I wrote about the class here.)
What I heard gave me some hope for change, so I scheduled an appointment.
Preparing for the Appointment
I did three things to prepare for my appointment with the nurse practitioner (NP).
First, I completed the questionnaire the office mailed me. Along with some basic medical history questions, I filled out the Female Sexual Function Index. The questions are about sexual interest, arousal, pain, variety of sexual activities, and orgasm.
The second thing I did was really helpful: I practiced! No, I wasn’t practicing for the actual examination. (Come to think of it, I suppose I could have asked my husband to play doctor.) I practiced talking. In general, I would say that I’m able to talk about sexual issues with little difficulty. But it really is different when I’m talking about my own specific sexual practices and problems face to face. Here and on the podcast, I try to be vague enough not to give you much of a glimpse into my bedroom—but that wasn’t going to help me resolve my problems with the NP. I would have to be specific.
So I practiced talking—out loud—about my symptoms. I practiced stating my goals for treatment. I practiced saying the words that I thought would come up—lubrication, clitoris, arousal, orgasm, and so on.
The third thing I did was to shave—my legs, that is. Why did I think the NP would care if I had hairy legs? I knew she wouldn’t even notice, but it helped me feel better heading into the appointment.
My favorite gynecologists have been the ones who let me start out the appointment with my clothes on. It’s a lot easier to be open about difficult things when you don’t have have a flimsy gown draped across your lap with your socks on display. The NP I met with was no exception. She treated me with dignity and respect, and I was grateful for this.
We began with conversation. The NP asked me what brought me to her office. We went through my questionnaire responses. She asked detailed questions about our sexual practices, including questions about oral and anal sexual activity, vibrator use, and monogamy. Yup, she got that specific.
She was thorough in her questions, and I was glad I’d practiced! It was a lot easier to say personal things when I knew I didn’t have to think about the wording. I’d already done that part before.
I was honest about everything—sexual frequency, frustration, the range of our sexual activity, my sexual history, and all of that.
She asked me what my goals for treatment were, and I said, “Basically, I want a happy ending, more frequently and more easily.” And then we realized that the background music in the exam room was playing “Girls Just Wanna Have Fun.” “That’s what I want!” I said. “I wanna have fun, and I wanna have fun more easily than I have been.”
Other than the fact that I had a gown and was in a gynecological exam chair, it was nothing like a regular gynecological exam.
Because arousal has been a challenge for me, she tested my nerves. She ran a cotton swab down over the labia (on each side). Apparently, if the nerves are in good order, the anus will pucker. Yeah, I didn’t know that, either. But it does. My nerves apparently are fine. I’m so glad I don’t have her job.
She checked the pH level of the vagina. With menopause, pH levels can increase and lead to vaginal infections. My level was perfectly average, so yay, me!
Although I have been fortunate not to be experiencing discomfort or pain, she wanted to find out whether any areas of the vulva or vagina were experiencing extra sensitivity, as that can be a precursor to pain. She touched a wet cotton swab to different locations around the vulva (the outside) and just inside the vagina. She said that with women who experience pain with sex, knowing exactly where the pain is helps with her treatment recommendation. She did find some spots with increased sensitivity, and if I hadn’t sought treatment now, it’s likely that I would be experiencing pain in the future.
As she was doing the exam, she described what she saw in terms of color and moisture. She gave me a hand mirror to hold while she used a swab to point out some of the things she’d observed. So there we were—the NP, a nurse, and me, with my private parts front and center, with a medical spotlight and a mirror. Good times, eh?
Because pelvic floor muscles contribute to orgasm quality, she wanted to check my muscle strength. With one finger in the rectum and another finger in the vagina, she told me to tighten my pelvic floor muscles. So I did that. I was surprised to learn that I did well.
I’d also been experiencing some stress incontinence, and we did a test for that. I’ve been waffling about whether to include this or not, because this next part was really embarrassing. But I KNOW some of you deal with this, and I want you to know that you can survive it and even laugh about it. She wanted to see just how bad the stress incontinence was, so she told me to cough. I asked her, “This isn’t your first rodeo, so I assume you’ve had patients pee on your hand before, right?” She laughed. Then I laughed. Guess what happened? Yes, I peed on her hand. I didn’t even need to cough. Yes, you may laugh. I did (which of course made me pee again).
As soon as she left the room, before I even put my clothes back on I texted some friends to tell them about it. Hey, if I’m going to go through an embarrassing experience, why not share it with good friends, right?
After I got cleaned up and dressed, the NP went over treatment options with me. They include vaginal moisturizer, artificial lubricant during sexual activity (we already do this, but I got free samples of some new stuff), arousal cream, systemic HRT (hormone treatment that affects the entire body), topical hormone treatment (such as a cream applied internally to aid the vaginal tissue), internal laser treatment that rejuvenates the tissue, and an arousal device (such as Fiera and Eros Therapy). We also discussed options to address the bladder issues, although as the vaginal atrophy is addressed, that alone may lessen those issues. Depending on my blood test results, I may be eligible for a research study that will include some of these treatments. A good portion of our conversation focused on ways to use a vibrator to help with sexual arousal.
We discussed my preferences for treatment, and I should see some improvement within the next several weeks, with more improvement to follow.
I feel hopeful about my sexual future.
My Tips for You
If you experience difficulties with sexual arousal, orgasm, dryness, or vulvar or vaginal pain or discomfort, you may be experiencing FSD—especially if you are at a time in life when your hormones are changing.
Here’s what I suggest:
- Know yourself. Pay attention to your body and your sexual response so you know when something changes. Check yourself out with a mirror between the legs. It’s good to know what looks normal for you. Ask your husband if he has noticed any changes in your sexual response. He may have noticed something you didn’t.
- Make an appointment with a sexual health expert. As comfortable as you may be with your own gynecologist, someone who specializes in women’s sexual health (rather than reproductive health) is going to be the most informed about research and treatment options that will help you regain your sexual function. Also, a sexual health specialist may be more likely to have nice samples of lube for you to take home.
- Push through the embarrassment. Yes, I found it a little embarrassing to be talking with a total stranger about my orgasms and sexual practices. Even though I knew she’d heard it all before, I wasn’t used to exposing so much of my sex life in such a specific way. But I am so, so glad I did. The more we chatted, the more comfortable I became. We laughed a LOT during my appointment. That helped make me more comfortable. Remember: If you don’t talk about it, you can’t fix it. And I’m here to say that I survived. I did NOT die of embarrassment, and neither will you.
- If you have any educational programs about menopause or women’s sexual health in your area, attend them. Hearing someone talk about these issues, out loud and in person, can help you realize that what you are experiencing is normal and that it really can be discussed. Challenge yourself to ask at least one question, even if it is, “Hey, that third point on the previous slide. Could you tell us a little more about that?”
- Practice explaining your problems. Practice saying what you want. Tell your husband. Tell a girlfriend. Talk when you’re alone in the car (that’s when I did most of my practicing). Write down all the words that you think will be hard or weird to say, and practice saying them. If you think you might freeze during the appointment, make a written list of your symptoms. Draw a diagram of where you are experiencing pain or where you think something looks different.
Even though I write and talk about sex all the time, I was nervous about my appointment. I knew I was seeing the right person and that she would help me address my issues, but I didn’t know what to expect from the exam. The experience was a bit weird and embarrassing. But you know what? Next time I WILL know what to expect, and it will be just fine.
Even in menopause, I am fearfully and wonderfully made. Addressing the menopause-related problems with sexual intimacy will be good for our marriage and good for me.
I hope this post has been helpful and has even made you laugh–but if made you pee a little, too, be sure to call your doctor, okay?
* Allahdadi, K. J., Tostes, R. C. A., & Webb, R. C. (2009). Female sexual dysfunction: Therapeutic options and experimental challenges. Cardiovascular & Hematological Agents in Medicinal Chemistry, 7(4), 260–269.
Image credit | Chris Taylor