Reduced sexual desire, difficulty with arousal or reaching orgasm, and pain during intercourse are common complaints among women. Sexual desire can change naturally at different stages of life, so not every change is a problem. Assessment is considered when a complaint has lasted a long time and causes marked distress.
Contributing factors
Sexual desire and arousal are influenced together by hormones, general health, medicines, mood and the relationship. More than one factor is often behind the complaints:
- Hormonal changes: periods of hormonal change such as menopause and the postpartum period
- Vaginal dryness: drying and thinning of the vagina, particularly after menopause, with resulting burning and pain during intercourse
- Medicines: various medicines, particularly certain antidepressants
- Long-term conditions: conditions such as diabetes and high blood pressure
- Psychological factors: depression, anxiety and stress
- Relationship factors: communication difficulties and other problems in the relationship
- Pain: pain during intercourse and involuntary tightening of the pelvic floor muscles (vaginismus)
Assessment
The consultation covers the type of complaint (desire, arousal, orgasm or pain), how long it has lasted, how much distress it causes, general health, current medicines and relationship factors. The gynecological examination assesses vaginal dryness, infection, findings that may cause pain and the pelvic floor muscles. Blood tests are not always needed; they are requested when considered necessary. When psychological or relationship factors are prominent, a referral may be made to a specialist experienced in this area for sex therapy or psychological support.
Non-surgical options
Treatment is planned according to the cause of the complaint. In most cases, the following options are considered first:
- Sex therapy and counseling: methods such as cognitive behavioral therapy, mindfulness-based approaches and couples therapy are provided by mental health professionals experienced in this area.
- Pelvic floor physical therapy: may be helpful for pain during intercourse, vaginismus and problems related to the pelvic floor muscles.
- Lubricants and vaginal moisturizers: can help relieve pain caused by vaginal dryness; they do not remove the underlying cause.
- Low-dose vaginal estrogen: considered in suitable people for vaginal dryness and pain related to menopause. In people with a history of breast cancer, this decision is made together with the oncologist.
- Reviewing medicines: if a medicine may be contributing to the complaint, options can be discussed with the doctor who prescribed it. Medicines should not be stopped without medical advice.
Procedures used for this purpose
The procedures used with the aim of increasing sexual desire or pleasure include the following; which one is suitable, or whether any procedure is needed at all, is assessed during the examination:
- Filler injection in the G-spot area: injection of a filler such as hyaluronic acid, or of the person’s own fat tissue, into the part of the front wall of the vagina near the opening. Whether the “G-spot” exists as a distinct anatomical structure is debated; scientific studies have not produced strong and consistent evidence on this.
- Plasma (PRP) injection: injection of platelet-rich plasma prepared from the person’s own blood into the front wall of the vagina and, in some protocols, around the clitoris as well. It is also known by trade names such as “O-Shot”. Details are on the Plasma (PRP) Treatments for the Genital and Vaginal Area page.
- Vaginal laser and other energy-based devices: application of laser or heat energy to the vaginal tissue. In 2018, the US Food and Drug Administration (FDA) issued a warning that the safety and effectiveness of these devices for vaginal “rejuvenation” and for complaints related to sexual function have not been established. Details are on the Vaginal Tightening (Vaginoplasty) page.
- Clitoral hood reduction: when the fold of skin covering the clitoris is large, reducing this fold may be suggested on the assumption that it could make arousal easier. There are no reliable data showing an effect on sexual function. Details are on the Clitoral Aesthetics (Clitoral Hood Reduction) page.
Level of evidence and realistic expectations
The effect of these procedures on sexual desire, arousal or orgasm has not been adequately studied. Most published studies involved small numbers of people and short follow-up, often without a comparison group, and the methods used differ from one another. In 2020, the American College of Obstetricians and Gynecologists (ACOG) stated that the safety and effectiveness of procedures that alter sexual appearance or function outside a clinical indication have not been established. In 2018, the International Society for the Study of Vulvovaginal Disease (ISSVD) also reported that there are no data supporting G-spot procedures or procedures aimed at increasing sexual function.
For this reason, it cannot be said with certainty that these procedures will increase sexual desire or pleasure. If a procedure is being considered, expectations are discussed in detail. If intense concern about body image or a psychological problem is suspected, an assessment by the relevant specialist is recommended before the procedure.
Before and after the procedure
How the procedure is performed, the method of anesthesia, the recovery time and the points to observe afterwards vary with the chosen procedure and are explained beforehand. Injection and laser treatments are mostly carried out without a hospital stay, whereas clitoral hood reduction is a surgical procedure. A break from intercourse may be advised for a time after the procedure; this period depends on the treatment.
Possible risks
Possible risks of these procedures include pain, bleeding or bruising, swelling, infection, scarring, adhesions, altered or reduced sensation, pain during intercourse and the need for a repeat procedure. With fillers, movement of the filler material and firm lumps (nodules) may occur. Very rare but serious cases have been reported in which filler or fat injected into the vaginal wall entered a blood vessel and reached the lungs. Burns, scarring and long-lasting pain have been reported with laser treatments. The level of risk varies with the procedure and the person’s health.