What Women Should Know About Sexual Health

A gynecologist explains how women can best take care of their sexual health at every stage.

The World Health Organization defines sexual health as “a state of physical, emotional, mental, and social well-being in relation to sexuality.” Even though it’s an essential component of overall well-being, sexual health is a topic that many women feel uncomfortable openly discussing due to stigma, says Dr. Mary Rosser, an OB-GYN at New York-Presbyterian/Columbia University Irving Medical Center.

“Sexual health and well-being are part of a woman’s overall general health, which includes physical and psychological health,” says Dr. Rosser. “Unfortunately, many people still feel that discussing sexual and reproductive health is taboo. By empowering women with information about their sexual health, the goal is that they feel comfortable discussing it with their doctor just like they would any other medical issue.”

Health Matters spoke with Dr. Rosser about how women can best maintain and improve their sexual health, from protecting against sexually transmitted diseases to screening for gynecologic cancers to managing sexual dysfunction.

Headshot of Dr. Mary Rosser

Dr. Mary Rosser

What are some myths about women’s sexual health?
Dr. Rosser: There are so many misconceptions about women’s sexual health, including that it’s something you can just “turn on or off.” In reality, sexual health does not exist in a vacuum. If someone is fatigued or stressed, experiencing body image issues, or having troubles in their relationship, for instance, any of these external factors may negatively affect the way they feel about sex.

Many of my patients who express that their libido is low, or that sex is painful, tell me that they just try to “get through it” for their partner because they don’t want to hurt their feelings. It’s incredibly important that women always feel secure enough with their partner to express why something is not working for them, and why.

Increased discussion and awareness around sexual health has definitely helped, but there’s still a long way to go in making sure that women don’t feel the constant need to perform during sex. I try to emphasize to my patients that they don’t have to think of either partner’s orgasm, or even intercourse itself, as the “endgame” each time they are intimate.

At what age should education and discussion around sexual health begin?
Ideally, discussion around sexual health should begin in childhood. Of course, you wouldn’t talk to a 5-year-old the same way you would talk to your 16-year-old, but studies have shown that having early talks with children about sexuality leads to a decreased incidence of sexual abuse.

Especially for very young children, it’s crucial to help them understand consent, boundaries, and respect for your body. Even explaining something as simple as, “No one should touch you in these places” can go a long way.

In general, I recommend discussing the reproductive system, safe sex, and sexual orientation before your child begins puberty, so that they’re well prepared. There is a plethora of helpful books that can help facilitate these conversations and equip them with supplemental information.

At what age should women begin seeing a gynecologist, and how often?
The American College of Obstetrics and Gynecology (ACOG) recommends that girls start seeing a gynecologist between the ages of 13 and 15.  However, women generally do not need an exam until 21 years of age for the first Pap test, which is the collection of a small sample of cells from the surface of the cervix.

Sexual Health Screening Recommendations

The CDC estimates that there are more than 110 million sexually transmitted infections (STI) among men and women in the U.S., with 20 million new cases each year.

“Even if it’s not time for your annual visit, you should always see a healthcare provider if you’re worried you may have an STD,” says Dr. Rosser. “Note that these diseases are transmittable for everyone, not just women in heterosexual relationships.”

Here are some screening recommendations for women.

HIV: Get tested at least once between the ages of 13 and 64, more often if at high risk and for anyone who is pregnant.

Hepatitis B, Hepatitis C:  Get tested at least once over the age of 18 and for anyone who is pregnant.

Chlamydia and Gonorrhea: All sexually active women younger than 25 should be tested for these infections. These infections are asymptomatic, but if left untreated, they can lead to serious health issues, including pelvic inflammatory disease, infertility, complications with pregnancy, and pelvic pain.

HPV: Get a Pap test (also known as a Pap smear) every three years between the ages of 21 to 29 (without HPV testing); Pap test every five years for women ages 30 and older (with HPV testing); screening may no longer be necessary for women over 65 if considered low risk.

The HPV vaccine is recommended for both girls and boys early in puberty for protection against HPV, as well as for men and women up to the age of 45 for the protection of head and neck cancers.

Trichomoniasis: Can get screened at any age if experiencing symptoms or are at high risk. This type of STD is caused by a parasite and is usually asymptomatic, but symptoms may include vaginal irritation or itching, discomfort with urination, or abnormal discharge.

What should women know about gynecologic cancer screenings?
There are five types of gynecologic cancers: cervical, endometrial, ovarian, vaginal, and vulvar. The risk for these cancers increases with age. It’s crucial that women go to their annual well-woman visit so that a gynecologist can assess any risk factors, symptoms, or family history of cancer.

The only type of gynecologic cancer we can screen for is cervical cancer with a Pap test, an HPV test, or both. (HPV is the most prevalent and contagious sexually transmitted infection in the US, especially among young women, and can lead to cervical cancer.)

If a patient is experiencing symptoms such as abnormal vaginal bleeding (bleeding that is heavier, longer, or more frequent than usual, bleeding after sex, or postmenopausal bleeding), abnormal vaginal discharge, painful or frequent urination or blood in urine, pain during intercourse, a change in color of the vulva, or pain, swelling, or a mass around their pelvic or vaginal area, it’s a good idea to see your gynecologist so that they can perform diagnostic tests, like an ultrasound, blood test, urine tests, or biopsy, if necessary.

What does sexual dysfunction look like for women?
When a woman experiences a recurrent, persistent lack of sexual desire, impaired arousal, inability to achieve orgasm, or pain with sexual activity, that is classified as sexual dysfunction.

Sexual dysfunction can be caused by a variety of factors, including medical conditions, depression or anxiety, certain medications (such as birth control pills, beta blockers for blood pressure, antidepressants, or aromatase inhibitors used in women with breast cancer), difficulty in relationships, and even social and cultural factors.

Women often start noticing a decrease in libido in their 40s. Decreasing estrogen levels during menopause often comes with vaginal dryness and vaginal thinning, which can cause pain during sex.

People who are breastfeeding may experience vaginal dryness because of estrogen reduction, and taking birth control pills can also cause a dip in libido. Women who have a history of sexual, physical, or emotional abuse or trauma might be more likely to experience difficulties with their sexual health.

What are some ways to boost sexual health and intimacy?
Vaginal lubricants and moisturizers can significantly help with vaginal dryness. There are also hormone therapies that may help with sexual dysfunction caused by menopause, such as systemic estradiol, vaginal estradiol, or testosterone. For non-menopausal patients, there are other medications that may help with libido, such as flibanserin.

Many women benefit significantly from seeing a pelvic floor physical therapist, especially if they have conditions like vaginismus, which causes involuntary contractions of the vagina, or urinary incontinence. It is highly recommended for women with sexual dysfunction get a pelvic exam, so that their gynecologist can assess the situation and see if there are any associated conditions that may be treatable.

Open communication with your partner is crucial for sexual health; there has to be an established emotional intimacy, respect, and trust. Many people benefit from couples therapy or sex therapy.

It seems like common sense to “just relax” and enjoy sex. But oftentimes, people are distracted and it becomes difficult to be present. While it’s difficult to reduce stress completely, I really encourage patients to try different ways of managing it, whether that’s through meditation, cognitive behavioral therapy, yoga, exercise, or eating healthfully. Improving your mental health is a key step in improving your sexual health.

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