Many women have problems with sex at some stage in their life. Here's a look at some forms of female sexual dysfunction (FSD) and advice on where to get help if it affects you.

According to the Sexual Advice Association, sexual problems affect around 1 in 3 young and middle-aged women, and around 1 in 2 older women.

To identify the reasons behind sexual dysfunction, both physical and psychological factors have to be considered, including a woman's relationship with her partner.

Reduced sex drive

A reduced sex drive (loss of libido), affects some women at certain times of life, such as during pregnancy, after having a baby, or during times of stress. But some women experience it all the time.

A loss of libido can have a range of physical or psychological causes, including:

• relationship problems
• depression
• previous mental or physical trauma
• tiredness
• diabetes – both type 1 and type 2 diabetes
• hormone disorders such as having an underactive or an overactive thyroid gland
• excessive alcohol consumption or drug use
• certain medicines, such as the SSRI type of antidepressants

Libido can also fall if a woman's natural testosterone levels drop. Testosterone is produced in the ovaries and adrenal glands, so levels can drop if these are removed or they're not functioning properly.

Orgasm problems

These can be divided into 2 types:

• primary – when a woman has never had an orgasm
• secondary – when a woman has had an orgasm in the past, but can't now

Some women do not need to have an orgasm to enjoy sex, but an inability to reach orgasm can be a problem for some women and their partners.

Reasons why a woman cannot have an orgasm can include:

• fear or lack of knowledge about sex
• being unable to "let go"
• not enough effective stimulation
• relationship problems
• feeling depressed or stressed
• previous traumatic sexual experience

Research is being done into certain health conditions that affect the blood and nerve supply to the clitoris to see whether this affects orgasm.

Psychosexual therapy may help a woman overcome orgasm problems. It involves exploring her feelings about herself, sex, and her relationship.

Pain during sex

Vaginismus

Pain during sex – also called dyspareunia – can be caused by vaginismus. Vaginismus is when muscles in or around the vagina go into spasm, making sexual intercourse painful or impossible. It can be very upsetting and distressing.

It can happen if a woman associates sex with pain or being "wrong", or if she's had vaginal trauma, such as an episiotomy during childbirth.

It can also stem from relationship problems, fear of pregnancy, or painful conditions of the vagina and the surrounding area.

Depending on the cause, it may be treated by focusing on sex education, counselling and using vaginal trainers, also known as vaginal dilators.

Vaginal trainers are cylindrical shapes that are inserted into the vagina. A woman will gradually use larger sizes until the largest size can be inserted comfortably. Some women may wish to try using their fingers instead.

Sex after menopause

Pain during sex is common after the menopause as oestrogen levels fall which can cause the vagina to feel dry. This can affect a woman's desire for sex, but there are lubrication creams that can help. Ask a GP or pharmacist.

Female genital mutilation

Women who have experienced female genital mutilation (FGM) can find it difficult and painful to have sex.FGM is where female genitals are deliberately cut, injured or changed, but there is no medical reason for this to be done.

It can also result in reduced sexual desire and a lack of pleasurable sensation. Talk to a GP or another healthcare professional if you have sexual problems that you feel may be the result of FGM. They can refer you to a therapist who can help.