A happy sex life is a crucial component of a fulfilling life. A happy sex life means different things to different people, and what is considered satisfying can vary based on individual desires, expectations, and needs. It is important to consider the subjectivity of sexual satisfaction in research and diagnosis of sexual dysfunction. There are several factors that can impact a person's sex life, including biological, psychological, physical, relational, and socio-environmental factors. Some of these factors can be modified, while others, like aging, cannot be changed. It is important to recognize that sexual function is not always fully within an individual's control and to feel comfortable discussing sexual health concerns with a healthcare provider.

Sexual anatomy and sexual pleasure

Sexual complaints can generally be divided into four main categories: desire (interest in sex), arousal (physical and emotional changes during sex), orgasm/satisfaction, and physical pain. Depending on the study, these categories may be further broken down into more specific subcategories. Sexual dysfunction is fairly common, affecting about 40% of women. A diagnosis of a sexual dysfunction disorder is given when the dysfunction significantly affects a person's quality of life.

Biological Factors

Age can have a significant impact on sexual function. As people get older, they are more likely to experience sexual dysfunction, particularly during perimenopause (the transition to menopause). This increase in sexual dysfunction may be due to both changing hormone levels and declining health. However, not all aspects of sexual function necessarily worsen with age. For example, a study of Iranian women found that women in their 50s and 60s were almost five times more likely to experience arousal dysfunction than women in their 20s and 30s, but were only about half as likely to report pain dysfunction. These results may be influenced by cultural differences among age groups, or may reflect positive changes in the body that occur with age. The menstrual cycle can also affect a person's sex life. A study of 43 heterosexual women found that as the hormone progesterone increased in saliva samples, participants reported a decrease in sexual desire for their partners. This may be because progesterone levels increase after ovulation, a time when it is unlikely that sex will result in pregnancy, so the body may not be as inclined towards having sex as during other parts of the cycle.

Psychological, physical and pharmaceutical factors

There are many known psychological, physical and pharmaceutical factors that affect sexual function. These include:

• Injury to the nervous system (ex. spine)
• Injury to the reproductive system
• Depression
• Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs)
• Surgery on reproductive organs, such as a hysterectomy
• Diabetes
• Urinary incontinence
• Endometriosis
• Cardiovascular disease
• Hypertension
• Obesity and large waist circumference
• Hormonal birth control
• Physical activity

While some factors that negatively impact sexual function cannot be changed, others can be addressed through behavioral modifications or with the assistance of a healthcare provider. For instance, certain antidepressants have a smaller impact on sexual function than others, and seeking treatment for depression can improve sexual dysfunction even when taking SSRIs. Additionally, some treatments for endometriosis have been shown to reduce sexual dysfunction caused by the condition, while others are less effective. Higher levels of physical activity have been found to improve sexual function. In a study of diabetic women, each metabolic equivalent of task (MET) significantly decreased the risk of female sexual dysfunction by 9%. In the same study of Iranian women, those who reported exercising several times per week were twice as likely to report female sexual dysfunction than those who exercised daily, while those who rarely or never exercised were three times more likely to report female sexual dysfunction.

Hormonal Birth Control

There is debate among researchers about whether hormonal birth control is associated with decreased sexual desire, but for most people, it does not seem to have this effect. In a review of the relationship between sexual dysfunction and hormonal birth control, about 15% of combined oral contraceptive users reported negative sexual effects from their birth control, and this effect was primarily seen with pills that had lower doses of estrogen. Most people reported no change in sexual function, either positive or negative. In a randomized control trial, women prescribed either a combined oral contraceptive or a hormonal vaginal ring reported improved sexual function in multiple categories compared to women not using hormonal birth control after three and six months of use. Women on either contraceptive reported statistically lower levels of anxiety and statistically higher levels of initiative, orgasms, and orgasm intensity compared to women not using hormonal birth control. Some studies have found opposite results, but the results are less clear. In a study of over 1,000 women, researchers found that hormonal birth control users were more likely to report negative sexual functions, including fewer orgasms and decreased arousal; however, the authors did not report the size of the differences between these categories when adjusted for important secondary factors such as age or whether the participant had a steady sexual partner, making it difficult to assess the extent of the change in light of these other factors.

External Factors

External factors, such as personal history or partner-related issues, can also affect a person's sexual life. These influences can be direct or mediated through factors such as depression or overall health. A history of abuse has been linked to negative sexual function, though not for all women. In one study, women who experienced sexual abuse as children were more likely to report negative responses when discussing their sexuality or during arousal. On the other hand, sexual assault, regardless of the attacker's gender, was not found to be related to sexual dysfunction in a study of women who have sex with women (WSW), even though WSW are two to three times more likely to have been assaulted compared to heterosexual women.

A person's sexual experience is heavily influenced by their partner.

In the study of Iranian women mentioned earlier, more than 70% of women with sexual dysfunction reported that their dysfunction was due to interpersonal problems with their partner, and more than 80% reported that their dysfunction was caused by their partner's sexual capabilities. Similarly, a study of Italian heterosexual women with sexual dysfunction found that a woman's partner's level of interest might have a stronger impact on her sexuality than any sexual dysfunction on the part of her partner. Women who have sex with women (WSW) may experience different sexual effects than those who have sex with men.

A study of over 1,500 WSW found that factors such as age, diabetes, and menopausal status that are often associated with sexual dysfunction were not related to sexual dysfunction in this group. It is possible that WSW have different physiological responses to these factors, but the authors of the study suggest that WSW may engage in different forms of sex than women who have sex with men, and these sexual activities are less affected by the side effects of conditions like diabetes or menopause. This underscores the subjectivity of sexual dysfunction research and highlights the fact that sexual dysfunction does not necessarily mean sexual dissatisfaction. If you are unhappy with your sexual function, you may want to consider speaking with your healthcare provider. Sexual dysfunction is common, and it is normal for a person to experience changes in their sexual function throughout their life.