While sex for men often begins in the bedroom, women’s desire for sex typically starts outside the bedroom. When, where, how and what a woman wants in a satisfying sexual relationship typically comes within the context of her relationship not just with her partner but also with herself. Challenges for women might stem from physiological, emotional, relational, cultural, spiritual and/or family concerns. The most common complaints that women present with include disorders of desire, arousal, orgasm and pain and most frequently a low libido or difficulty with orgasm.

Sexual concerns are not uncommon for women, especially as they journey through the life span. Forty-three percent of women report a sexual concern and a peak in middle age with women 45-65 having the most distressing complaints, according to a 2015 survey of over 30 thousand women.

Identifying the root cause is important to treatment. Sexual dysfunction in women can arise from physiological as well as mental concerns. Common co-occurring conditions that were noted in the survey include anxiety, depression, poor health urinary incontinence and thyroid conditions. Often there is assistance from a medical doctor, typically an obstetrician/gynecologist who can help rule out any physical and physiological causes and provide short and long-term options as well.

Dr. Winter has helped many women in sex therapy overcome:

• Age Related Sexual Difficulties
• Arousal and Orgasmic Disorders
• Health Related Sexual Difficulties
• Infertility Issues
• Infidelity and Healing After An Affair
• Low or No Sexual Desire
• Post-Partum Depression
• Sexual Avoidance or Anorexia
• Sexual Pain or Dyspareunia
• Sexual Trauma Recovery

While reaching for help can be uncomfortable, particularly when sex is at issue, there is hope and assistance. In a safe and confidential space, Dr. Winter offers sexual counseling for individuals and couples; she will help you improve your sexual health.

Dr. Winter brings together both traditional methods of sex and psychotherapy as well as state-of- the-art evidenced based therapies and techniques to help you restore your sexual functioning. With access to extensive and a unique blending of knowledge and experience, she will assess each and every factor to design and implement a treatment plan to help revive your sexual functioning and help you regain a satisfying sexual relationship.

Desire disorder, hypoactive disorder or female sexual interest/arousal disorder as it is referred to in the DSM5, be it no or lack of interest in sex or varying baselines of the partners involved, is the most common complaint of women and couples in therapy. It is important to assess multiple factors, including physical, physiological, emotional, cultural, relational and spiritual, in order to determine the best plan of action. Sexual health for women typically involves more than just one element and often multiple pieces are addressed.

There are instances in which the willingness to participate in any intimacy represents a radical shift in the relationship. This sometimes follows childbirth, trauma, infidelity and/or may represent a change in the health condition

With the extension of life and women staying sexual into later years, challenges often surface that include the interaction between hormonal and psychological factors. A team approach that includes a physician is often indicated.

Approximately 4.7% of women report difficulty or an inability to orgasm; this is not an uncommon complaint, with numbers higher amongst post-menopausal women. Primary anorgasmia, never having experienced an orgasm, is more often linked to psychological and sociocultural factors. Secondary anorgasmia, the loss of ability to orgasm or intermittently experiencing an orgasm or achieving orgasm under certain circumstances, on the other hand, may be linked to psychological and or physiological causes.

A diagnosis of female orgasmic disorder is typically made via a thorough history. Curative factors might include individual psychotherapy, couple’s therapy, mindfulness and relaxation, psycho-education and physiological intervention from a qualified physician.

An infrequent complaint, persistent genital arousal (persistent sexual arousal) exists when there is arousal that is perceived as intrusive and unwanted in the absence of any particular set of sexual circumstances. Symptoms typically do not subside on their own; masturbation provides temporary relief for what is described as vaginal congestion. Like other sexual dysfunctions, persistent sexual arousal is rooted in both psychogenic (emotional, spiritual, cultural) and biogenic (physical and physiological) causes.

Persistent genital arousal needs to be differentiated from hyper-sexuality (not a diagnosis) which now fits more into the category of sexual addiction that is psychological in origin.

Sexual pain disorders fall into three types – dyspareunia, pain with intercourse (referred to as genito-pelvic pain penetration disorder in the DSM5, vaginismus, an involuntary spasm that can occur at any phase of the sexual response cycle, and vulvodynia, chronic and intractable pain around the vaginal opening. A thorough history and medical examination can often reveal the cause, which can stem from physiological, physical and emotional concerns. The intractability of pain disorders can have long term consequences to a women’s self esteem and diminished sexuality.

Help for sexual pain disorders may involve more than psychotherapy; exercises and work with a pelvic pain specialist is usually indicated.