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Yuri Arcurs

The question

I'm very attracted to my partner - we've been together for eight years - but I am unable to get physically aroused for sex. It quickly becomes painful, so I avoid it at all costs. He takes it personally and we often fight over it. What's your advice?

The answer

You aren't alone. Due to the sensitive nature of the topic, many have a hard time discussing their concerns with their partner, or with their doctor. But approximately 40 per cent of women suffer some form of sexual dysfunction at some point in their lives, with decreased sexual arousal being one of the most common concerns.

Arousal is the response to sexual stimuli that helps increase vaginal lubrication and blood flow to the genital area, making intercourse comfortable and pleasurable. Lowered arousal can trigger an emotional response of avoidance and a reduction in physical response. This can lead to painful sex, which in turn causes further avoidance.

This cycle can lead to a partner feeling frustrated, sad and rejected.

The first thing to ask yourself: Are you experiencing decreased arousal specifically with your partner, or in general? If arousal is low in specific situations, you can pinpoint what may be the underlying trigger. If your arousal is low in all situations - with a partner, or on your own - there may be other potentially reversible causes.

There are several things that can affect our sex drive and arousal, both physical and psychological. Physical causes can include pain from infections or dryness, medical conditions such as diabetes, cancer or arthritis, and medications such as antidepressants, oral contraceptives or antihistamines.

If you are taking medication and have noticed a change in your sexual response, tell your doctor. There may be other options less likely to have this side effect.

Hormonal changes such as thyroid dysfunction, low testosterone or menopause can also contribute to decreased drive and arousal.

Psychological problems such as depression, anxiety, stress, concern with body image or a history of abuse can contribute to decreased arousal.

A visit to your doctor may be helpful to check out these potential causes with some simple investigations or suggestions for medication or counselling.

While the physical and psychological causes are important to review, also consider that conflict in your relationship may be contributing to your decreased arousal.

For many, emotional intimacy is essential for sexual intimacy. Often, decreased arousal is not simply due to a breakdown in intimate communication, but from a larger issue - a loss of trust in your partner, financial or family stressors, or unresolved issues from the past.

To help strengthen your connection with your partner, I suggest:

Increase communication: While this is easier said than done, sharing concerns and having an open and honest discussion can help rekindle your emotional connection and improve intimacy.

Go for counselling: Talking to your doctor or with a therapist trained in sexual health may provide helpful ideas.

Set aside time for intimacy: This might seem contrived, but due to busy schedules, intimacy is often put aside. Schedule time to reconnect.

Increase physical comfort during sex: Use of a lubricant can be helpful for vaginal dryness, and pelvic-floor exercises can help increase blood flow to the region and in turn increase lubrication.

Send family doctor Sheila Wijayasinghe your questions at She will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail web site. Your name will not be published if your question is chosen.

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The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.