What are menstrual cramps?

Menstrual cramps are pains in the abdominal (belly) and pelvic areas that are experienced by a woman as a
result of her menstrual period. Menstrual cramps are not the same as the discomfort felt during premenstrual
syndrome (PMS), although the symptoms of both disorders can sometimes be experienced as a continual
process. Many women suffer from both PMS and menstrual cramps.
Menstrual cramps can range from mild to quite severe. Mild menstrual cramps may be barely noticeable and of
short duration - sometimes felt just as a sense of light heaviness in the belly. Severe menstrual cramps can be
so painful that they interfere with a woman's regular activities for several days.
How common are menstrual cramps?
Menstrual cramps of some degree affect more than an estimated 50% of women, and among these, up to 15% would
describe their menstrual cramps as severe. Surveys of adolescent girls show that over 90% of girls report having menstrual
cramps.

What is dysmenorrhea?
The medical term for menstrual cramps is dysmenorrhea. There are two types of dysmenorrhea, primary and secondary.
In primary dysmenorrhea, there is no underlying gynecologic problem causing the pain. This type of cramping may begin
within six months to a year following menarche (the beginning of menstruation), the time when a girl starts having menstrual
periods. Menstrual cramps typically do not begin until ovulatory menstrual cycles (when an egg is released from the
ovaries) occur, and actual menstrual bleeding usually begins before the onset of ovulation. Therefore, an adolescent girl
may not experience dysmenorrhea until months to years following the onset of menstruation.
In secondary dysmenorrhea, some underlying abnormal condition (usually involving a woman's reproductive system)
contributes to the menstrual pain. Secondary dysmenorrhea may be evident at menarche but, more often, the condition
develops later.

What causes menstrual cramps?

Each month, the inner lining of the uterus (the endometrium) builds up in preparation for a possible pregnancy. After
ovulation, if the egg is not fertilized by a sperm, no pregnancy will result and the current lining of the uterus is no longer
needed. The woman's estrogen and progesterone hormone levels decline, and the lining of the uterus becomes swollen
and dies. It is then shed and will be replaced by a new lining in the next monthly cycle.
When the old uterine lining begins to break down, molecular compounds called prostaglandins are released.
These compounds cause the muscles of the uterus to contract. When the uterine muscles contract, they
constrict the blood supply (vasoconstriction) to the endometrium. This contraction blocks the delivery of oxygen
to the tissue of the endometrium which, in turn, breaks down and dies. After the death of this tissue, the uterine
contractions literally squeeze the old endometrial tissue through the cervix and out of the body by way of the
vagina. Other substances known as leukotrienes, which are chemicals that play a role in the inflammatory
response, are also elevated at this time and may be related to the development of menstrual cramps.
Why are some cramps so painful?
Menstrual cramps are caused by the uterine contractions that occur in response to prostaglandins and other
chemicals. The cramping sensation is intensified when clots or pieces of bloody tissue from the lining of the
uterus pass through the cervix, especially if a woman's cervical canal is narrow.
The difference between menstrual cramps that are more painful and those that are less painful may be related
to a woman's prostaglandin levels. Women with menstrual cramps have elevated levels of prostaglandins in
the endometrium (uterine lining) when compared with women who do not experience cramps. Menstrual
cramps are very similar to those a pregnant woman experiences when she is given prostaglandin as a
medication to induce labor.
Can menstrual cramps be measured?
Yes. Menstrual cramps can be scientifically demonstrated by measuring the pressure within the uterus and the
number and frequency of uterine contractions. During a normal menstrual period, the average woman has
contractions of a low pressure (50-80 mm Hg), which last 15-30 seconds at a frequency of 1-4 contractions
every 10 minutes. When a woman has menstrual cramps, her contractions are of a higher pressure (they may
exceed 400 mm Hg), last longer than 90 seconds, and often occur less than 15 seconds apart.
What other factors influence menstrual cramps?
As mentioned above, an unusually narrow cervical canal tends to increase menstrual cramps. Another
anatomical factor thought to contribute to menstrual cramps is a backwards tilting of the uterus (a retroverted
uterus).
Lack of exercise is now recognized to contribute to painful menstrual cramps.
It has long been thought that psychological factors also play a role. For example, it is widely accepted that
emotional stress can increase the discomfort of menstrual cramps
What are the symptoms of menstrual cramps?
Menstrual cramps are pains that begin in the lower abdomen and pelvis. The discomfort can extend to the
lower back or legs. The cramps can be a quite painful or simply a dull ache. They can be periodic or continual.
Menstrual cramps usually start shortly before the menstrual period, peak within 24 hours after the onset of the
pains, and subside again after a day or two.
Menstrual cramps may be accompanied by a headache and/or nausea, which can lead, although infrequently,
to the point of vomiting. Menstrual cramps can also be accompanied by either constipation or diarrhea because
the prostaglandins which cause smooth muscles to contract are found in both the uterus and intestinal tract.
Some women experience an urge to urinate more frequently.
How are menstrual cramps diagnosed?
The diagnosis of menstrual cramps is usually made by the woman herself and reflects her individual perception
of pain. Once a woman has experienced menstrual cramps, usually with the adolescent onset of her menses
(monthly menstrual flow), she becomes well aware of the typical symptoms.
What is the treatment for common menstrual cramps (primary dysmenorrhea)?
Every woman needs to find a treatment that works for her. Perhaps the most common treatment, especially in
the past, has been to lie down at the first sign of pain. It used to be that many women's restrooms contained a
cot or a couch so that a woman who felt "indisposed" could lie down. A bed in the school nurse's office served
the same purpose and girls were routinely excused from physical education or other classes because of
menstrual cramps.
Current recommendations include not only adequate rest and sleep, but also regular exercise (especially
walking). Some women find that abdominal massage, yoga, or orgasmic sexual activity help. A heating pad
applied to the abdominal area may relieve the pain and congestion.
A number of nonprescription (over-the-counter) agents can help control the pain as well as actually prevent the
menstrual cramps themselves. For mild cramps, aspirin or acetaminophen (Tylenol), or acetaminophen plus a
diuretic (Diurex MPR, FEM-1, Midol, Pamprin, Premsyn, and others) may be sufficient. However, aspirin has
limited effect in curbing the production of prostaglandin and is only useful for less painful cramps.
The main agents for treating moderate menstrual cramps are the nonsteroidal antiinflammatory drugs
(NSAIDs), which lower the production of prostaglandin and lessen its effect. The NSAIDs that do not require a
prescription are:
← ibuprofen (Advil, Midol IB, Motrin, Nuprin, and others);
← naproxen sodium (Aleve, Anaprox); and
← ketoprofen (Actron, Orudis KT).
A woman should start taking one of these medications before her pain becomes difficult to control. This might
mean starting medication 1-2 days before her period is due to begin and continuing taking medication 1-2 days
into her period. The best results are obtained by taking one of the NSAIDs on a scheduled basis and not
waiting for the pain to begin.
Prescription NSAIDs available for the treatment of menstrual cramps include mefenamic acid (Ponstel).
What if the cramps are very severe?
If a woman's menstrual cramps are too severe to be managed by these strategies, her doctor might prescribe
low dose oral contraceptives containing estrogen and progestin in a regular or extended cycle. This type of
approach can prevent ovulation (the monthly release of an egg) and reduce the production of prostaglandins
which, in turn, reduces the severity of cramping and causes a light menstrual flow.
Use of an IUD that releases small amounts of the progestin levonorgestrel directly into the uterine cavity, has
been associated with a 50 percent reduction in the prevalence of menstrual cramps In contrast, IUDs that do
not contain hormones, such as those containing copper, may worsen menstrual cramps.
Are there surgical solutions?
In the past, many women with menstrual cramps had an operation known as a D & C (dilation and curettage) to
remove some of the lining of the uterus. This procedure is also sometimes used as a diagnostic measure to
detect cancer or precancerous conditions of the uterine lining. Some women even resorted to the ultimate
solution to menstrual problems by having a hysterectomy, surgery that removes the entire uterus.
Today, when a woman has abnormally heavy and painful uterine bleeding, her doctor may recommend
endometrial ablation, a procedure in which the lining of the uterus is burned away or vaporized using a heat-
generating device.
What is the treatment of secondary dysmenorrhea?
The treatment of secondary dysmenorrhea depends on its cause. There are a number of underlying conditions
which can contribute to the pain including:
← Endometriosis (cells from the uterine lining tare located in other areas of the body);
← Uterine Fibroids (non-cancerous uterine growths that respond to estrogen levels);
← Adenomyosis (a benign condition in which the cells of the inner uterine lining invade its muscular wall,
the myometrium);
← Pelvic inflammatory disease (PID);
← Adhesions (abnormal fibrous attachments between organs); or
← Use of an intrauterine device (IUD) for contraception.
All of these conditions should be first diagnosed by a physician who will then recommend an appropriate
treatment.
If a woman begins to experience changes in her menstrual cramps, such as in their severity, timing, or location,
she should consult her physician, especially if the changes are of sudden onset.
What is the long term outlook (prognosis) for menstrual cramps?
In general, a woman's menstrual cramps do not worsen during her lifetime. In fact, the menstrual cramps of
primary dysmenorrhea usually diminish with age and after pregnancy. This is thought to be due to the fact that
the nerves of the uterus degenerate with age and disappear late in pregnancy, with only a portion of these
nerves regenerating after childbirth.
When there is secondary dysmenorrhea with an underlying condition contributing to the pain, the prognosis
depends on the successful treatment of that condition.
As women have learned more about their bodies and how to maintain them in maximum health, menstrual
cramps have become less of a debilitating illness, and more often, merely a minor monthly inconvenience.
Menstrual Cramps At A Glance
← Menstrual cramps are periodic abdominal and pelvic pains experienced by women.
← More than half of all menstruating women have cramps.
← The cramps are severe in at least one in seven of these women.
← Medically, menstrual cramps are called dysmenorrhea.
← Primary dysmenorrhea is common menstrual cramps without an identifiable cause.
← Secondary dysmenorrhea results from an underlying abnormality that usually involves the woman's
reproductive system.
← Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat cramps.
← Physical exercise can help alleviate menstrual cramps.
Menstrual cramps tend to improve with age.
Comment from: ricannblkhunie, 25-34 Female
I have been getting my period since the age of nine. I have had bad cramps since I started. I vomit up to 5
times a day. I can't eat so I just vomit stomach acids. Even when my period is over my stomach is still sore
from all the pain. Motrin used to be my best friend and would take away my pain, but my body started rejecting
it and now I have nothing. I go through the pain each month trying to find something to help but I have yet to
find my magic remedy or pill. Using a heating pad sometimes helps but I have to be sweating from it in order
for my body to completely relax to feel better. I miss days from work and no one seems to understand the pain
is unbearable! Published: September 11 ::
Comment from: kokomo19, 25-34 Female (Caregiver)
I have gotten horrible cramps for the last 6-7 years or so. I get really sweaty, diarrhea nausea, they go down
my legs, and I pretty much just lay or crouch in pain. I call in sick all the time because I can't get up. I've tried
hot baths, showers, heating pads, every pain killer that is out there, and several prescription pain killers. Motrin
800 doesn't prevent the cramps, but it's the only one that has made them less severe for me. I’ve tried several
birth control pills, which always help, but then the side effects I get from them are sometimes not any better
than the cramps! Published: September 11 ::
Comment from: stressisa4letterword, 25-34 Female (Patient)
I will take two ibuprofen (not Midol or Tylenol) when I first get the familiar symptoms just before my period
(gassy, bloated, kind of a diarrhea-type feeling). If it’s bad enough, I'll supplement it with one of those other
over-the-counter PMS medications containing ibuprofen and an antihistamine instead of acetaminophen and
caffeine, which is less effective and can make you agitated and restless. The medication needs to have some
form of diuretic in it to reduce the bloated, gassiness feelings. I recommend that you wear comfortable
pajamas, lie on your back with a pillow under your knees and one between your knees. Drink an herbal tea
designed for PMS (you can find them at your local health food store). Place a heat pack on your uterus. Read a
book, draw, watch TV, surf the Internet or sleep. Calming music, fresh clean sheets and the ambiance of a fan
also help. Tell everyone not to disturb you for the next few hours. Published: August 05 ::
I have had success taking magnesium (you also need calcium to release the magnesium from your cells - but
be careful not to take too much calcium or you'll use up all the magnesium). The pain gradually got less and
after about three months I had almost no pain. Some people also recommend omega 3 (not 6). Published: July
25 ::
Comment from: Painful, 25-34 Female (Patient)
I have had my period since the age of 13. The day I started, I had cramps. I have tried using Advil, Motrin,
Vicodin, heating pads, walking, and lying down. I still continue to have bad cramps, headaches, mood swings
and heavy bleeding. My doctor has even tried many forms of birth control pills, but nothing seems to help the
pain. I feel like the older that I get, the worse the pain gets. Published: September 25 ::
Comment from: Porchia, 19-24 Female (Patient)
I am a 21-year-old young lady and have been getting cramps since my first period. I get migraines, which make
me aware that I'm about to start, and the cramping lasts for three days. The only thing I find helpful is staying
on top of it. It’s not fun, but I take pills at least a day before my scheduled cycle and drink warm or hot drinks to
soothe my muscles. I also use a heating pad and try to relax as much as possible. Published: September 25 ::
I'm currently in South Korea where drug usage is nonexistent. For my cramps, I usually use herbal meditation
to calm me down, and relax my muscles. A heating pad, hot tea and a good book seems to do the trick.
Published: September 25 ::
Comment from: ginger, 35-44 Female (Patient)
I found that if I take Advil three to four days prior to my period that my periods are less painful. I also suffered
from bad PMS, tender breast, sadness, anger, you name it. My vision was even off if you know what I mean. I
started taking a multi vitamin with calcium and magnesium and within a couple of months I was no longer
suffering from the PMS. I haven’t had any symptoms for over a year now, so please start taking your vitamins. I
take Advil before period and take 2 every 4 to 5 hours the first 2 days of my period to keep the pain tolerable.
Not fun, but some relief. Published: September 11 ::
Comment from: Shelbie, 13-18 Female
I am 15 years old, and I started my period when I was 9. I have severe cramps. I vomit, wake up in cold sweats
in the middle of the night and can’t fall back asleep. I am extremely irate with anyone who touches me, my
upper legs hurt, my lower back and stomach cramp up. I have yet to find a sure way to help ease my pain. I’ve
tried herbal teas, pain relievers, strong pain relievers, light exercise, heat packs, warm baths, hot showers, and
even sleeping for long hours. Nothing seems to help.
During my period, I experience mild discomfort lasting for a few days before escalating to a high level. This
intense pain lasts up to 12 hours. It tends to accompany nausea, elevated temperature and headaches, and
can wake me from deep sleep and inhibit normal, everyday activity. A little careful massage can help. Constant
heat (careful not to burn yourself – I did this once!) on the lower abdomen while lying down helps even more. If
the pain is sufficiently intense, I take an over-the-counter ibuprofen combined with codeine – although I am
always cautious with medication of this strength. Published: August 22 ::
The only way to ease my pain is to take extra-strength Midol and Advil and apply two heat bags, one to my
lower abdomen and one to my lower back. I have severe cramps, and I also get nausea, but nothing seems to
help that. Published: July 15 ::
Heating pads seem to be the only things that help me. Applying heat to my lower back helps my muscles relax.
Once the pain subsides a bit, doing some light exercise also seems to help. My cramps also induce nausea
though, and nothing seems to help that except curling up into a ball and waiting it out. Published: July 08 ::
I have severe cramps and Midol maximum strength is the only medicine strong enough to take away the pain. I
also use a heating pad and lay either on my stomach or sit on my knees and curl into a ball. Concentrating on
taking deep breaths during the worst pain sometimes helps too. Published: June 30 ::
I take mefanamic acid after many years of trying to find a remedy! My cramps are in the severe range of being
sick, pains in legs and not knowing whether to stand up and walk or curl up and sleep! Mefenamic acid, a short
nap when I get in from work (or mid afternoon if I am not in work) and a hot pack on my abdomen usually helps
to ease the pain! Published: June 30 ::
I take ibuprofen and then put a warm rice bag on my stomach. Published: June 25 ::
Comment from: wings, 25-34 Female (Patient)
I agree with the person who suggested Magnesium, except that I suggest Magnesium Citrate, which is
absorbed better by the body. It is best if it is taken with calcium (or better yet -- calcium citrate.) I have had
severe cramps for over 10 years, although they have gotten a little better with time. I also have found that
eating Salmon and other forms of Omega 3 a few days before the period starts is helpful. Published:
September 11 ::
Comment from: Hanna, 25-34 Female (Patient)
About every six months or so, I have very severe cramps that cause me to pass out, vomit, cry, and moan. I
don't have any more energy for anything else. Every time, I almost go to the emergency room. The only thing
that helps me is to take some very, very strong pain relievers that put me to sleep. My gyno hasn't given me
any other recommendations, but she believes I have ovarian cysts. Published: August 29 ::
Comment from: Dani34, 13-18 Female (Patient)
I’m 18 years old, and I got my period when I was 10 years old. I experience bad cramps every month
(gassiness, diarrhea, lower back pain, abdomen and upper leg pains). The pains are so severe that they wake
me up in the middle of the night. I am unable to get comfortable. I have tried the heating pad, and it works the
times when I am able to relax my muscles. Sometimes, I am in so much pain that I am constantly tightening my
muscles and the heating pad does not have a chance to work. Taking three Advils instead of two has seemed
to help a little bit, although I still get cramps, they are not as severe. Published: August 29 ::
Comment from: Aurora, 25-34 Female
My period is of the nature that I have to sleep with a towel on my bed to prevent complete ruination of my
sheets. However I find for the cramps that if I do (and this may sound silly) Greer Childers Body Flex which
stretches the body and increases the oxygen to the blood that the cramps subside until I am done. A long, hot
shower, Ibuprofen, heating pad, pillows and (most importantly) Chocolate are just what I need to help calm the
cramps and nausea. Good luck ladies, it's nice to know that I am not alone in the painful period corner.
Published: August 14 ::
I have used an electric heating pad which has soothed the pain. Published: July 28 ::
Menstrual Cramps - Home Treatment
Try the following home treatment to help relieve your menstrual cramps:
Use heat, such as hot water bottles, heating pads, or hot baths, to relax tense muscles and relieve
cramping. Be careful not to burn yourself.
Drink herbal teas, such as chamomile, mint, raspberry, and blackberry, which may help soothe tense
muscles and anxious moods.
Exercise. Regular workouts decrease the severity of cramps. For more information, see the topic
Fitness.
Empty your bladder as soon as you have the urge to urinate.

For more information on managing menstrual cramps, see:

Menstrual cycle: Dealing with cramps.

Medicine you can buy without a prescription

Try a nonprescription medicine to help treat your fever or pain:

Acetaminophen, such as Tylenol or Panadol

Nonsteroidal anti-inflammatory drugs (NSAIDs):
Ibuprofen, such as Advil or Motrin
Naproxen, such as Aleve or Naprosyn

Aspirin (also a nonsteroidal anti-inflammatory drug), such as Bayer or Bufferin

Safety tips

Be sure to follow these safety tips when you use a nonprescription medicine:

Carefully read and follow all directions on the medicine bottle and box.
Do not take more than the recommended dose.
Do not take a medicine if you have had an allergic reaction to it in the past.
If you have been told to avoid a medicine, call your doctor before you take it.
If you are or could be pregnant, do not take any medicine other than acetaminophen
unless your doctor has told you to.

Do not give aspirin to anyone younger than age 20 unless your doctor tells you to.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home
treatment:
You become pregnant.
Pain is getting worse despite home treatment.
Menstrual cramps are lasting longer than your period.
 Other symptoms develop, such as fever, nausea, vomiting, or vaginal discharge.
Symptoms become more severe or frequent.
What is the treatment for common menstrual cramps (primary dysmenorrhea)
Treatment options vary and each woman needs to find a treatment that works for her. Non-drug measures that
may help include adequate rest and sleep, regular exercise (especially walking), and smoking cessation. Some
women find that abdominal massage, yoga, or orgasmic sexual activity can help. A heating pad applied to the
abdominal area may also relieve the pain. For mild menstrual cramps, over-the-counter (OTC) aspirin and
acetaminophen (Tylenol), or acetaminophen plus a diuretic (such as Diurex MPR, Midol, Pamprin, Premesyn)
may help. However, aspirin has a limited effect in curbing the production of prostaglandin and is only useful for
mild cramps. For moderate menstrual cramps, the nonsteroidal anti- inflammatory drugs (NSAIDs) can be
helpful. The NSAIDs are more effective than aspirin in inhibiting the production and action of the
prostaglandins. The NSAIDs that are available OTC are:
← ibuprofen (Advil, Midol IB, Motrin, Nuprin, and others);
← naproxen sodium (Aleve, Anaprox); and
← ketoprofen (Actron, Orudis KT).
For optimal control of menstrual cramps, a woman should start taking a NSAID before her pain becomes
difficult to control. This might mean starting medication 1 to 2 days before her period is due to begin and
continuing taking medication 1 to 2 days into her period. The best results are obtained by taking one of the
NSAIDs on a schedule rather than on an as needed basis. Therefore, ibuprofen should be taken every 4-6
hours, ketoprofen every 4-8 hours, and naproxen every 8-12 hours for the first few days of the menstrual flow.
What is premenstrual syndrome (PMS)?
Premenstrual syndrome (PMS) is a combination of emotional, physical, psychological, and mood disturbances
that occur after a woman's ovulation and normally end with the onset of her menstrual flow.
PMS remains a puzzle because of the wide-ranging symptoms and the difficulty in making a firm diagnosis.
Several theories have been advanced to explain the cause of PMS. None of these theories has been proven
and specific treatments for PMS still largely lack a solid scientific basis. Most evidence suggest that PMS
results from alterations in or interactions among the levels of sex hormones and brain chemical messengers
known as neurotransmitters.
What treatments are available for PMS
The treatment of PMS can sometimes be as challenging as diagnosing the condition. Some measures lack a
solid scientific basis but seem to help some women. Other treatments with a sound scientific basis may not
help all patients. General measures include:
← Exercise: Aerobic exercise for 30 minutes 3-5 times a week improves general health and helps relieve
nervous tension and anxiety. Exercise also improves cardiovascular fitness and muscle tone, decreases weight
and fluid retention, and improves self-esteem.
← Emotional support from family and friends.
← Stress reduction and stress management: Learn relaxation techniques, and develop coping
mechanisms to handle stress.
← Dietary changes: Reduce salt and refined sugar intake (too much salt and refined sugar aggravates
fluid retention).
← Avoid caffeine, which increases irritability
← Decrease intake of animal fats.
← Avoid cigarettes and alcohol.
← Some doctors advocate increasing the intake of complex carbohydrates (pasta and rice), magnesium,
zinc, and vitamins A, E, and B6 to alleviate symptoms related to PMS.
Furthermore, some studies suggest that vitamin B6, vitamin E, calcium, and magnesium supplements may
have some benefit. Large doses of vitamin B6 are discouraged, since they can cause neurologic symptoms
such as tingling and numbness in the arms and legs and even permanent nerve damage.
What medications are used to treat PMS
 Medications used to treat the different symptoms of PMS include:
← Diuretics are medications that increase urine production, thereby eliminating excess fluid and relieving weight
gain, bloating, swelling, and a full feeling. Ammonium chloride, caffeine, and pamabrom are mild diuretics that are
ingredients in nonprescription OTC products such as Diurex PMS, Lurline PMS, Midol PMS, Pamprin Multisymptom, and
Premesyn PMS. Spironolactone (Aldactone) is a prescription diuretic that has been used to treat premenstrual swelling of
the hands, feet, or face.
← Nonsteroidal anti-inflammatory medications (NSAIDs) are commonly used for menstrual cramps, headaches, and
pelvic discomfort. Examples of NSAIDs include ibuprofen (Advil, Motrin), naproxen (Aleve, Anaprox), ketoprofen (Orudis),
and mefenamic acid (Ponstel).
← Oral contraceptive pills (OCPs) are sometimes prescribed by doctors to decrease fluctuations in ovarian hormone
levels. While older studies failed to provide evidence that OCPs can consistently provide relief for symptoms of PMS, the
newer birth control pills, with their improved hormonal formulations, seem to be more beneficial.
← Ovarian suppressors such as danazol (Danocrine) have been prescribed by doctors to suppress ovarian hormone
production. Danocrine cannot be used over long periods because of side effects.
← Gonadotropin-releasing hormone (GnRH) analogs, which cause the complete suppression of ovarian function,
have recently been found to help some women with PMS. These GnRH analogs are not prescribed long term (more than 6
months) because of their adverse effects on bone density and an increased risk of bone thinning (osteoporosis).
Antidepressants are prescribed by doctors to treat the mood disturbances related to PMS. Antidepressants appear to work
by increasing brain chemical (serotonin and others) levels that are affected by the ovarian hormones.

Fluoxetine (Prozac) and paroxetine (Paxil) are examples of antidepressant medications that have been found to be
effective in treating the mood changes associated with PMS.

Introduction
A sexual problem, or sexual dysfunction, refers to a problem during any phase of the sexual response cycle that prevents
the individual or couple from experiencing satisfaction from the sexual activity. The sexual response cycle has four phases:
excitement, plateau, orgasm, and resolution.
While research suggests that sexual dysfunction is common (43% of women and 31% of men report some degree of
difficulty), it is a topic that many people are hesitant to discuss. Fortunately, most cases of sexual dysfunction are treatable,
so it is important to share your concerns with your partner and doctor.
What Causes Female Sexual Problems?
Sexual dysfunction can be a result of a physical or psychological problem.
← Physical causes: Many physical and/or medical conditions can cause sexual problems. These conditions include:
← diabetes,
← heart disease,
← neurological diseases,
← hormonal imbalances,
← menopause,

← chronic diseases such as kidney disease or liver failure, and

← alcoholism and drug abuse.
In addition, the side effects of certain medications, including some antidepressant drugs, can affect sexual desire and
function.
← Psychological causes: These include:

← work-related stress and anxiety,

← concern about sexual performance,
← marital or relationship problems,
← depression,
← feelings of guilt, and
← the effects of a past sexual trauma.

Who Is Affected by Sexual Problems?

Both men and women are affected by sexual problems. Sexual problems occur in adults of all ages. Among
those commonly affected are those in the geriatric population, which may be related to a decline in health
associated with aging.
How Do Sexual Problems Affect Women?
The most common problems related to sexual dysfunction in women include:
← Inhibited sexual desire: This involves a lack of sexual desire or interest in sex. Many factors can
 contribute to a lack of desire, including hormonal changes, medical conditions and treatments (for example
cancer and chemotherapy), depression, pregnancy, stress, and fatigue. Boredom with regular sexual routines
also may contribute to a lack of enthusiasm for sex, as can lifestyle factors, such as careers and the care of
children.
← Inability to become aroused: For women, the inability to become physically aroused during sexual
activity often involves insufficient vaginal lubrication. The inability to become aroused also may be related to
anxiety or inadequate stimulation. In addition, researchers are investigating how blood flow problems affecting
the vagina and clitoris may contribute to arousal problems.
← Lack of orgasm (anorgasmia): This is the absence of sexual climax (orgasm). It can be caused by
sexual inhibition, inexperience, lack of knowledge, and psychological factors such as guilt, anxiety, or a past
sexual trauma or abuse. Other factors contributing to anorgasmia include insufficient stimulation, certain
medications, and chronic diseases.
← Painful intercourse: Pain during intercourse can be caused by a number of problems, including
endometriosis, a pelvic mass, ovarian cysts, vaginitis, poor lubrication, the presence of scar tissue from
surgery, or a sexually transmitted disease. A condition called vaginismus is a painful, involuntary spasm of the
muscles that surround the vaginal entrance. It may occur in women who fear that penetration will be painful
and also may stem from a sexual phobia or from a previous traumatic or painful experience.
How Is a Female Sexual Problem Diagnosed?
The doctor likely will begin with a physical exam and a thorough evaluation of symptoms and a physical exam. The doctor
may perform a pelvic examination to evaluate the health of the reproductive organs and a Pap smear to detect changes in
the cells of the cervix (to check for cancer or a pre-cancerous condition). He or she may order other tests to rule out any
medical problems that may be contributing to the problem.
An evaluation of your attitude regarding sex, as well as other possible contributing factors (fear, anxiety, past sexual
trauma/abuse, relationship problems, alcohol or drug abuse, etc.) will help the doctor understand the underlying cause of
the problem and make appropriate recommendations for treatment.

How Are Female Sexual Problems Treated?

The ideal approach to treating sexual problems in women involves a team effort between the woman, doctors, and trained
therapists. Most types of sexual problems can be corrected by treating the underlying physical or psychological problems.
Other treatment strategies focus on the following:
← Providing education. Education about human anatomy, sexual function, and the normal changes associated with
aging, as well as sexual behaviors and responses, may help a woman overcome her anxieties about sexual function and
performance.
← Enhancing stimulation. This may include the use of erotic materials (videos or books), masturbation, and changes
to sexual routines.
← Providing distraction techniques. Erotic or non-erotic fantasies, exercises with intercourse, music, videos, or
television can be used to increase relaxation and eliminate anxiety.
← Encouraging non-coital behaviors. Non-coital behaviors (physically stimulating activity that does not include
intercourse), such as sensual massage, can be used to promote comfort and increase communication between partners.
Minimizing pain. Using sexual positions that allow the woman to control the depth of penetration may help relieve some
pain. The use of vaginal lubricants can help reduce pain caused by friction, and a warm bath before intercourse can help
increase relaxation.