Perhaps the most extreme symptoms of female sexual dissatisfaction are those associated with sexual pain disorders. The two most common pain disorders, say Drs. Laura and Jennifer Berman, are:

• Dyspareunia: recurrent or persistent genital pain related to attempted penetration during sex. The pain can be within the vagina or deep in the pelvis. Dyspareunia can emerge following a vaginal infection or vaginal and vulvular surgery, or result from vaginal thinning during menopause. Infections of the vagina, in particular, cause redness, itching, burning or stinging of the vulva — a condition known as vulvitis.
• Vaginismus: recurrent or persistent involuntary contraction of the muscles of the outer one-third of the vagina that interferes with vaginal penetration.

A third subcategory of sexual pain disorder is genital pain caused by any type of sexual stimulation besides intercourse.

Treating Sexual Pain Disorders
"A lot of women experience pain for a variety of different reasons," says Jennifer, a urologist, who adds that — as with most female sexual dissatisfactions — the causes are often a blend of physical and emotional factors. When the problem is medical and can be identified, treatment tends to be fairly straightforward. Among the most common solutions:

• Hormone replacement therapy (estrogen + progestin) to alleviate the vaginal dryness, thinning and urinary urgency that may cause dyspareunia. A vaginal estradiol ring (Estring) that delivers low-dose estrogen is an increasingly popular alternative to oral or transdermal estrogen, note the Bermans. If the woman is menopausal, the doctors have found that adding testosterone to the therapy provides additional benefits.
• Antibiotics for vaginal or urinary tract infections due to yeast, bacteria or parasites. Once the painful symptoms of these conditions clear, dyspareunia goes away. Chronic bladder infections, also a cause of dyspareunia, do not respond to antibiotics.
• Dilation Exercises: Commonly prescribed to treat vaginismus, these exercises involve stretching the opening of the vagina. The idea is to help the body accept penetration by conditioning the vagina muscles to relax. The exercise is done with manual objects like a finger, dilator or dildo. Once the woman can accept the object without pain, she can usually handle penile penetration.

Putting Sexual Dissatisfaction in Perspective
Desiring sex less often than your partner, failing to become excited, not achieving orgasm — all of these occurrences are perfectly normal. Daily stressors — financial concerns, demanding jobs, busy parenting schedules — can take a toll on our sex lives.

It's when the lack of or unsatisfying sex becomes the norm that we need to ask whether we could be suffering from one or more of the sexual disorders specific to women. And if we are, the physical or psychological causes or combination of both can be identified and successfully treated.

For more on this subject, see the Berman sisters' web site, NewShe.com.