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Women’s sexual problems run the gamut from A(rousal) to V(aginismus).

An estimated 23.5 million American women have difficulty achieving the Big O(rgasm), while an estimated 15 million women have sex-drive problems. Other women face lesser-known disorders such as dyspareunia, or painful intercourse.

Hormonal shifts such as menopause can dampen sex drive and make it harder for women to become aroused when they do pursue sex. But other factors, from medications to the stress of parenthood, also play a role.

“Drive really does wax and wane over a lifespan,” said University of Washington psychologist Dr. Cindy Meston, “and is very much linked with what’s going on in their life.”

For instance, she said, “a bad relationship affects women’s drive more than men’s.”

Other types of dysfunction include sexual pain and vaginismus, an involuntary closure of the vaginal opening that Meston said often has a psychological basis.

As with phobias, vaginismus is best treated through systematic desensitization. Typically, Meston said, women start by inserting a Q-tip and gradually learn to accommodate larger objects.