An estimated four in 10 women experience sexual difficulties at some stage in their lives, with many of these suffering in silence because they are too embarrassed to seek help, a women's health specialist has said.

According to Dr Rachel Mackey of the Women's Health Clinic in Dun Laoghaire, Co Dublin, while there are times in a woman's life when sexual difficulties are to be expected, ‘prolonged sexual problems should be addressed'.

"A lot of women suffer in silence, due to embarrassment. This should never be the case - all women are entitled to a satisfying and enjoyable sex life," she insisted.

Dr Mackey noted that two of the most common difficulties are dyspareunia (pain during or after intercourse) and low libido.

Dyspareunia can be caused by a number of things, including vaginal dryness, pelvic inflammatory disease, skin infections such as thrush, surgery to the vagina such as an episiotomy during childbirth or vaginismus.

Vaginismus is a common condition ‘which affects large numbers of women', Dr Mackey said. It refers to a vaginal tightness causing discomfort, burning, pain, penetration problems, or a complete inability to allow vaginal penetration. Causes can be varied and often, no cause can be found.

"Often it is as simple as their first sexual encounter being less than ideal, being coereced into having sex for the first time without being really willing or inadequate contraception and a fear of subsequent pregnancy. Other possible causes include child sexual abuse and a negativity towards sex instilled from childhood," she explained.

Dr Mackey pointed out that treatment of vaginismus is ‘highly successful but does require some work, both from the woman herself and her partner if she is in a relationship'. Treatment can include an examination of psychological issues, pelvic floor relaxation techniques and vaginal dilator exercises.

In relation to low libido, Dr Mackey acknowledged that this is a subject ‘which rarely comes up for discussion between a woman and her doctor'

She explained that a low libido varies at different times in a woman's life, however it is only a problem if it is unwanted.

"For some women, having a low libido is not a problem and they are quite happy. There is no ‘normal' level of libido for women. It varies and there is a natural decline with age," she said.

Low libido may have a physical cause, such as an illness or certain medications, or it can have a psychological cause, such as poor body image or depression.

There may also be relationship causes, such as if a partner has been unfaithful.

Treatment can include altering medication, hormone therapy or counseling. However, the patient can also help themselves.

According to Dr Mackey, ‘exercise, which will help with stress levels, improving communication and making time for intimacy' can all benefit the patient.

She made her comments in The Irish Journal of Clinical Medicine: Modern Medicine.