Sexual problems are defined as difficulty during any stage (desire, arousal, orgasm, and resolution) of the sexual act, which prevents the individual or couple from enjoying sexual activity. These apply equally to heterosexual, gay, lesbian and bisexual people.
Development of sexual disorders:
Sexual difficulties may begin early in a person’s life, or they may develop after an individual has previously experienced enjoyable and satisfying sex.
A problem may develop gradually over time, or may occur suddenly as a total or partial inability to participate in one or more stages of the sexual act. The causes of sexual difficulties can be physical, psychological, or both.
Emotional factors affecting sex include both interpersonal problems and psychological problems within the individual.
- Interpersonal problems include marital or relationship problems, or lack of trust and open communication between partners.
- Personal psychological problems include depression, sexual fears or guilt, or past sexual trauma.
Physical factors contributing to sexual problems include:
- Injuries to the back
- An enlarged prostate gland
- Disease (diabetic neuropathy, multiple sclerosis, tumors, and, rarely, syphilis)
- Drugs, such as alcohol, nicotine, narcotics, stimulants, antihypertensives (medicines that lower blood pressure), antihistamines, and some psychotherapeutic drugs (used to treat psychological problems such as depression)
- Endocrine disorders (thyroid, pituitary, or adrenal gland problems)
- Failure of various organs (such as the heart and lungs)
- Hormonal deficiencies (low testosterone, estrogen, or androgens)
- Nerve damage (as in spinal cord injuries)
- Problems with blood supply
- Some birth defects
Sexual dysfunction disorders are generally classified into four categories:
- sexual desire disorders,
- sexual arousal disorders,
- orgasm disorders, and
- sexual pain disorders.
Sexual desire disorders (decreased libido) may be caused by a decrease in the normal production of estrogen (in women) or testosterone (in both men and women).
Other causes may be aging, fatigue, pregnancy, and medications — the SSRI anti-depressants which include fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil) are well known for reducing desire in both men and women. Psychiatric conditions, such as depression and anxiety, can also cause decreased libido.
Sexual arousal disorders were previously known as frigidity in women and impotence in men. These have now been replaced with less judgmental terms. Impotence is now known as erectile dysfunction, and frigidity is now described as any of several specific problems with desire, arousal, or anxiety.
For both men and women, these conditions may appear as an aversion to, and avoidance of, sexual contact with a partner. In men, there may be partial or complete failure to attain or maintain an erection, or a lack of sexual excitement and pleasure in sexual activity.
There may be medical causes for these disorders, such as decreased blood flow or lack of vaginal lubrication. Chronic disease may also contribute to these difficulties, as well as the nature of the relationship between partners. As the success of Viagra attests, many erectile disorders in men may be primarily physical, not psychological conditions.
Orgasm disorders are a persistent delay or absence of orgasm following a normal sexual excitement phase. The disorder occurs in both women and men. Again, the SSRI antidepressants are frequent culprits — these may delay the achievement of orgasm or eliminate it entirely.
Sexual pain disorders affect women almost exclusively, and are known as dyspareunia (painful intercourse) and vaginismus (an involuntary spasm of the muscles of the vaginal wall, which interferes with intercourse). Dyspareunia may be caused by insufficient lubrication (vaginal dryness) in women. There may also be abnormalities in the pelvis or the ovaries that can cause pain with intercourse. Vulvar pain disorders can also cause dyspareunia and inability to have intercourse due to pain.
Poor lubrication may result from insufficient excitement and stimulation, or from hormonal changes caused by menopause or breast-feeding. Irritation from contraceptive creams and foams may also cause dryness, as can fear and anxiety about sex.
It is unclear exactly what causes vaginismus, but it is thought that past sexual trauma such as rape or abuse may play a role. Another female sexual pain disorder is called vulvodynia or vulvar vestibulitis. In this condition, women experience burning pain during sex which may be related to problems with the skin in the vulvar and vaginal areas. The cause is unknown.
Who suffers and when
Sexual dysfunctions are most common in the early adult years, with the majority of people seeking care for such conditions during their late 20s through 30s. The incidence increases again in the menopause transition and post-menopause years in women, and in the elderly population, typically with gradual onset of symptoms that are associated most commonly with medical causes of sexual dysfunction.
Sexual dysfunction is more common in people who abuse alcohol and drugs. It is also more likely in people suffering from diabetes and degenerative neurological disorders. Ongoing psychological problems, difficulty maintaining relationships, or chronic disharmony with the current sexual partner may also interfere with sexual function.
Men or women:
- Inability to feel aroused
- Lack of interest in sex (loss of libido)
- Pain with intercourse (much less common in men than women)
- Delay or absence of ejaculation, despite adequate stimulation
- Inability to control timing of ejaculation
- Inability to get an erection
- Inability to keep an erection adequately for intercourse
- Burning pain on the vulva or in the vagina with contact to those areas
- Inability to reach orgasm
- Inability to relax vaginal muscles enough to allow intercourse
- Inadequate vaginal lubrication before and during intercourse
- Low libido due to physical/hormonal problems, psychological problems, or relationship problems
Some forms of sexual dysfunction may cause infertility.
Persistent sexual dysfunction may cause depression in some individuals.
The importance of the disorder to the individual (and couple, when applicable) needs to be determined. Decreased sexual function is important only if it is a cause of concern for the couple. Sexual dysfunction that is not addressed adequately may lead to conflicts or potential breakups.
Call your health care provider if…
- Call for an appointment with your health care provider if sexual problems persist and are a concern.