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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:
- Drugs, such as alcohol, nicotine, narcotics, stimulants, antihypertensives
(medicines that lower blood pressure), antihistamines, and some psychotherapeutic
drugs (drugs that treat psychological problems such as depression)
- Injuries to the back
- An enlarged prostate gland
- Problems with blood supply
- Nerve damage (as in spinal cord injuries)
- Disease (diabetic neuropathy,
multiple sclerosis, tumors, and,
rarely, tertiary syphilis)
- Failure of various organs (such as the heart and lungs)
- Endocrine disorders (thyroid, pituitary,
or adrenal gland problems)
- Hormonal deficiencies (low testosterone, estrogen, or androgens)
- Some birth defects
Sexual dysfunctions are more 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 geriatric 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.
Sexual dysfunction disorders are generally classified into 4 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 female sexual dysfunction, a term that covers
a range 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.
Poor lubrication may result from insufficient excitement and stimulation, or
from hormonal changes caused by menopause, pregnancy, 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.
- Men or women:
- Lack of interest in sex (loss of libido)
- Inability to feel aroused
- Pain with intercourse (much less common in men than women)
- Men :
- Inability to attain an erection
- Inability to maintain an erection adequately for intercourse
- Delay or absence of ejaculation, despite adequate stimulation
- Inability to control timing of ejaculation
- Women:
- Inability to relax vaginal muscles enough to allow intercourse
- Inadequate vaginal lubrication before and during intercourse
- Inability to attain orgasm
- Burning pain on the vulva or in the vagina with contact to those areas
Specific physical findings and testing procedures depend on the form of sexual
dysfunction being investigated. A complete history is usually taken and a physical
examination performed to:
- Identify predisposing illnesses or conditions
- Highlight possible fears, anxieties, or guilt specific to sexual behaviors
or performance
- Uncover any history of prior sexual trauma
A physical examination of both the partners should include the whole body and
not be limited to the reproductive system.
Call for an appointment with your health care provider if sexual problems persist
and are a concern.
Treatment depends on the cause of the sexual dysfunction. Medical causes that
are reversible or treatable are usually managed medically or surgically. Physical
therapy and mechanical aides may prove helpful for some people experiencing sexual
dysfunction due to physical illnesses, conditions, or disabilities.
For men who have difficulty attaining an erection, the medication sildenafil
(Viagra.html" class="links">Viagra), which increases blood flow to the penis, may
be very helpful, though it must be taken 1 to 4 hours prior to intercourse.
Men who take nitrates for coronary heart disease should not take sildenafil.
Mechanical aids and penile implants are also an option for men who cannot attain
an erection and who find that sildenafil isn't helpful.
Women with vaginal dryness may be helped with lubricating gels, hormone creams,
and -- in cases of premenopausal or menopausal women -- with hormone replacement
therapy. In some cases, women with androgen deficiency can be helped by taking testosterone.
Vulvodynia can be treated with testosterone cream, with use of biofeedback, and
with low DOSes of some antidepressants, which also treat nerve pain. Surgery has
not been successful.
Behavioral treatments involve many different techniques to treat problems associated
with orgasm and sexual arousal disorders. Self-stimulation and the Masters and Johnson
treatment strategies are among the many behavioral therapies used.
Simple, open, accurate, and supportive education about sex and sexual behaviors
or responses may be all that is required in many cases. Some couples may benefit
from joint counseling to address interpersonal issues and communication styles.
Psychotherapy may be required to address anxieties, fears, inhibitions, or poor
body image.
Open, informative, and accurate communication regarding sexual issues and body
image between parents and their children may prevent children from developing anxiety
or guilt about sex and may help them develop healthy sexual relationships.
Review all medications, both prescription and over-the-counter, for possible
side effects that relate to sexual dysfunction. Avoiding drug and alcohol abuse
will also help prevent sexual dysfunction.
Couples who are open and honest about their sexual preferences and feelings are
more likely to avoid some sexual dysfunction. One partner should, ideally, be able
to communicate desires and preferences to the other partner.
People who are victims of sexual trauma, such as sexual abuse or rape at any
age, are urged to seek psychiatric advice. Individual counseling with an expert
in trauma may prove beneficial in allowing sexual abuse victims to overcome sexual
difficulties and enjoy voluntary sexual experiences with a chosen partner. |
