Sexual dysfunction is a term that covers any problem affecting any of the phases of sexual response, and which inhibits one or both partners from attaining sexual satisfaction. The various phases of the sexual cycle include excitement, plateau, orgasm, and resolution.
Sexual dysfunction affects up to 43 percent of women and 31 percent of men to varying extent and is of several types.
Some examples of male sexual dysfunction include erectile dysfunction, orgasm/ejaculation disorders, and priapism or painful erections. Female sexual problems include loss of interest in sex, difficulty reaching orgasm, negative thoughts during sex, and vaginal dryness and tightness causing painful intercourse.
Types of sexual dysfunction are:
- Sexual desire disorders
- Arousal disorders
- Orgasm disorders
- Sexual pain disorders
Sexual Desire Disorders
These are problems that involve a lack or absence of sexual drive, also referred to as a low libido. The lack of desire may apply in general or towards the current partner. The disorder may have always been present or may develop after a period of sexual function being normal.
Low levels of the female hormone estrogen and the male hormone testosterone can lead to a decrease in sexual desire. Testosterone maintains sexual drive in addition to sperm production, muscle and bone development and male pattern hair growth.
Precipitating factors include increasing age, pregnancy, depression, anxiety, and the use of certain medications such as selective serotonin re-uptake inhibitors. Relationship conflicts, and physical illness such as diabetes or hypertension are other contributors.
Sexual Arousal Ddisorders
Previously, terms used to describe a sexual arousal disorder have included “frigidity” in the case of women and “impotence” in the case of men but these terms are generally not currently used. Impotence is now described as erectile dysfunction and a number of terms exist to describe frigidity. These individuals may have an aversion to or tendency to avoid sexual contact with a partner. Males may find they can only maintain a partial erection or they may be unable to obtain one at all. Affected males may also find they gain no pleasure or excitement from sexual activity.
Erectile dysfunction refers to being unable to maintain an erection for intercourse, and may affect about 50 percent of males in America after the age of 40 years.
The causes of erectile dysfunction include:
- Hardening of the arteries or other vascular diseases
- Neurological disorders
- Psychological factors such as stress, conflicts between partners, depression and performance anxiety
- Penile trauma
- Chronic disease such as diabetes mellitus or hypertension
- Alcoholism, smoking, obesity and a sedentary lifestyle
Among affected females, the vagina may fail to become lubricated prior to intercourse.
Individuals affected by an orgasm disorder fail to achieve climax or find that climax is often delayed. These disorders may be caused by physical factors, illness or even as a result of using certain medications. In males, orgasm disorders include ejaculation disorders.
Ejaculation disorders are classified as:
- Premature ejaculation (before or very soon after penetration occurs)
- Inhibited or delayed ejaculation (taking a very long time to ejaculate following penetration)
- Retrograde ejaculation (ejaculation into the bladder rather than through the penile orifice) – especially in diabetics, but also with some medications or following certain bladder neck or prostatic surgeries
Some factors causing premature ejaculation may be psychological, such as:
- Performance anxiety during intercourse
- Stress or depression
- Conflict or communication barriers between the partners
Physical causes could include:
- Chronic illness
- Certain adverse effects due to medications
Sexual Pain Disorders
Sexual pain disorders are mainly confined to women and are caused by inadequate lubrication of the vagina during sex. This may be caused by a lack of stimulation or excitement about the sexual activity or by hormonal changes that occur as a result of pregnancy, breastfeeding or menopause. Other causes include irritation due to the use of contraceptive creams, and anxiety about engaging in sex.
Sexual pain may also be caused by a condition called vaginismus, where the muscles of the vaginal wall spasm involuntarily during intercourse. The cause of these spasms is not clear but previous sexual trauma such as abuse or assault has been suggested as a trigger of the condition.
One sexual pain disorder that occurs in males is referred to as priapism, which is a painful erection that may persist for several hours, even in the absence of sexual stimulation. This is caused by blood entrapment within the penis, failing to drain adequately. If left untreated, the condition may lead to a permanent loss of erectile function. Other sources of sexual pain in males include Peyronie’s disease which is post-traumatic, urinary infections, prostatic inflammation, yeast infections, genital herpes and skin disease.