Issues that cause a problem with an individual’s ability to have sexual pleasure are sexual dysfunctions. They not only interfere with the sexual cycle and response, but can harm what would normally be a healthy relationship. All people are able to have a sexual disorder, however certain ones increase in likelihood with age. 43% of women and 31% of men in the U.S. have reported that they experience some degree of difficulty in bed, which makes sexual dysfunction a fairly common issue, especially in those 40 years in age or older.
There are numerous causes of the various types of sexual dysfunction. Psychological issues could include stress, anxiety, depression, guilt, marital problems, poor body image, and even PTSD. A physical problem could also be the culprit, including neurological disorders, hormonal imbalances, heart disease, kidney failure, and diabetes. As well, substance abuse can cause these issues, or certain medications may have it as a side effect of using it.
Disorders in Women
Hypoactive Sexual Desire Disorder
HSDD is when a woman experiences a continuous lack of sexual interest, up to the point of it causes her heightened or great stress. It is normal, even healthy, to not desire sex all of the time, as it is just natural for libido to fluctuate, the difference between HSDD and “not being in the mood” is personal distress. If a woman does not express concern for her sex drive or libido, then more than likely it does not indicate HSDD.
All age groups are susceptible, and in the U.S. about 1 in 10 women experience HSDD, making it the most common female sexual dysfunction. The Mayo Clinic found that around 15% of women will continuously experience HSDD, and 40% will, at some point, experience it, though not so constantly.
There are several causes of HSDD, and often they will work together. Physically, it can be caused by cancer, arthritis and coronary artery disease, but it most commonly occurs as a result of menopause. Menopause causes a drop in both testosterone and estrogen in women, both of which are hormones that normally boost the libido. Additionally, hormonal changes during and after pregnancy can bring on HSDD.
Emotional and psychological stress can also bring about HSDD. If a woman suffers from anxiety, depression or low self-esteem, there is a chance that she will experience HSDD. However, in more serious cases, HSDD can be a direct result from trauma, such as physical abuse, sexual abuse or rape.
Diagnosing HSDD can be tricky. Since it’s categorized by a lack of sexual drive and that every woman is different, there is no official threshold or diagnostic test that completely confirms if a woman has HSDD or not. It’s often diagnosed through psychiatric assessment, where doctors assess whether or not a woman is distressed about her sex life. Once a diagnosis has been confirmed they can attempt to pinpoint the cause and then deal with that. It may be as simple as using a different prescription, however it may require that she visit a therapist who specializes in sexual disorders. Some women may need to undergo hormonal therapy in order to restore their libido.
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Sexual Arousal Disorder
Sexual arousal disorder is a biological condition, and as such it shouldn’t be mixed up with other desire disorders. It’s defined as a lack, or complete absence of sexual desires and fantasies in a situation that would typically cause some level of stimulation, or the inability to maintain the arousal. The short of it is that anyone with sexual arousal disorder will not have a genital response when they are participating in a romantic activity, things like dancing, kissing, and direct physical stimulation.
Some symptoms may be:
- A lack of lubrication in the vagina
- Lack of dilation in the vagina
- Decreased genital swelling
- Less sensation in the genitals
- Less sensation in the nipple
Physical factors are far more likely to be a cause of sexual arousal disorder than emotional factors are, though they are possible. In most cases, women with sexual arousal disorder suffer from depletion of hormones, reduced blood flow brought on by cardiovascular diseases, or some form of nerve damage.
Diagnoses requires that women, for a minimum of six months, report three or more of the symptoms, which include significantly fewer sexual fantasies and desires, lack of sexual receptiveness, reduce sexual interest, lack of initiation of sex, reduced responsiveness to erotic cues, lack of genital response to sexual activity, and lack of pleasure or excitement during sex.
Hormone therapy is commonly recommended for treating sexual arousal disorder, but a doctor may recommend blood-flow enhancing medications in order to encourage genital response. In addition, it is also recommended to consult a counselor or sex therapist with treatment to track progress and rule out any possible emotional restrictions towards intimacy.
Female Orgasmic Disorder
Female orgasmic disorder (FOD) is when a woman is constantly unable to achieve an orgasm. The woman is still able to sexually function, so it is different from sexual arousal disorder. They still experience arousal from either emotional or physical stimuli, but are unable or have extreme difficulty reaching climax and releasing tension. They’re stuck in a constant state of stimulation but are never able to be released. This can be extremely frustrating for romantic partners.
FOD may be caused by physical or psychological problems. No matter what stimulation was used, even self-stimulation, the women who have FOD never experience an orgasm during the remainder of the life, as it is a lifelong (or primary) disorder. Often these women are born with it, and there are a few physiological conditions that can include:
- Damage in the pelvic area to the blood vessels
- Lesions on the spinal cord or nerve damage in the pelvic region
- Clitoris removal (also known as female genital mutilation, a practice in Asia, Africa, and the Middle East)
There are some medications that are able to cause FOD as well, including antipsychotics and narcotics.
There are women who experience a secondary, or acquired FOD. These women have had orgasms, but lose the ability after illness, emotional trauma, or as a side effect of surgery or medication. Acquired FOD is often temporary and more easily treated than those who have been born with it. Usually theses cases are caused by psychological influence, including:
- Sexual abuse, incest, rape, or similar traumatic sexual encounters
- Emotional abuse
- Fear of becoming pregnant
- Fear of her partner rejecting her
- Fear of losing control while orgasming
- Self-image problems
- Relationship problems with partner
- Life stresses, such as financial worries, job loss, or divorce
- Feeling guilty with regards to sex or sexual pleasure
- How sex is viewed religiously or culturally
- Mental health disorders like major depression
Similar to the other sexual dysfunctions, FOD will be treated case by case. If the cause is physical, then those issues are treated medicinally and are encouraged to get more exercise with focus on kegel exercises, which improve the strength and tone of muscles in the genital area. Sex education, sex therapy, and psychotherapy may be needed for cases involving emotional related problems.
Genito-Pelvic Pain/Penetration Disorder
Genito-Pelvic Pain/Penetration Disorder (GPPD) is the condition in which women experience major difficulty during intercourse due to painful penetration. An individual’s pain tolerance levels determine the severity of it. For some, it only occurs during vaginal intercourse, while for others it can be as simple as inserting a tampon. Originally, GPPD was considered to be two separate conditions, known as dyspareunia and vaginismus, but the American Psychiatric Association combined them together since, while their technical definitions are strictly different, they commonly appear in tandem with one another are are difficult to tell apart in real life.
Some symptoms may be:
- Regularly struggling with intercourse
- Pain in the genital or pelvic area during vaginal intercourse or attempts at penetration.
- Major fears or anxieties related to the pain of intercourse This fear may be present before, during, or after vaginal penetration.
- Attempts at vaginal intercourse results in the tensing or tightening of pelvic floor muscles.
GPPD causes are still mostly unknown. Experts suspect that it is similar to any other sort of sexual dysfunction, but specifics simply aren’t known at this time. While the most commonly accepted idea is that infections of the pelvic region can cause this genital pain, leading to GPPD, there have also been cases of women who were born with it. Whether genital pain can be expected based on these factors can only be determined by a doctor.
Common Disorders Men Experience
Premature ejaculation (PE) is when ejaculation occurs with minimal stimulation before, during, or quickly after penetration. It is completely involuntary, and men who suffer from PE have little to no control over it. It is one of the most common sexual dysfunction, as almost 30% of men in the U.S. struggle with PE, although it is suspected that number could be higher, as it is considered to be taboo in American culture. All age groups are susceptible to PE.
The cause of PE is unknown at this time. Originally it was thought to be psychological, however studies have found changes in receptor sensitivity in the brain or chemical imbalances may also be a problem. It most commonly occurs later in life in association with age, but it has also been documented that some men experience this issue shortly after they finish puberty.
While it is not currently understood as to what exactly causes PE, the good news is that there are a number of widely accepted methods of treating PE. Desensitizing treatments and ointments are a possible solution, however doctors may also recommend that the men simply masturbate before intercourse. There also have been studies showing that therapy can be beneficial to those suffering from PE.
When a man has a firm erection and enough stimulation, yet still struggles to ejaculate they have delayed ejaculation, the opposite of PE. It’s not as common as PE, but it does occur in almost 5 percent of men in the U.S.
It’s currently believed to be a psychological problem. Self stimulation is able to cause ejaculation for about 85% of men with it. A few other possible causes including the side effect of medications, drug use, alcohol, and neurological damage.
Due to its major psychological component, sex therapy is a top treatment. If it’s the result of medication then a plan and possible alternatives must be discussed with a doctor before changes are made.
Retrograde ejaculation is when semen enters the bladder rather than leave via the penis during ejaculation. It isn’t known to be harmful, however since the sperm isn’t entering the vagina during intercourse it does make fertilization difficult. There’s no sign that it affects other healthy sexual functions, like having an erection or reaching orgasm. There are partial and entire variations, the latter being known as a “dry orgasm” due to the semen not being released. Some possible causes are:
- Damage to muscles or related nerves of the bladder after surgery.
- Nerve damage resulting from a medical illness, such as multiple sclerosis or diabetes.
- Some medications, including alpha-blockers for benign prostatic hyperplasia (BPH).
- Pelvic radiation therapy.
- A side effect of psychiatric drugs and medications for prostate enlargement and high blood pressure.
Unless it interferes with fertilization, retrograde ejaculation isn’t normally treated as it isn’t normally harmful. It is results from diabetes or surgery it typically won’t even be able to be fixed, and will become a lifelong problem. It is possible for a urologist to extract sperm from a man’s urine shortly after orgasm if the patient wishes to use it for artificial insemination. In short, it’s not impossible for men with retrograde ejaculation to impregnate anymore.
Erectile dysfunction (ED) is when a man is unable to fulfill their sexual desires and needs due to their inability to gain or maintain an erection. Men with ED don’t typically love their sexual desire, so the problem is biological and involuntary. This primarily affects 40 to 70 year olds, and is currently the most common sexual dysfunction in men, affecting about 100 million Americans.
In almost all cases, ED is caused by physical ailments, including age, obesity, diabetes, injury and cardiovascular issues such as heart disease. While it is possible to cause ED with psychological issues, like depression or stress, but it is most often caused by a physical condition, and should be discussed with a doctor. Often doctors will end up recommending that the patient takes performance enhancing medications, like Viagra or Cialis, however they may not do so if there are cardiovascular problems.