Sexual dysfunction is any issue that prevents you from enjoying sexual activity either fully or at all. They are disorders that interfere with a full sexual response cycle, and can cause serious strains on otherwise healthy relationships. Both genders are able to suffer from the disorders, and as you age you’ll be more likely to have problems. With over 31% of men and 43% of women experience varying degrees of trouble in the bedroom, sexual dysfunction has been found to be a common problem, which is especially true for those over the age of 40.
Sexual dysfunction can be brought on by a number of different sources. It can be psychological, which includes work-related stress, anxiety, marital or relationship issues, depression, guilt, concerns with body image, or even post-traumatic stress disorder. A physical problem could also be the culprit, including neurological disorders, hormonal imbalances, heart disease, kidney failure, and diabetes. Both substance abuse and regulated medications are capable of causing these problems as well.
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’s normal for a woman to not always be in the mood, as the libido will have a natural fluctuation to it, however HSDD is when a lack of desire causes personal distress. If a woman doesn’t show her concern for her libido or sex drive then she likely isn’t experiencing HSDD.
As the most common female sexual dysfunction, 1 in 10 women in the U.S. experience HSDD, and it is able to occur in all age groups. 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.
HSDD can be the result of numerous issues, and these issues will often work in tandem. It can be the physical result of arthritis, cancer, coronary artery disease, and most commonly menopause. Menopause causes a drop in both testosterone and estrogen in women, both of which are hormones that normally boost the libido. HSDD may also result from the hormonal changes that occur during and after pregnancy.
HSDD can also be the result of psychological and emotional stress. Women who suffer from depression, anxiety, or low self-esteem are able to develop HSDD. However, in more serious cases, HSDD can be a direct result from trauma, such as physical abuse, sexual abuse or rape.
It can be hard to diagnose HSDD. It’s a lack of a sex drive, and given that each woman is unique there’s no way to set a minimum bar or threshold that can be tested or used to make a confirmation. 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. While she may only need a different prescription, she might also have to go and visit a counselor who actually specializes in sexual disorders. In some cases, women undergo hormonal therapy to regain 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 an inability to maintain arousal, or the lack of sexual fantasies and desires in situations that would normally cause some level of stimulation. The idea is that most romantic activities do not trigger a genital response in those with sexual arousal disorder, such as kissing, or dancing, or even direct physical stimulation.
- Lacking in vaginal lubrication
- Lack of vaginal dilation
- Less swelling of the genitals
- Lacking in genital sensation
- Less sensation in the nipple
It is possible that sexual arousal disorder can be caused by more emotional factors (stress, relationships, low self-esteem, etc.), but more than likely it is caused by physical factors. Most cases of sexual arousal disorder are caused by a reduced blood flow due to cardiovascular disease, hormone depletion, and nerve damage.
In order to properly diagnose sexual arousal disorder, women must report, for at least six months, three or more symptoms, including reduced interest in sexual activity, significantly fewer sexual fantasies and desires, lack of initiation of sex, lack of receptiveness to sexual activities, lack of excitement or pleasure during sex, reduced responsiveness to erotic cues, and lack of genital response to sexual activity.
The most common treatment for sexual arousal disorder is hormone therapy, though a doctor may feel the need to recommend medications for blood-flow enhancement to help encourage response in the genitals. As well, its recommended that those who suffer from it should see a sex therapist or counselor in order to track the treatment and ensure there are no emotional restrictions.
Female Orgasmic Disorder
Woman who are unable to orgasm have FOD (female orgasmic disorder). The woman is still able to sexually function, so it is different from sexual arousal disorder. The women are still able to experience arousal due to physical or emotional stimuli, however they either have extreme difficulty with, or are completely unable to reach climax and release tension. It is a constant state of stimulation with no final release. This can be extremely frustrating for romantic partners.
FOD can be both physical and psychological. FOD is a primary, or lifelong disorder, and most often the women who have it have never achieved orgasm, no matter what type of stimulation they received. Often these women are born with it, and there are a few physiological conditions that can include:
- Pelvic blood vessel damage
- Pelvic nerve damage or spinal cord lesions
- Clitoris removal (also known as female genital mutilation, a practice in Asia, Africa, and the Middle East)
It is also worth mentioning that certain medications can cause FOD as well, such as narcotics and antipsychotics.
There are women who experience a secondary, or acquired FOD. These women were able to orgasm, however they’ve lost the ability to after emotional trauma, illness, or as a side effect of medication or surgery. Unlike primary FOD where an individual is typically born with the issue, acquired FOD is normally temporary and treatable. Usually theses cases are caused by psychological influence, including:
- Sexual abuse, incest, rape, or similar traumatic sexual encounters
- Abuse emotionally
- Pregnancy fear
- Fear of her partner rejecting her
- Fear of loss of control during orgasm
- Struggles with self-image
- Problems in the relationship
- Stress from life, including divorce, job loss, and financial concerns
- Guilt over sex or sexual pleasure
- Religious or cultural beliefs about sex
- 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. For those who have FOD due to an emotional problem they may use a combination of sex therapy, psychotherapy, and full sexual education.
Genito-Pelvic Pain/Penetration Disorder
Genito-Pelvic Pain/Penetration Disorder (GPPD) is a condition where women experience extreme difficulty during intercourse because of pain during penetration. The severity of the pain is dependent on the individual’s pain tolerance. Some may only experience it during vaginal intercourse, but others may experience it in something like inserting a tampon. While dyspareunia and vaginismus were two separate conditions originally, the American Psychiatric Association combined them together into GPPD, as they typically appear together and are hard to distinguish between in real life.
Symptoms may include:
- Persistent problems with having intercourse
- Pain in the genital or pelvic area during vaginal intercourse or attempts at penetration.
- Significant fear or anxiety associated with the pain of intercourse. The fear can be present before, during, or after any vaginal penetration.
- Tensing or tightening of the pelvic floor muscles when attempting vaginal intercourse.
GPPD causes are still mostly unknown. Currently specifics are unknown, however the thought is that it is similar to other sexual dysfunctions. 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 or not genital pain might be expected based on these factors can only be determined by your doctor.
Disorders in Men
PE (Premature ejaculation) is when an ejaculative response occurs with minimal stimulation either before, during, or short after penetration. It is completely involuntary, and men who suffer from PE have little to no control over it. The disorder affects 30% of men in the U.S., though this number is thought to be higher with many cases unreported, and thusly is the most common sexual dysfunction. All age groups are susceptible to PE.
PE causes are still unknown. It was historically accepted as a purely psychological disorder, but recent studies suggest that it can also be due to chemical imbalances or changes in receptor sensitivity in the brain. 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.
Despite the causes still being unknown, there are several methods to treat PE. Doctors can prescribe desensitization treatments or ointments, or may simply recommend that the patient masturbates before having 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. About 5% of men in the U.S. suffer from delayed ejaculation.
Generally speaking, delayed ejaculation is considered to be psychological in nature. 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 a medication is causing the issue then men should speak with a doctor and look for possible alternative options before they try to cut the medication out.
Semen entering the bladder rather than leaving the penis during ejaculation is called Retrograde ejaculation. While it isn’t necessarily harmful, it does make fertilization difficult as it affects the sperm delivery during vaginal intercourse. It does not inhibit other healthy sexual functions, such as having an erection or reaching orgasm. It can be partial or whole, which is also known as a “dry orgasm” as no semen is released. Possible causes of retrograde ejaculation include:
- Damage to the muscles of the bladder or to the nerves that control these muscles after surgery.
- Nerve damage due to medical illnesses, like diabetes or multiple sclerosis.
- Certain medications, including alpha blockers for BPH (benign prostatic hyperplasia)
- Pelvic radiation therapy.
- Side effect of certain psychiatric drugs and medications used to treat high blood pressure and prostate enlargement.
As retrograde ejaculation isn’t harmful it normally won’t need treatment, unless it is interfering with fertilization. However, if it is a result from surgery or diabetes, it is often not correctable, and it will affect the patient for the rest of his life. 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. It is still possible to impregnate someone with retrograde ejaculation.
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. The dysfunction is biological and 100% involuntary, since the men with ED continue to feel sexual desire. It is the most common sexual dysfunction in men, affecting what it estimated to be 100 million Americans, usually occurring in age groups between 40 and 70, but it can occur in younger age groups as well.
The causes are typically related to age, diabetes, obesity, cardiovascular issues, and injury. You should speak with a doctor about this issue as it is almost always the result of a physical condition, though on occasion there are psychological causes, like stress and depression. 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.