Dr.Joe's Data Base

PSYCHIATRY RESEARCH TRUST
COMMON SEXUAL DISORDERS
INTRODUCTION

Sex is an almost universal experience. Most men and women will participate in
sexual activity with opposite sex or same sex partners over a prolonged period of
their adult lives. Sexual health has become even more important in the past decade
or so and psychosexual medicine has emerged as a speciality in its own right. Most
individuals will have no problems at all in sexual functioning whereas some may
have short durations of sexual dysfunction. A minority may experience sexual
dysfunction over a prolonged period.

Sexual function can be divided into three phases of sexual arousal, sexual act itself,
then orgasm, or resolution. Sexual arousal may be the result of sexual thoughts,
fantasy, or the actual sexual act. This booklet will not be considering sexual arousal
which depends upon atypical objects like fetishes or other conditions which have
been classified as paraphilia. The aim here is to discuss some basic problems related
to sexual dysfunction in both men and women. It must be emphasised that sexual
dysfunction does not occur in a vacuum and is a reflection of the relationship and
the treatment will often involve both partners even if the dysfunction is experienced
by one individual.

FEMALE SEXUAL DYSFUNCTIONS
ORGASMIC DYSFUNCTION
It is important to note that sex can be enjoyable without reaching orgasm and
therefore not having an orgasm does not necessarily have to be a problem. Some
women may never have been able to reach orgasm, whereas other women may only
be able to have an orgasm in certain situations such as during masturbation or in
foreplay. In order for a woman to have an orgasm, she needs to be stimulated in the
right place. This usually involves touching the area around the clitoris, which is
very sensitive.

It is unusual for a woman to have an orgasm every time she has sex and to have an
orgasm at the same time as her partner. Whereas a man is only able to have one
orgasm at a time, women are capable of having multiple orgasms.

Women who are unable to reach orgasm or find it very difficult to do so, usually
respond quite well to treatment, which involves their partners co-operation.

SEXUAL NON-RESPONSIVENESS
A woman's level of sexual interest may be affected by many factors, especially the
nature of her current relationship, her attitudes towards sexuality, her age,
hormonal changes, and the stage of her menstrual cycle.

Sexual interest and responsiveness is also adversely affected by feelings of anxiety,
guilt, anger, depression and tiredness. This may be seen commonly after child-birth.

Women who have lost their interest in sex may find it difficult to respond to any
sexual advances from their partner. They may tense up when they are approached
which may lead to avoiding sex.

VAGINISMUS
This is a condition in which the muscles around the entrance to the vagina tighten
up whenever penetration is attempted. This is an automatic response, over which
the woman feels she has no control. This tightening of the muscles may make
intercourse impossible or very painful. It is important to note that this problem is
not due to the vagina being too small.

When a woman first starts having intercourse, it is not uncommon for her to have
a mild degree of vaginismus, although this usually disappears in time.

In most cases of vaginismus there is a fear of penetration often associated with a fear
of pain. Women with this problem often find it very difficult to use tampons, and
are often frightened of having internal examinations and of childbirth. Vaginismus
may develop following some traumatic experience such as assault or recurrent
vaginal infections.

This condition usually responds well to treatment using vaginal dilators.

DYSPAREUNIA
This refers to pain during sex. There are a number of possible reasons for this. A
common cause of pain is a failure to lubricate or get wet, which may be due to a lack
of sexual arousal.

Other possible causes are an infection in the vagina such as thrush, or stitching after
childbirth.

Pain or deep penetration often has a physical basis, such as pelvic or urinary
infections and such pain becomes worse with thrusting.

It is important in cases of pain during sex to be examined by your doctors to exclude
any physical problems.

MALE SEXUAL DYSFUNCTIONS
Men may also suffer from loss of interest in sex. This loss is not responsive to
"aphrodisiacs" commonly marketed.

ERECTILE DYSFUNCTION
This dysfunction, in a vast majority of cases, is due to psychological causes. The fear
of losing an erection, anxiety about one's own sexual performance and other factors
which may be related to the relationship contribute to the problem.

The treatment involves breaking the sexual activity down into stages. After the
initial ban on sexual intercourse emphasis is laid on enjoyment and taken away
from performance anxiety. The stages are gradually worked through.

The success rate is generally reported to be fairly high. This depends on the quality
of the relationship, the ability and willingness to carry out simple instructions and
to place the emphasis on the enjoyment rather than erections. Sometimes injections
and medications can be used in managing erectile dysfunctions.

DELAYED EJACULATION
This may include every degree of ejaculatory failure from complete failure to failure
in certain specific conditions only. A large proportion of cases have psychological
causes at the root of the problem. Once again with the help of the partner the
success is reasonably high.

PREMATURE EJACULATION
Premature ejaculation may be defined as ejaculation immediately or soon after
penetration, associated with feelings of loss of control.

This may be due to early sexual experiences being learned in situations where speed
of ejaculation is advantageous. Subsequently a familiar pattern is established which
adds to the anxiety and contributes to premature ejaculation. The experience of
premature ejaculation is relatively common among younger males and may be seen
earlier on in marriage or courtship.

The treatment of premature ejaculation includes simple behavioural techniques. The prognosis is
usually extremely good, although the role of the partner in treatment is very important.

MASTURBATION
Most men and women develop some sort of masturbating pattern in their teens. Some therapists
recommend masturbation using erotic material as part of learning to pleasure oneself.
Masturbation may also form a part of the treatment strategies in many dysfunctions.

In various ages and cultures masturbation has been seen as a shameful and dirty act which may
lead to various problems. This is not true and no correlation has been found between masturbation
and any other physical or emotional problem.

ARTIFICIAL AIDS
For certain sexual problems, artificial aids can have a role to play e.g. vibrators with orgasmic
dysfunction, body massagers for tension and lubricants such as KY jelly for dryness.

MEDICAL CONDITIONS AND DRUGS
Some sexual problems are a direct result of physical illness or medication. Illness generally tends
to result in a loss of interest in sex.

Certain specific medical conditions e.g. diabetes mellitus, myocardial infarction, hypertension,
chronic renal condition, obesity, anorexia, epilepsy and spinal injuries have been associated with
sexual difficulties. Some surgical procedures can also produce these difficulties. However, the
psychological factors may still play an important role in the initiation and perpetuation of such
sexual problems.

EFFECTS OF AGEING ON THE SEXUAL RESPONSE
Age affects sexual dysfunctioning in men and women.

Men experience their peak of sexual responsiveness and capacity in their late teens after which there
is a steady decline. Women on the other hand reach their sexual peak much later, usually in their
late thirties, and after that decline at a relatively slower rate than that of men.

It is important to note that both men and women remain capable of sexual performance and orgasm
through their life-into their eighties and nineties.

MEN
As a man gets older, his refractory period increases such that by the age of fifty, it may be as long
as twelve to twenty-four hours. In addition, the force of ejaculation declines with age and the
orgasm gradually assumes less importance within the sexual experience. After the age of fifty, most
men take longer and need more intense stimulation to achieve an erection and ejaculation.

WOMEN
Women tend to achieve orgasms more easily as they get older and tend to be more responsive
sexually in their thirties. The menopause affects women in different ways, whereas some women
become less interested in sex at this time, many women experience an increase in their sex drive.

THE PSYCHIATRY RESEARCH TRUST NEEDS FUNDS TO
SUPPORT PROJECTS RELATING TO SEXUAL
DYSFUNCTION.

For further information or to make a donation write to: Mrs. Sandra Refault, Psychiatry Research
Trust, De Crespigny Park, Denmark Hill, London SE5 8AF.
Telephone Number: 0171 703 6217 - Registered Charity No. 284286.