Sexual dysfunction is broadly defined as the inability to fully enjoy sexual intercourse. Specifically, sexual dysfunction is a group of disorders that interfere with a full sexual responsiveness. These disorders make it difficult for a person to enjoy or to have sexual intercourse. While sexual dysfunction rarely threatens physical health, it can take a heavy psychological toll, bringing on depression, anxiety, and debilitating feelings of inadequacy.
Sexual dysfunction takes different forms in men and women. A dysfunction can be lifelong and always present, or it can be temporary and sporadic. It can be situational or generalized. In either gender, symptoms of a sexual problem include the lack or loss of sexual desire, anxiety during intercourse, pain during intercourse, or the inability to achieve orgasm. In addition, a man may have a sexual problem if he:
- Ejaculates before he or his partner desires.
- Does not ejaculate, or experiences delayed ejaculation.
- Is unable to have or maintain an erection sufficient for pleasurable intercourse.
Also, a woman may have a sexual problem if she:
- Feels vaginal or other muscles contract involuntarily before or during sex.
- Has inadequate vaginal lubrication.
The most common sexual dysfunctions in men include:
- Erectile dysfunction: an impairment of a man's ability to have or maintain an erection that is firm enough for coitus or intercourse.
- Premature ejaculation, or rapid ejaculation, with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it.
- Ejaculatory incompetence: the inability to ejaculate within the vagina despite a firm erection and relatively high levels of sexual arousal.
- Retarded ejaculation: a condition in which the bladder neck does not close off properly during orgasm so that the semen spurts backward into the bladder.
Female sexual dysfunctions include:
- Sexual arousal disorder: the general arousal aspect of sexual response is inhibited. A woman with this disorder does not lubricate, her vagina does not swell, and the muscle that surrounds the outer third of the vagina does not tighten—a series of changes that normally prepare the body for orgasm ("the orgasmic platform"). Also, in this disorder, the woman typically does not feel erotic sensations.
- Orgasmic disorder: the orgasmic component of the female sexual response is impaired. The woman may be sexually aroused but never reach orgasm.
- Vaginismus: a condition in which the muscles around the outer third of the vagina have involuntary spasms in response to attempts at vaginal penetration.
- Painful intercourse also known as dyspareunia.
Causes & symptoms
Many factors of both physical and psychological origin can affect sexual response and performance. Injuries, such ailments as infections, and drugs of abuse are among the physical influences. Certain prescription medications, such as drugs to regulate blood cholesterol levels, may also affect sexual functioning. In addition, there is increasing evidence that chemicals and other environmental pollutants depress sexual function. As for psychological factors, sexual dysfunction may have roots in traumatic events such as rape or incest, guilt feelings, a poor self-image, depression, chronic fatigue, certain religious beliefs, or marital problems. Dysfunction is often associated with anxiety. If a man operates under the misconception that all sexual activity must lead to intercourse and to orgasm by his partner, he may consider the act a failure if his expectations are not met.
In Chinese medicine, sexual dysfunction is considered an imbalance of yin and yang. Yin and yang are the two dependent and constantly interacting forces of energy in the world, according to ancient Chinese thought. Yin energy is receptive, dark, feminine, and cool. It is associated with the heavy, the cold, and the moist. Yang energy is masculine, active, bright, and warm. It is associated with the dry, the light, and the hot. People with sexual dysfunction who have yin deficiency are too dry and tired, causing premature ejaculation or dry and spastic conditions. Symptoms of a yang deficiency may include erectile dysfunction as well as lack of sexual appetite or excitement. There are other imbalances that can cause sexual dysfunction.
Other types of alternative medicine, such as herbalism, regard sexual dysfunction as stemming from the same causes as those recognized by Western medicine. In such alternative approaches as homeopathy, sexual dysfunction is seen as an energy deficiency in the sexual organs or the glands that regulate these organs.
In deciding whether sexual dysfunction is present, it is necessary to remember that each person has a different level of sexual interest. While some people may be interested in sex at almost any time, others have low or seemingly nonexistent levels of sexual interest. A sexual condition is classified as sexual dysfunction only when it is a source of personal or interpersonal distress instead of a voluntary choice.
The first step in diagnosing a sexual dysfunction is usually discussing the problem with a doctor or an alternative practitioner, who will need to ask further questions so he or she can differentiate among the types of sexual dysfunction. The physician may also perform a physical exam of the genitals, and may order further medical tests, including measurement of hormone levels in the blood.
An expert in Chinese medicine will take the pulses at the wrist to assess the patient's overall health. According to Chinese thought, there are 12 pulses at the wrist, six on each wrist. The practitioner will ask questions that relate to yin and yang energy, such as whether the patient's hands and feet are cold or warm most of the time. An alternative practitioner is also likely to query the patient about his diet and any issues in his life that may be contributing to stress.
In allopathic medicine, men may be referred to a urologist, a specialist in diseases of the urinary and genital organs, and women may be referred to a gynecologist.
A variety of alternative therapies can be useful in the treatment of sexual dysfunction. Counseling or psychotherapy is highly recommended to address any emotional or mental components of the disorder. Nutritional supplementation, as well as Western, Chinese, or ayurvedic botanical medicine, can help resolve biochemical causes of sexual dysfunction.
Beneficial supplements and herbs include gingko biloba, which improves circulation to the genitals and has been shown to be effective in a number of studies. If the cause is a psychological, emotional, or energy disorder, such adrenal tonics as licorice, epimedium, eucommia, and cuscuta can restore the patient's mood and increase sexual interest. These herbs increase the ability to adapt to physical and mental stress because they increase the power of the adrenal system, which secretes the brain chemical epinephrine. If the patient's reproductive organs are not producing enough of the hormones that regulate sex drive and function, vitex is also a good solution. When a patient lacks sexual drive, such tonics as deer antler can increase interest in sex.
One drug derived from herbal sources that is used in mainstream medicine to treat impotence in men is
Homeopathic treatment can be helpful by focusing on the energetic aspects of the disorder. A Chinese medicine practitioner might address sexual dysfunction by using acupuncture, in which hair-thin needles are used to stimulate the body's energy (or qi). According to ancient Chinese theory, the body has 12 meridians that correspond to various organs, their functions, and the patient's emotions. Acupuncture needles might be applied at points on these meridians that regulate the kidney, which forms the foundation for the reproductive system in traditional Chinese medicine, or to other meridians that have roles in sexual function.
Yoga and meditation provide needed mental and physical relaxation for conditions such as vaginismus. A yoga teacher may advise forward bends to calm the patient and yoga twists to help the body produce hormones that increase sexual drive and a feeling of well-being.
A massage therapist or aromatherapist can also provide sandalwood or jasmine oils to boost sexual drive. An aromatherapist usually prescribes singular scents or a mixture created with the person's preferences and his or her symptoms in mind.
Allopathic treatments break down into two main categories: behavioral psychotherapy and physical treatment. Sex therapy, ideally provided by a member of the American Association of Sexual Educators, Counselors, and Therapists (AASECT), emphasizes correction of sexual misinformation, the importance of improved partner communication and honesty, anxiety reduction, sensual experience and pleasure, and interpersonal tolerance and acceptance. Sex therapists believe that many sexual disorders are rooted in learned patterns and values. These disorders or symptoms are termed psychogenic. An underlying assumption of sex therapy is that relatively short-term outpatient therapy can alleviate learned patterns, restrict symptoms, and allow a greater satisfaction with sexual experiences.
In some cases, a specific technique may be used during intercourse to correct a dysfunction. One of the most common is the "squeeze technique" to prevent premature ejaculation. When a man feels that an orgasm is imminent, he withdraws from his partner. Then, the man or his partner gently squeezes the head of the penis to halt the orgasm. After 20-30 seconds, the couple may resume intercourse. The couple may repeat this technique several times before the man proceeds to ejaculation.
In cases in which significant sexual dysfunction is linked to a broader emotional problem such as depression or substance abuse, intensive psychotherapy and/or medications may be appropriate. People who are taking such medications as fluoxetine (Prozac), paroxetine (Paxil), or reboxetine (Edronax) for depression, however, should be advised that sexual dysfunction in adults of either sex is a fairly common side effect of these medications.
In many cases, doctors prescribe medications to treat an underlying physical cause of sexual dysfunction. Possible medical treatments include:
- Clomipramine and fluoxetine for premature ejaculation.
- Papaverine and prostaglandin for erectile difficulties.
- Hormone replacement therapy or androgen therapy for female dysfunctions.
- Sildenafil (Viagra), a drug approved in 1998 as a treatment for impotence. As of 2002, however, sildenafil has been shown to have potentially serious side effects, including headaches, nausea, sudden changes in blood pressure, and eye disorders.
There is no single cure for sexual dysfunction, but almost all of the individual conditions can be controlled. Most people who have a sexual dysfunction fare well once they get into a treatment program. Most alternative therapies, however, take at least several weeks to take effect. If the patient doesn't see improvement in that time, he or she should consider trying another practitioner.
It often helps to continue such treatments, such as acupuncture and massage after the initial problem is resolved. Doing so keeps sexual energy high and the genital organs and sex glands healthy. By continuing to use alternative therapies, the patient can help maintain sexual interest even when normal sexual doldrums occur. Continuing to take alternative medicines or treatment also ensures the problem won't return.
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American Academy of Clinical Sexologists. 1929 18th Street NW, Suite 1166, Washington, DC 20009. (202) 462-2122.
American Association for Marriage and Family Therapy. 1100 17th Street NW, 10th Floor, Washington, DC 20036-4601. (202) 452-0109.
American Association of Oriental Medicine. 909 22nd St. Sacramento, CA 95816. (916) 451-6950. <http://www.aaom.org>.
American Association of Sex Educators, Counselors & Therapists. P.O. Box 238, Mt. Vernon, IA 52314. <http://www.aasect.org>.
Yoga Research and Education Center. P.O. Box 1386, Lower Lake, CA 95457. (707) 928-9898. <http://www.yrec.com.>.
Rebecca J. Frey, PhD