SEXUAL DYSFUNCTION IN WOMEN
Arousal Phase Disorders
The arousal phase of sexual excitement occurs in response to sexual stimuli and results in vaginal lubrication and expansion. Arousal disorders are defined as impaired female excitement or the persistent and recurrent lack of response to sexual stimuli and activity, resulting in lack of vaginal lubrication and engorgement. Estimates of the prevalence of arousal disorders in the general population vary between 11% and 48%.Causes of arousal problems include pelvic vascular disease; neurological conditions; hormonal changes; and psychosocial factors, such as stress, prior history of sexual trauma, painful intercourse, or relationship problems.
Orgasm Phase Disorders
Impaired or inhibited orgasm, or anorgasmia, is the total absence of orgasm or the persistent, recurrent delay of orgasm following normal and sufficient arousal. Today about one-third of young women experience orgasm phase disorder. Primary anorgasmia is never having experienced orgasm either alone or with a partner following any kind of stimulation. Secondary anorgasmia is the absence or delay of orgasm after previously having been orgasmic.
Vaginismus is defined as recurrent and persistent involuntary vaginal spasms or muscle contractions that make entry into the vagina impossible or painful. Although the woman is sexually aroused and capable of experiencing an orgasm, the vaginal muscles close tightly, preventing penile or digital entry into the vagina. Vaginismus may be caused by physical problems, emotional trauma, or psychosocial stressors.
Painful intercourse can occur for reasons that range from structural problems to psychological concerns. Many women have painful intercourse at some point in their lives. The medical term for painful intercourse is dyspareunia (dis-puh-ROO-nee-uh), defined as persistent or recurrent genital pain that occurs just before, during or after intercourse. Talk to your doctor if you are having painful intercourse. Treatments focus on the cause, and can help eliminate or lessen this common problem. Physical causes of painful intercourse differ, depending on whether the pain occurs at entry or with deep thrusting. Emotional factors might be associated with many types of painful intercourse.
SEXUAL DYSFUNCTION IN MEN
Premature ejaculation, or inadequate ejaculatory control, is the inability to exert voluntary control over the ejaculatory reflex, so that once a man reaches a certain level of sexual arousal or excitement, he ejaculates reflexively and rapidly soon after or even before vaginal penetration. Organic causes of premature ejaculation involve congenital conditions; neurological problems; side effects of medications; and other health problems, including hormonal changes (especially hormone medications used for infertility treatment). Psychological factors (apart from learned response) may be related to infertility with its emphasis on sex for procreation; the man’s (or couple’s) attempts to make the sexual encounter as brief as possible; or habituated rapid ejaculation to provide specimens for infertility treatment.
Inhibited or Delayed Ejaculation
Inhibited or delayed ejaculation or orgasm (sometimes referred to as retarded ejaculation) is the persistent and recurrent inhibition of orgasm, manifested by delay or absence of ejaculation following adequate sexual excitement. It is commonly defined as difficulty or inability to ejaculate during sexual intercourse or masturbation. Historically, physical causes have been rare; although delayed ejaculation may be symptomatic of underlying medical conditions or due to physical conditions such as spinal cord injury. Recently, delayed ejaculation has been identified as a common side effect of some antidepressant medications, particularly SSRIs. Psychological etiology may be due to performance anxiety; depression; anger; guilt regarding sex in general or with certain partners; relationship problems; traumatic sexual history; religious orthodoxy; prolonged fear of pregnancy leading to conditioned response; history of withdrawal method of birth control; gender identity issues; cultural factors; and/or partner unresponsiveness. Recently it has been suggested that delayed or retarded ejaculation is due to a combination of insufficient arousal to reach orgasm in intercourse and reflex inhibition.