Sexual Dysfunction .
Sexual dysfunction occurs when you have a problem that prevents you from wanting or enjoying sexual activity. It can happen anytime. Men and women of all ages experience sexual dysfunction, although the chances increase as you age.
Stress is a common cause of sexual dysfunction. Other causes include:
• sexual trauma
• psychological issues
• diabetes
• heart disease or other medical conditions
• drug use
• alcohol use
• certain medications
When does a bad night become a disorder?
Four categories of sexual dysfunction exist. It’s normal not to be in the mood sometimes. None of these should be considered a disorder unless it happens regularly and significantly affects your sexual life:
• Desire disorder is when you have little or no interest in sexual relations on an ongoing basis.
• Arousal disorder means you’re emotionally in the mood, but your body isn’t into it.
• Orgasm disorder means you’re emotionally in the mood, but you have an inability to climax that leaves you frustrated.
• Pain disorder involves having pain during intercourse.
Libido lowdown
In men, low levels of testosterone can cause a loss of libido, or sexual desire. In women, the following can affect desire:
• low estrogen levels
• low testosterone levels
• hormonal changes following childbirth
• breast-feeding
• menopause
Other causes include:
• high blood pressure
• diabetes
• certain medications
• relationship problems
• sexual inhibitions
• stress
• fatigue
• a fear of pregnancy
Sexual dysfunction in men: Erectile dysfunction (ED)
ED occurs when a man cannot achieve or maintain an erection appropriate for intercourse. This can occur due to:
• a problem with blood flow
• a nerve disorder
• an injury to the penis
• psychological problems, like stress or depression
• relationship issues
• Peyronie’s disease
• chronic illness
• some medications
Ongoing ED can cause anxiety.
Sexual dysfunction in men: Ejaculation disorders
Premature ejaculation is ejaculation that happens before or immediately after penetration. This is often a consequence of performance anxiety. It can also be due to:
• other psychological stressors
• sexual inhibitions
• nerve damage
• spinal cord damage
• certain medications
Impaired ejaculation occurs when you can’t ejaculate at all. Some men, particularly those who have diabetic neuropathy, experience retrograde ejaculation. During orgasm, ejaculation enters the bladder instead of exiting out of the penis. Although this doesn’t cause major medical issues, it can impair fertility. You should see your doctor about it if you have it.
Sexual dysfunction in women: Pain and discomfort
Many things can cause pain during sexual activity. Inadequate lubrication and tense vaginal muscles make penetration painful. Involuntary vaginal muscle spasms, or vaginismus, can make intercourse hurt. These may be symptoms of neurological, urinary tract, or bowel disorders.
The hormonal changes of menopause can make intercourse uncomfortable. A drop in estrogen levels can result in thinning of the skin in the genital area. It can also thin the vaginal lining and decrease lubrication.
Sexual dysfunction in women: Difficulty having an orgasm
Stress and fatigue are the enemies of orgasm. So are pain and discomfort during sexual activity. Women may be unable to achieve orgasm when their sex drive is low or when hormones are out of whack.
When to see your doctor
When sexual problems keep happening, both partners can have anxiety. Things can escalate if you don’t discuss it.
If the situation doesn’t improve or you suspect a physical reason, it’s time to see your doctor. Be prepared to give a complete medical history, including a list of prescription and over-the-counter medications. Tell your doctor the specifics of your problem.
Your doctor will begin with a physical exam. Depending on the outcome, this may be followed by a diagnostic testing. If they don’t find a physical cause, consider seeing a therapist.
Treating psychological causes
Psychological counseling may help. A therapist can teach you how to cope with stress and anxiety. Joint counseling with your partner can help improve communication and increase intimacy.
Sometimes, support and education about sexual behavior are all that you need. You can address body image and other inhibitions in counseling. For deeply rooted sexual dysfunction, psychotherapy may be necessary.
Long-term outlook
Often, the longer a sexual dysfunction goes on, the more your level of stress and anxiety rises. This can perpetuate the problem. Most of the time, the outlook for people with sexual dysfunction is quite good. However, some medical conditions make it more difficult to overcome.
You can reverse sexual dysfunction due to stress or temporary circumstances if you approach them openly. Deep-seated psychological issues may take longer to manage or may never fully resolve, but you can improve them.
Dr Anshul Mahajan
Consultant psychiatrist