Sexual problems - an overview

Related pages

• Sex problems, areas to consider

• Sex therapy

• Vaginismus

• Erectile dysfunction

• Rapid orgasm in men

• Taking too long to ejaculate

• Low sex drive

• Negotiating differences in sexual desire

• Sensate focus

• Sexual aversion and vaginal aversion

• Increasing your sensuality

• Female Sexual Arousal Disorder

She says:

Below is a list with brief descriptions of the main problems described in the psychosexual literature for men and women. Once you find a name for a problem you're struggling with, it can help you to understand it better and get more information about it. However, don't panic when you read about sexual "disorders". The field of psychosexual problems is dominated by doctors and their language, and doctors call anything they work on a "disorder", even if other people refer to it as a "problem"!

If you do find your issue in the following list, please remember that you're not the only one dealing with it - these are common psychosexual issues, which occur all over the world in millions and millions of people.

On the other hand, if your issue is not included in the following list, it doesn't mean you're the only one it ever happened to or that it's not important. Your problem might not be on this list because it's a medical issue such as a sexually transmitted disease or a physical thing like having a penis or vulva that's a bit different to the usual (e.g. hypospadias).

Feel free to write to us to find out more about anything which is not listed here. To look at what might cause and affect sexual problems in your life look at this page: sexual problems - areas to consider.

One last word: many sexual problems will be caused by a number of factors, not just a single one. Quite often sexual problems have a medical or physiological side to them as well as a psychological one. If you have any medical concerns around sexual problems you should get them checked out first by a doctor - even when you're pretty sure your problem is all psychological! It can't do any harm and you can then continue working on the psychological issues involved without worrying about your physical health. On the other hand, if you are being treated with drugs for a medical or sexual problem, consider whether there are also psychological factors involved. Sometimes we make it a bit too easy for ourselves by swallowing a pill but not taking responsibility or ownership of the problem we are faced with.

Sexual problems for men and women

1. Desire problems: low sexual desire

Low sex drive is one of the most common sexual problems in both men and women. Low sexual desire means you normally don't have any problems with sexual arousal or orgasm, but you simply lack the motivation to go after sex.

It's a bit more complicated than that, though, because if you have another sexual problem like you can't reach orgasm, and sex isn't working for you, then you'll probably give up on it after a while. Is that then a case of low sexual desire? Some writers look at how individual men and women behave sexually to try and understand low sexual desire, while others emphasize that low sexual desire occurs in a relationship and you need to look at what's going on between the partners.

After all, who says how much sex is "normal"? Up to now there has been no single cause or treatment for low sexual desire. But more and more men are coming forward with low sexual desire and therapists now sometimes talk about Inhibited Sexual Desire (ISD) in men.

Finally, low sexual desire can also be a sign of a medical condition such as diabetes, multiple sclerosis, hyperthyroidism and depression - among others. If you have any concerns about your general health, please consult a medical doctor! Please be persistent with your doctor or get a second opinion if you don't feel your doctor is taking your concerns serious enough.  Medical professionals can also get embarrassed about sex and may not pursue the matter as they should.

Additional pages:

• Low sexual desire

• Tips for improving your sex drive

• Low sex drive in men

• My partner has temporarily gone off sex - what can I do?

• Negotiating differences in sexual desire

Sexual problems for women

1. Female sexual arousal disorder

This is the female equivalent to erectile dysfunction (difficulties with erection) in men. It has not received much attention in the past, although the new drug treatments for men have also stimulated some interest in this condition for women. Female sexual arousal disorder specifically refers to problems or interruptions in the sexual arousal phase for women which result in a lack of bodily and emotional signs of arousal. In other words, you don't get into sex, but keep on planning your shopping in your head; in addition, your body does not respond to the sexual situation by, for example, producing vaginal wetness. Treatment is based on what's happening with the woman and her relationship, as well as dealing with any medical issues such as hormonal problems.

Additional pages:

• Female sexual arousal disorder

2. Orgasmic disorders or anorgasmia

This means you have problems with achieving orgasm such as a complete lack of orgasms or only having orgasms from time to time. Sometimes anorgasmia occurs only with specific partners or in specific circumstances; sometimes orgasm can only be achieved in a certain way. One survey suggested that a difficulty with reaching orgasm is the third most common sexual complaint for women.  However, anorgasmia (absence of orgasms or inability to experience orgasms) is also a very "political" issue. First, pre-the sexual revolution women were not supposed to have orgasms, then Freud told us we had to have vaginal orgasms rather than clitoral ones, and now we have to have orgasms all the time otherwise there is something wrong with us! It is a really important point as to who is saying a woman is "anorgasmic": does she feel this is an issue for herself, or does she feel she has to be a certain way to be "normal"? Or is it other people who say she has to be one way or another? The causes of anorgasmia are hard to establish, but psychological, physical, social and cultural, religious and interpersonal factors all play their part..

3. Dyspareunia

Dyspareunia describes any situation where a woman experiences acute and recurrent genital or pelvic pains when she tries to have sexual intercourse. There is some overlap with vaginismus (see below), which is classed separately. However, dyspareunia does not necessarily say anything about what kind of pain is experienced - the pain could be caused by various things. Most writers see dyspareunia as a pain disorder, rather than a classical sexual disorder. Areas which need to be considered in its treatment are medical (neurology, muscles, gynecological issues such as infections), emotional issues and interpersonal and couple dynamics. It is important that dyspareunia is looked at in a holistic way including medical and psychological causes as well as possible treatments and teaching a woman strategies to cope with the problem.

4. Vaginismus

Vaginismus describes a condition in which the muscles around the vaginal entrance and in the pelvic floor contract and spasm involuntarily before or at penetration, thereby preventing penetration and penile-vaginal intercourse. In other words, the muscles around the vagina and the pelvic floor contract rapidly and close the vaginal opening. This happens outside of the voluntary control of the affected woman, much like blinking one's eyelids or retracting your hand from a hot object. Contraction of the vaginal muscles can be painful, which means this condition can be confused with dyspareunia. However, vaginismus is mostly caused by psychological factors, such as gender identity conflict, history of rape, sexual abuse or assault, or intense suppression of sex in childhood. Other factors which may contribute to the establishment of vaginismus are relationship difficulties or pain due to medical causes, such as vaginal infections. Women with vaginismus may feel very sexual, become aroused and can experience orgasms even though penetration is not possible.

Additional Pages:

• Vaginismus

Sexual problems for men

1. "Retarded" ejaculation

Retarded ejaculation is a fairly rare condition, in which a man has an erection during intercourse, but does not achieve orgasm with his partner, despite long sessions of sex. In the past, men with this condition have been seen as "withholding" from their partners and have been treated with more stimulation, or emotional pressure to be more "giving". Today retarded ejaculation is seen as a male equivalent to female anorgasmia (lack of orgasms). Possible explanations for retarded ejaculation are that the man is physically ready for intercourse, but not emotionally, or that he feels he has to perform, and so is not able to enjoy sex with his partner. It is also possible that some of us, men and women alike, will always prefer our own stimulation to a partner's and can only achieve orgasm that way. Retarded ejaculation can be a difficult condition to live with as frustration and expectations build up and make it even harder for a man to relax and enjoy his physical sensations.

Additional pages:

• Taking too long to ejaculate: "retarded ejaculation"

2. Erectile dysfunction

This is the big one for most men, especially as they get older. Erectile dysfunction is the term used when a man can't get or sustain an erection sufficient for vaginal intercourse or even masturbation. Erectile dysfunction is a matter of degree. It starts from complete erectile dysfunction (defined as the total inability to obtain or maintain erections during sexual stimulation plus the absence of nocturnal erections, i.e. impotence). The other end of the scale is erectile dysfunction to a lesser degree, such as losing one's erection during intercourse. The problem affects a significant proportion of men, including at least 20% of men over the age of 50. Most men experience problems with their erections at some point in their lives. Erectile dysfunction can be caused by medical problems such as diabetes or anti-hypertension drugs as well as by emotions like depression, guilt or anxiety. Most often erectile dysfunction is caused by a mixture of physical and psychological factors. Since the advent of Viagra, erectile dysfunction can be treated with medication; however, working on the psychological side of the problem as well as maintaining a healthy lifestyle is important.

Additional pages:

• Erectile dysfunction in men

3. Premature ejaculation

Premature ejaculation refers to a man's inability to control his ejaculation so that it occurs before he or his partner want it to. Most often premature ejaculation is caused by psychological factors and men with this condition are often anxious about their sexual performance. Premature ejaculation can be treated with behavioral approaches such as training programs which teach men how to control their premature ejaculation. Sometimes other factors need to be taken into account - for example what sexuality means to the individual man, or what happens in the relationship between him and his partner.

Additional pages:

• Coming too soon: How to last longer in bed

• Rapid orgasm in men - what women think about rapid orgasm

• Rapid orgasm - the effect on men

• Premature ejaculation treatment - how to stop premature ejaculation

There are many places on the webs where you can see information on men and women's sexual problems.

Sexual problems in special populations

1. Sexual minorities

Mainstream attitudes have been changing towards gay, lesbian and bisexual lifestyles over the last few decades. Today, even the minority communities themselves are becoming more flexible and many different lifestyles are possible for gay, lesbian, bisexual, transgendered and heterosexual people. This may cause confusion for some people as well as generating options for others. Although we can all explore alternative lifestyles, possibly with the help of the internet from the safety of our living rooms, doing so may bring up many big issues for people. And gay, lesbian, bisexual and transgendered communities need access to good sexual health and relationship information which is non-judgmental and supportive of their choice of lifestyle.

2. Gender dysphoria

Gender dysphoria describes the sense of incongruence and dissatisfaction some people experience with their biological gender. Negative feelings towards their own gender generally start in childhood and tend to stay with individuals throughout their adult lives. Gender dysphoria often causes the individual considerable distress. Today we are living in a world which (in some areas at least) does allow some flexibility to individuals as to how they express their sexuality - think of transsexuals, transvestites, drag queens and kings, and cross-dressers. Additionally, surgical sex change ("gender reassignment") is possible, although treatment should always be aimed at managing the distress an individual is experiencing as well as dealing with the issues and dilemmas a person may face living in a world which often allows only for two sexes.

3. Sexuality and chronic illness

Sexual problems are frequent by-products of chronic illness or major illnesses such as cancer or diabetes. However, quite often sexual problems in people with illnesses are not dealt with or even talked about, as society is biased towards seeing sexuality as appropriate only for healthy people. Nevertheless, sexuality is a big part of all our lives whether we are ill or not. Sexuality can be an important part of a well functioning relationship whether or not a person is ill - and managing the ill person's sexuality so it is expressed fully may be crucial to managing their illness. Sexual problems can also be a side effect of medication taken for other conditions such as depression or hypertension. As usage of these drugs is widespread, so are the sexual problems they can cause.

4. Sexuality and aging adults

We are all getting older and some of us are living longer than previous generations. A growing population of older adults is finally claiming back their right to be sexual beings, although society still portrays sexuality as the exclusive domain of the young and healthy. Main concerns for older adults are the menopause in women and a similar, but more gradual process in men. Generally speaking, sex drive does diminish as we get older, however older adults can and do stay interested in sex and may need advice and support for their sex lives. Drugs such as Viagra and hormone replacement therapy are available to help with the symptoms of aging. A frequent issue around sexuality for older adults is the loss of their partner, which may require psychological support, but does not necessarily mean the end of a sex life.

5. Atypical sexual behavior (paraphilia)

This is a mixed bag of unusual sexual behaviors. Atypical sexual behavior is defined by being different to what people experience as mainstream sexual behavior in any one culture at a specific point in time. Sexual practices which do not fit this model of normality are labeled as "deviant" or "bizarre". Within the psychosexual field the term "atypical" is being used to allow a more non-judgmental approach. Some of the more common atypical sexual behaviors are exhibitionism, voyeurism, transvestism, and sexual masochism and sadism (S&M), which can include bondage or spanking. As is clear from this list, some of these behaviors - such as transvestism - are already almost an acceptable lifestyle choice (depending where you are in the world), whereas other behaviors - such as voyeurism - are seen to be fairly unacceptable. When considering atypical sexual behavior it is important to question (1) whether they are legal or illegal behaviors in your society, (2) whether they cause harm or distress to others, and (3) whether an individual feels he or she has control and a sense of choice over this atypical sexual behavior.

6. Illegal sexual behavior

Although the laws about sexual behavior are different in different countries and evolve as time goes by, there is currently some consensus about what is generally considered completely unacceptable and harmful sexual behavior. One of the main issues in this category is pedophilia, which is in itself a sexual desire disorder, namely to desire sex with children rather than with adults. As children are not able to give informed consent to an adult's sexual advances and because children are never as powerful as adults, pedophilia is considered a very serious crime if acted upon in most countries. Sexual advances by an adult towards a child are always abusive and constitute a crime in most societies. Additionally, sex between minors or between an adult and an adolescent is in some countries illegal depending on the age of consent at which a young person is deemed to be able to make an informed choice about sex. The age seen as appropriate is heavily influenced by culture. Other sexual behaviors, which are currently illegal in Great Britain are bestiality (having sex with an animal) and owning or viewing child pornography.

7. Paraphilia-related disorders: nonparaphilic hypersexuality and sexual addictions

In this category we include behaviors generally thought of as "sexual addictions", such as compulsive masturbation, uncontrolled promiscuity, and dependency on pornography, whether printed or online, or telephone sex. The internet has created an additional phenomenon - sexual addiction to pornography on the internet. This is partly due to the instantaneous and anonymous availability of porn on the net. Writers have thought about sexual addictions primarily as addictions and problems with impulse control, rather than first and foremost sexual behavior. Quite often sexual addicts use their behavior as a "drug of choice" to self-soothe or self-medicate, just like other people use alcohol, cigarettes or over-eating. In this sense sexual addiction is more about controlling anxiety, other difficult feelings, or stress rather than sex. Things which need to be considered about sexual addiction include whether the behavior is illegal or not (for example, looking at child pornography on the web is illegal), frequency of the behavior, lack of control over sexual impulses, time spent on sexual behavior and the impact this has on the rest of an individual's life, e.g. on their relationship, job, finances, etc. Therapy in this area often starts with gaining control over the behavior, possibly through an 12-step abstinence based program or other behavioral interventions. Additionally, individuals need to look into how the sexual addiction represents a coping mechanism in their life and what they will do instead of using this pattern in the future.

References:

Leiblum, S., Rosen, R. (2000) Principles and Practice of Sex Therapy. 3rd Edition. The Guilford Press, New York, London.

Written by Anna 27.12.2006, last edited 14.01.08

All material copyright, ©2009 Sex And Relationships
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