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learn how you can make love
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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.
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.
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 orgasms is the third most
common sexual complaint for women. However, anorgasmia (absence 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
it is 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.
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.
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.
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.
There are
many places on the webs where you can
see information on men and women's
sexual problems. For example, a lot of
men's
penis and
sexual worries are discussed
here.
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.
