Sexual Dysfunction

Sexual problems are defined as difficulty during any stage of the sexual act (which includes desire, arousal, orgasm, and resolution) that prevents the individual or couple from enjoying sexual activity.

Sexual difficulties may begin early in a person's life, or they may develop after an individual has previously experienced enjoyable and satisfying sex. A problem may develop gradually over time, or may occur suddenly as a total or partial inability to participate in one or more stages of the sexual act. The causes of sexual difficulties can be physical, psychological, or both.

**Emotional factors affecting sex include both:

1- interpersonal problems: marital or relationship problems, or lack of trust and open communication between partners.

2- psychological problems within the individual:epression, sexual fears or guilt, or past sexual trauma.

**Physical factors contributing to sexual problems include:

• Drugs, such as alcohol, nicotine, narcotics, stimulants, antihypertensives (medicines that lower blood pressure), antihistamines, and some psychotherapeutic (drugs that treat psychological problems "Antidepressants") drugs
• Injuries to the back
• An enlarged prostate gland
• Problems with blood supply
• Nerve damage (as in spinal cord injuries)
• Disease (diabetic neuropathy, multiple sclerosis, tumors, and, rarely, tertiary syphilis)
• Failure of various organs (such as the heart and lungs)
• Endocrine disorders (thyroid, pituitary, or adrenal gland problems)
• Hormonal deficiencies (low testosterone, estrogen, or androgens)
• Some birth defects

**Classified into 4 categories:

a-sexual desire disorders,
b-sexual arousal disorders,
c-orgasm disorders,
d-sexual pain disorders "Lubrication disorder".

Significant differences in mean domain scores among 18 women with complaints of sexual dysfunction and 14 control women with no complaints of sexual dysfunction responding to the ASFQ"Abbreviated Sexual Function Questionnaire".

Sexual desire disorders (decreased libido) may be caused by a decrease in the normal production of estrogen (in women) or testosterone (in both men and women). Other causes may be aging, fatigue, pregnancy, and medications -- the SSRI"Selective Serotonin Reuptake Inhibitor" anti-depressants which include fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil) are well known for reducing desire in both men and women. Psychiatric conditions, such as depression and anxiety, can also cause decreased libido.

Sexual arousal disorders were previously known as frigidity in women and impotence in men. These have now been replaced with less judgmental terms. Impotence is now known as erectile dysfunction, and frigidity is now described as any of several specific problems with desire, arousal, or anxiety.

There may be medical causes for these disorders, such as decreased blood flow or lack of vaginal lubrication. Chronic disease may also contribute to these difficulties, as well as the nature of the relationship between partners. As the success of Viagra attests, many erectile disorders in men may be primarily physical, not psychological conditions.

Orgasm disorders are a persistent delay or absence of orgasm following a normal sexual excitement phase. The disorder occurs in both women and men. Again, the SSRI antidepressants are frequent Causes -- these may delay the achievement of orgasm or eliminate it entirely.

Sexual pain disorders affect women almost exclusively, and are known as dyspareunia (painful intercourse) and vaginismus (an involuntary spasm of the muscles of the vaginal wall, which interferes with intercourse). Dyspareunia may be caused by insufficient lubrication (vaginal dryness) in women.

Poor lubrication result from:
1-Insufficient excitement and stimulation.
2-Hormonal changes caused by menopause, pregnancy, or breast-feeding.
3-Irritation from contraceptive creams and foams may also cause dryness, as can fear and anxiety about sex.

It is unclear exactly what causes vaginismus, but it is thought that past sexual trauma such as rape or abuse may play a role. Another female sexual pain disorder is called vulvodynia or vulvar vestibulitis. In this condition, women experience burning pain during sex which may be related to problems with the skin in the vulvar and vaginal areas. The cause is unknown.

Sexual dysfunctions are more common in the early adult years, with the majority of people seeking care for such conditions during their late 20s through 30s. The incidence increases again in the geriatric population, typically with gradual onset of symptoms that are associated most commonly with medical causes of sexual dysfunction.