Female Sexual Problems Other Than Arousal Disorder

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A host of sexual problems besides female sexual arousal disorder (FSAD) can affect women at any stage of life. As with FSAD, the cause can be primarily physical, psychological, or both. To be considered a disorder, the problem must cause personal distress or problems in a woman’s relationship with her partner. Keep in mind that sexual activity is not correlated with overall sexual satisfaction or intimacy in all woman. A physician will need to determine the cause before deciding on an appropriate treatment. The most common disorders include:

Hypoactive sexual desire disorder

Women with this disorder experience a persistent lack of sexual desire or appetite, absence of sexual fantasies and complete lack of interest in and avoidance of sexual contact with a partner. A Journal of the American Medical Association study says sexual dysfunction was common in 43 percent of women. It may be caused by boredom or unhappiness in a long-standing relationship or may result from traumatic events in childhood or adolescence. Depression also may play a role. Possible physical causes include drug side effects and a hormone deficiency.

Painful intercourse

Dyspareunia and vaginismus are the two most common sexual pain disorders in women. Women with dyspareunia experience pain during sexual intercourse. This disorder can have a range of causes:

Poor vaginal lubrication because of inadequate foreplay
The natural changes that occur after menopause
Postmenopausal thinning of the vaginal wall
Inflammation or infection of the area
Irritation from an allergic reaction or to a contraceptive device
Pelvic pain may also be a symptom of a condition affecting the cervix and/or uterus, such as the growth of tumors. A physician will need to determine the underlying cause before prescribing treatment. For women who have passed menopause, and therefore have lower blood levels of the female hormone estrogen in their bodies, estrogen replacement therapy or topical creams may be helpful. Liberal use of a water-soluble lubricant just before intercourse may also alleviate pain for some women.

A relatively rare condition, vaginismus is a painful, involuntary spasm of the muscles that surround the vaginal entrance, interfering with sexual intercourse. Its cause is almost always psychological: It usually occurs in women who fear that penetration will be painful and may stem from a previous traumatic or painful experience.

The problem is treated with educational counseling and, sometimes, progressive vaginal dilation, which helps to relax the muscle spasm. This therapy involves the use of vaginal inserts, each progressively larger than the last, which help condition the vaginal opening. As one becomes comfortable, the next larger size is inserted in the vagina. This process continues until the vagina has been dilated sufficiently for intercourse to take place painlessly.

Female orgasmic disorder

Women with this disorder are aroused by sexual stimulation but then are unable to cross the threshold from arousal to climax, or orgasm. It is not just the failure to have an orgasm during intercourse. This can be quite common for women. But most are able to achieve orgasm when their partner manually or orally stimulates the clitoris. Women who don’t have orgasms are considered to have the disorder. Antidepressants and some medications may contribute to the problem.

Other causes have to do with the sexual relationship itself:

Inadequate foreplay
Ignorance of genital function and anatomy
Premature ejaculation
Some women may fear losing control, abandoning themselves to a partner or finding pleasure in a sexual experience. Counseling usually is prescribed.

Male Sexual Problems Other Than Erectile Dysfunction

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Erectile dysfunction (ED), or impotence, is what most people think of when they hear the term “male sexual problem.” The National Institutes of Health estimates 15 million to 30 million American men do suffer from erectile dysfunction and need drugs to have sexual intercourse. However, other forms of sexual dysfunction can affect men. These include:

Hypoactive sexual desire disorder: Men with this disorder have a persistent lack of sexual desire or appetite, absence of sexual fantasies and complete lack of interest in and avoidance of sexual contact with a partner. Possible physical causes include drug side effects and hormonal deficiencies. Sometimes, boosting abnormally low testosterone levels helps. It may also be caused by or result from traumatic events in childhood or adolescence. Depression also may play a role.

Male orgasmic disorders: Also called ejaculatory disorders, these include inhibited ejaculation (orgasm does not occur) and premature ejaculation (when ejaculation occurs before, during or soon after penetration and before the man desires). Inhibited orgasm is usually caused by a psychological disorder such as depression or anxiety, or use of substances like alcohol or drugs. The man’s emotional state and feelings such as guilt, boredom or resentment also may play a role. The cause of premature ejaculation is unclear but is thought to result from a combination of psychological and physical factors. Both problems are typically treated by teaching the man and his partner techniques for either producing or slowing down orgasm. In some cases, premature ejaculation can be treated with small doses of an SSRI antidepressant such as Prozac®, Paxil® or Zoloft®, taken either daily, or one to two hours before a sexual encounter.

Children, teens and adults being treated with antidepressants, particularly anyone being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior. Close watching may be especially important early in treatment, or when the dose is changed, either increased or decreased. Bring up your concerns immediately with a doctor.

Peyronie’s disease: Thought to affect about 1 percent of men usually between the ages of 40 and 60, Peyronie’s disease is characterized by the formation of a hard, fibrous layer called plaque under the skin on one side of the penis. This disorder usually starts out as an inflammation, leading to a hardened scar that causes the penis to bend sharply when erect. If hardening occurs on both sides, indentations and shortening may result. The scarring or hardening can make erections painful and intercourse difficult or impossible. The bent or misshapen appearance of the penis can lead to emotional distress, which in turn worsens any sexual difficulties. Doctors are not sure what causes Peyronie’s disease, but in many cases, the condition resolves itself. A physician will usually monitor the man closely for about a year, watching the plaque development and checking erectile function. Medications that might help to alleviate plaque buildup include topical vitamin A, collagenase ointment, B-complex vitamins or calcium channel blockers. These treatments are still unproven.

Some researchers have given vitamin E orally to men with Peyronie’s disease in small studies and have reported improvements. Yet, no controlled studies have established the effectiveness of vitamin E therapy. Similar inconclusive success has been attributed to oral application of para-aminobenzoate, a substance belonging to the family of B-complex molecules. Researchers have injected chemical agents such as verapamil, collagenase, steroids, calcium channel blockers, and interferon alpha-2b directly into the plaques. These interventions are still considered unproven because studies included small numbers of patients and lacked adequate control groups.

If treatment doesn’t work and the condition doesn’t go away on its own, surgery may be necessary. Surgeons have developed techniques for removing the plaque without affecting the proper functioning of the penis.

Dyspareunia: Men who experience dyspareunia, or pain during intercourse, usually have an underlying problem such as prostatitis (inflammation of the prostate gland) or some kind of nerve damage.