Sexual Disorders
Sexual disorders are a group of medical and psychological problems that interfere with a person’s ability to have sexual intercourse or to enjoy sexual activity. There are many common sexual disorders, but this section will focus on vulvodynia, premature ejaculation, erectile dysfunction, and sexual desire disorder.
VULVODYNIA
Vulvodynia is a chronic pain problem experienced by women. The area affected is the vulva, the genital region at the outside of the vaginal canal. In comparison, women can also experience pain inside the vagina during intercourse, which is more commonly referred to as dyspareunia, and both men and women can experience pain near the anus, which is often referred to as perineal pain syndrome.
Vulvodynia often feels like a burning, itching, or painful sensation. It can be triggered during sexual activity, when a woman inserts a tampon, or sometimes for no clear reason at all.
According to one group of experts,1 the exact causes of vulvodynia often remain unknown, but there are factors that are thought to contribute to its onset, including frequent irritation, yeast infection, herpes virus, human papillomavirus, childbirth, menopause, and surgery. According to these same experts, it’s important to note that vulvodynia is not a sexually transmitted disease that can be spread to a sexual partner, it isn’t necessarily caused by sexual trauma, and it isn’t caused by psychological problems such as depression, although depression can be a result of vulvodynia.1 According to a large survey of women published in 2006, approximately 4 percent of them experienced chronic vulvar pain during the six months prior to the survey.2
Common treatment strategies for vulvodynia include a number of options, from simple lifestyle changes to more invasive procedures.1 Initially, a woman can try to eliminate irritants that might be contributing to the problem, such as fragrances, dyes, and tight clothing. The next step might be to try a medication that helps block painful stimulation, such as certain antidepressants. For some women, a specific form of biofeedback that teaches them to relax muscles around the vulva can be helpful, while for other women, surgery may be an option.
In addition, some women may find it beneficial to use complementary treatments that are helpful for chronic pain, such as physical therapy, yoga, and psychotherapy to discuss problems related to vulvodynia. (Click here for more information about vulvodynia and its treatment.)
PREMATURE EJACULATION
Men who experience premature ejaculation cannot control when they orgasm in most sexual encounters and ejaculate before they want to. As a result, many men who have this problem feel inadequate or defective, and unfortunately, beliefs like these often make the next sexual encounter even more difficult to control. According to experts on premature ejaculation, the problem can be caused by psychological, medical, and relationship factors, and therefore a multifaceted approach to treatment is required.3
For many men, premature ejaculation is a result of self-imposed performance pressure during sexual intercourse. Many men believe that they should be able to withhold their ejaculations for as long as an hour, or at least as long as it takes for their partner to reach orgasm. However, for many heterosexual men this is a problem because men and women reach orgasm in different ways, often with different timing, and some women don’t always need to orgasm in order to experience sexual pleasure.
Premature ejaculation can also be the result of a physical illness, a medication side effect, depression, or other psychological stressors, such as problems that arise between two people in a relationship.
Men who experience premature ejaculation as a result of a medical condition or a medication side effect should first consult with a medical professional for advice about treatment. On the other hand, men who experience the problem as a result of interpersonal conflict might benefit from learning how to communicate about emotions and sexual expectations in an honest and open way. Psychotherapy can often be helpful for this.
But no matter what the cause, most men will also benefit from learning ejaculatory control skills.3 This group of skills focuses on helping men experience arousal in a more satisfying way. The first step is to develop relaxation skills that can help enhance a man’s comfort with sexual experiences. This step is especially important for men who have trouble having or maintaining an erection. The second step is to help the man tolerate pleasure for longer periods of time by using pacing skills to start and stop ejaculations. The next step is learning how to experience longer periods of pleasure without ejaculating. And, finally, the last step involves couples communication skills to make the sexual experience even more satisfying. (Click here for more information about premature ejaculation and its treatment.)
ERECTILE DYSFUNCTION
Men who struggle with erectile dysfunction experience difficulties having or maintaining an erection during sexual activity. Most men will struggle with this problem on an occasional basis at some point in their lives,4 but by age fifty, approximately half of the male population will struggle with this problem, if only in mild forms.5 For men who experience this problem on a regular basis, it can causes great distress, both for themselves and their sexual partners.
Experts agree that, like premature ejaculation, erectile dysfunction can be caused by psychological, medical, and relationship factors, and therefore a multifaceted approach to treatment is required.4 Tobacco, drugs, and alcohol can contribute to erectile dysfunction, as can certain medications, illnesses, and mental health issues like anxiety, stress, depression, and fear. And as with premature ejaculation, many men with erectile dysfunction feel pressured to perform in a certain way when having sex, but, ironically, this pressure only leads to dysfunction, self-doubt, and further sexual difficulties in the future.
Many men now turn to the use of medications like sildenafil (Viagra) and vardenafil (Levitra) to “solve” their erectile dysfunction, but even these drugs don’t work all the time. If a man is able to eliminate medical causes for his problem and is also able to experience an erection at certain times, like early in the morning or while masturbating, it’s very possible that he could benefit from education and nonmedical treatment.
Since many men experience this problem at some point in their lives, the treatment for erectile dysfunction encourages men and their partners to think about sexuality in a new way. For men, the focus of sex is often on having an erection and experiencing penetration. Instead, it’s often helpful to consider other ways to be intimate with a partner, especially if a man experiences a problem maintaining an erection during sexual activity. Many men also benefit from education about sexual functioning and learning more about sexual expectations, both their own and their partner’s. Men who experience erectile dysfunction due to mental health issues like depression, or who struggle with relationship issues with their sexual partners, might also benefit from psychotherapy to resolve these issues.
But no matter what the cause, most men will benefit from erectile control skills, which are very similar to the ejaculatory control skills for premature ejaculation.3, 4 The first step is developing relaxation skills. The next step involves learning how to develop an erection. Next is developing the ability to maintain, lose, and regain an erection. And, finally, the last step helps the man and his partner develop confidence about engaging in sexual activity and developing an effective sexual style. (Click here for more information about erectile dysfunction and its treatment.)
SEXUAL DESIRE DISORDER
People who experience a lack of sexual desire are said to be struggling with sexual desire disorder. This problem can affect people of all ages, genders, and sexual orientations.
It’s normal for sexual desire to decrease somewhat over time. As people get older, their sexual desire naturally decreases, but it doesn’t always disappear. Similarly, many people often experience enhanced sexual desire early in a relationship and then their desire decreases as the relationship progresses. Again, this is normal.
But for some people, sexual desire seems to disappear completely. Sexual desire disorders can be caused by increasing age, illness, hormonal imbalance, medication side effects, depression, drug or alcohol use, and stress.6 However, sexual desire disorder is often the result of interpersonal conflict between the people involved in a sexual relationship.
Treating this problem often begins with education about sexual desire and its relationship with arousal and orgasm.6 It’s also helpful for the couple to rediscover the boundaries and rules of their relationship, which once made their relationship intimate, and to identify what circumstances are currently interfering with their relationship. Similarly, it’s also very important to identify any behaviors that are contributing to a lack of sexual desire, such as one partner flirting with people outside the relationship or one partner being dishonest.
The goal of the treatment for sexual desire disorder is to help each member of the couple create a healthy, positive, and powerful self-image, and to use that power to rekindle the passion in the relationship.6 Equally as important are interpersonal skills such as honesty, humor, and effective communication skills. (Click here for more information about sexual desire disorder and its treatment.)
REFERENCES FOR SEXUAL DISORDERS
1. Glazer, H. I., and G. Rodke. 2002. The Vulvodynia Survival Guide: How to Overcome Painful Vaginal Symptoms and Enjoy an Active Lifestyle. Oakland, CA: New Harbinger Publications.
2. Bachmann, G. A., R. Rosen, L. D. Arnold, I. Burd, G. G. Rhoads, S. R. Leiblum, and N. Avis. 2006. Chronic vulvar and gynecologic pain: Prevalence and characteristics in a self-reported survey. Journal of Reproductive Medicine 51: 3-9.
3. Metz, M. E., and B. W. McCarthy. 2003. Coping with Premature Ejaculation: How to Overcome PE, Please Your Partner and Have Great Sex. Oakland, CA: New Harbinger Publications.
4. Metz, M. E., and B. W. McCarthy. 2004. Coping with Erectile Dysfunction. Oakland, CA: New Harbinger Publications.
5. Feldman, H., I. Goldstein, D. Hatzichristou, R. Krane, and J. McKinlay. 1994. Impotence and its medical and psychosocial correlates: Results of the Massachusetts Male Aging Study. Journal of Urology 151: 54-61.
6. Cervenka, K. A. 2003. In the Mood Again: A Couple’s Guide to Reawakening Sexual Desire. Oakland, CA: New Harbinger Publications.
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