Sexual Problems

Sexual dysfunctions prevent or reduce an individual’s enjoyment of normal sex and prevent or reduce the normal physiological changes brought on normally by sexual arousal. These dysfunctions can be classified by the phase of the sexual cycle in which they occur. It is important to keep in mind that the diagnosis of sexual dysfunction is made only when the disability persists. The common sexual disorders are:

• Hypoactive sexual disorder

A persistently reduced sexual drive or libido, not attributable to depression where there is a reduced desire, sexual activity and reduced sexual fantasy. It is more common in females. In males, there may be less desirable due to premature ejaculation or pain during intercourse.

• Sexual aversion disorder

An avoidance of or aversion to genital sexual contact or by masturbation. It is more seen in females usually with a history of childhood sexual abuse.

• Female sexual arousal disorder

A failure of arousal and lubrication/swelling response of sexual excitement until the completion of sexual activity.

• Male erectile disorder

Inability to gain an erection or inability to maintain an erection once it has occurred.

• Female orgasmic disorder

A lengthy delay or absence of orgasm following a satisfactory excitatory phase. The diagnosis must take into account the patient’s age, previous sexual experience and adequacy of sexual stimulation.

• Male orgasmic disorder

A lengthy delay or absence of orgasm following normal excitation, erection and adequate stimulation.it is also called erectile dysfunction and impotence. A man with the lifelong male erectile disorder has never been able to obtain an erection sufficient for vaginal insertion.

• Premature ejaculation

Ejaculation occurring with only minimal stimulation, either before penetration, or soon afterwards, in either case certainly before the patient wishes it.

• Dyspareunia

Recurrent pain associated with intercourse, but in women not due to vaginismus, poor lubrication and in women and men not due to drugs or other physical causes.

• Vaginismus

An involuntary or persistent spasm of the muscles of the outer third of the vagina that interferes with penile insertion and intercourse. Vaginismus may be either lifelong or recent generalized to all sexual encounters or specific to certain partners or situations.

• Secondary sexual dysfunction

Dysfunctions secondary to illness like hyperthyroidism, mental disorder, depression or drugs.

• Sexual Masochism and Sadism

A sadist is applied to those who derive sexual excitement from the pain of others. Masochist is applied to those who derive sexual excitement through their own pain.

• Gender identity disorder

Strong and persistent identification of the self with another gender is considered as gender identity disorder. The persistent dissatisfaction with own sex and desire to participate in stereotyped games and pastimes of opposite sex are common among them. These individuals have a preference for cross-dressing. It may occur in children, adolescents and adults.

Treatment

Usually treating both partners simultaneously. It involves three stages

1. Sex education
2. A behavioural component in which the partners are prescribed certain procedures or ways to go about the sexual act.
3. A psychotherapeutic component in which the partners are counselled if any difficulties arise in carrying out the instructions given. Emotional problems are also treated.