Sexual dysfunction

You would think I'd feel comfortable writing about sex. After all I'm a middle-aged family doctor, married for over thirty years with grownup kids. But I find this subject a little embarrassing. I can understand why, even though a third of them have sexual problems, my patients seldom ask for help solving them.

Stats and Definitions

According to the Journal of the American Medical Association and the Foundation for Urological Diseases, sexual problems are common. For women, over 20% report lack of sexual desire, 14% have problems with arousal or reaching orgasm and for 7% sexual intercourse is painful. Men have it slightly better, but over 20% complain of premature ejaculation, 5% report erectile dysfunction (previously called impotence) and 5% just aren't much interested in sex. These sexual problems can be serious enough to hinder important relationships and hurt self-esteem.

Painful intercourse in females (dyspareunia) might be due to vaginismus, vaginitis or lack of lubrication. Vaginismus refers to painful spasm of the muscles around the vagina making intercourse difficult and painful. This is usually due to fear, sometimes because of previous trauma. Vaginitis or inflammation of the delicate tissues of the vagina is due to infection or irritation. Erectile dysfunction is more common in older males and of the more than 20 million North American males who suffer from this, fewer than 10% ever receive treatment.

Causes

Some sexual problems have less to do with organs and chemistry than they have to do with emotions and previous experiences. Sexual dysfunction might be caused by drugs such as antidepressants, blood pressure medications and alcohol or other mood-altering drugs including nicotine. Medical causes include diabetes, heart disease, neurological disorders, pelvic scarring, or menopause. Loss of sexual interest and function might also be due to reduced levels of hormones such as testosterone.

Chronic stress, anxiety or depression will often diminish a person's sexual interest or sexual response. Sometimes sexual problems develop and worsen simply because one partner doesn't understand his partner's needs and she either assumes he should know or she is too shy to tell him. Often sexual problems have nothing to do with sex: especially for the woman, sexual receptiveness and response requires first a relationship of emotional intimacy with her partner

Diagnosis and assessment

There are specialty clinics dedicated to the investigation and treatment of sexual problems. It's important to be evaluated with a thorough history and physical exam. From the medical evaluation further investigations such as hormone tests or other diagnostic investigations might be ordered.

Treatment and Recovery