Sexual Dysfunction

Are you happy with your sex life? A satisfactory sex life is difficult to define as everyone has varying degrees of satisfaction. It is only when there is a persistent impairment of normal patterns of sexual interest or response which result in distress for the individual(s) involved that help may be necessary. Normal patterns of sexuality are personal in that it depends on whether the person or his/her partner thinks there is a problem. This may be influenced by other factors such as friends, the media or medical opinion. Indeed, human sexuality is an intricate interplay of many factors ranging from the physical to psychological, from religious beliefs to social and cultural norms.

There are male and female sexual problems relating to interest, arousal, orgasm, pain or fear/anxiety.

  1. Lowered or lack of sexual interest (low libido)
    This dysfunction, where there is little desire to engage in sexual intercourse, is one of the most frequent in women. There is usually no biological cause to this but it is most often related to general relationship difficulties and depression.
  2. Impaired sexual arousal (frigidity)
    This is characterised by the failure to have normal physiological responses such as vaginal swelling and lubrication, and the lack of sensation to sexual stimulation. Usually associated with impaired interest, this problem can be common in women following menopause and shortly after childbirth, and can also occur in women with a lot of inhibitions about sexuality.
  3. No orgasm or very infrequent orgasms
    Women generally reach orgasm with greater consistency as they get older but having an orgasm regularly is not necessary for experiencing satisfaction. Some women require additional external stimulation to attain orgasm during sexual intercourse.
  4. Pain-related dysfunction
    There are two main types of pain-related dysfunction – “vaginsmus” and “dyspareunia”.

Vaginismus is the contraction of the vaginal muscles due to anticipated penetration, resulting in extremely painful or impossible intercourse. While women with vaginismus may have misconceptions about the size and other characteristics of their vagina, they are usually otherwise sexually responsive. Any abnormality of genitals or vaginal structures causing pain can also lead to this condition. Psychological factors leading to this may include pain during previous intercourse, sexual trauma, ignorance, and fear of pain and injury by the penis.

Dyspareunia is the experience of pain during intercourse. This may be at the entrance or deep in the vagina. Deep vaginal pain usually has a physical cause, so a gynaecological examination is important. This form of dyspareunia can lead to other dysfunctions such as loss of desire, lack of lubrication, inhibition of orgasm and avoidance of sexual activity. Superficial pain is most often due to lack of lubrication because of insufficient arousal, inadequate foreplay or ignorance about anatomy and the physiology of sexual activity.

  1. Impotence or erectile dysfunction
    This is the most common problem. It can be caused by physical factors such as disease (e.g. diabetes, epilepsy, multiple sclerosis, etc), certain types of drugs, substance abuse (e.g. alcohol), low levels of testosterone, mental handicap and trauma (e.g. spinal injury, surgery, prostatectomy). Impotence also has psychological causes such as depression, aging fears, poor self image, anxiety, problems within the relationship, concerns over sexual dysfunction in partner, fears of intimacy, performance anxiety and many others.
  2. Ejaculatory difficulties
    These occur in the form of premature ejaculation, where dissatisfaction is felt by a couple because of rapid ejaculation by the male, or retarded ejaculation whereby the male is unable to ejaculate. Sometimes, there may be pain during ejaculation. This may be due to narrowing of the urinary tract or infection in the bladder or other related genital organs.

A thorough investigation of probable physical and psychological causes should be conducted. Thereafter, treatment will follow according to the type and extent of the sexual dysfunction as well as probable causes. Treatment can be broadly classified into physical treatments and psychological treatments or a combination of both. Psychological treatments may include brief counselling and sex therapy.

From studies that have been conducted, it appears that approximately two-thirds of patients appear to benefit from treatment. Erectile problems, premature ejaculation, vaginismus and orgasmic dysfunction do especially well with treatment.