Sexual problem, or sexual dysfunction, refers to a
problem during any phase of the sexual
response cycle that prevents the individual or couple from
experiencing satisfaction from the sexual activity. The sexual
response cycle has four phases: excitement, plateau, orgasm, and
While research suggests that sexual dysfunction is
common (43% of women and 31% of men report some degree of
difficulty), it is a topic that many people are hesitant to discuss.
Fortunately, most cases of sexual dysfunction are treatable, so it
is important to share your concerns with your partner and doctor.
What Causes Sexual Problems?
Sexual dysfunction can be a result of a physical or
Physical causes: Many physical and/or medical
conditions can cause problems with sexual function. These
conditions include diabetes, heart and vascular (blood vessel)
disease, neurological disorders, hormonal imbalances, chronic
diseases such as kidney or liver failure, and alcoholism and
drug abuse. In addition, the side effects of certain
medications, including some antidepressant drugs, can affect
sexual desire and function.
Psychological causes: These include work-related stress
and anxiety, concern about sexual performance, marital or
relationship problems, depression, feelings of guilt, and the
effects of a past sexual trauma.
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Who Is Affected by Sexual Problems?
Both men and women are affected by sexual problems.
It is more common in the early adult years, with the majority of
people seeking help during their late 20s and early 30s. Sexual
dysfunction also is common in the geriatric population, which may be
related to a decline in health associated with aging.
How Do Sexual Problems Affect Men?
The most common sexual problems in men are
ejaculation disorders, erectile dysfunction, and inhibited sexual
What Are Ejaculation Disorders?
There are different types of ejaculation disorders,
Premature ejaculation -- This refers to ejaculation
that occurs before or soon after penetration.
Inhibited or retarded ejaculation -- This is when
ejaculation does not occur.
Retrograde ejaculation -- This occurs when, at orgasm,
the ejaculate is forced back into the bladder rather than
through the urethra and out the end of the penis.
In some cases, premature and inhibited ejaculation
are caused by psychological factors, including a strict religious
background that causes the person to view sex as sinful, a lack of
attraction for a partner and past traumatic events. Premature
ejaculation, the most common form of sexual dysfunction in men,
often is due to nervousness over how well he will perform during
sex. Certain drugs, including some anti-depressants, may affect
ejaculation, as can nerve damage to the spinal cord or back.
Retrograde ejaculation is most common in males with
diabetes who suffer from diabetic neuropathy (nerve damage). This is
due to problems with the nerves in the bladder and the bladder neck
that allow the ejaculate to flow backward. In other men, retrograde
ejaculation occurs after operations on the bladder neck or prostate,
or after certain abdominal operations. In addition, certain
medications, particularly those used to treat mood disorders, may
cause problems with ejaculation.
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What Is Erectile dysfunction?
Also known as impotence, erectile dysfunction is
defined as the inability to attain and/or maintain an erection
suitable for intercourse. Causes of erectile dysfunction include
diseases affecting blood flow, such as atherosclerosis (hardening of
the arteries); nerve disorders; psychological factors, such as
stress, depression, and performance anxiety (nervousness over his
ability to sexually perform); and injury to the penis. Chronic
illness, certain medications, and a condition called Peyronie's
disease (scar tissue in the penis)
also can cause erectile dysfunction.
What Is Inhibited Sexual Desire?
Inhibited desire, or loss of libido, refers to a
decrease in desire for, or interest in sexual activity. Reduced
libido can result from physical or psychological factors. It has
been associated with low levels of the hormone testosterone. It also
may be caused by psychological problems, such as anxiety and
depression; medical illnesses, such as diabetes and high blood
pressure; certain medications, including some anti-depressants; and
How Are Male Sexual Problems Diagnosed?
The doctor likely will begin with a physical exam
and a thorough history of symptoms. He or she may order other tests
to rule out any medical problems that may be contributing to the
dysfunction. The doctor may refer you to other doctors, including an
urologist (a doctor specializing in the urinary tract and male
reproductive system), an endocrinologist (a doctor specializing in
glandular disorders), a neurologist (a doctor specializing in
disorders of the nervous system), sex therapists, and other
What Tests Are Used to Evaluate Sexual Problems?
Blood tests -- These tests are done to evaluate hormone
Vascular assessment -- This involves an evaluation of
the blood flow to the penis. A blockage in a blood vessel
supplying blood to the penis may be contributing to erectile
Sensory testing -- Particularly useful in evaluating
the effects of diabetic neuropathy (nerve damage), sensory
testing measures the strength of nerve impulses in a particular
area of the body.
Nocturnal penile tumescence and rigidity testing --
This test is used to monitor erections that occur naturally
during sleep. This test can help determine if a man's erectile
problems are due to physical or psychological causes.
How Is Male Sexual Dysfunction Treated?
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