Sexual Dysfunction

Sexual dysfunction may be due to physical or mental illness, or result from social or marital problems or stress, and may prevent an individual or couple from enjoying or engaging in sexual intercourse. A dysfunction exists if the sexual interaction is seen as unsatisfactory by either or both partners. Sexual dysfunctions are distinguished from sexual variations in which individuals may successfully engage in sexual activity in an unconventional way or with an unconventional object and their sexual behavior may produce harmful consequences for the individual or for others.

The increasing demand for help with disorders of sexual function probably reflects a change in attitude of the public and medical profession, rather than an increase in the incidence of dysfunctions. Sexual dysfunction can cause much unhappiness and can have bitter consequences that extend far beyond the sexual problem. These effects would not be as devastating if it were not for the attitude of society and the pressures imposed by the mass media.

There is an important difference between "making love" and "having sex". The former does not have to include coitus, and coitus does not have to include orgasm. Couples can greatly enjoy giving and receiving pleasure, and the intimacy and sensuality of sexual expression, apart from coitus, once performance pressures are removed. A simple comparison can be made with going for a walk, listening to a concert or having a meal, which are enjoyed while they last, not when completed. A woman who enjoys sexual stimulation is not dysfunctional even if she is not orgasmic, provided she and her partner do not consider it a problem.

Difficulties may arise if there is concern about what is "normal", and through lack of awareness. For example, women naturally take longer than men to become aroused, and this disparity may be compounded by ignorance, guilt or anxiety, which will further inhibit their natural ability to respond.

Up to 75% of men ejaculate within 2 minutes, whereas the majority of women require up to 10 minutes of sexual intercourse to experience an orgasm.This may be due to lack of communication the man's lack of awareness of his partner's needs for extended foreplay and direct clitoral stimulation, or for stimulation after his orgasm.

This "illustration" and the following explanation helps couples to understand the evolution of their sexual problem, and to recognize that it is not the fault of either partner, but that it is based on the natural disparity between their responsivity and lack of awareness.

1. Once the man has ejaculated, the woman may continue to be aroused for a while but discourages further stimulation, or he may not 'be aware of the possibility of or her need for manual or oral stimulation. This results in orgasmic dysfunction.The woman recognizes after a while that her arousal to point I leads no further than frustration.

2. The woman may become aroused to point 2 but no further once her partner's thrusting ceases.

3. Once the woman is aware that her partner's orgasm is imminent, she "switches off ": arousal dysfunction.

4. Arousal is minimal or absent, as natural responsivity is suppressed because of the realization that her response is unfulfilling, and her feeling that she is being used without concern. It is often at this point that women present complaining of "feeling nothing" during sex desire dysfunction.

5. The woman encourages her partner to "get it over with as soon as possible", and this promotes premature ejaculation. This further reduces the possibility of her arousal, and increases her resentment at being "used as a receptacle", and may cause her to taunt and humiliate her partner. Sex becomes granted as a favour or used as a weapon, and the inevitable avoidance further compounds the problems.

6. The man's concern that he is unable to satisfy his partner, and his desire to delay ejaculation blocks his response and may result in secondary erectile impairment.

This progression to dysfunction can be further illustrated in the following way: a couple go to a restaurant and the man orders a delicious dish, the woman enjoys the smell and sight of it and he offers her a bite, which she enjoys, and he then proceeds to finish the meal. The same thing happens every time they go. After a while the woman resents his complete enjoyment and her own frustration at partaking of only a morsel, and encourages him to finish quickly. This as well as his guilt affects his enjoyment. Gradually she finds reasons to excuse herself from accompanying him to the restaurant in the same way as the woman who realizes she is not going to get much enjoyment out of having sex makes excuses to avoid it.

There are other differences in responsivity between men and women which patients (and therapists) should recognize in order to minimize false expectations and avoid problems.

It is important to have a clear understanding of the sexual dysfunctions that occur in order to deal with them effectively.

The term impotence has been used to cover all forms of male dysfunction and is unclear. The terms "erectile" or "ejaculatory" "impairment" or "dysfunction" are preferred. The term "frigidity" was used to cover all degrees of disinclination or lack of response in women, from failure to achieve mutual orgasm during intercourse, to total rejection of any sexual approach. Both these terms are emotive, disparaging and unclear and should be avoided.