Sexual dysfunction explained

Occasional problems with sexual function are common, but if problems last more than a few months or cause distress for either or both partners, a healthcare provider should be consulted.

One of the most common causes of sexual dysfunction is a low libido - when a person loses interest in sex. The most common causes for a low libido are:

• Illness: In general a person's sexual desire decreases when they are sick, but normally the condition improves once they feel better. However, more serious illnesses such as hypothyroidism, diabetes, cancer, heart and lung disorders, and STIs may have a long-lasting negative effect on a person's sex drive.
• Medication: Many prescription and over-the-counter drugs can decrease your sexual desire. Well-documented sex drive crushers include antidepressants such as Prozac and Xanax, but medication for hypertension, psychotropic drugs, sedatives, opiates and even birth control pills can lessen your interest in sex or make reaching orgasm difficult.
• Lifestyle: If you've recently married, ended a relationship, changed jobs or moved, you may be mentally and physically out of sorts. Lifestyle changes are yet another form of stress, and even if they are positive ones, they can sometimes adversely affect your sex life.
• Relationship blues: Temporary disinterest in your partner is normal. But if you're finding that the seesaw of sexual desire is grounded on the down side for an extended period of time, it could be tied to relationship issues. If there's tension or unhappiness in your relationship, it will eventually show up in your sex life.
• Body image: Learning to love your body is probably one of the greatest hurdles to developing a strong sense of sexuality. If you feel uncomfortable with your physical self, you may hide your body from your partner, which can lead to a slowdown in sexual activity.
• Depression: If you are depressed, sex will not be at the top of your agenda. Everyone experiences a bad day or two, but if those weeks turn into months, your depressed state will put your sexual interest on hold.
• Drugs and alcohol: Excessive consumption of drugs and/or alcohol may increase the number of your sexual encounters, but in the long run both can take its toll on your sex drive. Be aware if your drop in libido seems to correlate with an increase in alcohol or drug consumption.

Factors that cause female sexual dysfunction include:

• Inability to become aroused - Women who rarely feel any sexual excitement or who don't have vaginal lubrication are often labelled as "frigid". These women may be suffering from female sexual arousal disorder
• Lack of orgasm, or sexual climax - A lack of orgasm is not as uncommon as one might believe. This is only considered a dysfunction when a woman doesn't experience an orgasm at any time including during masturbation or sexual intercourse.
• Painful intercourse - Two of the most common conditions are either dyspareunia (pelvic or vaginal pain with intercourse) or vaginismus (recurrent involuntary spasms of the perineal muscles which prevent all vaginal penetration). Although pain with sex tends to increase after menopause because of a decrease in vaginal lubrication, it can occur at any age.

Sexual dysfunction in males are caused by:

• Erectile dysfunction (ED):
• Occurs when a man has difficulty achieving or maintaining an erection that is sufficient to ensure satisfactory sex for both partners.
• Erectile dysfunction can have a physical or psychological cause, but in the majority of cases it is primarily physical.
• Most men experience occasional problems with obtaining an adequate erection, and this should not be a cause for concern.
• Erectile dysfunction can be treated at any age.
• Treatment options include psychotherapy, drug therapy, vacuum pumps and surgery.

• Premature ejaculation (PE): reaching orgasm too quickly can be caused by physical or psychological factors, or a combination of both:
• Physical factors : Research indicated that the pelvic muscles, specifically the muscles that surround the erectile bodies in the penis, are in a hyperactive state in men with PE. It is also known that during the ejaculation process there is increased activity of these same muscle groups. Consequently, it is likely that men who have PE have hyperactive muscles that are already on their way toward the threshold to producing ejaculations.

Infection of the prostate can also cause PE.

• Psychological causes: For the majority of men with PE, the origin is psychological. It may stem from a first sexual experience, where there is an enormous amount of pressure to perform and PE occurs. This can cause a feeling of inadequacy that can manifest again as performance anxiety and cause the problem to escalate. This may result in years of feeling inadequate and frustrated. Some men go through their whole lives never really experiencing control of their ejaculation.

• Physical abnormalities of the penis includes:
• Priapism: a persistent, often painful erection that can last from several hours to a few days. The priapism erection is not associated with sexual activity and is not relieved by orgasm. It occurs when blood flows into the penis but is not adequately drained.
• Peyronie's disease: a condition in which a plaque, or hard lump, forms on the penis. The plaque may develop on the upper (more common) or lower side of the penis, in the layers that contain erectile tissue. The plaque often begins as a localised area of irritation and swelling (inflammation), and can develop into a hardened scar. The scarring reduces the elasticity of the penis in the area affected.
• Balanitis: an inflammation of the skin covering the head of the penis. A similar condition, balanoposthitis, refers to inflammation of the head and the foreskin. Symptoms of balanitis include redness or swelling, itching, rash, pain and a foul-smelling discharge.
• Phimosis and paraphimosis
  Phimosis is a condition in which the foreskin of the penis is so tight that it cannot be pulled back (retracted) to reveal the head of the penis. Paraphimosis occurs when the foreskin, once retracted, cannot return to its original location.
• Penile cancer: A rare form of cancer, penile cancer occurs when abnormal cells in the penis divide and grow uncontrolled. Certain benign (non-cancerous) tumors may progress and become malignant.

• Lowered levels of testosterone: Signs of low testosterone in men may include decreased sex drive, poor erections, lowered sperm count and reduced fertility, or increased breast size.
• Disorders affecting blood vessels: Such as atherosclerosis (hardening of the arteries) and high blood pressure, are risk factors for ED.