Sexual problems, also called sexual dysfunction or sexual malfunction, are defined as difficulty during any stage of the sexual act (which includes desire, arousal, orgasm, and resolution) that prevents the individual or couple from enjoying sexual activity. Sexual behavior is a form of physical intimacy that may be directed to reproduction (one possible goal of sexual intercourse) and/or to the enjoyment of activity involving sexual gratification. ... Desire can refer to preference, on which microeconomic theory is based; a thought that leads to an action; the concept in Lacanian psychoanalytic theory, related to the Oedipus complex; tanha in Buddhist psychology, as described in the Four Noble Truths; a Bob Dylan album of that name; a feeling due... Sexual arousal is the process and state of an animal being ready for sexual intercourse. ... An orgasm, also known as a sexual climax, is a pleasurable physical, psychological or emotional response to prolonged sexual stimulation. ...

Onset

Sexual difficulties can begin early in a person's sex life or they may develop after an individual has previously experienced enjoyable and satisfying sex. A problem may develop gradually over time, or may occur suddenly as a total or partial inability to participate in one or more stages of the sexual act. The causes of sexual difficulties can be physical, psychological, or both.

Emotional factors affecting sex include both interpersonal problems (such as marital/relationship problems, or lack of trust and open communication between partners) and psychological problems within the individual (depression, sexual fears or guilt, past sexual trauma, and so on). Clinical depression is a health condition of depression with mental and physical components reaching criteria generally accepted by clinicians. ...

Physical factors include drugs (alcohol, nicotine, narcotics, stimulants, antihypertensives, antihistamines, and some psychotherapeutic drugs); injuries to the back, problems with an enlarged prostate gland, problems with blood supply, nerve damage (as in spinal cord injuries); or disease (diabetic neuropathy, multiple sclerosis, tumors, and, rarely, tertiary syphilis); failure of various organ systems (such as the heart and lungs); endocrine disorders (thyroid, pituitary, or adrenal gland problems); hormonal deficiencies (low testosterone, estrogen, or androgens); and some birth defects. Nicotine is an organic compound, an alkaloid found naturally throughout the tobacco plant, with a high concentration in the leaves. ... The term narcotic, derived from the Greek word narkotikos, meaning benumbing or deadening, originally referred to a variety of substances that induced sleep (such state is narcosis). ... An antihistamine is a drug which serves to reduce or eliminate effects mediated by histamine, an endogenous chemical mediator released during allergic reactions, through action at the histamine receptor. ... Diabetic neuropathies are neuropathic disorders that are associated with diabetes mellitus. ... See the article about cancer for the main article about malignant tumors. ... Depression-era U.S. poster advocating early syphilis treatment Syphilis (historically called lues) is a sexually transmitted disease (STD) that is caused by a spirochaete bacterium, Treponema pallidum. ... The endocrine system is a control system of ductless endocrine glands that secrete chemical messengers called hormones that circulate within the body via the bloodstream to affect distant organs. ... Located at the base of the skull, the pituitary gland is protected by a bony structure called the sella turcica. ... In mammals, the adrenal glands (also known as suprarenal glands or colloquially as kidney hats) are the triangle-shaped endocrine glands that sit atop the kidneys. ... Testosterone is a steroid hormone from the androgen group. ... Estrogens (or oestrogens) are a group of steroid compounds that function as the primary female sex hormone. ... Androgen is the generic term for any natural or synthetic compound, usually a steroid hormone, that stimulates or controls the development and maintenance of masculine characteristics in vertebrates by binding to androgen receptors. ... A congenital disorder is a medical condition or defect that is present at or before birth (for example, congenital heart disease). ...

Sexual dysfunction disorders are generally classified into four categories: sexual desire disorders, sexual arousal disorders, orgasm disorders, and sexual pain disorders.

1. Sexual desire disorders or decreased libido can be caused by a decrease in normal estrogen (in women) or testosterone (in both men and women) production. Other causes may be aging, fatigue, pregnancy, medications -- the SSRI antidepressants which include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa) are well known for reducing desire in both men and women, sometimes permanently (see link below) -- or psychiatric conditions, such as depression and anxiety.
2. Sexual arousal disorders were previously known as frigidity in women and impotence in men, though these have now been replaced with less judgmental terms. Impotence is now known as erectile dysfunction, and frigidity has been replaced with a number of terms describing specific problems with, for example, desire or arousal.
   For both men and women, these conditions can manifest as an aversion to, and avoidance of, sexual contact with a partner. In men, there may be partial or complete failure to attain or maintain an erection, or a lack of sexual excitement and pleasure in sexual activity.
   There may be medical causes to these disorders, such as decreased blood flow or lack of vaginal lubrication. Chronic disease can also contribute, as well as the nature of the relationship between the partners. As the success of Viagra attests, most erectile disorders in men are primarily physical, not psychological conditions. SSRI antidepressants also frequently cause erectile dysfunction, which can sometimes be permanent even after the drug is discontinued (see link below).
3. Orgasm disorders are a persistent delay or absence of orgasm following a normal sexual excitement phase. The disorder can occur in both women and men. Again, the SSRI antidepressants are frequent culprits -- these can delay the achievement of orgasm or eliminate it entirely. Sometimes the anorgasmia caused by SSRIs can be permanent (see link below).
4. Sexual pain disorders affect women almost exclusively and are known as dyspareunia (painful intercourse) and vaginismus (an involuntary spasm of the muscles of the vaginal wall that interferes with intercourse). Dyspareunia may be caused by insufficient lubrication (vaginal dryness) in women.

Poor lubrication may result from insufficient excitement and stimulation, or from hormonal changes caused by menopause, pregnancy, or breast-feeding. Irritation from contraceptive creams and foams can also cause dryness, as can fear and anxiety about sex. SSRI is an acronym that stands for several things: It is a class of antidepressants called selective serotonin reuptake inhibitor SSRI also is used as the stock symbol for Silver Standard Resources Inc. ... An antidepressant is a medication used primarily in the treatment of clinical depression. ... Fluoxetine hydrochloride is an antidepressant drug used medically in the treatment of depression, obsessive-compulsive disorder, bulimia nervosa, premenstrual dysphoric disorder and panic disorder. ... Sertraline hydrochloride (Zoloft®, Lustral®, Apo-Sertral®, Asentra®, Gladem®, Serlift®, Stimuloton®, Xydep®, Serlain®) is an orally administered antidepressant of the selective serotonin reuptake inhibitor (SSRI) type. ... Paroxetine or paroxetine hydrochloride (sold under the trade names Paxil® in the United States, Seroxat® in the UK and China, Aropax® in Australia and New Zealand, Deroxat in Switzerland) is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) type. ... Citalopram or nitalapram is an antidepressant drug used to treat the depression associated with mood disorders. ... SSRI is an acronym that stands for several things: It is a class of antidepressants called selective serotonin reuptake inhibitor SSRI also is used as the stock symbol for Silver Standard Resources Inc. ... An antidepressant is a medication used primarily in the treatment of clinical depression. ... SSRI is an acronym that stands for several things: It is a class of antidepressants called selective serotonin reuptake inhibitor SSRI also is used as the stock symbol for Silver Standard Resources Inc. ... An antidepressant is a medication used primarily in the treatment of clinical depression. ... Dyspareunia is painful sexual intercourse, due to medical or psychological causes. ... In medicine, vaginismus is a condition where the muscles at the entrance to vagina contract, preventing successful sexual intercourse. ... Vaginal lubrication is the naturally produced lubricating fluid that reduces friction during sexual intercourse. ... Menopause (also known as the Change of life or climacteric) is a stage of the human female reproductive cycle that occurs as the ovaries stop producing estrogen, causing the reproductive system to gradually shut down. ... A pregnant woman Pregnancy is the carrying of one or more embryos or feti by female mammals including humans inside their bodies. ...

It is unclear exactly what causes Vaginismus, but it is thought that past sexual trauma (such as rape or abuse) may play a role. Another female sexual pain disorder is called vulvodynia or vulvar vestibulitis. In this condition, women experience burning pain during sex which seems to be related to problems with the skin in the vulvar and vaginal areas. The cause is unknown. The term vulvodynia is used to describe pain in the vulva, often severe, of unknown cause. ...

Sexual dysfunctions are more common in the early adult years, with the majority of people seeking care for such conditions during their late twenties through thirties. The incidence increases again in the geriatric population, typically with gradual onset of symptoms that are associated most commonly with medical causes of sexual dysfunction.

Sexual dysfunction is more common in people who abuse alcohol and drugs. It is also more likely in people suffering from diabetes and degenerative neurological disorders. Ongoing psychological problems, difficulty maintaining relationships or chronic disharmony with the current sexual partner can also interfere with sexual function.

Symptoms

Psychological sexual disorders

The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders lists the following psychological sexual disorders: The Diagnostic and Statistical Manual published by the American Psychiatric Association The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, is the handbook used most often in diagnosing mental disorders in the United States and internationally. ...

• Hypoactive sexual disorder (see also Asexuality)
• Sexual aversion disorder (avoidance of contact with genitalia)
• Female sexual arousal disorder (failure of normal lubricating arousal response)
• Male erectile disorder (see also Impotence)
• Female orgasmic disorder (see Anorgasmia)
• Male orgasmic disorder (see Anorgasmia)
• Premature ejaculation
• Dyspareunia
• Vaginismus
• Secondary sexual dysfunction
• Paraphilias
• Gender identity disorder

This article is about human asexuality; asexual reproduction is a separate topic. ... Female sexual arousal disorder can take many forms. ... Impotence or, more clinically, erectile dysfunction is the inability to maintain an erection of the penis for satisfactory sexual intercourse regardless of the capability of ejaculation. ... Impotence or, more clinically, erectile dysfunction is the inability to develop or maintain an erection of the penis for satisfactory sexual intercourse regardless of the capability of ejaculation. ... Anorgasmia is a form of sexual dysfunction, sometimes classified as a psychiatric disorder, where the patient cannot achieve orgasm, even with adequate stimulation. ... Anorgasmia is a form of sexual dysfunction, sometimes classified as a psychiatric disorder, where the patient cannot achieve orgasm, even with adequate stimulation. ... Premature ejaculation, also known as rapid ejaculation, the most common sexual problem in men, is characterized by a lack of voluntary control over ejaculation. ... Dyspareunia is painful sexual intercourse, due to medical or psychological causes. ... In medicine, vaginismus is a condition where the muscles at the entrance to vagina contract, preventing successful sexual intercourse. ... Paraphilia (in Greek para παρά = besides and -philia φιλία = love) is a mental health term recently used to indicate sexual arousal in response to sexual objects or situations which may interfere with the capacity for reciprocal affectionate sexual activity. ... Gender identity disorder as identified by psychologists and medical doctors is a condition where a person who has been assigned one gender (usually at birth on the basis of their sex, but compare intersexual) but identifies as belonging to another gender, or does not conform with the gender role their...

Other sexual problems

• Lack of a sexual partner
• Sexual dissatisfaction (non-specific)
• Lack of sexual desire
• Anorgasmia
• Impotence
• Sexually transmitted diseases
• Infidelity
• Delay or absence of ejaculation, despite adequate stimulation
• Inability to control timing of ejaculation
• Inability to relax vaginal muscles enough to allow intercourse
• Inadequate vaginal lubrication preceding and during intercourse
• Burning pain on the vulva or in the vagina with contact to those areas
• Unhappiness or confusion related to sexual orientation
• Transsexual and transgender people may have sexual problems (before or after surgery), though actually being transgendered or transsexual is not a sexual problem in itself.
• Persistent sexual arousal syndrome
• Sexual addiction
• Hypersexuality

Sexual dissatisfaction is when a person wants more sex than they can achieve, or get. ... Anorgasmia is a form of sexual dysfunction, sometimes classified as a psychiatric disorder, where the patient cannot achieve orgasm, even with adequate stimulation. ... Impotence or, more clinically, erectile dysfunction is the inability to develop or maintain an erection of the penis for satisfactory sexual intercourse regardless of the capability of ejaculation. ... Sexually-transmitted infections (STIs), also known as sexually-transmitted diseases (STDs), are diseases that are commonly transmitted between partners through some form of sexual activity, most commonly vaginal intercourse, oral sex, or anal sex. ... In a religious context, infidelity is an absence of faith in the beliefs or teachings of a religion, such that one who lacks such faith is an infidel. ... Illustration of the human male anatomy. ... Human female internal reproductive anatomy The vagina (from the Latin for sheath or scabbard ) is the tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. ... The word intercourse in its broadest sense refers to any kind of human communication and interaction. ... Appearance of the vulva Labeled picture of external female reproductive anatomy. ... Sexual orientation refers to the sex or gender of people who are the focus of a persons amorous or erotic desires, fantasies, and spontaneous feelings, the gender(s) toward which one is primarily oriented. The alternative terms sexual preference and sexual inclination have similar meanings. ... A transsexual (sometimes transexual) person establishes a permanent identity with the opposite gender to their assigned (usually at birth) sex. ... Transgender is generally used as an overarching, general term for a variety of individuals, behaviors, and groups centered around the full or partial reversal of gender roles; however, compare other definitions below. ... Sex reassignment surgery (SRS) includes the surgical procedures by which a persons physical appearance and function of their existing sexual characteristics are changed to that of the other sex. ... Persistent Sexual Arousal Syndrome or PSAS is a rare disorder found in women. ... Sexual addiction is an alleged form of addiction to sexual intercourse and other sexual behavior. ... Hypersexuality describes human sexual behavior at levels high enough to be considered clinically significant. ...

Other related problems

• Infertility
• Paraphilias

Infertility is the inability to naturally conceive a child or the inability to carry a pregnancy to term. ... Paraphilia (in Greek para παρά = besides and -philia φιλία = love) is a mental health term recently used to indicate sexual arousal in response to sexual objects or situations which may interfere with the capacity for reciprocal affectionate sexual activity. ...

Clinical studies

Since people tend not to talk to one another about their sexual problems, many people imagine that they are "abnormal", or that their sexual problems are unique or shameful. Images of sexuality presented by society and the media often present people with unrealistic ideals of sexual behavior, whether of the ideals of chastity and sexual fidelity presented by religion, or the ideal of sexual inexhaustibility and promiscuous availability presented by pornography. Neither image appears to be representative of human behavior in real life: this has been summed up in the phrase "everyone lies about sex". Shame is a social condition and a form of social control consisting of an emotional state and a set of behaviors, caused by the consciousness or awareness of having acted inappropriately. ... For the song by the California punk band Pennywise, see Society (song). ... Chastity is a pure state of the human body and mind -- especially pursued for religious or other ethical reasons, as by virtuous sexual abstience in the Judeo-christian usually referred to in modern speech. ... Promiscuity is the practice of making relatively unselective, casual and indiscriminate choices. ... Pornography (from Greek πορνογραφία pornographia — literally writing about or drawings of harlots) (also informally referred to as porn or porno) is the representation of the human body or human sexual behaviour with the goal of sexual arousal, similar to, but (according to some) distinct from, erotica. ...

The genuine clinical study of sexual problems is usually dated back no further than 1970 when Masters and Johnson's Human Sexual Inadequacy was published. It was the result of over a decade of work at the Reproductive Biology Research Foundation in St. Louis, involving 790 cases. The work grew from Masters and Johnson's earlier Human Sexual Response (1966). Time magazine, May 25, 1970 Gynecologist William Howell Masters (December 27, 1915 – February 16, 2001) and psychologist Virginia Eshelman Johnson (born February 11, 1925) pioneered research into human sexual behavior during the 1950s and 1960s. ... Time magazine, May 25, 1970 Gynecologist William Howell Masters (December 27, 1915 – February 16, 2001) and psychologist Virginia Eshelman Johnson (born February 11, 1925) pioneered research into human sexual behavior during the 1950s and 1960s. ... Sexual arousal is the process and state of an animal being ready for sexual intercourse. ...

Prior to Masters and Johnson the clinical approach to sexual problems was largely derived from the thinking of Freud. It was held with psychopathology and approached with a certain pessimism regarding the chance of help or improvement. Sexual problems were merely symptoms of a deeper malaise and the diagnostic approach was from the psychopathological. There was little distinction between difficulties in function and variations nor between perversion and problems. Despite work by psychotherapists such as Balint sexual difficulties were crudely split into frigidity or impotence, terms which too soon acquired negative connotations in popular culture. Sigmund Freud His famous couch Sigmund Freud (May 6, 1856 - September 23, 1939) was an Austrian neurologist and the founder of the psychoanalytic school of psychology, a movement that popularized the theory that unconscious motives control much behavior. ... Psychopathology is a term which refers to either the study of mental illness or mental distress the manifestation of behaviours and experiences which may be indicative of mental illness or psychological impairment. ... Inhibited sexual desire (ISD), sometimes called frigidity, sexual aversion, Sexual apathy or Hypoactive sexual desire, refers to a low level of sexual desire and interest manifested by a failure to initiate or be responsive to a partners initiation of sexual activity. ... Impotence or, more clinically, erectile dysfunction is the inability to develop or maintain an erection of the penis for satisfactory sexual intercourse regardless of the capability of ejaculation. ...

The achievement of Human Sexual Inadequacy was to move thinking from psychopathology to learning, only if a problem did not respond to educative treatment would psychopathological problems be considered. Also treatment was directed at couples, whereas before partners would be seen individually. Masters and Johnson saw that sex was a joint act. They believed that sexual communication was the key issue to sexual problems not the specifics of an individual problem. They also proposed co-therapy, a matching pair of therapists to the clients, arguing that a lone male therapist could not fully comprehend female difficulties and vice versa.

The basic Masters and Johnson treatment program was an intensive two week program to develop efficient sexual communication. Couple-based and therapist led the program began with discussion and then sensate focus between the couple to develop shared experiences. From the experiences specific difficulties could be determined and approached with a specific therapy. In a limited number of male only cases (41) Masters and Johnson had developed the use of a female surrogate, an approach they soon abandoned over the ethical, legal and other problems it raised.

In defining the range of sexual problems Masters and Johnson defined a boundary between dysfunction and deviations. Dysfunctions were transitory and experience by the majority of people, dysfunctions bounded male primary or secondary impotence, premature ejaculation, ejaculatory incompetence; female primary orgasmic dysfunction and situational orgasmic dysfunction; pain during intercourse (dyspareunia) and vaginismus. According to Masters and Johnson sexual arousal and climax are a normal physiological process of every functionally intact adult, but despite being autonomic it can be inhibited. Masters and Johnson treatment program for dysfunction was 81.1% successful. Impotence or, more clinically, erectile dysfunction is the inability to develop or maintain an erection of the penis for satisfactory sexual intercourse regardless of the capability of ejaculation. ... Premature ejaculation, also known as rapid ejaculation, the most common sexual problem in men, is characterized by a lack of voluntary control over ejaculation. ... Dyspareunia is painful sexual intercourse, due to medical or psychological causes. ... In medicine, vaginismus is a condition where the muscles at the entrance to vagina contract, preventing successful sexual intercourse. ... Sexual arousal is the process and state of an animal being ready for sexual intercourse. ... An orgasm, also known as a sexual climax, is a pleasurable physical, psychological or emotional response to prolonged sexual stimulation. ...

Despite the work of Masters and Johnson the field in the US was quickly over-run by ethusiastic rather than systematic approaches, blurring the space between 'enrichment' and therapy. Although it has been argued that the impact of the work was such that it would be impossible to repeat such a clean experiment.

See also

• Agony aunt

An agony aunt is an advice columnist at a magazine or newspaper. ...

External links

• NIH site on sexual problems
• 100 FAQs about sexual dysfunction
• Site for men with sexual dysfunction
• Support group for people with persistent sexual dysfunction after using SSRIs
• NIH Report on the reproductive toxicology of Prozac (Fluoxetine)