Sexual Problems

What are sexual problems?

Sexual problems prevent a person or couple from enjoying sexual activity. Sexual problems may develop gradually over time or may start suddenly. They include problems like not being interested in sex, not being excited about sex, being unable to have sex, or not being able to have an orgasm.

How do they occur?

The causes of sexual problems can be physical, emotional, or both.

Physical causes include:

• alcohol or drugs such as nicotine, narcotics, stimulants, blood pressure medicines, and some antidepressants
• chronic pain
• an enlarged prostate gland
• problems with blood supply
• nerve damage, for example from a spinal cord injury or from surgery
• diseases such as heart disease, diabetes, cancer, or lung disease
• thyroid, pituitary, or adrenal gland problems
• hormone problems such as low testosterone or low estrogen

Emotional causes of sexual problems include:

• lack of trust or poor communication between partners
• depression
• past sexual abuse or memories of painful intercourse
• a belief that sexual intercourse is a duty or only for the purpose of having children
• religious beliefs that sex should not be enjoyable
• fear that sex is dangerous if you have health problems
• fear of being rejected or of being unable to perform well
• feeling awkward or embarrassed
• anger
• not finding your partner attractive
• a poor body image or lack of self-esteem
• fear of pregnancy

When women feel that they are misunderstood, unappreciated, or unattractive, they will often have less sexual desire. Sexuality is both pleasure and communication.

Many men blame their lack of sexual desire on stress or worries. Rather than talking about these issues, they may avoid sex.

What are the symptoms?

Symptoms of sexual problems may include:

• lack of interest or desire in sex
• being unable to feel aroused
• pain with intercourse (much more common in women)
• trouble having an erection or not being able to keep an erection long enough to finish having sex
• premature ejaculation
• being unable to relax vaginal muscles enough to allow intercourse
• not enough vaginal lubrication before and during intercourse
• being unable to have an orgasm

How are they treated?

Treatment depends on the cause of the sexual problem. If you are concerned that you have a sexual problem, see your healthcare provider. Physical causes may be treated with medicine or, in some cases, with surgery. Physical therapy and mechanical aides may help people with some illnesses, conditions, or disabilities.

Talking openly and supporting each other is a very important part of treating emotional causes of sexual problems. Education about sex and sexual behaviors or responses may also be helpful. Books, videos, and movies offer the chance to watch different sexual behavior. You and your partner may want to discuss and try something new if you feel it might improve your relationship.

Some couples may benefit from sexual therapy. Sex therapy is based on the beliefs that sex is healthy and that relationships should be meaningful. Sex therapists believe sexual skills are learned, and that learning more about sex may help correct some sexual problems. The therapy is short, usually 6 to 12 sessions. Between sessions you may be given homework assignments. These assignments may include exercises involving communication or touching. The goal is to help couples improve their intimate relationship.

Psychotherapy may help people deal with anxieties, fears, inhibitions, or poor body image.

What can I do to help myself?

Talking with your partner in a clear and positive way may be the most important part of a healthy sexual relationship. Open and effective communication can go a long way in solving sexual problems.

• Find a time when you both are free to listen and talk with one another. Don't try to have a conversation while everyone is getting ready to leave the house in the morning or when things are hectic. If you already have a time when you often talk about personal things, that might be a good time to start the conversation.
• Start by saying something like: "Lately I've been thinking about ...," or "Sometimes I've been worried about ..." and then say as clearly as you can what is on your mind. It's okay to not always have the right words. It can help to use "I" language. For example, say "I feel...I need...I want...."
• The final step to good communication is listening. Sometimes your partner says things you don't agree with or don't want to hear. The best communication is when each partner says clearly what they think and feel and also tries to understand what the other person is thinking and feeling.

Nearly every couple has sexual problems at some time in their lives. Most sexual problems can be treated. The first step is to accept that there is a problem, and then get the needed help.