Sexual Disorders  

Inhibited Sexual Desire

Female Dysfunctions:
    Female Sexual Arousal Disorder (FSAD).
    Female Orgasmic Disorder.
    Vaginismus.
    Dyspareunia (Painful Intercourse)

Male Dysfunctions:
    Erectile Dysfunction
    Male Orgasmic Disorder
    Premature Ejaculation
    Impotence

for more information on Sexual Dysfunctions and Sexuality:

Inhibited Sexual Desire (ISD).
Although this is, strictly speaking, not a sexual dysfunction, it is a disorder that can severely disrupt the sexual relationship of a couple. ISD is the persistent and pervasive inhibition of sexual desire.

ISD is present if there is both a low rate of sexual activity and a subjective lack of desire for sexual activity; desire here includes sexual dreams and fantasies, attention to erotic material, awareness of wishes for sexual activity, noticing attractive potential partners, and feelings of frustration if deprived of sex.

The DSM IV describes Hypoactive Sexual Desire Disorder as:

• Persistent or recurrent deficient (or absent) sexual fantasies and desire for sexual activity. The judgment of deficiency or absence is made by the clinician, taking into account factors that affect sexual functioning, such as age, sex, and the context of the person's life."

The problem with the above description is the lack of a relationship context. To deal with this the American Psychiatric Association added Sexual Aversion Disorder,"(a) persistent or recurrent extreme aversion to, and avoidance of, all (or almost all) genital sexual contact with a sexual partner.

Both physical and psychological factors contribute to ISD. Physical causes include: hormone deficiencies; depression; stress; alcoholism; kidney failure; and chronic illness. Psychological causes include: relationship problems, e.g. power struggles, conflict, hostility; sexual trauma, e.g. rape; major life changes, e.g. death of a family member, childbirth, geographic relocation; and pairing negative memories with sexual interaction. People who are angry, fearful, or distracted are usually not desirous of sexual intimacy.

FEMALE SEXUAL DYSFUNCTIONS

Female Sexual Arousal Disorder (FSAD).
FSAD is the inhibition of the general arousal aspect of sexual response. The woman with FSAD does not lubricate, her vagina does not expand, and there is no formation of the orgasmic platform. She also typically does not feel erotic sensations. She may find physical contact repulsive, she may have no feelings with regard to physical contact, or she may enjoy contact to a point.

Like all the dysfunctions, FSAD may be life long or acquired. Life long means that the woman has never been responsive to sexual stimulation. Acquired means that at some point the women has been responsive to sexual stimulation but is now unresponsive. But it can also be situational or generalized. Situational is when the dysfunction occurs in some situations and not others. Generalized is when the dysfunction occurs regardless of the situation. Therefore a woman can had FSAD that is; life long and situational, acquired and situational, life long and generalized, or acquired and generalized. For example, a woman who has FSAD as life long and situational would have always had trouble becoming aroused, but only with her partner. A woman who has FSAD as acquired and situational would have some period in the past without having trouble becoming aroused, but now does, but only with her partner. A woman who has FSAD as life long and generalized would have always had trouble getting aroused in all situations. And finally, a woman with FSAD as acquired and generalized would have had some period in the past absent of problems but now is unable to become aroused regardless of the situation.

The DSM IV describes FSAD as:

• persistent or recurrent inability attain or maintain until completion of sexual activity, an adequate lubrication-swelling response of sexual excitement.

Some of the most common causes of this dysfunction are guilt and hostility. Guilt usually involves an internal conflict between a desire to enjoy sexual interaction and an unconscious fear of doing so. Hostility often involves her specific partner.

Female Orgasmic Disorder.
Female Orgasmic Disorder is the impairment of the orgastic component of the female sexual response. It is important that this be separated from FSAD. With Female Orgasmic Disorder, the woman may be very sexually aroused but never reach orgasm.  Female Orgasmic Disorder can be either life long or acquired, situational or generalized. Life long Female Orgasmic Disorder (sometimes called anorgastic or preorgastic) is when the woman has never had an orgasm either through masturbation or with a partner. Acquired Female Orgasmic Disorder is when a woman has had an orgasm at some point in the past, but is now unable to experience an orgasm.

On one extreme are the women who have never climaxed at all. Next are women who require intense clitoral stimulation when they are alone and not "disturbed" by a partner. Women who need direct clitoral stimulation but are able to climax with their partners fall into the middle range. Also near the middle are women who can climax on coitus but only after lengthy and vigorous stimulation. Near the upper range are women who require only brief penetration to reach their climax and at the extreme are women who can achieve an orgasm via fantasy and/or breast stimulation alone.

The DSM IV identifies it as:

• Persistent or recurrent delay in, or absence of, orgasm in a female following a normal sexual excitement phase. Women exhibit wide variability in the type or intensity of stimulation that triggers orgasm. The diagnosis of Female Orgasmic Disorder should be based on the clinician's judgment that the woman's orgasmic capacity is less than would be reasonable for her age, sexual experience, and the adequacy of sexual stimulation she receives."

Of special import in the above description is the phrase, " the woman's orgasmic capacity is less than would be reasonable for her age, sexual experience, and the adequacy of sexual stimulation she receives." It is important to recognize normal individual variation when attempting to label this particular dysfunction. Sigmund Freud differentiated vaginal from clitoral orgasm. He believed that an orgasm produced by clitoral stimulation was immature and neurotic, whereas an orgasm produced by vaginal stimulation was seen as mature. Although we now understand that this is not true, the influence of this type of thinking still persists. If a woman is unable to experience an orgasm through intercourse, she is often seen as having a problem. This often leads to the woman being mislabeled as having an Female Orgasmic Disorder.

One of the most common causes of Female Orgasmic Disorder is the sex-equals-intercourse model of thinking. This model sets intercourse and orgasm as the goal for sexual interaction. Having intercourse and orgasm as a goal leads to pressure which often prevents orgasm from occurring.

Also, hostility towards her partner can lead a woman to Female Orgasmic Disorder. If a woman is angry at her partner she may "withhold" her orgasm in an attempt to get back at him/her.

Another cause of Female Orgasmic Disorder is ineffective sexual techniques. Sometimes the woman and/or her partner simply do not stimulate her effectively. Making love is not something we just "know," it is something we have to learn. Occasionally people simply do not know how to give or receive effective stimulation. Anxiety can also lead to ineffectual sexual techniques. Familial and/or religious teachings regarding sexuality sometimes cause the woman to avoid or actively discourage effective sexual stimulation.

Vaginismus.
Vaginismus is an involuntary spasm of the vaginal entrance making intercourse impossible. This is generally thought to be a fairly rare dysfunction. This includes difficult or uncomfortable penetration due to involuntary vaginal contractions.

The DSM IV defines Vaginismus as, "Recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with sexual intercourse." Therefore the DSM-IV takes the more standard approach defining vaginismus in relation to sexual intercourse.

The cause of vaginismus is often a result of an aversive stimulus associated with penetration. Some of the more common aversive stimuli are traumatic sexual assaults, painful intercourse, and traumatic pelvic exam. Other causes can be pelvic disease and unconscious fear and/or guilt.

Dyspareunia (Painful Intercourse)
Many women have had the experience of discomfort or pain with sexual intercourse. This can be felt as external or deep or both. The causes and solutions depend on the exact details.

External or Superficial Dyspareunia
This type of discomfort usually feels like a burning sensation or a sensation of dryness, with too much friction. This most commonly occurs as a result of inadequate lubrication. The solution is more foreplay to increase arousal and natural lubrication and/or assisting nature by adding some lubrication. External dyspareunia can also be a sign of infection, most commonly a yeast infection. Persistence of this problem requires an evaluation by a gynecologist.

Deep Dyspareunia
Many women sometimes feel discomfort or pain with deep penetration. This may be a normal response to the pressure on sensitive internal parts. The obvious solution is to avoid deep penetration.

MALE SEXUAL DYSFUNCTIONS

Erectile Dysfunction.
Erectile dysfunction is the impairment of the erectile reflex. The man is unable to have or maintain an erection. Like other dysfunctions, erectile dysfunction can be either life long or acquired, situational or generalized. Life long erectile dysfunction is when a man has never had an erection. Acquired is when a man has in the past had an erection but no longer is able to have or maintain an erection either in certain situations or at all.

As a situational dysfunction, erectile dysfunction is very common, almost universal. At some time in a man's life he will be unable to have an erection even though he is being sufficiently stimulated. In its situational form, there is a variety of ways it occurs. For some men they are unable to have an erection during foreplay, while others have difficulty only attempting intercourse. Still other men only have difficulty with specific partners but no dysfunction with other partners.

The DSM IV describes Erectile Disorder as:

• persistent or recurrent inability to attain, or maintain erection until completion of the sexual activity, an adequate erection."

Erectile dysfunction is more likely than the other dysfunctions to have a physical cause. Drugs (especially alcohol), diabetes, Parkinson's disease, multiple sclerosis, and spinal cord lesions can all be causes of erectile dysfunction.

Approximately 85% of the cases of erectile dysfunction are psychogenic. Anxiety seems to be the most likely psychological cause of erectile dysfunction.  The autonomic vascular reflexes which govern erection are delicate and subject to disruption by unconscious conflict and by emotion, i.e., anxiety and fear.

Male Orgasmic Disorder.
Male Orgasmic Disorder is an involuntary inhibition of the male orgastic reflex. As with the other dysfunctions, the man can experience either life long or acquired, situational or generalized Male Orgasmic Disorder.

The DSM IV describes Male Orgasmic Disorder as:

• Persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase during sexual activity that the clinician, taking into account the person's age, judges to be adequate in focus, intensity, and duration.

The cause of this dysfunction is rarely physical although it is sometimes confused with retrograde ejaculation. Retrograde ejaculation is when the man ejaculates into his bladder instead of out the urethra. More often than not, the cause is a traumatic sexual experience, strict religious upbringing, hostility, over control, or lack of trust.

Premature Ejaculation.
Exactly what constitutes premature ejaculation is unclear.

The DSM IV defines premature ejaculation as:

• Persistent or recurrent ejaculation with minimal sexual stimulation or before, on, or shortly after penetration and before the person wishes it. The clinician must take into account factors that affect duration of the excitement phase, such as age, novelty of the sexual partner or situation, and frequency of sexual activity.

Impotence
Impotence is the lack of an erection when one is desired. It can be relative (sometimes a problem) or absolute (never). Relative impotence also includes situations where the erection is not a firm as desired, or doesn't last long enough.

Organic (medical) causes of impotence include Diabetes, Other endocrine problems, Nerve dysfunction, including spinal cord injury, Vascular disease, Medication, Surgery and Drug abuse.  The sudden appearance of impotence requires medical evaluation by a urologist.

Situational causes of impotence include fatigue, alcohol, drugs and other distractions.

Acceptance and reassurance is the best response. There are many options that might be helpful, including medication, injections and prosthetic implants. Viagra (generic name Sildenafil) is the first of a new class of drugs that are very useful.

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