sexual malfunction. sexual disorder
Sexual dysfunction is difficulty experienced by an individual or a couple during any stage of a normal sexual activity, including physical pleasure, desire, preference, arousal or orgasm.
The World Health Organization's International Classifications of Diseases defines sexual problems as "the various ways in which an individual is unable to participate in a sexual relationship as he or she would wish." Sexual disorders, according to the 5th edition of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-5), are disturbances in sexual desire and psycho-physiological changes that characterize the sexual response cycle and cause marked distress and interpersonal difficulty.
According to the DSM-5, sexual dysfunction requires a person to feel extreme distress and interpersonal strain for a minimum of 6 months (excluding substance or medication-induced sexual dysfunction). Sexual dysfunctions can have a profound impact on an individual's perceived quality of sexual life.
Sexual dysfunction disorders may be classified into seven categories: sexual desire disorders, arousal disorders, erectile dysfunction, premature ejaculation, orgasm disorders, pain disorders and post-orgasmic diseases.
1. Sexual desire disorders
Sexual desire disorders, or decreased libido, are characterized by a lack or absence of desire for sexual activity or of sexual fantasies. The condition may have started after a period of normal sexual functioning or the person may always have had low or no sexual desire. The causes vary considerably, but include a possible decrease in the production of normal estrogen (the primary female sex hormone) in women or testosterone (the primary male sex hormone) in both men and women. Other causes may include aging, fatigue, hormone imbalance, pregnancy, postpartum depression, medications (antidepressants), or psychiatric conditions such as depression and anxiety.
2. Sexual arousal disorders
Sexual arousal disorder is characterized by a lack or absence of sexual fantasies and desire for sexual activity in a situation that would normally produce sexual arousal, or the inability to attain or maintain typical responses to sexual arousal.
For both men and women, these conditions can manifest themselves 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.
3. Erectile dysfunction
Erectile dysfunction (ED) or impotence is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis.
The causes of erectile dysfunction may be psychological or physical. Psychological erectile dysfunction can often be helped by almost anything that the patient believes in; there is a very strong placebo effect. Physical damage is much more severe. One leading physical cause of ED is continual or severe damage taken to the nervi erigentes (fibers to the genitalia that are involved in erection of the penis).
4. Premature ejaculation
Premature ejaculation (PE) is a persistent or recurrent ejaculation with minimal stimulation before, on or shortly after penetration and before the person wishes it, over which the sufferer has little or no voluntary control which causes the sufferer and / or his partner bother or distress. There is no correct length of time for intercourse to last, but generally, premature ejaculation is thought to occur when ejaculation occurs in under 2 minutes from the time of the insertion of the penis.
Premature ejaculation is a condition that affects men of all ages. PE however, is actually more prevalent, involving up to 31% of men aged 18-59, and is considered to be most common among male sexual disorders. PE is more prevalent in young men and in men who lack sexual experience and frequency.
Men with PE often report emotional and relationship distress, and some avoid pursuing sexual relationships because of PE-related embarrassment.
5. Orgasm disorders
Orgasm disorders are persistent delays or absence of orgasm (anorgasmia) following a normal sexual excitement phase in at least 75 percent of sexual encounters.
The disorder can have physical, psychological, or pharmacological origins. Antidepressants are a common pharmaceutical culprit, as they can delay orgasm or eliminate it entirely.
A common physiological culprit of anorgasmia is menopause (a woman stops having periods and is no longer able to get pregnant naturally), where one in three women report problems obtaining an orgasm during sexual stimulation following menopause.
6. Sexual pain disorders
Painful sexual intercourse is problem affecting women as well as men, although in men it is much less common.
The painful feeling during sexual intercourse (dysparenuria) can be classified as superficial or deep depending on the location of the pain.
Superficial dyspareunia results from pain at the vaginal introitus (the vaginal opening) upon penile penetration, whereas deep dyspareunia occurs with deep thrusting of the penis. Superficial dyspareunia is more prevalent. Dyspareunia has been estimated to have a lifetime incidence of over 60% in women. The list of physical disorders related with dyspareunia is very extend and defining the cause may represent quite challenge.
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.
Another type is called vaginismus, which is an involuntary spasm of the muscles of the vaginal wall that interferes with intercourse.
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.
Pain is sometimes experienced in the testicular or glans area of the penis immediately after ejaculation. Infections of the prostate, bladder, or seminal vesicles can lead to intense burning or itching sensations following ejaculation. Men suffering from cystitis (an inflammation of bladder) may experience intense pain at the moment of ejaculation.
Gonorrheal infections are sometimes associated with burning or sharp penile pains during ejaculation. Urethritis (an inflammation of the urethra) or prostatitis (an inflammation of prostate gland) can make genital stimulation painful or uncomfortable.
Anatomic deformities of the penis may also result in pain during coitus. One cause of painful intercourse is due to the painful retraction of a too-tight foreskin, occurring either during the first attempt at intercourse or subsequent to tightening or scarring following inflammation or local infection.
Another cause of painful intercourse is due tension in a short and slender frenulum (a connecting membrane on the underside of the penis) as the foreskin retracts on entry to the vagina irrespective of lubrication.
7. Post-orgasmic diseases
Post-orgasmic diseases cause symptoms shortly after orgasm or ejaculation. Post-coital tristesse (PCT) is a feeling of melancholy and anxiety after sexual intercourse that lasts for up to two hours. Sexual headaches occur in the skull and neck during sexual activity, including masturbation or orgasm.
In men, postorgasmic illness syndrome (POIS) causes severe muscle pain throughout the body and other symptoms immediately following ejaculation. The symptoms last for up to a week.
Sexual desire and arousal disorders
Very often people with low sexual desire and arousal are avoiding sex. Without sexual intercourse the natural conception is impossible.
As was mentioned above, feelings of stress, depression, guilt, or anxiety in infertile men can cause psychogenic impotence, which heightens the feelings of inadequacy that already accompany infertility. The psychological stress of infertility has been shown to affect sperm parameters in significant and demonstrable ways that may further contribute to difficulties with erectile potency; emotional reactions to the infertility may alter or even undermine a previous consolidation of a sense of self as sexually adequate. Infertility weighs on many males' minds; this creates mental instability, which often results in impotence.
Even with an erection problem, a man may still have sexual desire and be able to have an orgasm and to ejaculate. Thus, it is important to keep in mind that it can be helped if the roots of stress are detected.
A direct impact on fertility is in cases, when man ejaculate before he enters his penis to vagina and sperm will not be able to fertilize an egg. But more often this condition cause depression and reduced libido. This was also associated with onset of smoking. Strained relationships and sexual difficulties appear to be central to male infertility-related stress. However, the degree of desperation experienced may vary between clients depending on their situation: age, number of years married, whether primary or secondary infertility and result of investigations.
Without man’s orgasm followed with ejaculation the natural conception is also impossible.
This disorder is unfortunatelly more often associated with women’s orgasm. In this case there is no connection with infertility and orgasm disorder, because orgasm is not neccessary for woman to became pregnant.
Sexual pain disorders
If man or woman is feeling pain during the sex, it leads to avoidance of intercourse. Without sex, there is no chance to became pregnant naturally.
Post- orgasmic diseases
Symptoms followed after sex and orgasm cannot influence fertility.
Sexual problems have different effects on the life of people by influencing their interpersonal and marital relationships and satisfaction. Relationship between sexual dysfunctions and infertility can be mutual. Sexual dysfunction may cause difficulty conceiving but also attempts to conceive, may cause sexual dysfunction.
Paying attention to sexual aspects of infertility and presence of programs for training of sexual skills seems necessary for couples.