The many moods of sexual dysfunction

MANY things can cause sexual dysfunction – medication, pregnancy and other factors that will cause a woman not to enjoy sex; or not to be able to perform sexually as she should. There are four different types of sexual dysfunctions listed – desire disorders, arousal disorders, orgasmic disorders and sexual pain disorders – with the most popular being desire disorder. This is when the woman has very little or no desire for sex.

Certain medicines (such as oral contraceptives and chemotherapy drugs), diseases (such as diabetes or high blood pressure), excessive alcohol use or vaginal infections can cause sexual problems. Depression, relationship problems or abuse (current or past) and aging can also be factors.

Ocasionally, a woman may have less sexual desire during pregnancy and right after childbirth or when she is breastfeeding. After menopause many women also feel less sexual desire, have vaginal dryness or have pain during sex due to a decrease in oestrogen (a female hormone). But the stresses of everyday life can also affect one’s ability to have sex. Being tired from a busy job, caring for young children and boredom by a long-standing sexual routine may affect sexual desire.

“Sexual dysfunction is a very complex issue, with women it is more complicated than with men,” Professor Horace Fletcher, gynaecologist and obstetrician at the University Hospital said.

Dr Fletcher explained that in both genders there are natural sexual urges (drives) which are innate and are due to hormonal influences, especially the secretion of testosterone and other “male” hormones. These are called male hormones because although they occur in women and men, the levels are much higher in men and give rise to most of the male characteristics such as facial and body hair as well as the male body shape (muscular) and enlarged male genitals. This hormone is also responsible for sex drive (libido) in both males and females. Loss of the hormone results in a low sex drive.

“Although all humans have libido the brain can control these urges to a certain extent, therefore limiting the need to fulfil these drives until the time is appropriate,” Dr Fletcher said. “In some people the ability to suppress the sex drive is very powerful and is dictated by culture, religion and values. In others they give in to their natural urges and have casual sex. This can lead to promiscuity and even worse, mental illness.”

In mental illness the woman does not have any sense of limitation. In some cases, a past sexual experience may have left an indelible memory, blocking the ability to desire sex as pleasurable. Past experiences could include sexual abuse as a child or adolescent, sexually abusive relationships as an adult or as a result of a sexual assault. The fear of pregnancy as well as sexually transmitted disease can also be a deterrent to normal sexual relationships

“In a normal consensual relation the drive to have sex is also controlled by hormonal urges as well as interpersonal relationship. The man or woman may overcome the natural sex drive mentally because of anger or guilt,” he said.

He explained too that the menstrual cycle has fluctuations in hormonal levels, which in some women affects their sex drive while the rise in male hormones, which occurs at certain times of the month may cause intense sexual desire. Genital problems such as pelvic pain, bleeding and discharge can also decrease desire. So although the woman may have the natural sex drive, she avoids sex when she remembers the problems it may cause. This can lead to a vicious cycle, when she tries to have sex the vagina goes into spasm (vaginismus) and does not relax leading to very painful penetration and inability to complete the sex act.

Sexual stimulation and orgasm usually satisfies the libido and sexual desire. In some people the intense feeling of pleasure from sexual stimulation is not easily satisfied and they may want to maintain this feeling for a long time with repeated sexual contact. In some cases the partner has the ability and desire also to continue, however, in other cases one or the other partner has a lower threshold of satisfaction and this mismatch can cause relationship problems for men and women leading them to seeking satisfaction otherwise through masturbation or outside partners. Again cultural and religious values may prevent this.

“Orgasm occurs if all else is in place,” Dr Fletcher said. “Libido, desire, proper sexual stimulation with or without penetration (it varies from woman to woman) and the right mental frame of mind. If the conditions are not right orgasm may not occur.”

He explained that for example if the woman is with a partner she really cares for but the situation is not right (eg your mother in law is upset with you) libido may not be there, desire may not be there, sex is not pleasurable and therefore orgasm may not occur. The problem can arise from any of these steps and the mental aspect is very powerful.

As women and men get older, the amount of male hormone falls. It falls as a result of failing of the gonads and other organs like the adrenals. The effect is very variable and in some women it occurs earlier than for others. In some older people the drives are still there but the genitals may not work as well as when they were younger. In some women loss of ovarian function leads to vaginal dryness and tissue atrophy (thinness). These can cause painful intercourse leading to lack of desire. In many older couples loss of desire in their partner may lead to their own cessation of sexual intercourse since their values would not allow them to have sex with anybody else.

Treating sexual dysfunction

“The treatment of sexual dysfunction is therefore complex,” Dr Fletcher said.

He noted that the doctor must take a careful history to find out if there were any past sexual abuses. He must ask about interpersonal relationships and stress factors. He must check for the presence or absence of pelvic problems and other medical illnesses and past treatment. The doctor must also examine the patient and do tests to see if there is a pelvic or hormonal problem.

“There is usually no quick fix. Some people will get better with psychoanalysis (talking about the problem to a specialist). Some will get better with drug treatment or surgery depending on the underlying condition.”

– husseyd@jamaicaobserver.com