Understanding sexual dysfunction

COUPLES who have issues with intercourse may chalk it up to incompatibility, but while that may be true, it could also be that one partner is experiencing a sexual dysfunction.

While the incidence in men is easily identifiable, women can mask a dysfunction and go through relationships keeping it a secret without seeking help.

According to Dr Karen Carpenter, clinical sexologist, neither men nor women want to be seen as sexually inadequate, but women succeed at hiding their dysfunction much better than men.

“Women don’t require an erection in order to have intercourse, because a woman doesn’t have to show a visible sign of being ready for sex other than lubrication. If she’s having a lubrication problem, we’ve already worked around that by providing gels. So a woman really doesn’t have to show her dysfunction except where she’s totally turned off by sex or finds it difficult to have an orgasm, so that’s probably why women don’t seek help because they can mask it,” Dr Carpenter said.

Sexual dysfunction refers to a problem during any phase of the sexual response cycle that prevents the individual or couple from experiencing satisfaction from the sexual activity. The response cycle, according to Dr Carpenter, includes desire, arousal, orgasm and resolution.

Generally, sexual dysfunction affects women by causing a lack of sexual desire or interest in sex, which might be sparked by other issues such as hormonal changes or medical conditions. Another issue that may arise is the inability to become aroused physically during sexual intercourse, which involves insufficient vaginal lubrication. The sexual dysfunction might also include not being able to have an orgasm, which is oftentimes caused by abuse. Painful intercourse is also a sexual dysfunction.

Dr Charles Rockhead, gynaecologist, explained that sexual dysfunction is caused by a myriad of issues, which include obesity and abuse, whether physically or psychologically, which will offset the symptoms associated with the dysfunction.

“The most common cause that I see is physical abuse, particularly rape. But looking at it you have to do so on a spectrum, as it might range from some not wanting sex, to some experiencing vaginismus, which is a painful, involuntary spasm of the muscles that surround the vaginal entrance preventing penetration, or people being overtly sexual and having multiple partners.”

Moreover, other underlying issues such as menopause may cause women to experience sexual dysfunction.

Doctors Carpenter and Rockhead said while menopause can affect women during sexual intercourse, it doesn’t always affect them badly.

“There’s a myth that all women go through terrible menopause, lose their interest in sex, lose their ability to lubricate, simply feel unattractive and won’t have sex — that’s not true. The people who come to doctors are people who need help, so we only report on the population that comes to the doctor, and that’s a very small population. A number of women go through menopause perfectly healthy and maintain their sex drive and some report a higher sex drive as their testosterone hormone exceeds their oestrogen,” Dr Rockhead said.

Meanwhile, Dr Carpenter explained that the majority of sexual dysfunctions have a psychological basis and fewer of them have a medical basis, but the dysfunction generally relates to how you function with a partner or partners.

She said anyone can be affected, and knowledge of the dysfunction can occur without having sex.

“Anybody can have a sexual dysfunction and you can be aware that you are somehow affected without even having sex. Children can be affected, adolescents are often affected, and certainly adults are affected by these problems, particularly adults who are already sexually active,” Dr Carpenter said.

But as it relates to women, she said the dysfunction by extension will affect men, too, as most women have sex with men.

“Any sexual dysfunction you have is likely to have an effect on your partner as well. So because it is an interaction issue, it will tend to have an effect on your partner,” the clinical sexologist said.

In these circumstances, Dr Carpenter suggests that seeking help is best, especially if it causes distress.

“You have to understand what your dysfunction is. See someone who is qualified to assist you to understand. This person is usually happy to explain it to your partner as well. If you’re in a committed relationship, we would normally want your partner to attend therapy,” she said.

The good news is that sexual dysfunctions are treatable and women are encouraged to set aside the embarrassment and seek help.

“The initial diagnosis or presenting problem could be done by your gynaecologist, general practitioner, your urologist, or by you,” Dr Carpenter said.

“You can recognise it, go online and look up the symptoms. However, for you to have a treatable diagnosis it must be something that is diagnosed by someone like myself who is a clinical sexologist or sex therapist — someone who diagnoses and treats; or a gynaecologist if it is related to your biology, or a urologist. Those would normally be the three sets of people who would diagnose a problem,” she said.

Dr Carpenter said people can receive help from a free sexology research clinic at the University Hospital of the West Indies. The clinic is open every other Friday by appointment through the Caribbean Sexuality Research Institute office. Appointments for the clinic can be made by visiting loveandsexja.com and completing a return form.