Sex can be a complex topic to address, but it's also an important one to address. A pleasurable sex life can improve our mental, emotional, and physical health and wellbeing - and good sex depends on good, open communication. Communication is where many of us run into problems. No matter how comfortable or confident we may be, sometimes it's just hard to talk about sexual function, especially when there's dysfunction. Often, it is tough bringing up problems relating to sex function with our partners or even our doctors. Holding in our concerns and not talking about them may only create more problems in the long run. It can cause anxiety, stress, insecurity, guilt, and worry. In turn, this can create more sexual dysfunction.
Often, there can be individual factors that impact sexual functioning, but there are also strong social, religious, and cultural pressures on sex that can externally affect sexual functioning, expression, and desire. Being able to look at all aspects critically is important, as humans are sexual beings that, at times, have difficulty conforming to artificial, external behavioural pressures.
Let's Talk about Sexual Function
"Sexual function is how the body reacts in different stages of the sexual response cycle or as a result of sexual dysfunction. The aspects of sexual function defined as being relevant to the assessment include sexual desire, erection, orgasm and ejaculation."
Function generally refers to sexual desire, erection, orgasm, and ejaculation. Masters and Johnson, pioneers in the research of sexual responses, outlined guidelines for assessing sexual function to diagnose and treat sexual disorders and dysfunction. This involves evaluating occurrences and frequency of sexual function or aspect of sexual function, as well as the distress, overall wellbeing, and emotional isolation caused by waning sexual functions
Sexual dysfunction, on the other hand, refers to any difficulty experienced 'normal sexual activity’. This can affect individuals and couples. The definition is broad and can have varying degrees of impact on your perceived quality of sex life and the distress caused. Sexual dysfunctions are common in both men and women. They can be caused by various factors, including physical and medical conditions or psychological problems such as anxiety, depression, and the effects of past trauma.
Types of Sexual Dysfunction
There are four main types of sexual dysfunction:
A lack of sexual desire is one of the most common sexual disorders. It affects libido for sexual activity, sexual fantasies, and sexual relationships. The condition may start after a period of nominal sexual functioning, or the person may always have had an absence or a lesser intensity of sexual desire. Lack of desire can begin after a period of normal sexual functioning or as a constant absence or a lesser intensity of sexual desire. The causes of this type of sexual dysfunction vary widely. It can be brought on by physical changes in the body, such as hormonal changes and low estrogen or testosterone levels. Medical conditions like diabetes and heart disease can also affect desire. Finally, it can be caused by psychological inhibitions, such as relationship problems, sexual inhibitions, fatigue, fear, depression, anxiety, etc.
It is important to remember that this category of sexual dysfunction does not refer to people who are asexual; sexual dysfunction broadly refers to a person's inability to participate in a sexual relationship as they would wish.
Arousal disorders broadly refer to the inability to become physically aroused or excited during sexual activity. One may be interested in sexual activity but unable to gain physical satisfaction from it. Erectile dysfunction in men is the most common, as well as lack of orgasm in women. They can occur by an array of physiological and psychological causes. They can lead to an aversion or avoidance of sexual contact.
A note about stress:
Both arousal and desire disorders are very responsive to stress and the fight or flight response. In most cases, anxiety, and depression work to shut down non-essential survival systems which includes sexual functioning. In some cases, though, high anxiety can produce the opposite effect and increase arousal to level much higher than previously experienced. This can be due to the procreation response; if an organism believes it is going to perish, the desire to pass on the genetic coding can surface causing inappropriate arousal response. This is sometimes seen in first responders or military and can be very disturbing if unexpected.
These involve any disorder relating to orgasm or climax. Most commonly, the absence of orgasm or delayed orgasm. It can also include disorders like:
Premature ejaculation - in men, when ejaculation occurs in under two minutes from the time of the insertion
Post-orgasmic disorders - when symptoms like melancholy, anxiety, headaches, and/or muscle pain arise shortly after orgasm and last for two hours up to a week.
All of these disorders have a variety of physiological and psychological causes.
These disorders include any dysfunction that causes pain during intercourse. Pain can occur in both men and women for different reasons. Most commonly for women, pain is caused by:
Vaginismus - an involuntary spasm of the muscles of the vaginal wall that interferes with intercourse
Vulvodynia – pain, burning or stinging sensations, in the vulva
Urinary tract infections (UTIs)
Hormonal changes during menopause.
In men, pain may be caused by:
Priapism - painful erections caused by blood getting trapped in the penisand is unable to drain
Physical damage to the penis
Factors that Affect Sexual Function
Many factors can affect a person's sexual function. These include:
Age: As we age, both men and women may experience changes in their bodies' response to sexual stimulation. Our bodies respond differently as we age because of hormonal and physical changes.
Menopause/Hormone changes: Women going through menopause often experience a decrease in libido or desire for sex; however, other factors may also contribute to this. Men also see a reduction of testosterone as they age which can sometimes result in decreased libido or sexual functioning.
Medications: Several medications have been linked to side effects that may affect sexual function; these include antidepressants (SSRIs), blood pressure medications (beta blockers), heart treatments (angiotensin-converting enzyme inhibitors), anti-anxiety drugs (benzodiazepines), and certain medications used for cancer treatment (antiandrogens).
Alcohol: Excessive alcohol intake can cause erectile dysfunction in men; however, other factors such as smoking can also cause problems with arousal and orgasm in both men and women.
Stress: Chronic stress has been linked with decreased libido or desire for sex due to the release of stress hormones like cortisol.
Depression: Individuals who suffer from depression often have lower levels of desire for sex due to a lack of interest in life events/pleasurable activities.
Nutrition: an unbalanced diet or one that is high in refined sugars can affect both physical sexual functioning as well as desire.
Treatments for Sexual Dysfunction
There is a range of treatments that can help address sexual dysfunction. Some, like psychotherapy and cognitive behavioural therapy, can be done with the help of a therapist. Others, including medications, can be taken alone. Therapists specializing in sexual dysfunction may use a number of approaches to help restore sexual function and improve quality of life. These may include sex therapy, couples therapy, or sexual medicine for erectile dysfunction. Options for addressing low libido include antidepressants, anti-anxiety medications, and medications for sleep disorders. For men, medications such as alprostadil may be used to increase blood flow to the penis and relax the muscles responsible for erectile dysfunction. A good question to ask yourself is: does the medication help 100% of the time, or is my sexual function/dysfunction selective? If it is the latter, psychotherapy can help.
Additionally, research shows that increasing communication between couples that experience sexual function/dysfunction issues can help improve their sex lives. Open communication requires trust and support.
A fulfilling sex life is essential to your mental, emotional, and physical wellbeing and can have wide-ranging health benefits like lower blood pressure, better heart health, stress reduction, better sleep, and can strengthen our sense of closeness and connection or intimacy. Nevertheless, sex can also be the source of stress, anxiety, and guilt, especially when dysfunction is involved; relationship problems, low self-esteem/confidence, and many other negative consequences can result from sexual dysfunction.
It is important to remember that everyone gets sexual roadblocks from time to time. The ability to address the problem and talk about it is imperative to overcome those roadblocks. You need to take on an active role in your sexual health and your health care and seek out help if you need it. Even if it feels embarrassing to talk about.
Nomina Integrated Health is dedicated to helping individuals improve their sexual health and wellbeing. Our therapists offer guidance and support for those who are struggling with sexual function or dysfunction. If you are experiencing any problems in this area, please do not hesitate to contact us for assistance.