You would think I'd feel comfortable writing about sex. After all I'm a middle-aged family doctor, married for over 30 years with grownup kids. But I find this subject a little embarrassing. I can understand why, even though a third of them have sexual problems, my patients seldom ask for help solving them.
Stats and definitions
According to the Journal of the American Medical Association and the Foundation for Urological Diseases, sexual problems are common. For women, over 20% report lack of sexual desire, 14% have problems with arousal or reaching orgasm, and for 7% sexual intercourse is painful. Men have it slightly better, but over 20% complain of premature ejaculation, 5% report erectile dysfunction (previously called impotence), and 5% just aren't much interested in sex. These sexual problems can be serious enough to hinder important relationships and hurt self-esteem.
Painful intercourse in females (dyspareunia) might be due to vaginismus, vaginitis, or lack of lubrication. Vaginismus refers to painful spasm of the muscles around the vagina making intercourse difficult and painful. This is usually due to fear, sometimes because of previous trauma. Vaginitis or inflammation of the delicate tissues of the vagina is due to infection or irritation. Erectile dysfunction is more common in older males and of the more than 20 million North American males who suffer from this, fewer than 10% ever receive treatment.
Some sexual problems have less to do with organs and chemistry than they have to do with emotions and previous experiences. Sexual dysfunction might be caused by medications such as antidepressants, blood pressure medications, and alcohol or other mood-altering drugs including nicotine. Medical causes include diabetes, heart disease, neurological disorders, pelvic scarring, or menopause. Loss of sexual interest and function might also be due to reduced levels of hormones such as testosterone.
Chronic stress, anxiety, or depression will often diminish a person's sexual interest or sexual response. Sometimes sexual problems develop and worsen simply because one partner doesn't understand the other's needs, and the other person either assumes the partner should know, or the person is too shy to tell the partner. Often sexual problems have nothing to do with sex: especially for a woman, sexual receptiveness and response requires first a relationship of emotional intimacy with her partner.
Diagnosis and assessment
There are specialty clinics dedicated to the investigation and treatment of sexual problems. It's important to be evaluated with a thorough history and physical exam. From the medical evaluation further investigations such as hormone tests or other diagnostic investigations might be ordered.
Treatment and recovery
If the problem is due to mood disorder or even premature ejaculation, then effective treatment will be a combination of cognitive-behavioural therapy and perhaps medications. One man's poison might be another's potion: the same antidepressants whose pesky side effects include loss of libido, erectile dysfunction, or delayed orgasm sometimes prove effective in treating premature ejaculation. A history of previous emotional trauma or sexual abuse requires sensitive counselling by a skilled professional. If an underlying medical or psychiatric disorder is the cause, then effective treatment of that problem will often restore healthy sexual function. Education about the sexual needs and sexual response of women and of men helps both members of a couple understand the other's behaviours and responses. Sometimes hormone replacement both in males and females can restore sexual function. For persistent erectile dysfunction there are a number of effective procedures and medications. Programs, retreats, and couples therapy that improve communication and emotional intimacy will usually improve the couple's sex life. Sometimes couples need to learn and practice techniques, such as sexual touching without penetration or orgasm, in order to develop new ways to please their partners.
Sex is a wonderful, healthy gift for humans. It's one of the few things we can do that feels good and doesn't cause weight gain, hangovers, or broken bones. Sex includes a wide continuum of pleasant, rewarding activities that don't have to end even when intercourse is impossible.
If you have sexual problems the first step could be the hardest: getting up the courage to ask for help. But go ahead, it's worth it!
Dr. Ray Baker, MD
in association with the MediResource Clinical Team