3.3.3 Categories of Sexual Dysfunction

1. Sexual desire disorders

2. Sexual arousal disorders

3. Orgasm disorders

4. Sexual pain disorders.

Sexual Desire Disorders

This is also called “decreased libido”. It is characterized by lack of sexual desire or libido for some period of time. The condition may ranges from a general lack of sexual desire to a lack of sexual desire for the current partner. The individual may have had a period of normal sexual desire. There are usually no sexual fantasies in the individual.

Causes

1. Decrease in the production of oestrogen in women 

2. Decrease in the production of testosterone in both men and women.

3. Pregnancy

4. Fatigue

5. Medication e.g. Antihistamine, Anti-depressants, Major Tranquillizers, Antihypertensive etc.

6. Depression.

Sexual Arousal Disorders

This condition is characterized by strong dislike (aversion), and avoidance of sexual contact with a partner. Sexual arousal disorders were previously referred to as frigidity in women and impotence in men, though these have now been replaced with less judgmental terms.

• Erectile Dysfunction (Impotence):

It is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis. It may be partial or complete failure to attain or maintain the erection, or a lack of sexual excitement and pleasure in sexual activity.

Causes

The causes of erectile dysfunction are many, the following are just a few:-

1. Psychological causes: this has to do with the individuals frame of mind in terms of his partner, the relationship, his perception of himself, guilt/ fear or anxiety (anxiety disorder is the commonest cause of premature ejaculation, which eventually leads to avoidance of sex).

2. Physical Causes: These includes among others: - Damage to the nervierigentes which prevents or delay erection (it is a nerve arising from the sacral plexus and passes beside the prostate). Damage can be due to direct or indirect trauma as in surgery of the prostate or colo-rectal areas.

3. Medical Conditions:

• Diabetes Mellitus- which simply decreases blood flow to the tissue in the penis.

• Vascular Disease- It impairs blood flow to the penis (it is only common amongst elderly individuals who have atherosclerosis). 

4. Hormonal Causes: Hormones deficiency is a relatively rare cause of erectile dysfunction. It may be found in individuals with testicular failure due to Klinefelter’s syndrome, chemotherapy or childhood exposure to mumps virus. All these may lead to low testosterone production.

Other hormonal causes include brain tumors hyperthyroidism, hypothyroidism or disorders of the adrenal gland.

5. Drugs: Antipsychotic, antidepressants, sedative narcotics, antacids or alcohol, affects sexual functions.

• Frigidity or non-arousal: 

It is the inability of a woman to respond to sexual stimuli. A woman upbringing may play a role in her response to sexual stimuli e.g. when certain acts are condemned as dirty in the act of lovemaking.

All the senses, i.e. sight, sound, taste, smell and touch are involved in increasing sexual arousal. Irritation of any of the senses during sex can be repelling.

Causes

1. Decreased blood flow to vaginal wall

2. Lack of vaginal lubrication

3. Nature of relationship e.g. lack of trust, fear, lack of love (emotional disturbance generally).

4. Low self esteem

5. Depression or anxiety

6. Medications

7. Sexual abuse especially at a tender age.

8. Chronic diseases e.g. PID

Orgasm Disorders (Anorgasmic Intercourse)

These are persistent delays or absence of orgasm following a normal sexual excitement phase. The failure to achieve orgasm in the male usually causes considerable frustration and may contribute to future anxiety and inadequate sexual performance. Many women, however, do not become frustrated by failure to achieve orgasm. Some may simply enter the resolution phase and sleep but many will remain in the Plateau phase, seeking further stimulation.

Causes

The cause may originate from physical, psychological or pharmacological origins.

Sexual Pain Disorders

These disorders affect women almost exclusively and are known as dyspareuria or vaginismus.

1. Dyspareunia: It is defined as painful intercourse for women.

Causes

1. Insufficient lubrication (vaginal dryness).Poor lubrication may result from insufficient excitement and stimulation, or from hormonal changes caused by menopause, pregnancy or breastfeeding.

The use of anticholinergic drugs can also dry up vaginal secretion just as it decreases nasal secretion

2. Irritation from contraceptive creams and foams can also cause dryness.

3. Fear and anxiety about sex.

2. Vaginismus:It is defined as involuntary spasm of the muscles of the vaginal wall which interferes with intercourse. It occurs usually when the vulva or vagina is touched, resulting in painful sexual intercourse or dyspareunia.

The cause is unclear, but it is somehow related to past sexual trauma e.g. rape or sexual abuse especially in early age.