Women's Sexual Problems (Female Sexual Dysfunction, FSD)
Orgasm Difficulty (anorgasmia)
Difficulty reaching orgasm are a frequent concern for many women. There is no consensus and much controversy on how frequently and in which situations women should reach orgasm.
Lack of (reduced) Sexual Desire
This may be the most common complaint in women. The causes are not well understood but may vary from life stressors (e.g. relationship difficulties, work problems, childcare issues, and hormonal imbalances). Because of the complexity of causes, a very careful assessment must be carried out to plan effective treatment which can range from varying one's sexual repertoire, to dealing with conflicts in your relationship with your partner, to hormonal intervention.
Lack of (reduced) Sexual Arousal
There are both subjective (e.g. feeling turned on) and physical markers (e.g. lubrication) of sexual arousal in women. One or both may be reduced. The treatments for arousal difficulties are similar to those for reduced desire. When vaginal dryness is the primary problem, it sometimes can be treated with lubricants or hormonal intervention. Pain during sexual intercourse (dyspareunia, vulvodynia, vestibulodynia) About 15% of women in North America report recurring pain during sexual intercourse. For most women, there are no known simple physical causes for this pain. Our clinic has been at the forefront of developing new treatments (see ) for this pain during sexual intercourse. These treatments include cognitive-behaviorally oriented pain management, pelvic floor physical therapy and medical/surgical intervention.
Genito-pelvic Pain/Penetration Disorder (GPPPD)
Genito-pelvic pain/penetration disorder refers to a condition in which people experience difficulty having intercourse and feel significant pain upon penetration. The severity of the condition ranges from a total inability to experience vaginal penetration in any situation to the ability to easily experience penetration in one situation but not in another. For example, a women might not feel pain when inserting a tampon but might experience intense discomfort when attempting to have vaginal intercourse.
GPPD is a new diagnosis in the DSM-V. It was previously referred to as a sexual pain disorder consisting of dyspareunia, which refers to pain in the pelvic area during or after sexual intercourse, or vaginismus, referring to an involuntary spasm of the musculature surrounding the vagina causing it to close, resulting in penetration being difficult, painful, or impossible.
Postmenopausal Sexual Problems
Until recently almost all sexual problems in post-menopausal women were attributed to changes in hormonal status. While this may be true for some women, it is an oversimplification. Changes in sexual functioning occurring in the post-menopausal period are also likely to be result of personal, interpersonal, social, occupational, and lifestyle factors.
Men's Sexual Problems
Premature ejaculation is a very common sexual complaint. It is interesting that there is no universally accepted definition perhaps because expectations about how long intercourse should last vary dramatically between individuals. Men who regularly ejaculate in less than a minute after penetration would meet most definitions and might wish to consult a professional if this is a cause for concern. There are effective sex therapy and pharmacological treatments that can prolong intercourse. Prolonging intercourse, however, does not necessarily increase pleasure and should be evaluated in the context of a comprehensive evaluation of an individual/couple’s sexual/intimate relationship.
Delayed ejaculation is much less common than premature ejaculation but no less distressing. It is similar to premature ejaculation in that there is no universally accepted definition. Sometimes, delayed ejaculation is the result of medication side effects; other times the cause is unknown. Modifying medications should only be done in consultation with a physician. Sex therapy treatment is also often effective. The goal of treatment is not only to reduce time to ejaculation but also to enhance pleasure. This often requires a comprehensive psychosocial and medical evaluation.
Erectile Dysfunction (erection difficulties)
A large number of men are concerned with their ability to achieve or maintain an erection. It is rare for men of any age to be able to have an erection 100% of the time. Individuals and couples have differing expectations about what is acceptable. There are many causes for erectile difficulties ranging from "performance anxiety" to reduced blood flow to the penis. Men over 50 have an increased risk of medical causes. A thorough sexological, couple and medical/urological assessment is often useful to assess the causes and decide upon appropriate treatment. Both sex therapy and medical (e.g. Viagra) treatments are available.
Lack of (reduced) Sexual Desire
Lack of (reduced) sexual desire in men appears to be becoming a more frequent complaint. Sometimes reduced desire is linked to a stressor such as loss of a job or relationship difficulties; other times, there is an illness or a medical problem. A comprehensive psychosocial and medical assessment is typically a good first step in order to decide upon the best treatment. Treatments range from sex therapy to medical treatment.
Pain During Sexual Intercourse (sexual pain, pain during orgasm, prostatitis, chronic pelvic pain syndrome)
There are many terms used to describe the experience of genital or pelvic pain related to sex. Often, the pain occurs during or after ejaculation; sometimes during or before intercourse. Once it was thought that such pain was directly related to prostate infection. While this is true for 10% of men, most have no known medical cause. There are promising pain management programs that have been developed to treat this common problem. Pelvic floor physical therapy may also be useful.
Some chronic illnesses or their treatments (e.g. diabetes or hypertension) can have sexual effects resulting in erection problems, reduced desire, premature ejaculation etc). There is no reason to give up on your sex life because of these illnesses. Many of these side-effects can be reduced by adjusting your medication (in consultation with your physician) or by modifying your sexual repertoire. The treatment goal is maximize your pleasure and regain as much sexual function as possible.