Sunday, January 23, 2011

Female sexual problems

Many women have problems with sex at some stage in their life. Here's a look at some forms of female sexual dysfunction (FSD), and advice on where to get help if FSD affects you.

According to The Sexual Advice Association, sexual problems affect around 50% of women, and become more common as women get older. Dysfunction can include loss of desire, loss of arousal, problems with orgasm and pain during sex.

When identifying the reasons behind sexual dysfunction, both physical and psychological factors are explored, including a woman’s relationship with her partner.
Loss of desire

Loss of desire, or lack of sex drive, affects some women at certain times of life (such as pregnancy or times of stress). But some experience it all the time.

A lack of sex drive can have a range of physical or psychological causes, including diabetes, depression, relationship problems, hormone disorders, excessive alcohol and drug use, tiredness, and previous, traumatic sexual experience.

Sex drive can also fall if a woman’s natural testosterone levels drop. Testosterone is produced in the ovaries and adrenal glands, so levels can drop if these are removed or they're not functioning properly.

Orgasm problems

These can be divided into two types: primary (when a woman has never had an orgasm) and secondary (when a woman has had an orgasm in the past but can't now). Some women don’t need to have an orgasm to enjoy sex, but inability to reach orgasm can be a problem for some women and their partners.

Reasons why a woman can’t have an orgasm can include fear or lack of knowledge about sex, being unable to ‘let go’, not enough effective stimulation, relationship problems, mood disorders (such as depression), and previous traumatic sexual experience. Research is being done into certain medical conditions that affect the blood and nerve supply to the clitoris to see whether this affects orgasm.

Psychosexual therapy can help a woman overcome orgasm problems. It involves exploring her feelings about sex, her relationship and herself.

Pain during sex (also called dyspareunia) is common after the menopause as oestrogen levels fall and the vagina feels dry. This can affect a woman’s desire for sex, but there are creams that can help. Ask your GP or pharmacist.

Vaginismus is when muscles in or around the vagina go into spasm, making sexual intercourse painful or impossible. It can be very upsetting and distressing. Vaginismus can occur if the woman associates sex with pain or being ‘wrong’, if she's had vaginal trauma (childbirth, episiotomy), relationship problems, fear of pregnancy, or painful conditions of the vagina and the surrounding area.

Vaginismus can often be successfully treated, by focusing on sex education, counselling and the use of vaginal trainers. Vaginal trainers are cylindrical shapes inserted into the vagina. A woman will gradually use larger sizes until the largest size can be comfortably inserted.
Getting help

To establish the cause of sexual dysfunction, a doctor or therapist will need to ask you questions about your medical, sexual and social history. Your GP can carry out tests for underlying medical conditions.

If your problem is related to lack of hormones (such as testosterone or oestrogen), hormone replacement therapy (HRT) can help.

Treating other conditions such as diabetes or depression might also alleviate symptoms of sexual dysfunction.

In many cases of sexual dysfunction, sexual therapy can help. Talk with your partner about your problem, and see a therapist together if you can. Don't be embarrassed. Many people experience sexual dysfunction, and there are ways to get help.

Your GP can refer you to a therapist or you can see one privately. Look for a therapist who is a member of the Institute of Psychosexual Medicine or the British Association for Sexual and Relationship Therapy. This means they'll be fully qualified, and will make sure you get a proper check-up of physical and psychological factors.

More information
For more on sexual health, dysfunction and the menopause, read Sexual Health and the Menopause (RSM Press), edited by John Tomlinson, Margaret Rees and Tony Mander.

Male sexual problems

It’s estimated that one man in 10 has a problem related to having sex, such as premature ejaculation or erectile dysfunction. Dr John Tomlinson of The Sexual Advice Association explains some of the causes, and where to seek help.

“Sexual dysfunction in a man is when he's not able to perform properly,” says Dr Tomlinson. “The main problem is being unable to get an erection. It’s much more common than people realise. In the 20-40 age group it affects around 7-8% of men, in the 40-50 age group it affects 11%. In the over-60s it affects 40%, and more than half of men over 70.”

It can affect any man, whether he is straight, gay, bisexual or transgender. Read more about erectile dysfunction (impotence) and premature ejaculation.
Erectile dysfunction (impotence)

This is when a man can’t get, or keep, an erection. Most men experience it at some time in their life. “It only becomes a problem when the man or his partner considers it a problem,” says Dr Tomlinson.
What causes erectile dysfunction?

“A variety of things cause it. Some psychological and some physical,” says Dr Tomlinson. “Psychological issues tend to affect younger men, such as first night nerves and so on. Often, these problems don’t persist. But there can be more serious psychological problems about sex that need the help of a psychosexual therapist.”

Worries about work, money, your relationship, family, and even worrying about not getting an erection, can all be factors.

Physical reasons for erectile dysfunction include:

Medical conditions, such as:

* Heart disease
* Diabetes
* Raised blood pressure
* Raised cholesterol: this can lead to clogging of arteries, including the arteries in the penis, which are very narrow: 1-2mm in diameter compared with around 10mm in the heart artery
* Low testosterone: testosterone levels fall as men get older, but not all men are affected by it. Those who are affected will have symptoms such as feeling tired and unfit, and loss of interest in (and inability to have) sex


* Some prescription drugs: these can include medicines (such as beta-blockers) used to treat raised blood pressure, and antidepressants, antipsychotic drugs and anticonvulsant drugs
* Alcohol
* Recreational drugs such as cannabis and cocaine
* Smoking: nicotine affects the blood supply to the areas of the penis that cause erections

What should I do if I have erectile dysfunction?

See your GP. He or she can give you a physical examination and carry out blood tests to identify the cause.

Erectile dysfunction can be an important signal to other issues. “It's associated with raised cholesterol, diabetes and raised blood pressure. Any of these can be a warning of future heart disease,” says Dr Tomlinson. Your doctor can ensure that you get the treatment you need.
What's the treatment?

First, adjust any lifestyle factors that might be causing your problem.

“If you stop smoking, drinking too much or using recreational drugs, the problem should eventually go away. But it can take months,” says Dr Tomlinson. “There is no overnight cure.”

If you're prescribed blood pressure tablets or antidepressants, your doctor may be able to put you on a different kind.

Low testosterone can be treated with hormone replacement therapy, which should resolve erectile dysfunction as long as it's used together with erection-helping drugs. Other conditions, such as diabetes and high blood pressure, can be treated, which may improve erections. The Sexual Advice Association has useful factsheets on all of this.

Some men benefit from psychosexual therapy, which is a form of relationship therapy where you and your partner can discuss any sexual or emotional issues or concerns. You can contact the Sexual Advice Association, Relate, sexual health charity FPA or your GP to ask about psychosexual therapy.

Sexual arousal in men

Researchers have identified four stages of sexual response: arousal, plateau, orgasm and resolution.

Stage 1: excitement or arousal

A man gets an erection with physical or psychological stimulation, or both. This causes more blood to flow into three spongy areas (called corpora) that run along the length of his penis. The skin is loose and mobile, allowing his penis to grow. His scrotum (the bag of skin holding the testicles) becomes tighter, so his testicles are drawn up towards the body.

Stage 2: plateau

The glans (head) of his penis gets wider and the blood vessels in and around the penis fill with blood. This causes the colour to deepen and his testicles to grow up to 50% larger.

His testicles continue to rise, and a warm feeling around the perineum (area between the testicles and anus) develops. His heart rate increases, blood pressure rises, breathing becomes quicker, and his thighs and buttocks tighten. He's getting close to orgasm.

Stage 3: orgasm and ejaculation

A series of contractions force semen into the urethra (the tube along which urine and semen come out of the penis). These contractions occur in the pelvic floor muscles, in the vas deferens (tube that carries sperm from the testicles to the penis), and also in the seminal vesicles and the prostate gland, which both add fluid to the sperm. This mix of sperm (5%) and fluid (95%) is called semen.

These contractions are part of orgasm, and the man reaches a point where he can’t stop ejaculation from happening. Contractions of the prostate gland and the pelvic floor muscles then lead to ejaculation, when semen is forced out of the penis.

Stage 4: resolution

The man now has a recovery phase, when the penis and testicles shrink back to their normal size. He is breathing heavily and fast, his heart is beating rapidly, and he might be sweating.

There's a period of time after ejaculation when another orgasm isn’t possible. This varies between men, from a few minutes to a few hours or even days. The time generally gets longer as men get older.

If a man gets aroused but doesn’t ejaculate, this resolution stage can take longer, and his testicles and pelvis might ache.

If you are worried about your health have a look at the Man MOT, a confidential, online surgery where you can talk to a GP anonymously.

Sexual arousal in women

There are various stages of physical response during arousal and sex. Researchers have identified four stages of sexual response: arousal, plateau, orgasm and resolution. This is what happens in your body when you're sexually aroused.

Stage 1: excitement or arousal

When a woman becomes aroused, the blood vessels in her genitals dilate. There is increased blood flow in the vaginal walls, resulting in fluid passing through them. This is the main source of lubrication, which makes the vagina wet.

Her external genitalia or vulva (including the clitoris, vaginal opening, and inner and outer lips or labia) become engorged (swollen) due to the increased blood supply. Inside her body, the top of the vagina expands.

Her pulse and breathing quicken, and her blood pressure rises. She may become flushed, especially on her chest and neck, due to her blood vessels dilating.

Stage 2: plateau

Blood flow to the lower third of the vagina reaches its limit, and causes the lower area of the vagina to become swollen and firm. This is called the introitus, sometimes known as the orgasmic platform, and it undergoes rhythmic contractions during orgasm.

The woman’s breasts may increase in size by up to 25%, and blood flow to the area around the nipple (the areola) increases, making the nipples look less erect.

As she gets closer to orgasm, her clitoris pulls back against the pubic bone and seems to disappear. A woman needs continuous stimulation in this phase to build up enough sexual excitement for orgasm.

Stage 3: orgasm

Orgasm is the intense and pleasurable release of sexual tension that has built up in the earlier stages, characterised by contractions (0.8 seconds apart) of the genital muscles, including the introitus.

Most women don’t experience the recovery period that men do after an orgasm. A woman may have another orgasm if she's stimulated again.

Not all women have an orgasm every time they have sex. Foreplay is an important role in orgasm occurring in most women. It can include stroking erogenous zones and stimulating the clitoris.

Stage 4: resolution

This is when the woman's body slowly returns to its normal state. Swelling reduces, and breathing and heart rate slow down.