A sexual problem, or sexual dysfunction, refers to a problem during any phase of the sexual response cycle that prevents the individual or couple from experiencing satisfaction from the sexual activity. The sexual response cycle has four phases: excitement, plateau, orgasm, and resolution.

While research suggests that sexual dysfunction is common (43% of women and 31% of men report some degree of difficulty), it is a topic that many people are hesitant to discuss. Fortunately, most cases of sexual dysfunction are treatable, so it is important to share your concerns with your partner and doctor.


Sexual dysfunction can be a result of a physical or psychological problem.

• Physical causes -- Many physical and/or medical conditions can cause problems with sexual function. These conditions include diabetes, heart and vascular (blood vessel) disease, neurological disorders, hormonal imbalances, chronic diseases such as kidney or liver failure, and alcoholism and drug abuse. In addition, the side effects of certain medications, including some antidepressant drugs, can affect sexual desire and function.
• Psychological causes -- These include work-related stress and anxiety, concern about sexual performance, marital or relationship problems, depression, feelings of guilt, and the effects of a past sexual trauma.

Both men and women are affected by sexual problems. Sexual problems occur in adults of all ages. Among those commonly affected are those in the geriatric population, which may be related to a decline in health associated with aging.


The most common sexual problems in men are ejaculation disorders, erectile dysfunction, and inhibited sexual desire.


There are different types of ejaculation disorders, including:

• Premature ejaculation -- This refers to ejaculation that occurs before or soon after penetration.
• Inhibited or retarded ejaculation -- This is when ejaculation is slow to occur.
• Retrograde ejaculation -- This occurs when, at orgasm, the ejaculate is forced back into the bladder rather than through the urethra and out the end of the penis.

In some cases, premature and inhibited ejaculation are caused by a lack of attraction for a partner, past traumatic events and psychological factors, including a strict religious background that causes the person to view sex as sinful. Premature ejaculation, the most common form of sexual dysfunction in men, often is due to nervousness over how well he will perform during sex. Certain drugs, including some anti-depressants, may affect ejaculation, as can nerve damage to the spinal cord or back.

Retrograde ejaculation is common in males with diabetes who suffer from diabetic neuropathy (nerve damage). This is due to problems with the nerves in the bladder and the bladder neck that allow the ejaculate to flow backward and into the bladder. In other men, retrograde ejaculation occurs after operations on the bladder neck or prostate, or after certain abdominal operations. In addition, certain medications, particularly those used to treat mood disorders, may cause problems with ejaculation. This generally does not require treatment unless it impairs fertility.


The success of treatment for sexual dysfunction depends on the underlying cause of the problem. The outlook is good for dysfunction that is related to a treatable or reversible physical condition. Mild dysfunction that is related to stress, fear, or anxiety often can be successfully treated with counseling, education, and improved communication between partners.


While sexual problems cannot be prevented, dealing with the underlying causes of the dysfunction can help you better understand and cope with the problem when it occurs. There are some things you can do to help maintain good sexual function:

• Follow your doctor's treatment plan for any medical/health conditions
• Limit your alcohol intake
• Quit smoking
• Deal with any emotional or psychological issues such as stress, depression, and anxiety. Get treatment as needed.
• Increase communication with your partner

Many men experience a problem with sexual function from time to time. However, when the problems are persistent, they can cause distress for the man and his partner, and have a negative impact on their relationship. If you consistently experience sexual function problems, see Dr. Marks for evaluation and treatment



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