While some problems of sexual functioning (desire, erection, lubrication, orgasm, pain, etc.) may result from biological or chemical (drugs and alcohol) problems, the majority of the sexual problems treated by sex therapists and affecting peoples lives can be generally placed in the psychology or stress category. It is estimated that as many as half of the sexual problems that damage peoples lives and relationships are the result of inadequate knowledge. We know that the sexuality of even very highly educated people are adversely affected by a lack of sexuality knowledge resulting in beliefs in sexual myths or incorrect "facts." Sometimes a rigid or fearful "sex education" in childhood from parent, teacher, church or media can cause very serious problems. In addition, the widespread and severe occurrence of rape, incest, and sexual harassment in our society often leads to a profoundly negative impact on self-esteem and sexual functioning. Add to this the high incidence of physical abuse, emotional abuse, neglect and sexual abuse that occurs in our society to children and adolescents and you begin to understand why studies show that half of all long-term intimate relationships will experience at least one sexual dysfunction. Significant problems within a relationship can result in diminished or absent sexual pleasure. Finally, medical and environmental issues related to aging may deteriorate a formerly healthy sexuality. Fortunately, advances in psychology, medicine and sexual science have led to a reasonable potential for healing most or all of the damage wrought by these destructive influences.

What Are The Most Common Sexual Problems?

In males, especially among young males, the most common problem is Premature Ejaculation …the inability to exert consistent control over the timing of his orgasm. Although some males discover ejaculatory control more quickly than others, the important fact is that it must be learned. Ejaculatory control is not biologically normal. From an evolutionary perspective, the male who was able to ejaculate quickest was most likely to pass along his genetic material. (An African gazelle is able to copulate and ejaculate in mid-air while on the run!) However, given the importance of mutual sexual pleasure to most relationships, it is vital that men learn to control the timing of their orgasm about three-fourths of the time in order to have good ejaculatory control.

The next most common male sexual problem is Erectile Dysfunction …the incapacity to achieve or maintain an adequate erection. Although all men experience occasional difficulties achieving or maintaining an erection, for some it is a frequent or chronic problem causing problems within a relationship. It is important to determine if the problem is primarily medical or psychological. If he is able to achieve and maintain an erection when alone, or notices nocturnal or waking erections there is less likelihood that that there is a medical problem …unless the problem appears associated with alcohol or drug/medication use. Psychologically, the major culprit causing erectile dysfunction is "performance anxiety" …worry about performance and erection. There are many usual events that might trigger enough worry or anxiety that difficulties with erection occur. Recent medical pharmacology advances (e.g., Viagra) have proved to be excellent treatments for some men.

Although much more common among females, both men and women experience Anorgasmia …the inability to experience an orgasm. It is probable that the majority of female inability to orgasm during heterosexual intercourse is perfectly normal. It is estimated that only 30-40% of women are able to orgasm due to heterosexual intercourse alone… that is without additional sensory attention to the clitoris. Most women who report consistent orgasm during intercourse also report that added direct stimulation to the clitoris during intercourse is necessary. In almost all of the common heterosexual positions, the penis does not come in contact with her most erotically sensitive areas… the clitoris, or the Grafenberg spot within the vagina. However some people report that they have never or only very rarely orgasm regardless of a substantial number of attempts and no matter the stimulation source… self, partner, or intercourse. They report that they get adequately aroused, but orgasm doesn’t occur. In these cases it would be best to visit a sex therapist if she/he experiences it as a problem.

Males and females also might experience Inhibited Sexual Desire (ISD)… people who report they never or almost never think about sex in a positive way. Fear, past sexual trauma, severe psychological depression, and relationship problems are frequent causes of ISD, usually requiring general psychotherapy specific to the actual cause, and sex therapy following successful psychotherapy or relationship counseling. Much less frequently, there may be a medical problem (e.g., hormone imbalance) that may be associated with ISD.

Physical pain during sex called Dyspareunia is almost always caused by a medical problem and should be investigated by a gynecologist or urologist. An likely exception to this rule is the female disorder called Vaginismus …the spastic and painful tensing of the muscles surrounding the vagina whenever any vaginal penetration begins, or is about to begin. Sex therapists can effectively treat this problem.

What To Do?

There are other, less frequent sexual problems than those listed above. In most cases it is a good idea for the person experiencing a problem of sexual functioning to consult a sensitive physician specialist to rule out the possibility of medical causes. If the problem is obviously related to difficulties within a relationship, getting professional assistance by a trained sex therapist or relationship counselor may greatly enhance the sexual pleasure within the relationship. If the problem is not medical, but of long duration (or there has never been adequate functioning) it is probably best to consult with a certified sex therapist. Finally, accurate sex information often leads to increased comfort and confidence.

Sexual Difficulty (U California Santa Barbara)