Sexual Problems

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KEY POINTS

• Sexual problems such as not wanting to have sex, being unable to have sex, or not being able to have an orgasm prevent a person or couple from enjoying sexual activity.
• Some short-term sexual problems are common. You need not worry about sexual problems if they only last a short time. However, if you continue to have problems, talk with your healthcare provider.
• Treatment depends on the cause of the sexual problem, and may include medicines, physical therapy, couples therapy, sex therapy, or counseling.

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What are sexual problems?

Sexual problems prevent a person or couple from enjoying sexual activity. Sexual problems may happen slowly over time or may start suddenly. They include not wanting to have sex, being unable to have sex, or not being able to have an orgasm.

What is the cause?

The causes of sexual problems can be physical, emotional, or both.

Physical causes include:

• Alcohol or drugs such as nicotine, narcotics, stimulants, blood pressure medicines, antihistamines, some antidepressants, antipsychotics, seizure medicines, and chemotherapy
• Chronic pain
• An enlarged prostate gland
• Problems with blood supply to the genitals
• Nerve damage, for example from a spinal cord injury or from surgery
• Diseases such as heart disease, diabetes, cancer, or lung disease
• Problems with glands in your body that make hormones, such as thyroid, pituitary, or adrenal gland problems
• Low levels of one or more of the hormones made by the body

Emotional causes of sexual problems include:

• Lack of trust or poor communication between partners
• Anger, anxiety, stress, and depression
• Past sexual abuse or memories of painful sex
• A belief that sex is a duty or only for the purpose of having children
• Religious or cultural beliefs that sex should not be enjoyable
• Fear that sex will cause a heart attack or stroke if you have heart problems
• Fear of being rejected or of not performing well
• Feeling awkward or embarrassed, or a lack of self-esteem
• Not finding your partner attractive
• Fear of pregnancy

For some couples, the problem is not knowing what to do, or not knowing what to expect.

Sometimes women feel that they are not understood or appreciated, or that they are not attractive. Feeling this way can decrease sexual desire.

Men may have less sexual desire due to feeling stressed or worried. Rather than talking about these issues, they may avoid sex.

What are the symptoms?

Symptoms may include:

• Lack of interest or desire in sex
• Not feeling aroused
• Pain with sex (much more common in women)
• Trouble having an erection or not being able to keep an erection long enough to finish having sex
• Premature ejaculation, which is having an orgasm sooner than you or your partner wishes during sex
• Being unable to relax vaginal muscles enough to allow sex
• Not enough vaginal lubrication before and during sex
• Being unable to have an orgasm

How are they treated?

Treatment depends on the cause of the sexual problem. If you are concerned that you have a sexual problem, see your healthcare provider. If medicine is the cause, a change in medicines can usually resolve the problem. Physical causes may be treated with medicine or, in some cases, with surgery. If you have problems with erectile dysfunction, your provider can prescribe medicines to treat the problem. If you have diabetes, high blood pressure, depression, or anxiety, treating those problems may help with erectile dysfunction.

Physical therapy and mechanical aides may help for some illnesses, conditions, or disabilities.

Several kinds of therapy can help with sexual problems:

• Couples therapy helps partners improve their ability to communicate with each other. It may help you decide what changes are needed in the relationship and in the behavior of each partner. Both partners then work to learn new behaviors.
• Sex therapy can help you learn about sexual behaviors and responses, and help reduce pressure to perform during sex. You may go to therapy every week or every other week.
• Cognitive behavior therapy (CBT) is a way to help you identify and change views you have of yourself, the world, and the future. CBT can make you aware of unhealthy ways of thinking. It can also help you learn new ways to think and act. Therapy may help you deal with anxieties, fears, or poor body image.

What can I do to help myself?

Talking with your partner may be the most important part of a healthy sexual relationship. Open and effective communication can go a long way in solving sexual problems.

Other things that can help include:

• Talk to your healthcare provider if you have a problem with alcohol or if you think that a medicine you take is affecting your sex life. Your provider may prescribe a medicine that is less likely to cause the sexual problems.
• Try making love in the morning. Being well rested after a good night's sleep can mean good sex.
• Cuddling, kissing, and sharing fantasies can be healthy and satisfying even without intercourse. Tell and show your partner what feels good and how you like to be touched.

Some short-term sexual problems are common. You need not worry about sexual problems if they only last a short time. However, if you continue to have problems, talk with your healthcare provider.