Sexual problems overview

Sexual problems are defined as difficulty during any stage of the sexual act (which includes desire, arousal, orgasm, and resolution) that prevents the individual or couple from enjoying sexual activity.

Sexual difficulties may begin early in a person's life, or they may develop after an individual has previously experienced enjoyable and satisfying sex. A problem may develop gradually over time, or may occur suddenly as a total or partial inability to participate in one or more stages of the sexual act. The causes of sexual difficulties can be physical, psychological, or both.

Emotional factors affecting sex include both interpersonal problems and psychological problems within the individual. Interpersonal problems include marital or relationship problems, or lack of trust and open communication between partners. Personal psychological problems include depression, sexual fears or guilt, or past sexual trauma.

Physical factors contributing to sexual problems include:

• Drugs, such as alcohol, nicotine, narcotics, stimulants, antihypertensives (medicines that lower blood pressure), antihistamines, and some psychotherapeutic (drugs that treat psychological problems such as depression) drugs
• Injuries to the back
• An enlarged prostate gland
• Problems with blood supply
• Nerve damage (as in spinal cord injuries)
• Disease (diabetic neuropathy, multiple sclerosis, tumors, and, rarely, tertiary syphilis)
• Failure of various organs (such as the heart and lungs)
• Endocrine disorders (thyroid, pituitary, or adrenal gland problems)
• Hormonal deficiencies (low testosterone, estrogen, or androgens)
• Some birth defects

Sexual dysfunction disorders are generally classified into 4 categories: sexual desire disorders, sexual arousal disorders, orgasm disorders, and sexual pain disorders.

Sexual desire disorders (decreased libido) may be caused by a decrease in the normal production of estrogen (in women) or testosterone (in both men and women). Other causes may be aging, fatigue, pregnancy, and medications -- the SSRI anti-depressants which include fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil) are well known for reducing desire in both men and women. Psychiatric conditions, such as depression and anxiety, can also cause decreased libido.