Sexual dysfunction information
Male Sexual Dysfunctions
Difficulties related to having sex, such as premature ejaculation, erectile dysfunction and inability to orgasm during sexual activity with a partner, are common.
Sexual problems can affect any man, whether he is straight, gay, bisexual or transgender.
Erectile Dysfunction
This is when a man cannot get, or keep, an erection that allows him to take part in sexual intercourse or other types of sexual activity. The causes can be physical, psychological or both. Erection problems are very common, particularly in men over 40. It's usually nothing to worry about, but you should see a GP if it keeps happening.
Causes of Erection Problems
Physical causes include heart disease, diabetes and raised blood pressure. Unhealthy lifestyle, alcohol, smoking and illegal drugs, as well as some prescription medicines, can also cause erectile problems. Worries about work, money, your relationship, family and not getting an erection can all be factors.
Treatments for erectile dysfunction are much better than they used to be, and may improve or resolve the problem.
There are specific treatments for some of the physiological causes of erectile dysfunction. A doctor or urologist can advise on the best treatment.
Narrowing of penis blood vessels, high blood pressure, high cholesterol may be treated by medication to lower blood pressure or statins to lower cholesterol
Hormone problems may be treated with hormone replacement therapy (e.g. testosterone)
Side effects of prescribed medication may require a change to a different medication, after discussion with a GP
Medicine such as sildenafil (sold as Viagra) is also often used by doctors to treat erectile dysfunction. It's also available from chemists.
Because of changes in regulations, you no longer need a prescription to get sildenafil but you will have to have a consultation with the pharmacist to make sure it's safe for you to take it.
There are other similar medicines called tadalafil (Cialis), vardenafil (Levitra) and avanafil (Spedra) that work in a similar way. You'll still need a prescription to get these medicines.
Do Vacuum Pumps Work?
Vacuum pumps encourage blood to flow to the penis, causing an erection. They work for most men and can be used if medicine is not suitable.
They're not always available on the NHS. Speak to a doctor about where to get one.
Emotional (Psychological) Problems
It's more likely to be an emotional problem if you only have erection problems some of the time. For example, you still get erections in the mornings, but not during sexual activity.
Psychosexual Therapy can help identify and address the underlying psychological issues behind Erectile Dysfunction. Even when there is a physical cause for Erectile Dysfunction, the effects on the individual and/or couple may mean that Psychosexual Therapy or Couple Counselling can be very helpful
Things you can do to help with Erectile Dysfunction
Do
- Lose weight if you're overweight
- Stop smoking
- Eat a healthy diet
- Exercise daily
- Try to reduce stress and anxiety
Don't - Do not cycle for a while (if you cycle for more than 3 hours a week)
- Do not drink more than 14 units of alcohol a week
Premature Ejaculation
This is the most common male sexual difficulty. Premature ejaculation is when a man ejaculates (cums) sooner than he wants to during sex. It's only a problem if it bothers him or his partner.
Causes can include anxiety about sexual performance, stress, unresolved issues in a relationship or depression. Treatments may include Psychosexual Therapy and/or medication. You can see a GP or a psychosexual therapist for help.
Loss of Sex Drive
Loss of sex drive (also known as libido) is when a person has a reduced interest in sexual activity or sexual thoughts.
Losing your sex drive is common. It can be linked to a number of factors, including relationship issues, stress, anxiety, some medical conditions and side effects of medication.
Help is available from a Psychosexual Therapist or your GP.
Advice and support is also available from the Sexual Advice Association.
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 it affects you.
According to the Sexual Advice Association, sexual problems affect around 1 in 3 young and middle-aged women, and around 1 in 2 older women.
To identify the reasons behind sexual dysfunction, both physical and psychological factors have to be considered, including a woman's relationship with her partner.
Reduced Sex Drive
A reduced sex drive (loss of libido), affects some women at certain times of life, such as during pregnancy, after having a baby, or during times of stress. But some women experience it all the time.
A loss of libido can have a range of physical or psychological causes, including: - Relationship problems
- Depression
- Previous mental or physical trauma
- Tiredness
- Diabetes – both type 1 and type 2 diabetes
- Hormone disorders such as having an underactive or an overactive thyroid gland
- Excessive alcohol consumption or drug use
- Certain medicines, such as the SSRI type of antidepressants
Libido 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 2 types: - Primary – when a woman has never had an orgasm
- Secondary – when a woman has had an orgasm in the past, but can't now
Some women do not need to have an orgasm to enjoy sex, but an inability to reach orgasm can be a problem for some women and their partners.
Reasons why a woman cannot have an orgasm can include: - Fear or lack of knowledge about sex
- Being unable to "let go"
- Not enough effective stimulation
- Relationship problems
- Feeling depressed or stressed
- Previous traumatic sexual experience
Research is being done into certain health conditions that affect the blood and nerve supply to the clitoris to see whether this affects orgasm.
Psychosexual therapy may help a woman overcome orgasm problems. It involves exploring her feelings about herself, sex, and her relationship.
Pain during sex
Vaginismus
Pain during sex – also called dyspareunia – can be caused by vaginismus.
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.
It can happen if a woman associates sex with pain or being "wrong", or if she's had vaginal trauma, such as an episiotomy during childbirth. It can also stem from relationship problems, fear of pregnancy, or painful conditions of the vagina and the surrounding area.
Depending on the cause, it may be treated by focusing on sex education, counselling and using vaginal trainers, also known as vaginal dilators.
Vaginal trainers are cylindrical shapes that are inserted into the vagina. A woman will gradually use larger sizes until the largest size can be inserted comfortably. Some women may wish to try using their fingers instead.
Sex After Menopause
Pain during sex is common after the menopause as oestrogen levels fall which can cause the vagina to feel dry.
This can affect a woman's desire for sex, but there are lubrication creams and hormonal treatments that can help. Ask a GP or pharmacist.
Female Genital Mutilation
Women who have experienced female genital mutilation (FGM) can find it difficult and painful to have sex. FGM is where female genitals are deliberately cut, injured or changed, but there is no medical reason for this to be done. It can also result in reduced sexual desire and a lack of pleasurable sensation.
Talk to a GP or another healthcare professional if you have sexual problems that you feel may be the result of FGM. They can refer you to a therapist who can help.
Getting Help
To find out what is causing a sexual problem and how to treat it, a doctor, practice nurse or therapist will need to ask you questions about your medical, sexual and relationship history.
A GP or practice nurse may order tests to check for underlying health conditions.
If your problem is related to lack of hormones, such as testosterone or oestrogen, hormone replacement therapy (HRT) may help.
Treating other conditions, such as diabetes or depression, may also alleviate symptoms of sexual dysfunction.
Sex Therapy
Psychosexual Therapy can help. Talk with your partner about your problem, and see a therapist together if you can. Do not be embarrassed. Many people experience sexual dysfunction and there are ways to get help.
Look for a therapist who is an accredited member of the College of Sexual and Relationship Therapists (COSRT). This means they will be fully qualified and able to advise on physical, psychological and medical factors that can affect sexual wellbeing.
If needed, they can also refer you to a GP or another medical practitioner who can do the required tests or examination.
Additional Information
The Sexual Advice Association https://sexualadviceassociation.co.uk offers sexual health factsheets on topics ranging from loss of libido to how to talk to a GP about your sexual problems.
The above includes information taken from the NHS and a fuller version can be accessed on www.nhs.uk
Useful Books
"Men's Sexual Health: Fitness for Satisfying Sex" by McCarthy & Metz.
This book is designed to present "a new model of male and couple sexuality, which establishes positive, realistic expectations of pleasure and satisfaction, as opposed to the self-defeating traditional demand for perfect intercourse performance".
"Guide to Getting It On Unzipped" by Paul Joannides.
This is an explicit book (containing graphic illustrations of sex and anatomy) which extensively covers the majority of sexual practices. It can be very helpful for those wishing to expand their sexual repertoire but isn't for the faint hearted!
"The V Book: A Doctor's Guide to Complete Vulvovaginal Health" by Elizabeth G. Stewart M.D. and Paula Spencer"
This comprehensive book covers all of the basics of vulvovaginal health. It includes sections on: vulvovaginal health throughout the life cycle, the latest research on vaginal pain disorders, diagnosing and treating common infections and gives tips for pleasurable sex.
