Sexuality & Sexual Problems Articles & Resources
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What Is Sexuality?
Sexuality is an umbrella term used to describe a wide array of sex-related attitudes, values, feelings and experiences. (1) While sexuality is deeply personal, it can also be influenced by everything from familial and cultural beliefs to political leanings and education.
Sexual orientation, a major component of sexuality, deals with the nature of someone’s sexual attraction and romantic relationships. (2) Essentially, orientation is about who someone is attracted to physically, mentally, and emotionally. People may be attracted to individuals of the same gender, of another gender, of all genders, or of no set gender at all. They may choose to identify with labels like gay, lesbian, bisexual, or asexual or opt to refuse labels altogether.
In addition to sexual orientation, sexuality covers these other key topics:
- Sensuality and intimacy. This is how people choose to express and enjoy sex-related activities. This may include sexual expression and sexual acts as well as the structure of intimate and/or romantic relationships (e.g., monogamy, open relationships, polyamory, etc.). (3)
- Gender identity. Gender is a social construct that exists as a spectrum. (4) While people are traditionally assigned male or female at birth, today there is increasing recognition of gender as an important part of someone’s expression and identity rather than a singular label. In addition to the traditional male and female genders, some other gender identities include nonbinary, bigender, pangender, and transgender.
- Sexual health. This part of sexuality encompasses everything from the physical health of reproductive organs to how people understand and wield their sexual agency. (1) Some aspects of sexual health are introduced during sex ed classes in school, while others (such as overcoming sexual dysfunction) are incredibly nuanced and may take years and professional guidance to fully grasp.
What Are Sexual Problems?
Sexual problems, also known as sexual dysfunctions, are defined as any sex-related problems that meet two essential criteria: (5)
- The issue must prevent an individual or couple from having and/or enjoying sex.
- The issue must bother the person experiencing it.
According to the Cleveland Clinic, approximately 43% of women and 31% of men have sexual issues. (6)
Sexual problems happen during one of the four stages of the sexual response cycle: excitement, plateau, orgasm, and resolution. It’s not unusual for someone—especially women—to experience cycles out of order. Sexual issues arise when an individual is unable to achieve or complete one of the phases.
There are four main categories of sexual dysfunction: (7)
- Desire/interest disorders: Lack of interest in having sex—also known as low libido or low sex drive
- Arousal disorders: Difficulty or total inability to achieve arousal related to sexual intimacy
- Orgasm disorders: Difficulty or total inability achieving an orgasm or, in the case of persistent genital arousal disorder in women, repeated orgasms that occur without stimulation and against the individual’s wishes
- Pain disorders: Discomfort experienced during sexual activity
Diagnosing sexual problems requires a comprehensive assessment that includes a professional evaluation of the individual’s medical history and symptoms. Those symptoms can look quite different depending on what gender the affected individual was assigned at birth. (6) For instance, people assigned male at birth may experience difficulty maintaining an erection and delayed or premature ejaculation. People assigned female at birth may report inadequate lubrication and uncontrolled vaginal tightness that prevents comfortable intercourse.
Sexual dysfunction may be tied to psychological, behavioral, and physical concerns. Common causes include: (5)
Common Sexual Problems in Men
Most sexual problems in men fall into one of three categories. (8)
Issues with Ejaculation
Men may experience:
- Premature ejaculation: Ejaculating before penetration or quickly after
- Delayed ejaculation: Difficulty or inability to ejaculate
- Retrograde ejaculation: Ejaculation that reverses into the bladder rather than exiting the body through the penis
Issues With Erections
One of the most common sexual issues affecting men is erectile dysfunction (ED), which is the inability to achieve and maintain an erection. One study found that approximately 52% of men ages 40 to 70 experience ED. (7)
Issues With Sexual Desire
Men may experience low libido or decreased sex drive as a natural result of aging. (8) This is due to low testosterone levels, which can also affect sperm production, muscle tone, and bone density. Lack of desire can also be tied to mental health issues and medications for high blood pressure and depression.
Diagnosis requires an assessment by a medical professional who will likely check vitals, order blood tests, and conduct a physical exam of the penis, testicles, and prostate. Treatment options will depend on the results of those tests and a possible mental health evaluation. Treatment may include:
- Hormone therapy
- Mechanical aids, such as a penile implant, to assist in achieving an erection
- Psychology therapy
- Lifestyle changes, such as quitting smoking and eating a heart-healthy diet
Common Sexual Problems in Women
Approximately 30% to 40% of women experience sexual problems. (9) Most issues fall into one of four categories:
- Anorgasmia: The inability to orgasm
- Dyspareunia: Painful intercourse
- Hypoactive sexual desire disorder: Poor sex drive
- Sexual arousal disorder: Difficulty becoming aroused
Women share many of the same possible underlying cases of sexual dysfunction as men, including blood flow disorders, certain medications, health conditions (such as diabetes), and mental health concerns. But the hormonal changes women experience due to pregnancy, childbirth, and menopause can have a major impact on sexual health as well. (10)
Low estrogen levels can lead to decreased sex drive and reduced vaginal lubrication, which may lead to increased pain during intercourse. Hormone replacement therapy can help treat vaginal dryness and other symptoms of low estrogen. (11)
The diagnostic process for sexual disorders in women starts with a full physical workup that may include a gynecological exam, imaging, and blood tests. The evaluation should also include a comprehensive patient history with room to discuss past trauma and current symptoms. Treatment options depend on the results of those tests and may include anything from medication and therapy to surgery.
Sexual dysfunction is common, treatable, and nothing to be embarrassed about. Being honest and forthcoming about sexual difficulties and discomfort is the first step toward finding relief and being able fully embrace one’s sexuality.