Introduction to Sexual Problems
Fertility and Reproduction
At the most biological level, sex exists as a means of reproduction, enabling couples to have children. While most women and men are fertile (e.g., capable of having children, fertility is not a given. Several things are required in order for fertility to be possible. First, the reproductive organs must be sexually mature. Reproductive cells in a mans body (sperm) must reach similar reproductive cells in a womans' body (eggs), at a time when individual egg cells are mature enough to be fertilized. In order for this contact to occur, all reproductive organs such as the man's penis and testicles, and the woman's vagina, uterus and ovaries must be in good working order with no defects. Egg and sperm have to get together, and then share genetic material in a complex and easily derailed process wherein individual chromosomes divide and intermingle. The fertilized egg must successfully implant in the woman's uterus and develop throughout nine months of pregnancy. Finally, the baby and the mother must endure the process of birth. There are many things that can go wrong during this chain of events, but for the most part it works. You may read more about the pregnancy process in our Pregnancy Topic Center.
Fertility develops with the onset of puberty in the early teen years, and generally lasts throughout young adulthood. Women's fertility drops off faster than mens, in general. Women in their late 30s are increasingly likely to be infertile, while men remain fertile for many years. This is because women are born with every egg they will ever have, while men are capable of generating new sperm throughout most of their adult life. Women's eggs age and become less likely to fertilize, or fertilize but have genetic problems and spontaneously miscarry. They also drop off in number as women approach menopause. Infertility is a significant problem for a significant minority of women, particularly women who have put off having children. You may read more about infertility in our Infertility Topic Center
Suppression of Reproduction
There are many times when sexuality needs to be more about bonding, exploration and pleasure than simple reproduction. When this is the case, it is advisable that couples take precautions to limit their possibility of becoming pregnant, and the risk of sharing sexually transmitted diseases. Multiple contraceptive methods for avoiding pregnancy exist, but none of them work if they are not used as directed. Articles describing the various contraceptive methods can be found in this topic center, while information on preventing sexually transmitted diseases can be found here.
Sex is often the very glue that binds couples together, at least in the formative phases of the relationship. The presence or absence of sexual intimacy amongst relationship partners is a powerful indicator of the health of that relationship. For many people, sexuality is also an important part of self-esteem. Men and women both may pride themselves on their fertility, their capacity for sexual activity, or their attractiveness to sexual partners prior to, during, and after actual sexual relations. For all its importance in the life of couples, however, sexuality is surprisingly fragile. "mechanical" problems can occur that make it difficult for partners to enjoy satisfying sex. Partners may experience different amounts of desire for sexual contact as well, which can be very frustrating for all. Couple's sexual problems and incompatibilities end up having a powerfully negative impact on how partners feel about themselves and each other.
A common complaint that many couples experience occurs when one partner desires sexual relations more frequently than the other partner. It may appear to a partner wanting many multiple sexual encounters per week that her partner who wants sexual relations only once per week has a disorder (or vice versa), but this is not necessarily the case. Rather, individual differences in sexual desire are normal and may have multiple causes. Low (or high) sexual desire can be a life-long trait, it can reflect a temporary loss of respect for a particular partner, or it can reflect medical problems, or medications. Modern anti-depressant medicines are famous for suppressing sexual interest, for example. Sexual desire disorders are diagnosed only when sexual desire is markedly deficient or absent, and this deficit causes distress.
An extensive variety of 'diagnosable' sexual disorders are described in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is the bible for making mental illness diagnoses. These diagnoses include:
- Hypoactive (low) sexual desire disorder
- Sexual Aversion Disorder (which generally involves a person experiencing panic symptoms in response to sexual situations, and learning to avoid sexual relations as a result of this panic)
- Sexual arousal disorder (a failure to lubricate/swell appropriately during sexual relations)
- Erectile dysfunction (a failure to maintain an erection sufficient for sexual relations) Orgasmic disorders (an inability or marked difficulty for either sex to experience an orgasm).
- Premature ejaculation
- Dyspareunia (female genital pain during intercourse)
- Vaginismus (an involuntary muscular contraction of the outer vagina that makes penetration all but impossible)
Sexual problems are not punishment for sins, or a reflection of poor moral character, or even present for a lack of trying. Rather, sexual problems are often created or maintained by a variety of life problems that people experience. A very frequent cause of sexual dysfunction are medical conditions. Many medicines, including widely prescribed anti-anxiety and anti-depressant medicines temporarily inhibit sexual desire, arousal and orgasmic capacity in those who take them. Being a victim of sexual abuse, either as a child (incest, fondling, rape, etc.) or as an adult in the form of rape or torture can cause a person to have sexual difficulties. Conditions like Vaginismus commonly occur in the wake of sexual abuse (although not all sexually abused women experience this condition). Marital difficulties can create and maintain sexual difficulties between partners.
It is far more productive to seek help for sexual dysfunctions through education and professional assistance, than to blame one's self or one's partner. A variety of internet and book resources can provide a reference point for understanding what normal and healthy forms of sexuality are like. Similar resources can help to educate people about sexual anatomy, reproductive health, and family planning. When necessary, sexual therapists can be hired to help people overcome more difficult issues.
We've linked to resources to address various sexual incompatibilities and dysfunctions of normal sexuality in this Sexual Problems topic center. If you are looking for information on the Paraphilias (perhaps commonly known as 'sexual perversions'), please check out our Sexual Disorders topic center.