Sexual Problems

Sexual Problems


    Many men and women who call or come to me are initially confused and wish to know exactly what the nature of my work is. “Doctor, I have this …sexual…. problem. Often, they are scared that the difficulty they are facing is a unique problem and no one else can have a similar complaint. Do you treat such problems? What is the type of treatment you offer? Is it possible to get cured? …. These are the questions that bother them.

    Defining Sexual Problems:

    Any difficulty you face during any stage of the sexual act (which includes desire, arousal, orgasm, and resolution) that prevents you or your partner from enjoying sexual activity constitutes a sexual problem. In addition, any question concerning sexuality that bothers your mind is also a sexual problem.

    Given below are some of the most commonly encountered sexual problems. If you feel that your problem does not fit here, don’t worry. Seek help and getting all questions answered from a sexologist. That must be your first priority because once your problem is resolved your life would surely be better and free of anxiety.


    1 Lack of Information on Sexual Matters

    As youngsters, many of us have questions regarding masturbation, size and shape of genitals, seminal discharge, sperm, volume, menstruation, birth control, fear of sex (in women and men), sex abuse (as a child or by partner), homosexuality, menopause, andropause, etc.

    Very few of us seriously discuss sex and sexuality with our parents, teachers and elders. Most of the information about sex we get in our youth is from our friends. Needless to say, a lot of this ‘knowledge’ that we obtain in the form of jokes or ‘hear-say’ stories about sex and masturbation is usually wrong and misleading.The truth is that many persons who approach me with sexual ‘problems’ really do not have any major disease, but lack knowledge about sex and sexuality. And that’s because proper and accurate scientific information is difficult to obtain not only from parents, teachers, and other elders but also from doctors! And this is purely because they have never had proper sex education and the chance to become truly knowledgeable on sexual matters in the first place.

    Although now a days, some schools and colleges to do have sex education classes, in the past this concept was completely unknown, even in medical colleges! The sex education imparted in schools and colleges today discuss more of AIDS and other sexually transmitted diseases. This instills more fear and dislike for sex in the minds of youngsters. Healthy, enjoyable sex and the joy of sex with your loved one are never spoken about. Same is the case of sexual problems you or your partner may face later in your life because they are not at all discussed and therefore when you are faced with such a difficulty you do not know what to do or even who to approach for help!

    Many people believe that sex education should be imparted by regular school teachers and parents, however I personally think this is very difficult or rather impossible. The reason for this conclusion is based on my observation that majority of regular teachers and parents are themselves ill informed, ignorant about sexual matters and very uncomfortable whilst talking about human sexuality. Furthermore they are not trained to pass on information on this sensitive topic. In addition many youngsters prefer not to ask such questions to their teachers and parents out of shame, guilt and fear of being labeled promiscuous. Would a teen ask a parent or teacher on how to use a condom or methods of giving or receiving enhanced sexual pleasure?

    Group sex education is of use only to ‘break the ice’ and encourage them to come forth and discuss all issues personally.Seeking personal and confidential help from a sexologist doctor who is trained to hear all complaints and offer correct scientific and medically sound advice on all such matters is the best option you can seek.

    Therefore sex education should ideally be done on an individual basis rather than in a group because many persons are shy to ask questions in a group and they are the ones who are most likely to get affected because their ‘personal’ question is never answered to their satisfaction.


    2 Painful Intercourse

    Dyspareunia is the medical term for “painful intercourse.” It’s specific cause is generally irritation of the vulva or vaginal opening due to trauma, infection, or anxiety. Sexual intercourse must be pleasurable to both partners and is therefore never supposed to hurt. However certain problems can make it painful in either partners and if this happens, the couple must seek immediate treatment from a doctor. Here is a list of commonly encountered problems that can make sex a hurtful experience.

    Infection - Any infection can irritate the sexual parts of women and men. Women are more commonly affected and if the sexual act causes pain during or after, it is obvious that the person would never like to do it ….. let alone enjoy it. Therefore if intercourse is painful, your first step should be a trip to the doctor and get the problem treated correctly.

    Lack of lubrication – Just as the erection of the penis is a sign that a man is sexually aroused, the sign of sexual arousal in women is wetness of her vagina. This lubricates the vaginal barrel and decreases the friction of intercourse. If this does not happen, it becomes painful during intercourse and after. To know the cause of lack of wetness in a woman is of utmost importance & this can be ascertained by detailed questioning & proper examination. Once the cause is ascertained, correct advice and treatment can easily solve this problem.

    Vaginismus –In this condition, having sex for the first time itself becomes impossible for a woman. This is a serious problem and sometimes not understood by the couple and their family. I have witnessed broken marriages because this condition was not treated in time and correctly. If you are a woman contracting your legs tightly each time whilst attempting sex with your partner or if you have great fear of any object nearing your vagina because the object may penetrate inside, then is very likely that you have vaginismus.This action is similar to automatic shutting of eyes when you sense an approaching object like a finger, insect or dust particle in the air. Vaginismus can be effectively treated only by seeking professional help. Patience perseverance and support from the family (especially the mother or a close friend of the woman) can immensely help the doctor to treat this condition.

    Vulvodynia – Sometimes, even if your genitals may look healthy and you're experiencing wetness, and there is no vaginismus, and yet intercourse still hurts, then vulvodynia or vulvar vestibulitis syndrome is the possible diagnosis. Treatment for this condition may be slightly longer term and you must seek professional help in overcoming this difficulty.


    3 Lack of Desire for sex

    Although many men complain that their partner has a lack of desire for sex, this problem is also commonly faced by men. The first clarification regarding lack of desire is that it's okay if you sometimes do not want sex even if your partner is ‘in mood’ for it. However, if and when the problem becomes of a long standing and recurrent, to put your relationship in jeopardy (danger) you must seek professional help without delay.Therefore if you or your partner notices a sudden big drop in your level of interest and it bothers one or both of you, it's generally a signal that something else is going on – either in your relationship, or in your mind or in your body.

    Here are some things that can affect your level of desire for sex:

  • Stressful changes in your life - a new job or additional responsibilities in an existing job, or quarrels at home or office, or changing your home, etc., all affect your desire for sex. Stress in any form can have a debilitating impact on your sexuality.
  • Recurrent quarrels within the family members can also dampen sex. Constant feelings of suspicion, resentment, grief, anger towards anyone can cause loss of desire.
  • General ill-health, many chronic diseases, medications of such diseases, etc., can reduce sexual desire.
  • Women using pills that contain hormones for preventing pregnancy can complain of decrease in sexual urge.
  • Andropause - a condition affecting middle age men is also known to cause loss of desire for sex causing stress and worry in both partners.
  • After a careful and patient discussion with both partners a good doctor will surely be able to pinpoint the cause or causes of the problem. Your patience and perseverance is also important.


    4 Lack of or delayed Orgasm or Climax

    The ultimate euphoria that you experience at the peak of sexual excitement that’s commonly accompanied with tremors of body along with mental as well as physical satisfaction is called orgasm or climax. In men, orgasm is normally accompanied with seminal discharge in spurts (ejaculation) and this is an exceptionally pleasurable sensation. In women the genital area also contracts in spasms. Majority of women have no discharge of fluid but some women report of a fluid spurting from the urethra. Because this does not happen in all women and the volume of the fluid is small, it is still not accepted by everyone as ‘female ejaculation’.

    After orgasm, men and women usually report of sudden loss of sexual desire accompanied with general gratification and sleepiness. Lack of, or delayed orgasm is said to be a predominantly a women's problem but men can also be affected and it can be very bothersome to the person concerned. Majority of men and women indulge in sex to enjoy the orgasmic experience and if it does not happen in spite of prolonged intercourse, it’s natural for anyone to feel frustrated. If the person has to struggle and work excessively hard to climax, the intensity of orgasmic pleasure gets reduced.

    Following are the complaints of women and men about the above mentioned problem.

  • Never Had An Orgasm
  • Can't Orgasm in Certain Situations
  • Can have Orgasm only after Vigorous ThrustingDelayed orgasm and absent orgasm (Anorgasmia)
  • A good sex therapist should be able to treat such problems after ascertaining the facts and circumstances when this occurs.

    Almost everyone on the planet is capable of having orgasms: if you haven't had one yet, there is nothing wrong with you, you’ve perhaps just not understood the ‘technique’ of how to have one as yet. But if you are patient, you surely can! A common cause of this problem is anxiety or stress and lack of knowledge.


    5 Premature Ejaculation

    In men, especially among newly married and in the forty plus age group, premature ejaculation is a common problem. Premature ejaculation is the inability of the man to exert consistent control over the timing of his ejaculation. It is very frustrating for the man and his partner if the sexual act is terminated early because the man discharges early and subsequently loses his erection and interest in sex. And if this becomes recurrent, the woman is unable to experience orgasm which makes her irritable and unhappy. Sometimes, men are unaware that this problem is making their spouse unhappy because women are shy to speak openly on such issues. However, given the importance of mutual sexual pleasure to most relationships, it is vital that men learn to control the timing of their orgasm at least three-fourths of the time they have sex.

    Anxiety and stress about premature ejaculation or impotence itself can be a maintaining cause of premature ejaculation! If both partners are willing, premature ejaculation can be easily treated by a sex therapist.


    6 Impotence ( Erectile Dysfunction)

    Inability of a man to experience erection and hardness of his penis following sexual stimulation is termed as impotence or erectile dysfunction (ED). This problem makes it impossible for the man to insert his penis in a woman’s vagina to complete the sexual intercourse. Although erection problems of penis are more common in older men, it can certainly trouble men from their 20’s onwards. In olden days it was believed that 80% of erection problems are psychogenic in nature but now we know that more than half of all erectile difficulties are due to some diseases process in the body. Anxiety (either about sexual performance or just general anxiety) is a common cause of impotence.

    A wide range of diseases and medicines used to treat those diseases can also cause erection problems. There are instances where men with diabetes, blood pressure, heart disease, etc. were unaware of their disease when they came to my clinic complaining of impotence.

    ‘Andropause’ a condition occurring due to ‘androgen’ or testosterone deficiency in men above 40 is associated with impotence. Such men may or may not complain of loss of desire for sex. Recent research shows that like women, some men in their forties and beyond also complain of decreased energy, mood swings, irritability, poor concentration, forgetfulness, reduced muscle strength, general increase in weight and abdominal obesity in particular, sleep disturbances, anxiety, depression, etc. and all of this can happen due to testosterone deficiency.Testosterone is an all important hormone in all men. It is responsible for changing a ‘boy’ into a ‘man’. Change in voice, growth of moustache, beard, body hair, development and enlargement of penis and testicles, etc. happens only because of testosterone. It is responsible for reproductive and sexual functions of all men. It is also responsible for up-keeping of good health, strength of bones and muscles as well as many other body functions.

    Androgen deficiency can occur in young men because of disease or injury to testes, or as an inborn defect. In older men (above 25-30 years), androgen deficiency could be because of other illnesses, long standing mental stress, excess weight gain, depression, etc. Unlike women who have sudden drop of hormones at Menopause, there is a gradual reduction of hormones men, and therefore Andropause brings about symptoms little by little. Therefore men and their partners usually ‘accept’ this condition as a part of ‘getting old outcome’. When such men are advised to undergo investigations to check if they do suffer from Andropause, they remain reluctant to do so because the blood tests are costly. Therefore, it is very likely that Andropause is under-diagnosed in our country and men are missing on the benefits of a better life.


    7 Gender Issues

    Being sexually attracted to a person of the same sex makes many people feel anxious and confused. Homosexuality (Gays and Lesbianism) is a grey area in sexual medicine and as time passes by we should be able to understand more about this. Nevertheless, if you feel that you are a man entrapped in a woman’s body or a woman in a man’s body and are bothered about this issue for yourself or about a near and dear one (like your partner, child, friend, etc.), the best approach again is to seek an opinion from an expert in those issues. As gender issues are unique to each person, its difficult to generalize on this subject and a sexologist would need to discuss all the issues at length before an opinion can be given about a particular case.


    7 Gender Issues

    With the advent of AIDS, sexually transmitted diseases suddenly came in the focus of society. What was initially thought to be a problem of homosexuals soon became a problem of all sexually promiscuous persons who had careless sex with multiple partners. Surveys show that even today, that almost 50% men and women do not think it necessary to use a condom when having sex with a new unknown partner. I have seen young men and women die in the prime of their life because of just one careless sex act. I have witnessed men and women transmitting this deadly disease to their innocent partner before dying with disastrous consequences.

    In addition to AIDS, other sexually transmitted diseases like Herpes, Gonohorrhoea, etc. can also cause a lot of medical and relationship problems. Although treatment of advanced cases of AIDS is the job of a person specializing in the field, a sex therapist can be of immense help in imparting sex education and advance information is crucial in prevention.

    Hence, if you are faced with any quandary on sexual issues like……………….Am I normal? Have I done any ‘mistake’ in childhood? Will I be able to produce children? Is my penis normal in size? Are my testes normal? Are there enough sperm in my semen? Do I know all the ‘basics’ of sex? Will I be able to satisfy my wife after marriage? Am I homosexual? Can my homosexual feelings be treated? Do I have AIDS? Do I have Herpes? ………ETC. ETC……………………..must be sorted out without delay.

    Your first step is to go to the doctor who specializes in this field. Your case history, examination, investigations are crucial in treating the problem.