This document discusses various types of sexual difficulties, including problems with desire, arousal, orgasm, and pain during intercourse. It outlines desire-phase difficulties such as hypoactive sexual desire disorder and dissatisfaction with sexual frequency. Excitement-phase difficulties include female and male arousal disorders as well as persistent genital arousal disorder. Orgasm difficulties and dyspareunia (painful intercourse) are also examined. Physiological factors like diabetes, cancer treatments, medications and general health problems are reviewed as potential contributors to sexual problems. Relationship, self-esteem and communication issues can also play a role in sexual difficulties.

1. Types of specific sexual difficulties
• In reality, these overlap considerably
- problems w/desire and arousal often
affect orgasm;
- problems w/orgasm easily affect desire
and arousal
Desire-phase difficulties
Excitement/arousal-phase difficulties
3) Orgasm-phase difficulties
4) Dyspareunia
Painful intercourse

2. Desire-phase difficulties
1) Hypoactive sexual desire disorder (HSDD)
– lack of interest both prior to sexual activity as well as lack
of desire during the sexual experience
• If “sexual appetite” is low, but person can become
aroused/desirous after sexual experience begins, then person
does not have HSDD
– Used to be defined as generally low sexual appetite
– In these terms, very common sexual difficulty
– Contributing factors:
• Life stress
• Relationship problems
• Medical problems
• History of sexual abuse or trauma

3. Desire-phase difficulties (cont.)
2) Dissatisfaction w/frequency of sexual
activity
– 2005 Global Sex Survey: 41% of men and 29% of women
want sex more frequently
– Couples normally have some differences in preferences re:
sexual frequency (may go back & forth)
• When these differences are significant source of conflict or
dissatisfaction in the relationship, couple can have major
difficulties
3) Sexual Aversion disorder: extreme and
irrational fear of sexual activity
– Thought of sexual activity can induce intense anxiety and
panic

4. Excitement-phase difficulties
1) Female Sexual Arousal Disorder: 2 types
a. Genital sexual arousal disorder: persistent inability to
attain or maintain lubrication-swelling response
_ Subjective sexual arousal disorder: absent or diminished
awareness of physical arousal
• Physical signs are there, but feelings of excitement and pleasure
are missing
2) Persistent Sexual Arousal Disorder
– Spontaneous, intrusive, and unwanted genital arousal in
the absence of sexual interest
– Uncomfortable tingling, throbbing, pulsating; not relieved
by orgasms--can last hours or days

5. Excitement-phase difficulties (cont.)
3) Male erectile disorder (ED)
– Consistent or recurrent inability to have
or maintain an erection sufficient for sexual
activity for >3 months. Quite
common
• 1 in 5 men over age of
20 experience ED
• Incidence of ED increases with age (see
graph)

6. Origins of sexual difficulties:
physiological factors
• Vascular, hormonal, neurological problems
• Poor general health, diet, and exercise
– For example, body fat, especially around the abdomen, reduces
testosterone levels in men, and men who are obese are 90% more
likely to have ED
• Drug use
– See table
14.4

7. Physiological factors (cont.)
• General chronic illness
– Many different illnesses can impact sexual functioning, either due to
direct impairment of nerves, hormones, or blood flow, or due to pain
and fatigue suppressing desire
• Diabetes:
– Nerve damage and circulatory problems resulting from diabetes cause
~50% of diabetic men to have reduction or loss of capacity for
erection
– Women w/diabetes often have problems w/sexual desire, lubrication,
and orgasm
• Cancer
– Chemotherapy & radiation can damage hormonal, vascular, and
neurological functions necessary for sexual functioning
– Nausea, fatigue, pain, negative body image after surgery
– Cancers of the reproductive system usually have the worst impact on
sexual functioning

8. Physiological factors (cont.)
• Multiple sclerosis (MS)
– Neurological disease of the brain and spinal cord due to damage to
the myelin sheath covering nerve fibers
– Most MS patients experience problems w/sexual functioning, ranging
from loss of sexual interest or genital sensation, reduced arousal or
orgasm, or hypersensitivity to genital stimulation
• Strokes:
– Occur when brain tissue is destroyed as a result of blockage of blood
to the brain or internal bleeding in the brain
– Often result in limited mobility, altered/lost sensation, impaired verbal
communication
– Stroke survivors frequently report reduced sexual interest, arousal,
and activity

9. Effects of medications
• Over 200 prescription and OTC medications have negative effects
on sexuality
• Health care practitioners don’t always discuss potential sexual side
effects -- ask or do your own research
• Psychiatric medications
– Antidepressants: reduced sexual interest, arousal, delayed or absent orgasm
in up to 60% of users
– Antipsychotics: frequent loss of arousal, orgasm
– Tranquilizers (valium, xanax, etc.): interfere w/orgasm
• Antihypertensive medications (treat high b.p.)
– Can interfere w/desire, arousal, and orgasm
• Other medications
– Prescription and OTC gastrointestinal, antihistamine medications can
interfere w/desire, arousal, erection
– Methadone can reduce desire, arousal, orgasm

10. Individual factors (cont.)
• Self-concept
– Self-esteem, self-confidence correlate w/higher
sexual satisfaction in women and men
– Body image strongly affects sexuality
• Affects women especially
– Many women feel sexually inhibited b/c they are uncomfortable
with their bodies
• Media images of women have gotten further and further
from the average size of women
– Early 1980s: average model weighed 8% less than the average
American woman; today, it’s 23% less
• Men are increasingly affected as well
– Male models/stars typically have no visible body hair and are
getting ‘beefier’
– Porn gives men unrealistic idea of normal penis size

11. Relationship factors
• Unresolved resentments, trust issues, disrespect for
partner
• One partner feels pressured
• Partners are too dependent on each other
– Need balance of togetherness and separateness
• Ineffective communication
• Issues around pregnancy, STIs
– Anxiety about unwanted, or desired pregnancy
– Anxiety about contracting a STI
• Problems accepting one’s sexual orientation
– Homosexuals who fear societal or familial disapproval about
being gay may attempt to live in heterosexual relationships
despite their lack of desire for other sex

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