Sexual dysfunction

Definition

Sexual dysfunction is broadly defined as the inability to fully enjoy sexual intercourse. Specifically, sexual dysfunctions are disorders that interfere with a full sexual response cycle. These disorders make it difficult for a person to enjoy or to have sexual intercourse. While sexual dysfunction rarely threatens physical health, it can take a heavy psychological toll, bringing on depression, anxiety, and debilitating feelings of inadequacy.

Description

Sexual dysfunction takes different forms in men and women. A dysfunction can be life-long and always present, acquired, situational, or generalized, occurring despite the situation. A man may have a sexual problem if he:

• ejaculates before he or his partner desires
• does not ejaculate, or experiences delayed ejaculation
• is unable to have an erection sufficient for pleasurable intercourse
• feels pain during intercourse
• lacks or loses sexual desire

A woman may have a sexual problem if she:

• lacks or loses sexual desire
• has difficulty achieving orgasm
• feels anxiety during intercourse
• feels pain during intercourse
• feels vaginal or other muscles contract involuntarily before or during sex
• has inadequate lubrication

The most common sexual dysfunctions in men include:

• Erectile dysfunction: an impairment of the erectile reflex. The man is unable to have or maintain an erection that is firm enough for coitus or intercourse.
• Premature ejaculation: rapid ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it.
• Ejaculatory incompetence: the inability to ejaculate within the vagina despite a firm erection and relatively high levels of sexual arousal.
• Retarded ejaculation: a condition in which the bladder neck does not close off properly during orgasm so that the semen spurts backward into the bladder.

Until recently, it was presumed that women were less sexual than men. In the past two decades, traditional views of female sexuality were all but demolished, and women's sexual needs became accepted as legitimate in their own right.

Female sexual dysfunctions include:

• Sexual arousal disorder: the inhibition of the general arousal aspect of sexual response. A woman with this disorder does not lubricate, her vagina does not swell, and the muscle that surrounds the outer third of the vagina does not tighten—a series of changes that normally prepare the body for orgasm ("the orgasmic platform"). Also, in this disorder, the woman typically does not feel erotic sensations.
• Orgasmic disorder: the impairment of the orgasmic component of the female sexual response. The woman may be sexually aroused but never reach orgasm. Orgasmic capacity is less than would be reasonable for her age, sexual experience, and the adequacy of sexual stimulation she receives.
• Vaginismus: a condition in which the muscles around the outer third of the vagina have involuntary spasms in response to attempts at vaginal penetration.
• Painful intercourse: a condition that can occur at any age. Pain can appear at the start of intercourse, midway through coital activities, at the time of orgasm, or after intercourse is completed. The pain can be felt as burning, sharp searing, or cramping; it can be external, within the vagina, or deep in the pelvic region or abdomen.

— David James Doermann

For more information on sexual dysfunction, visit Britannica.com.

Definition

Sexual dysfunction is broadly defined as the inability to fully enjoy sexual intercourse. Specifically, sexual dysfunction is a group of disorders that interfere with a full sexual responsiveness. These disorders make it difficult for a person to enjoy or to have sexual intercourse. While sexual dysfunction rarely threatens physical health, it can take a heavy psychological toll, bringing on depression, anxiety, and debilitating feelings of inadequacy.

Description

Sexual dysfunction takes different forms in men and women. A dysfunction can be lifelong and always present, or it can be temporary and sporadic. It can be situational or generalized. In either gender, symptoms of a sexual problem include the lack or loss of sexual desire, anxiety during intercourse, pain during intercourse, or the inability to achieve orgasm. In addition, a man may have a sexual problem if he:

• Ejaculates before he or his partner desires.
• Does not ejaculate, or experiences delayed ejaculation.
• Is unable to have or maintain an erection sufficient for pleasurable intercourse.

Also, a woman may have a sexual problem if she:

• Feels vaginal or other muscles contract involuntarily before or during sex.
• Has inadequate vaginal lubrication.

The most common sexual dysfunctions in men include:

• Erectile dysfunction: an impairment of a man's ability to have or maintain an erection that is firm enough for coitus or intercourse.
• Premature ejaculation, or rapid ejaculation, with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it.
• Ejaculatory incompetence: the inability to ejaculate within the vagina despite a firm erection and relatively high levels of sexual arousal.
• Retarded ejaculation: a condition in which the bladder neck does not close off properly during orgasm so that the semen spurts backward into the bladder.

Female sexual dysfunctions include:

• Sexual arousal disorder: the general arousal aspect of sexual response is inhibited. A woman with this disorder does not lubricate, her vagina does not swell, and the muscle that surrounds the outer third of the vagina does not tighten—a series of changes that normally prepare the body for orgasm ("the orgasmic platform"). Also, in this disorder, the woman typically does not feel erotic sensations.
• Orgasmic disorder: the orgasmic component of the female sexual response is impaired. The woman may be sexually aroused but never reach orgasm.
• Vaginismus: a condition in which the muscles around the outer third of the vagina have involuntary spasms in response to attempts at vaginal penetration.
• Painful intercourse also known as dyspareunia.

Causes & Symptoms

Many factors of both physical and psychological origin can affect sexual response and performance. Injuries, such ailments as infections, and drugs of abuse are among the physical influences. Certain prescription medications, such as drugs to regulate blood cholesterol levels, may also affect sexual functioning. In addition, there is increasing evidence that chemicals and other environmental pollutants depress sexual function. As for psychological factors, sexual dysfunction may have roots in traumatic events such as rape or incest, guilt feelings, a poor self-image, depression, chronic fatigue, certain religious beliefs, or marital problems. Dysfunction is often associated with anxiety. If a man operates under the misconception that all sexual activity must lead to intercourse and to orgasm by his partner, he may consider the act a failure if his expectations are not met.

In Chinese medicine, sexual dysfunction is considered an imbalance of yin and yang. Yin and yang are the two dependent and constantly interacting forces of energy in the world, according to ancient Chinese thought. Yin energy is receptive, dark, feminine, and cool. It is associated with the heavy, the cold, and the moist. Yang energy is masculine, active, bright, and warm. It is associated with the dry, the light, and the hot. People with sexual dysfunction who have yin deficiency are too dry and tired, causing premature ejaculation or dry and spastic conditions. Symptoms of a yang deficiency may include erectile dysfunction as well as lack of sexual appetite or excitement. There are other imbalances that can cause sexual dysfunction.

Other types of alternative medicine, such as herbalism, regard sexual dysfunction as stemming from the same causes as those recognized by Western medicine. In such alternative approaches as homeopathy, sexual dysfunction is seen as an energy deficiency in the sexual organs or the glands that regulate these organs.

Diagnosis

In deciding whether sexual dysfunction is present, it is necessary to remember that each person has a different level of sexual interest. While some people may be interested in sex at almost any time, others have low or seemingly nonexistent levels of sexual interest. A sexual condition is classified as sexual dysfunction only when it is a source of personal or interpersonal distress instead of a voluntary choice.

The first step in diagnosing a sexual dysfunction is usually discussing the problem with a doctor or an alternative practitioner, who will need to ask further questions so he or she can differentiate among the types of sexual dysfunction. The physician may also perform a physical exam of the genitals, and may order further medical tests, including measurement of hormone levels in the blood.

An expert in Chinese medicine will take the pulses at the wrist to assess the patient's overall health. According to Chinese thought, there are 12 pulses at the wrist, six on each wrist. The practitioner will ask questions that relate to yin and yang energy, such as whether the patient's hands and feet are cold or warm most of the time. An alternative practitioner is also likely to query the patient about his diet and any issues in his life that may be contributing to stress.

In allopathic medicine, men may be referred to a urologist, a specialist in diseases of the urinary and genital organs, and women may be referred to a gynecologist.

Treatment

A variety of alternative therapies can be useful in the treatment of sexual dysfunction. Counseling or psychotherapy is highly recommended to address any emotional or mental components of the disorder. Nutritional supplementation, as well as Western, Chinese, or ayurvedic botanical medicine, can help resolve biochemical causes of sexual dysfunction.

Beneficial supplements and herbs include gingko biloba, which improves circulation to the genitals and has been shown to be effective in a number of studies. If the cause is a psychological, emotional, or energy disorder, such adrenal tonics as licorice, epimedium, eucommia, and cuscuta can restore the patient's mood and increase sexual interest. These herbs increase the ability to adapt to physical and mental stress because they increase the power of the adrenal system, which secretes the brain chemical epinephrine. If the patient's reproductive organs are not producing enough of the hormones that regulate sex drive and function, vitex is also a good solution. When a patient lacks sexual drive, such tonics as deer antler can increase interest in sex.

One drug derived from herbal sources that is used in mainstream medicine to treat impotence in men is yohimbine, an alkaloid derived from the bark of the yohimbe or rauwolfia tree. Yohimbine is used to treat inadequate circulation in the arms and legs and to dilate the pupil of the eye as well as to treat impotence. It is available as a prescription medication under such brand names as Yocon and Yohimex. Yohimbine does not work for all men affected by impotence, but appears to have fewer side effects than sildenafil (Viagra).

Homeopathic treatment can be helpful by focusing on the energetic aspects of the disorder. A Chinese medicine practitioner might address sexual dysfunction by using acupuncture, in which hair-thin needles are used to stimulate the body's energy (or qi). According to ancient Chinese theory, the body has 12 meridians that correspond to various organs, their functions, and the patient's emotions. Acupuncture needles might be applied at points on these meridians that regulate the kidney, which forms the foundation for the reproductive system in traditional Chinese medicine, or to other meridians that have roles in sexual function.

Yoga and meditation provide needed mental and physical relaxation for conditions such as vaginismus. A yoga teacher may advise forward bends to calm the patient and yoga twists to help the body produce hormones that increase sexual drive and a feeling of well-being.

Relaxation therapy eases and relieves anxiety about dysfunction. Massage is extremely effective at reducing stress, especially if performed by the partner.

A massage therapist or aromatherapist can also provide sandalwood or jasmine oils to boost sexual drive. An aromatherapist usually prescribes singular scents or a mixture created with the person's preferences and his or her symptoms in mind.

Allopathic Treatment

Allopathic treatments break down into two main categories: behavioral psychotherapy and physical treatment. Sex therapy, ideally provided by a member of the American Association of Sexual Educators, Counselors, and Therapists (AASECT), emphasizes correction of sexual misinformation, the importance of improved partner communication and honesty, anxiety reduction, sensual experience and pleasure, and interpersonal tolerance and acceptance. Sex therapists believe that many sexual disorders are rooted in learned patterns and values. These disorders or symptoms are termed psychogenic. An underlying assumption of sex therapy is that relatively short-term outpatient therapy can alleviate learned patterns, restrict symptoms, and allow a greater satisfaction with sexual experiences.

In some cases, a specific technique may be used during intercourse to correct a dysfunction. One of the most common is the "squeeze technique" to prevent premature ejaculation. When a man feels that an orgasm is imminent, he withdraws from his partner. Then, the man or his partner gently squeezes the head of the penis to halt the orgasm. After 20-30 seconds, the couple may resume intercourse. The couple may repeat this technique several times before the man proceeds to ejaculation.

In cases in which significant sexual dysfunction is linked to a broader emotional problem such as depression or substance abuse, intensive psychotherapy and/or medications may be appropriate. People who are taking such medications as fluoxetine (Prozac), paroxetine (Paxil), or reboxetine (Edronax) for depression, however, should be advised that sexual dysfunction in adults of either sex is a fairly common side effect of these medications.

In many cases, doctors prescribe medications to treat an underlying physical cause of sexual dysfunction. Possible medical treatments include:

• Clomipramine and fluoxetine for premature ejaculation.
• Papaverine and prostaglandin for erectile difficulties.
• Hormone replacement therapy or androgen therapy for female dysfunctions.
• Sildenafil (Viagra), a drug approved in 1998 as a treatment for impotence. As of 2002, however, sildenafil has been shown to have potentially serious side effects, including headaches, nausea, sudden changes in blood pressure, and eye disorders.

Expected Results

There is no single cure for sexual dysfunction, but almost all of the individual conditions can be controlled. Most people who have a sexual dysfunction fare well once they get into a treatment program. Most alternative therapies, however, take at least several weeks to take effect. If the patient doesn't see improvement in that time, he or she should consider trying another practitioner.

Prevention

It often helps to continue such treatments, such as acupuncture and massage after the initial problem is resolved. Doing so keeps sexual energy high and the genital organs and sex glands healthy. By continuing to use alternative therapies, the patient can help maintain sexual interest even when normal sexual doldrums occur. Continuing to take alternative medicines or treatment also ensures the problem won't return.

Resources

Books

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision. Washington, D.C.: American Psychiatric Association, 2000.

Masters, William H., Virginia E. Johnson, and Robert C. Kolodny. Human Sexuality. New York: HarperCollins, 1992.

Molony, David. The American Association of Oriental Medicine's Complete Guide to Herbal Medicine. New York: Berkley Books, 1998.

Periodicals

Guay, A. T., R. F. Spark, J. Jacobson, et al. "Yohimbine Treatment of Organic Erectile Dysfunction in a Dose-Escalation Trial." International Journal of Impotence Research 14 (February 2002): 25-31.

Haberfellner, E. M. "Sexual Dysfunction Caused by Reboxetine." Pharmacopsychiatry 35 (March 2002): 77-78.

Hensley, P. L., and H. G. Nurnberg. "SSRI Sexual Dysfunction: A Female Perspective." Journal of Sex and Marital Therapy 28 (2002, Suppl. 1): 143-153.

Pomerantz, H. D., K. H. Smith, W. M. Hart, Jr., and R. A. Egan. "Sildenafil-Associated Nonarteritic Anterior Ischemic Optic Neuropathy." Ophthalmology 109 (March 2002): 584-587.

Traish, A. M., N. Kim, K. Min, et al. "Androgens in Female Genital Sexual Arousal Function: A Biochemical Perspective." Journal of Sex and Marital Therapy 28 (2002, Suppl. 1): 233-244.

Wagstaff, A. J., S. M. Cheer, A. J. Matheson, et al. "Spotlight on Paroxetine in Psychiatric Disorders in Adults." CNS Drugs 16 (2002): 425-434.

Organizations

American Academy of Clinical Sexologists. 1929 18th Street NW, Suite 1166, Washington, DC 20009. (202) 462-2122.

American Association for Marriage and Family Therapy. 1100 17th Street NW, 10th Floor, Washington, DC 20036-4601. (202) 452-0109.

American Association of Oriental Medicine. 909 22nd St. Sacramento, CA 95816. (916) 451-6950. .

American Association of Sex Educators, Counselors & Therapists. P.O. Box 238, Mt. Vernon, IA 52314. .

Yoga Research and Education Center. P.O. Box 1386, Lower Lake, CA 95457. (707) 928-9898. .

[Article by: Barbara Boughton; Rebecca J. Frey, PhD]

This article may require cleanup to meet Wikipedia's quality standards. Please improve this article if you can. (October 2007)

Sexual dysfunction
Classification and external resources
ICD-10	F52.
ICD-9	302.7
MeSH	D020018

Sexual dysfunction or sexual malfunction (see also sexual function) refers to a difficulty experienced by an individual or a couple during any stage of a normal sexual activity, including desire, arousal or orgasm.

Contents 1 Categories 1.1 Sexual desire disorders 1.2 Sexual arousal disorders 1.3 Erectile dysfunction 1.4 Orgasm disorders 1.5 Sexual pain disorders 1.6 General 2 Causes 3 Symptoms 3.1 Psychological sexual disorders 3.2 Other sexual problems 3.3 Other related problems 4 Treatment for females 5 Clinical studies 6 See also 7 References 8 Further reading 9 External links

Categories

Sexual dysfunction disorders may be classified into four categories: sexual desire disorders, arousal disorders, orgasm disorders and pain disorders.

Sexual desire disorders

Main article: Hypoactive Sexual Desire Disorder

Sexual desire disorders or decreased libido are characterised by a lack or absence for some period of time of sexual desire or libido for sexual activity or of sexual fantasies. The condition ranges from a general lack of sexual desire to a lack of sexual desire for the current partner. The condition may have started after a period of normal sexual functioning or the person may always have had no/low sexual desire.

The causes vary considerably, but include a possible decrease in the production of normal estrogen in women or testosterone in both men and women. Other causes may be aging, fatigue, pregnancy, medications (such as the SSRIs) or psychiatric conditions, such as depression and anxiety.^[1] Loss of libido from SSRIs usually reverses after SSRIs are discontinued, but in some cases it does not. This has been called PSSD; however, this is not a classification that would be found in any current medical text. While a number of causes for low sexual desire are often cited, only some of these have ever been the object of empirical research. Many rely entirely on the impressions of therapists.^[2]

Sexual arousal disorders

Sexual arousal disorders were previously known as frigidity in women and impotence in men, though these have now been replaced with less judgmental terms. Impotence is now known as erectile dysfunction, and frigidity has been replaced with a number of terms describing specific problems with, for example, desire or arousal.

For both men and women, these conditions can manifest themselves as an aversion to, and avoidance of, sexual contact with a partner. In men, there may be partial or complete failure to attain or maintain an erection, or a lack of sexual excitement and pleasure in sexual activity.

There may be medical causes to these disorders, such as decreased blood flow or lack of vaginal lubrication. Chronic disease can also contribute, as well as the nature of the relationship between the partners. Unlike disorders of orgasm, as the success of Viagra (sildenafil citrate) attests, most erectile disorders in men are primarily physical conditions.

Erectile dysfunction

Main article: Erectile dysfunction

Erectile dysfunction or impotence is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis. There are various underlying causes, such as damage to the nervi erigentes which prevents or delays erection, or diabetes, which simply decreases blood flow to the tissue in the penis, many of which are medically reversible.

The causes of erectile dysfunction may be psychological or physical. Psychological impotence can often be helped by almost anything that the patient believes in; there is a very strong placebo effect. Physical damage is much more severe. One leading physical cause of ED is continual or severe damage taken to the nervi erigentes. These nerves course beside the prostate arising from the sacral plexus and can be damaged in prostatic and colo-rectal surgeries.

Due to its embarrassing nature and the shame felt by sufferers, the subject was taboo for a long time, and is the subject of many urban legends. Folk remedies have long been advocated, with some being advertised widely since the 1930s. The introduction of perhaps the first pharmacologically effective remedy for impotence, sildenafil (trade name Viagra), in the 1990s caused a wave of public attention, propelled in part by the news-worthiness of stories about it and heavy advertising.

The Latin term impotentia coeundi describes simple inability to insert the penis into the vagina. It is now mostly replaced by more precise terms.

Orgasm disorders

Orgasm disorders are persistent delays or absence of orgasm following a normal sexual excitement phase. The disorder can occur in both women and men. The SSRI antidepressants may be the reason for the disorder, as they can delay orgasm or eliminate it entirely.

Sexual pain disorders

Sexual pain disorders affect women almost exclusively and are known as dyspareunia (painful intercourse) or vaginismus (an involuntary spasm of the muscles of the vaginal wall that interferes with intercourse).

Dyspareunia may be caused by insufficient lubrication (vaginal dryness) in women. Poor lubrication may result from insufficient excitement and stimulation, or from hormonal changes caused by menopause, pregnancy, or breast-feeding. Irritation from contraceptive creams and foams can also cause dryness, as can fear and anxiety about sex.

It is unclear exactly what causes vaginismus, but it is thought that past sexual trauma (such as rape or abuse) may play a role. Another female sexual pain disorder is called vulvodynia or vulvar vestibulitis. In this condition, women experience burning pain during sex which seems to be related to problems with the skin in the vulvar and vaginal areas. The cause is unknown.

General

Sexual dysfunctions are more common in the early adult years, with the majority of people seeking care for such conditions during their late twenties through thirties. The incidence increases again in the geriatric population, typically with gradual onset of symptoms that are associated most commonly with medical causes of sexual dysfunction.

Sexual dysfunction is more common in people who abuse alcohol and drugs. It is also more likely in people suffering from diabetes and degenerative neurological disorders. Ongoing psychological problems, difficulty maintaining relationships or chronic disharmony with the current sexual partner can also interfere with sexual function.

Causes

There are many factors which may result in a person experiencing a sexual dysfunction. These may result from emotional or physical causes.

Sexual dysfunction may arise from emotional factors, including interpersonal or psychological problems. Interpersonal problems may arise from marital or relationship problems, or from a lack of trust and open communication between partners, and psychological problems may be the result of depression, sexual fears or guilt, past sexual trauma, sexual disorders,^[3] among others.

Sexual dysfunction is especially common among people who have anxiety disorders. Ordinary anxiousness can obviously cause erectile dysfunction in men without psychiatric problems, but clinically diagnosable disorders such as panic disorder commonly cause avoidance of intercourse and premature ejaculation. Pain during intercourse is often a comorbidity of anxiety disorders among women. ^[1]

Sexual activity may also be impacted by physical factors. These would include use of drugs, such as alcohol, nicotine, narcotics, stimulants, antihypertensives, antihistamines, and some psychotherapeutic drugs.^[4] For women, almost any physiological change that affects the reproductive system—premenstrual syndrome, pregnancy, postpartum, menopause—can have an adverse effect on libido. ^[4] Injuries to the back may also impact sexual activity, as would problems with an enlarged prostate gland, problems with blood supply, nerve damage (as in spinal cord injuries). Disease, such as diabetic neuropathy, multiple sclerosis, tumors, and, rarely, tertiary syphilis may also impact on the activity, as would failure of various organ systems (such as the heart and lungs), endocrine disorders (thyroid, pituitary, or adrenal gland problems), hormonal deficiencies (low testosterone, estrogen, or androgens), and some birth defects.

Symptoms

Psychological sexual disorders

The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders lists the following psychological sexual disorders:

• Hypoactive sexual desire disorder (see also asexuality, which is not classified as a disorder)
• Bestiality
• Sexual aversion disorder (avoidance of or lack of desire for sexual intercourse)
• Female sexual arousal disorder (failure of normal lubricating arousal response)
• Male erectile disorder
• Female orgasmic disorder (see Anorgasmia)
• Male orgasmic disorder (see Anorgasmia)
• Premature ejaculation
• Dyspareunia
• Vaginismus
• Paraphilias
• PTSD due to genital mutilation or childhood sexual abuse
• anhedonia

Other sexual problems

• Sexual dissatisfaction (non-specific)
• Lack of sexual desire
• Anorgasmia
• Impotence
• Sexually transmitted diseases
• Delay or absence of ejaculation, despite adequate stimulation
• Inability to control timing of ejaculation
• Inability to relax vaginal muscles enough to allow intercourse
• Inadequate vaginal lubrication preceding and during intercourse
• Burning pain on the vulva or in the vagina with contact to those areas
• Unhappiness or confusion related to sexual orientation
• Transsexual and transgender people may have sexual problems (before or after surgery), though actually being transgendered or transsexual is not a sexual problem in itself.
• Persistent sexual arousal syndrome
• Post SSRI Sexual Dysfunction
• Sexual addiction
• Hypersexuality
• Female genital cutting

Other related problems

• Infertility
• Paraphilia

Treatment for females

Although there are no approved pharmaceuticals for addressing female sexual disorders, several are under investigation for their effectiveness.^[5] A vacuum device is the only approved medical device for arousal and orgasm disorders. It is designed to increase blood flow to the clitoris and external genitalia.^[5] Women experiencing pain with intercourse are often prescribed pain relievers or desensitizing agents. Others are prescribed lubricants and/or hormone therapy.^[5] Many patients with female sexual dysfunction are often also referred to a counselor or therapist for psychosocial counseling.^[5]

A manual physical therapy, the Wurn Technique, which is designed to reduce pelvic and vaginal adhesion, may also be beneficial for women experiencing sexual pain and dysfunction. In a controlled study, Increasing orgasm and decreasing intercourse pain by a manual physical therapy technique, ^[6] twenty-three (23) women reporting painful intercourse and/or sexual dysfunction received a 20-hour program of manipulative physical therapy. The results were compared using the validated Female Sexual Function Index, with post-test vs. pretest scores. Results of therapy showed improvements in all six recognized domains of sexual dysfunction. The results were significant (P </= .003) on all measures, with individual measures and P-values as follows: desire (P < .001), arousal (P = .0033), lubrication (P < .001), orgasm (P < .001), satisfaction (P < .001), and pain (P < .001). A second study to improve sexual function in patients with endometriosis showed similar statistical results. ^[7]

Clinical studies

The earliest attempts at treating sexual dysfunctions, especially erectile dysfunction, date back to Muslim physicians and pharmacists in the medieval Islamic world. They were the first to prescribe medication for the treatment of this problem, and they developed several methods of therapy for this issue, including a single-drug therapy method where a drug was prescribed and a "combination method of either a drug or food." Most of these drugs were oral medication, though a few patients were also treated through topical and transurethral means. Sexual dysfunctions were being treated with clinically tested drugs in the Islamic world since the 9th century until the 16th century by a number of Muslim physicians and pharmacists, including Muhammad ibn Zakarīya Rāzi, Thabit bin Qurra, Ibn Al-Jazzar, Avicenna (The Canon of Medicine), Averroes, Ibn al-Baitar, and Ibn al-Nafis (The Comprehensive Book on Medicine).^[8]

In modern times, the genuine clinical study of sexual problems is usually dated back no further than 1970 when Masters and Johnson's Human Sexual Inadequacy was published. It was the result of over a decade of work at the Reproductive Biology Research Foundation in St. Louis, involving 790 cases. The work grew from Masters and Johnson's earlier Human Sexual Response (1966).

Prior to Masters and Johnson the clinical approach to sexual problems was largely derived from the thinking of Freud. It was held with psychopathology and approached with a certain pessimism regarding the chance of help or improvement. Sexual problems were merely symptoms of a deeper malaise and the diagnostic approach was from the psychopathological. There was little distinction between difficulties in function and variations nor between perversion and problems. Despite work by psychotherapists such as Balint sexual difficulties were crudely split into frigidity or impotence, terms which too soon acquired negative connotations in popular culture.

The achievement of Human Sexual Inadequacy was to move thinking from psychopathology to learning, only if a problem did not respond to educative treatment would psychopathological problems be considered. Also treatment was directed at couples, whereas before partners would be seen individually. Masters and Johnson saw that sex was a joint act. They believed that sexual communication was the key issue to sexual problems not the specifics of an individual problem. They also proposed co-therapy, a matching pair of therapists to the clients, arguing that a lone male therapist could not fully comprehend female difficulties and vice versa.

The basic Masters and Johnson treatment program was an intensive two week program to develop efficient sexual communication. Couple-based and therapist led the program began with discussion and then sensate focus between the couple to develop shared experiences. From the experiences specific difficulties could be determined and approached with a specific therapy. In a limited number of male only cases (41) Masters and Johnson had developed the use of a female surrogate, an approach they soon abandoned over the ethical, legal and other problems it raised.

In defining the range of sexual problems Masters and Johnson defined a boundary between dysfunction and deviations. Dysfunctions were transitory and experienced by the majority of people, dysfunctions bounded male primary or secondary impotence, premature ejaculation, ejaculatory incompetence; female primary orgasmic dysfunction and situational orgasmic dysfunction; pain during intercourse (dyspareunia) and vaginismus. According to Masters and Johnson sexual arousal and climax are a normal physiological process of every functionally intact adult, but despite being autonomic it can be inhibited. Masters and Johnson treatment program for dysfunction was 81.1% successful.

Despite the work of Masters and Johnson the field in the US was quickly over-run by ethusiastic rather than systematic approaches, blurring the space between 'enrichment' and therapy. Although it has been argued that the impact of the work was such that it would be impossible to repeat such a clean experiment.

See also

• Sexual function for information about assessing sexual dysfunction
• Sexual arousal disorder
• Female sexual arousal disorder
• Post SSRI Sexual Dysfunction
• Agony aunt
• Anorgasmia
• Premature ejaculation
• Dapoxetine
• Sexless marriage

References

1. ^ ^{a b} Coretti G and Baldi I (August 1, 2007). "The Relationship Between Anxiety Disorders and Sexual Dysfunction". Psychiatric Times 24 (9). http://www.psychiatrictimes.com/anxiety/article/10168/54881. 
2. ^ Maurice, William (2007): “Sexual Desire Disorders in Men.” in ed. Leiblum, Sandra: Principles and Practice of Sex Therapy (4th ed.) The Guilford Press. New York
3. ^ Michetti, Paolo Maria; Roberta Rossi, Daniele Bonanno, Andrea Tiesi and Chiara Simonelli (2006). "Male sexuality and regulation of emotions: a study on the association between alexithymia and erectile dysfunction (ED)". International Journal of Impotence Research 18 (2): 170–174. doi:10.1038/sj.ijir.3901386. PMID 16151475. http://www.nature.com/ijir/journal/v18/n2/full/3901386a.html. Retrieved 2007-02-02. 
4. ^ ^{a b} Saks BR (April 15, 2008). "Common issues in female sexual dysfunction". Psychiatric Times 25 (5). http://www.psychiatrictimes.com/sexual-issues/article/10168/1153918. 
5. ^ ^{a b c d} Amato P, MD. An update on therapeutic approaches to female sexual dysfunction [1]. 2007. Retrieved August 14, 2008.
6. ^ Wurn LJ, Wurn BF, King CR, Roscow AS, Scharf ES, Shuster JJ. Increasing Orgasm and Decreasing Dyspareunia by a Manual Physical Therapy Technique. Med Gen Med 2004 Dec 14; 6(4): 47. PMID 15775874.
7. ^ Wurn LJ, Wurn BF, King CR, Roscow AS, Scharf ES, Shuster JJ. Improving sexual function in patients with endometriosis via a pelvic physical therapy. Fertil Steril. 2006; 86 (Supp 2): S29-30. Abstract.
8. ^ A. Al Dayela and N. al-Zuhair (2006), "Single drug therapy in the treatment of male sexual/erectile dysfunction in Islamic medicine", Urology 68 (1), p. 253-254.

Further reading

• Kaplan, Helen Singer, The New Sex Therapy: Active Treatment Of Sexual Dysfunctions, New York, Brunner/Mazel, 1974. ISBN 0876300832

External links

• International Society for Sexual Medicine
• NIH site on sexual problems
• 100 FAQs about sexual dysfunction
• "PEhomepage.com - treatments for premature ejaculation" - an article on dapoxetine
• "Premature Ejaculation Drug Promising"
• "The many mysteries of the female orgasm" - An editorial about advances in sexual pharmacology
• Vaginimus Awareness Network: A non-profit site offering facts and advice to women with vaginismus, their partners and gynaecologists
• Sexual Dysfunction Research Community
• homepage for Premature Ejaculation patients
• Traumatic Masturbatory Syndrome and other masturbation issues
• Sexual Medicine Society of North America's website: SexHealthMatters.org
• Persistent Sexual Arousal Syndrome - Language: Dutch and English

v • d • e WHO ICD-10 mental and behavioral disorders (F · 290–319) Neurological/symptomatic Dementia (Alzheimer's disease, multi-infarct dementia, Pick's disease, Creutzfeldt–Jakob disease, Huntington's disease, Parkinson's disease, AIDS dementia complex, Frontotemporal dementia, Sundowning, Wandering) · Delirium · Post-concussion syndrome · Organic brain syndrome Psychoactive substance alcohol (acute alcohol intoxication, drunkenness, alcohol dependence, alcoholic hallucinosis, Alcohol withdrawal, delirium tremens, Korsakoff's syndrome, alcohol abuse) · opioids (opioid overdose, opioid dependency) · sedative/hypnotic (benzodiazepine overdose, benzodiazepine dependence, benzodiazepine withdrawal) · cocaine (cocaine dependence) · general (Intoxication/Drug overdose, Drug abuse, Physical dependence, Rebound effect, Withdrawal) Schizophrenia, schizotypal and delusional Psychosis (Schizoaffective disorder, Schizophreniform disorder, Brief reactive psychosis) · Schizophrenia (Disorganized schizophrenia, Delusional disorder, Folie à deux) · Personality disorder (Schizotypal personality disorder) Mood (affective) Mania · Bipolar disorder (Bipolar I, Bipolar II, Cyclothymia) · Depression (Major depressive disorder, Dysthymia, Seasonal affective disorder, Atypical) Neurotic, stress-related and somatoform Anxiety disorder/ adjustment disorder phobic anxiety disorders: Agoraphobia · Social anxiety/Social phobia (Anthropophobia) · Specific phobia (Claustrophobia) Panic disorder/Panic attack · Generalized anxiety disorder · OCD · stress (Acute stress reaction, PTSD) Somatoform disorder Somatization disorder · Body dysmorphic disorder · Hypochondriasis · Nosophobia · Da Costa's syndrome · Psychalgia · Conversion disorder (Ganser syndrome, Globus pharyngis) · Neurasthenia Dissociative disorder Dissociative identity disorder · Psychogenic amnesia Physiological/physical behavioral Eating disorder Anorexia nervosa · Bulimia nervosa · Rumination syndrome · NOS Nonorganic sleep disorders Nonorganic hypersomnia, Nonorganic insomnia · Parasomnia (REM behavior disorder, Night terror) · Nightmare Sexual dysfunction Erectile dysfunction · Premature ejaculation · Vaginismus · Dyspareunia · Hypersexuality · Female sexual arousal disorder Postnatal Postpartum depression · Postnatal psychosis Adult personality and behavior Personality disorder · Impulse control disorder (Kleptomania, Trichotillomania, Pyromania) · Factitious disorder (Munchausen syndrome) · Sexual maturation disorder · Ego-dystonic sexual orientation · Sexual relationship disorder · Paraphilia (Voyeurism, Fetishism) Mental disorders diagnosed in childhood Mental retardation X-Linked mental retardation (Lujan-Fryns syndrome) Psychological development (developmental disorder) Specific speech and language (expressive language disorder, aphasia, expressive aphasia, receptive aphasia, Landau–Kleffner syndrome, lisp) · Scholastic skills (dyslexia, dysgraphia, Gerstmann syndrome) · Motor function (developmental dyspraxia) Pervasive Autism · Rett syndrome · Asperger syndrome Behavioral and emotional ADHD · Conduct disorder (ODD) · emotional disorder (Separation anxiety disorder) · social functioning (Selective mutism, RAD, DAD) · Tic disorder (Tourette syndrome) · Speech (Stuttering, Cluttering) · Movement disorder (Stereotypic) psychology navs: mental processes, disorders, symptoms/signs, speech/voice, psychotherapy

v • d • e Diseases of the pelvis and genitals (N40-N99, 600-629) Female Adnexa Ovary Oophoritis · Ovarian cyst (Follicular cyst of ovary, Corpus luteum cyst, Chocolate cyst of ovary) · Ovarian hyperstimulation syndrome · Anovulation · Mittelschmerz Fallopian tube Salpingitis · Hydrosalpinx · Hematosalpinx Parametrium Parametritis Uterus Endometrium: Endometriosis (Adenomyosis) · Endometrial polyp menstruation (Amenorrhoea, Anovulation, Hypomenorrhea, Oligomenorrhea, Menorrhagia, Menometrorrhagia, Metrorrhagia, Dysmenorrhea) Hematometra · Retroverted uterus · Asherman's syndrome Cervix Cervicitis - Cervical polyp - Nabothian cyst Vagina Vaginitis (Bacterial vaginosis, Atrophic vaginitis, Candidal vulvovaginitis) · Leukorrhea · Hematocolpos/Hydrocolpos Sexual dysfunction (Dyspareunia, Sexual arousal disorder, Vaginismus) Prolapse (Cystocele, Rectocele, Urethrocele) · Fistulae (Vesicovaginal, Rectovaginal) Vaginal discharge Vulva Vulvitis · Bartholin's cyst Clitoral hood or Clitoris Clitoral phimosis · Clitorism Other/general Pelvic inflammatory disease · Female infertility (Habitual abortion) Male Testicular Orchitis · Hydrocele testis · Testicular torsion · Male infertility (Azoospermia, Oligospermia) Epididymis Epididymitis · Spermatocele · Hematocele Prostate Prostatitis (Acute prostatitis, Chronic bacterial prostatitis, Chronic prostatitis/chronic pelvic pain syndrome) · Benign prostatic hyperplasia Penis Balanoposthitis/Balanitis · Phimosis · Priapism · Sexual dysfunction (Erectile dysfunction) · Peyronie's disease · Penile fracture Other Hematospermia · Retrograde ejaculation reproductive system navs: anat female,male/physio/dev, noncongen/congen/neoplasia, symptoms+signs/eponymous, proc

v • d • e Family planning and Reproductive health Rights Reproductive rights (Contraceptive security · Genital integrity) Education Sex education · Pre-conception counseling · Genetic counseling Planning Childfree · Parenting (Childbirth, Adoption, Foster care) Implement Birth control · Safe sex Health Men's · Women's (Vulvovaginal) Pregnancy Maternal health · Obstetrics · Prenatal care · Pregnant patients' rights · Unintended pregnancy · Pregnancy options counseling · Abortion · Teenage pregnancy Medicine Andrology · Gynaecology · Obstetrics and gynaecology · Reproductive endocrinology and infertility · Genitourinary medicine Disorder Sexual dysfunction · Infertility (Assisted reproductive technology) · Reproductive system disease · Sexually transmitted disease (clinic, test) Related navboxes {{Birth control methods}} · {{Pregnancy}} · {{Sex}} · {{sexual abuse}} · {{STD/STI}} · {{Assisted reproductive technology}}

v • d • e Sex History History of erotic depictions · Sexual revolution · Feminist Sex Wars Human sexual behavior Sexual intercourse (Foreplay · Sex position · List of sex positions) · Oral sex · Anal sex · Group sex · Masturbation Anal–oral sex · Sexual sublimation · Bareback · Dirty talk · Facial · Fisting · Non-penetrative sex (syn. Petting, e.g. Fingering/Handjob · Sumata) · Quickie · Ass to mouth · Creampie · Snowballing · Deep-throating · BDSM Physiological events Sexual arousal · Erection · Orgasm (Ejaculation · Female ejaculation) · Insemination · Pregnancy Health and education Birth control · Condom · Reproductive medicine (Andrology · Gynaecology · Urology) · Safe sex · Sexual dysfunction (Erectile dysfunction · Hypersexuality) · Sex education · Sex therapy · Sexually transmitted disease · Sex surrogate Identity Sexual identity · Sexual orientation Law Age of consent · Criminal transmission of HIV · Incest · Obscenity · Public indecency · Sexual abuse (Sexual harassment · Rape · Sexual assault · Sexual violence) Relationships and society Family planning · Marriage · Paraphilia · Polyamory · Promiscuity · Religion and sexuality · Romance · Sexual abstinence · Sexual attraction · Sexual ethics · Sexual objectification Sex industry Adult video game · Erotica · Pornography · Prostitution · Sex toys · Sex doll · Sex shop · Sex tourism · Female sex tourism Human sexual behavior · Human sexuality · Sexology · Sexual slang · Animal sexual behavior

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