Sex and Relationships

 

What is the most common cause of sex problems among couples?

While they can take many forms, sex problems are defined as any physical or emotional issue that prevents a couple from achieving a mutually satisfying intimate relationship. Among the most common for men include prostate problems, a decrease in the blood supply to the penis due to diabetes, heart disease or other health concerns, nerve damage to the spinal cord, or a decrease in the hormone testosterone. In women common problems include a lack of desire caused by a decrease in the hormone estrogen, thyroid disorders (which can also affect some men), and pain during intercourse caused by any number of vaginal problems, including a lack of lubrication.

Some couples also find that the use of certain drugs can also cause sexual problems. These include alcohol, nicotine, narcotics, stimulants, some blood pressure drugs, antihistamines, and certain antidepressant medications.


What is the most common sexual condition affecting men?

Studies show it is premature ejaculation, which can affect up to 75% of men. Clinically it is defined as the release of the ejaculate from the penis either before intercourse can take place, or quickly after it starts, usually within less than 15 "thrusts." While every man will experience premature ejaculation at least once in their life, for some the problem is chronic. When this is the case causes can be linked to a highly sensitive and easily stimulated nervous system, obsessive compulsive disorder, or sometimes a lack of control over the body's response to excitement. A frequently overlooked cause of temporary premature ejaculation is an infection in the prostate gland known as prostatitis. When this is the case, a course of antibiotics often solves the problem. Temporary problems can also result from stress, or from the use of certain medications including some cold pills.

Treatments for chronic premature ejaculation include the antidepressant medication clomipramine (Anafranil) taken 12 hours before sex, and use of a condom to help reduce sensation. Sometimes a prescription lidocaine cream can also help by reducing sensation, but that can also impact the partner.

 

What is the true definition of erectile dysfunction -- and what are the most common causes?

Erectile dysfunction (ED), also known as impotence, has a far broader definition than many couples realize. It includes, of course, not being able to obtain an erection, but also the inability to sustain an erection sufficient for intercourse, as well as the inability to ejaculate on a consistent basis.

While once believed to be largely an emotional problem, today doctors know ED is most often the result of other health concerns including diabetes, high blood pressure, kidney failure, early heart disease, prostate problems, and depression. Additionally, alcohol abuse is a major contributing factor, and in some men, cigarette smoking. Chronic stress can also play a role. In some men certain drugs can result in erectile dysfunction, most notably some high blood pressure medications and some treatments for depression.


What causes sexual dysfunction in women?

Unlike men who require certain physiological events to have intercourse, women have no such restrictions. As such, the most common reasons for sexual dysfunction are often based in matters of desire, sexual arousal, or sometimes painful intercourse. Some women also report an inability to have an orgasm or experience pain when achieving one.

While a decrease in desire can be caused by many things, including a negative relationship with a partner, or other life stresses, physical causes are often traced to a decrease in the hormones estrogen and testosterone that occur during menopause. Not only can this put a damper on desire, it can also cause a decrease in vaginal lubrication making it more difficult to become aroused and causing intercourse to be painful (see question 6). In addition, certain illnesses, most notably a thyroid disorder or depression, can also impact a woman's desire. The inability to achieve orgasm is seldom caused by a physical problem, but more often the result of inadequate stimulation by a woman's partner.

 

What causes pain in the penis?

Like in any other part of the body, pain in the penis can be the result of many things, including infection, trauma, or disease. Excessive manipulation can sometimes lead to pain, as can simple things such as insect bites or pimples. At the same time, painful lesions or sores on the penis may be genital herpes or another infection. Additionally, prostate inflammation, urethritis (an infection of the urinary tube frequently caused by gonorrhea or chlamydia), and sometimes sickle cell anemia can also cause penile pain. A condition known as Peyronie's disease results in an abnormal bend in the penis that makes intercourse painful for a man. In rare instances, pain can be a sign of penile cancer, so always check with your doctor if discomfort is significant and does not subside within a few days.


Why is intercourse painful for some women?

Medically known as dyspareunia, in up to 80% of women the cause is physiological. This can be the result of a decrease in female hormones leading to vaginal dryness, the presence of yeast or other sexually transmitted infections, cystitis or urethritis (infections of the urinary tract), or certain orthopaedic problems. In some instances, even chronic constipation may play a role. A condition known as vulvar vestibulitis, an inflammation in a particular area of the vagina, is the most commonly overlooked cause of dyspareunia.

 

A specific type of dyspareunia known as vaginismus causes involuntary spasms of the muscles within the vagina. In some instances, they can be so strong, the vagina seals shut making penetration extremely painful or sometimes, impossible. It often has roots in psychological trauma.

 

What is retrograde ejaculation -- and how is it treated?

A form of male sexual dysfunction, retrograde ejaculation means the ejaculate fluid that normally leaves the penis during orgasm takes a wrong biological turn and ends up depositing in the bladder. Here it mixes with urine and eventually leaves the body as waste product. The problem isn't harmful unless the couple is trying to conceive. Retrograde ejaculation can occur either partially or completely. In either instance the cause is frequently linked to prior prostate or urethral surgery, diabetes, and the use of certain drugs including medications for high blood pressure. Controlling blood sugar can help improve the problem, as can some epinephrine-like medications. Sometimes switching blood pressure medications also works.


Is having an erection for an extended period of time dangerous?

A lot depends on your definition of "extended!" The condition itself is known as "priapism" and it's defined, in clinical terms, as an erection that lasts four hours or more without sexual stimulation. Normally, stimulation causes blood to flow into the penis, which in turn results in an erection. After ejaculation -- or if stimulation is discontinued -- the blood drains and the erection recedes. When priapism occurs, blood that is sent to fill the penis becomes trapped, causing the erection to remain without relief. Not only can this be extremely painful, if not treated early on it can result in scarring inside the penis, and sometimes, permanent erectile dysfunction. Priapism can occur in any male, even newborns, but most commonly develops between the ages of 5 and 10 years old, and 20 and 50 years old. Treatment can be as simple as applying ice packs, or may involve injecting the penis with medications, or aspirating blood to reduce pain and swelling. Occasionally surgery is necessary to restore proper blood flow and drainage.


Which medications commonly cause sex problems for men or women?

The most well-known are antidepressant drugs such as Prozac, or tranquilizers, such as Valium, both of which can impact desire in both men and women. For women, certain birth control pills can put a damper on desire, as can some formulations of HRT used to treat menopause symptoms. Drugs known to increase the risk of impotency in men include certain high blood pressure medications, antihistamines used for colds or allergies, some nonsteroidal anti-inflammatory drugs (NSAIDs) (like ibuprofen), heartburn drugs such as Tagamet, Zantac, and Pepcid, some lipid-lowering drugs for cholesterol, and certain medications used to treat Parkinson's disease or cancer.


Is it true that sex can actually give some people a headache?

Yes, it's true. Medically, the condition is known as coital cephalalgia, and surprisingly, it affects men more often than women -- surprising because in general women get more headaches than men. While no one is certain what's behind the problem, some say it may be related to the sudden change in blood flow and subsequent drop in blood pressure following orgasm. Others contend it may be the result of a release of adrenaline that floods the body during periods of intense sexual activity. While some folks can have sex headaches for several weeks followed by permanent remission, for others the problem may come and go indefinitely, or sometimes be present with every sexual encounter. Although you might not suffer from migraine headaches, sex headaches are thought to be chemically related and frequently respond to similar treatments. One word of caution: Don't assume that a headache you experience after sex is a sex headache. Experts say sometimes, benign lesions in the brain or aneurysms (a blood vessel disorder) can also cause headaches after sex. To rule out such problems, don't diagnose yourself -- see your doctor.