SEXUAL AROUSAL DISORDERS

Disorder of sexual arousal can be caused by physical or psychological factors, or both. Careful assessment helps to clarify the cause.

FAILURE TO ACHIEVE ORGASM The failure of a women to achieve orgasm can be a result of poor sexual technique, concentrating too hard on achievement, or negative attitudes toward sexual relationships.

ORGASM DISORDERS: Like arousal disorders, disorders of orgasm occur in both men and women.

ERECTILE DYSFUNCTION: Formerly referred to as impotence, is the inability of a man to produce or maintain erection long enough for vaginal penetration or partner sensation Sexual dysfunction characterized by the inability to develop or maintain an erection of the penis sufficient for satisfactory sexual performance. It may also occur as a side effect of certain drug. CAUSES: Most causes of ERECTILE DYSFUNCTION are physical, such as aging, atherosclerosis or diabetes. Psychological causes: performance anxiety, stress, mental disorders (clinical depression, schizophrenia, substance abuse, panic disorder, generalized anxiety disorder, personality disorders or traits.), psychological problems, negative feelings Neurogenic Disorders (spinal cord and brain injuries, nerve disorders such as Parkinson's disease, Alzheimer's disease, multiple sclerosis, and stroke.) Lifestyle: alcohol and drugs, obesity, cigarette smoking (Incidence of impotence is approximately 85 percent higher in male smokers compared to non-smokers

TREATMENT: Testosterone supplements may be used for cases due to hormonal deficiency. Cases can be treated by drugs taken orally, injected, or as penile suppositories. DRUG OF CHOICE FOR ERECTILE DYSFUNCTION: Sildenafil (Viagra) Tadalafil (cialis)

Vardenafil (levitra)

PREMATURE EJACULATION: Is ejaculation before penile-vaginal contract. The term is often use to mean ejaculation before the sexual partners satisfaction has been achieved. Premature ejaculation can ba unsatisfactory and frustrating for both partners. CAUSES: Masturbating to orgasm Doubt about masculinity Fear of impregnating the woman TREATMENT: Training and improving mental habituation to sex and physical development of stimulation control. Performing routines such as Kegel exercises, which, as mentioned above, relate to gaining voluntary control of the PC muscle and thus give a person more control over ejaculation. When ejaculating, the control of this muscle is said to be lost, and thus, learning to maintain control of it can be of aid to some. Serotonergic medications, such as SSRIs, can delay ejaculation PAIN DISORDERS: VAGINISMUS: Involuntary contraction of the muscle at the outlet of the vagina when coitus attempted. PRIMARY VAGINISMUS Primary vaginismus occurs when a woman has never been able to have penetrative sex or experience any kind of vaginal penetration without pain. CAUSES: sexual abuse, rape, or attempted sexual abuse knowledge of (or witnessing) sexual or physical abuse of others, without being personally abused having been taught that sex is immoral, vulgar, or demoralizing fear of pain associated with penetration, particularly the popular misconception of 'breaking' the hymen upon the first attempt at penetration, or the idea that vaginal penetration will inevitably hurt the first time it occurs

SECONDARY VAGINISMUS Secondary vaginismus occurs when a woman who has previously been able to achieve penetration develops vaginismus. This may be due to physical causes such as a yeast infection or trauma during childbirth, or it may be due to psychological causes. TREATMENT: PSYCHOLOGICAL TREATMENT A woman may choose to address the issue on her own terms, or she may avail the help of a therapist. Some women, especially those with secondary vaginismus, may rely on a physical rather than psychological treatment and also be successful. There are emotional difficulties associated with vaginismus, which can include low selfesteem, fears, and depression.

PHYSICAL TREATMENT Physical treatment of the internal spasms may include sensate focus exercises, exploring the vagina through touch, and desensitization with vaginal dilators. Botox is a relatively new treatment for vaginismus, first described in 1997

DYSPAREUNIA/VESTIBULITIS: Painful sexual intercourse, due to medical or psychological causes. CAUSES: (WOMEN) Can occur due to endometriosis(abnormal placement of endometrial tissues). Numerous medical causes of dyspareunia exist, ranging from infections (candidiasis, chlamydia, trichomoniasis, urinary tract infections)tumors, xerosis (dryness, especially after the menopause)

female genital mutilation, when the introitus has become too small for normal penetration (often worsened by scarring).

(MEN) Pain is sometimes experienced in the testicular or glans area of the penis immediately after ejaculation. Infections of the prostate, bladder, or seminal vesicles can lead to intense burning or itching sensations following ejaculation. TREATMENT: Treatment is aimed at the underlying cause. Encouraging open communication between sexual partners