Sexuality concerns

Overview
Human sexuality includes individual sexual knowledge, beliefs, attitudes, values and behaviors. Dimensions of sexuality include the anatomy, physiology and biochemistry of the sexual response system; sexual identity, orientation, roles and personality; and thoughts, feelings and relationships.
Healthy sexuality is characterized by the capacity to enjoy safe sexual activity through behavior that's consistent with your values and ethics. Healthy sexuality includes taking responsibility for your sexual behaviors, communicating respectfully with your partner, and being honest with each other. Healthy sexual relationships are consensual and mutually satisfying. Healthy sexuality also includes freedom from medical or psychological problems that can interfere with sexual functioning.

Sexual identity, sexual function and sexual satisfaction all influence sexual health. Impairments in any of these areas may lead to sexual dysfunction.


Common sexuality issues
Sexual dysfunction is defined as a disturbance in sexual desire and the sexual response cycle that causes significant distress and interpersonal difficulty. There are four phases of the sexual response cycle: desire, excitement, orgasm and resolution. A disturbance in the sexual response cycle can occur in any phase.
Sexuality concerns in early adulthood often center around communication between sexual partners, concerns about safe sex, and issues regarding birth control, family planning and fertility. Later, family responsibilities and making adequate time for your partner and the relationship may take center stage. Sexual satisfaction can also be impacted by job satisfaction, changes in roles and responsibilities, life stages such as menopause, and becoming single due to divorce or death. Men may begin to experience erectile dysfunction, especially with chronic conditions such as alcoholism, diabetes or vascular disease. Women may have similar troubles.

Healthy adults can experience satisfying sex into their 80s and beyond. However, older adults are more likely to take prescription medications, many of which list sexual dysfunction as a possible side effect. Physiological changes associated with aging, such as decreased vaginal lubrication and elasticity and decreased ability to maintain an erection, may also impact sexual satisfaction.

Various medical conditions may contribute to sexual dysfunction, including cardiovascular or arterial disorders, diabetes, menopause, endocrine disorders, chronic pain or kidney disease. Medications, such as tricyclic antidepressants, stimulants, sedatives, antipsychotics, antihypertensives and anabolic steroids, may also contribute to sexual dysfunction.

Sexual satisfaction in one or both sexual partners can be hindered by certain impairments or conditions, including erectile dysfunction (inability to sustain an erection sufficient for intercourse at least 25 percent of the time), premature or delayed ejaculation, anorgasmia (inability to experience orgasm), lack of sexual desire and dyspareunia (painful intercourse). A chronic illness, medical or surgical event, recent childbirth, urological or hormonal problems may also impact sexuality.

Although significant, physical intimacy is only one component of intimacy. The lack of intimacy in other areas, such as emotional intimacy, can also affect a couple's sex life. In some cases, couples may need to focus on improving intimacy in other areas of their lives to improve their sex lives.

Possible relationship issues that can contribute to sexual dysfunction include ongoing or unresolved conflict, anger or resentment toward your partner, communication breakdowns, emotional distancing, a lack of trust, and perceived betrayal in the relationship.

Common emotional issues that can affect a couple's sex life include physical changes due to obesity or a mastectomy, for example, as well as feelings of undesirability, depression, anxiety, stress, substance abuse, or preoccupations and obsessive thoughts unrelated to sex.


Characteristics
Sexuality concerns can affect you in many ways. Physically, sex may be painful. Men may have the inability to attain or maintain an erection. Women may have the inability to attain or maintain vaginal lubrication.
Psychologically, you may be anxious about external stressors or sexual performance. You may develop low self-esteem and become frustrated or guilty about disappointing your partner. You may feel inadequate, irritable or ashamed. You may lack an emotional connection with your partner or lack the desire for sexual activity.

Socially, you may avoid sex or blame your partner for your sexual concerns. You may experience other conflict, particularly if you have a history of sexual abuse. Culturally sanctioned beliefs or attitudes concerning sexuality can also play a role.

Sometimes, sexuality concerns can be more than you're able to handle at the time. Symptoms such as sleep disturbances, decreased energy, appetite changes, anxiety, depression, inability to concentrate and hopelessness may warrant further evaluation by a health care professional.

As with all physical symptoms, consult a medical doctor to rule out a medical condition. If these or any other symptoms cause you distress that doesn't seem to improve, seek additional help and support from a mental health care professional.


Coping strategies
Depending on the specific concern, you may have various options for dealing with the problem.
Because physical factors can impact sexual experience, you may want to consult your doctor about contraception, fertility, erectile dysfunction or other medical issues. Prescription drugs can also impact sexuality, so be sure to discuss any medications you're taking with your doctor as well. In some cases, medication can help you deal with related issues, such as depression.

Relationship problems with your partner can also influence how you cope with a specific sexual concern. Consider the level and quality of intimacy in your relationship, as well as your ability to freely discuss sexual issues with your partner. Consider if you have any anxiety around satisfying your partner or the potential consequences of sex, such as a sexually transmitted disease or unplanned pregnancy. If you're having trouble communicating with your partner, individual or couple's therapy may be helpful.

Your sexual history can also impact your current feelings about sexuality, including any high-risk sexual behaviors, such as unprotected sex or sex with multiple partners. Other potential influences include substance abuse, symptoms of depression or a history of sexual abuse. Consult a mental health professional if you feel you have unhealthy or distressing feelings or behaviors about sexuality.

With any specific type of sexual dysfunction, understanding the many dynamics that may be involved is important. For example, a man's erectile dysfunction could be related to anxiety about performance or being seen as inadequate in his partner's eyes. The diagnosis of a sexual dysfunction must take into account the person's ethnic, cultural, religious and social background, all of which may influence sexual desire, expectations and attitudes about performance. In some cases, specific medical procedures may be used to treat the dysfunction (for example, hormonal replacement, prostheses or reconstruction).

Finally, consider your knowledge about sexual function, reproductive health and contraception. To further educate yourself about sexuality, seek reliable information from a trusted and reputable source.