Sexual dysfunction encompasses issues such as negative experiences, trauma, sexually transmitted diseases, and unwanted pregnancies.
Sexual dysfunction can sometimes lead to other psychiatric disorders. In such cases, it is essential to consult a psychiatrist.
In the treatment of sexual dysfunction, it is first necessary to identify the cause and then plan the treatment. Determining the appropriate course of action in this situation will lead to a more effective outcome.
The goal of treating sexual dysfunction is to reduce the psychological factors that negatively impact his life and to help him regain a normal sex life.
Receiving treatment support at this stage will help prevent other psychological problems that may arise in the future for individuals with sexual dysfunction. Sexuality is important in a healthy relationship.
What Is a Sexual Dysfunction?
Sexuality is a concept with multiple dimensions and stages. A dysfunction occurring in at least one of these stages is referred to as a sexual dysfunction. The stages of sexuality include the increase in sexual desire, sexual arousal—which involves penile erection and vaginal lubrication—and orgasm. Different sexual dysfunctions—which may be interdependent or independent of one another—can occur in each of these stages individually.
What Are the Symptoms of Sexual Dysfunction?
In men
- Inability to achieve sufficient penile rigidity
- Sufficient penile rigidity but an inability to experience sufficient pleasure
- Premature ejaculation, leading to a decrease in penile rigidity
- Uncontrollable ejaculation
- Insufficient sexual satisfaction
- Anxiety experienced before, during, and after sexual intercourse
In women
- Painful sexual intercourse
- Extreme difficulty or inability to achieve vaginal-penile penetration
- Pain and discomfort when using a tampon
- Pain in the vagina during a gynecological exam
- Muscle spasms during sexual intercourse
What Causes Sexual Dysfunction?
A healthy sex life contributes to happiness, good sleep, and physical and mental well-being.
Sexual dysfunction and negative experiences in one’s sex life can also lead to psychiatric problems.
According to the World Health Organization’s definition, sexual health requires not only a positive and respectful approach to sexuality and sexual relationships but also the ability to have pleasurable and safe sexual experiences free from coercion, discrimination, and violence.
To overcome sexual dysfunction and to ensure and maintain sexual health, the sexual rights of all individuals must be protected and upheld.
An individual begins to recognize and experience his sexuality as early as childhood. The first contours of his sexual identity form between the ages of 3 and 6; they become fully defined during adolescence. Every detail he hears, learns, or experiences regarding sexuality during these periods serves as a fundamental determinant of the quality of his future sexual life. To avoid sexual dysfunction, he must navigate this period in a healthy manner in every respect.
- Low testosterone levels
- Use of medications such as antidepressants and those for hypertension
- Atherosclerosis (hardening of the arteries) and other circulatory disorders
- Nerve damage caused by diabetes or surgery, or a stroke
- Smoking
- Excessive consumption of alcohol and addictive substances
- Side effects of certain medications
- Pregnancy and the postpartum breastfeeding period
- Worrying about sexual performance
- Relationship and marriage problems
- Depression and feelings of guilt
- Trauma from past sexual experiences
- Stress at work
- Aging
- Having overly high expectations regarding sexual performance
- Lack of sex education
- Taboos surrounding sexuality
- Growing up in a repressive environment regarding sexuality and many other issues
- Personal characteristics
- Lack of self-confidence
- Problems in family relationships
What Are Sexual Dysfunctions in Men?
Sexual dysfunction is common among men, but it is often swept under the rug and not discussed due to various reasons, particularly those related to the society in which they live. As a result, instead of seeking professional help, individuals may resort to ineffective or temporary solutions they find on their own, which can cause the condition to worsen.
Premature Ejaculation (Erectile Dysfunction)
Premature ejaculation is defined as a man’s involuntary ejaculation before or immediately after penetration, with less sexual stimulation than normal. Premature ejaculation is a common sexual dysfunction in men. If this issue does not occur consistently, there is no cause for concern. There is no universally accepted, clear-cut diagnosis of premature ejaculation, but a diagnosis can be made if the following characteristics are present:
- Ejaculation occurring immediately after the penis enters the vagina in most sexual encounters
- Ejaculation occurring before the penis enters the vagina
- Avoiding sexual intercourse due to stress and anxiety
Premature ejaculation is often seen as an embarrassing condition for many men, and they tend to avoid discussing it; however, it is both a common and treatable condition. Premature ejaculation may start out mild but can gradually worsen over time. If premature ejaculation is ignored and not addressed, it can lead to communication problems between partners and cause other sexual dysfunctions. There are four types of premature ejaculation.
- Lifelong premature ejaculation: This type of premature ejaculation occurs during the first sexual encounter and continues to occur in all subsequent sexual encounters. Generally, this is the least common type of premature ejaculation.
- Acquired premature ejaculation: This type of ejaculation, which arises due to physiological or psychological changes, is more common among men.
- Variable premature ejaculation: This type, in which ejaculation is sometimes premature and sometimes normal, is the most common form.
- Perceived (subjective) premature ejaculation: In this type, no actual premature ejaculation occurs physically, but due to certain cultural and psychological factors, the individual may believe he is experiencing premature ejaculation.
When men try to resolve the problem of premature ejaculation on their own, they may inadvertently cause other sexual problems to arise. It can also lead to a decrease in communication with their partner regarding the sexual pleasure they experience. For example, shortening the foreplay phase is one such approach and is an ineffective solution. Another ineffective solution involves performing actions that cause pain, such as biting one’s lips or squeezing the penis. While these actions may extend the duration, they will diminish the quality of the experience. The most appropriate action a man can take on his own is to prolong foreplay and ensure his partner’s sexual satisfaction.
To diagnose a man with premature ejaculation, he must first have an active sex life. Extensive consultations with a doctor and a physical examination are required. The patient must provide a detailed medical history and describe his sexual life.
The most commonly used treatment for premature ejaculation involves the use of medications known as Selective Serotonin Reuptake Inhibitors (SSRIs). The effects of these medications begin to be noticed approximately 10 days after use; however, because they cause side effects such as fatigue, nausea, yawning, and similar symptoms, patients may become reluctant to continue treatment. A new medication containing the active ingredient dapoxetine is taken a few hours before intercourse and has proven effective. Since this medication does not require continuous use, it is preferred by patients. Kegel exercises, which strengthen the pelvic muscles that support the reproductive organs, are another method used to treat premature ejaculation. Additionally, creams, gels, and sprays applied to the penis before intercourse—which contain local anesthetics—cause a loss of sensation in the penis, thereby delaying ejaculation. Since this method acts locally, it does not cause side effects like oral medications do. However, depending on the amount applied, some creams and gels can reduce or even eliminate the sensation of orgasm in both partners, and the unpleasant odor of some products may create an uncomfortable atmosphere during intercourse. Condoms are used in the treatment of premature ejaculation because they reduce sensitivity in the same way as these creams and gels. Another method is sex therapy. The final option is surgery, and this method is irreversible. Based on the assumption that the penis is overly sensitive, the nerves in the penis are severed, and this is expected to reduce the penis’s excessive sensitivity. As a result of all this, it can be said that the most appropriate and trouble-free treatment for premature ejaculation is to consult a specialist and implement a personalized treatment plan.
Premature Erection
Premature erection is a condition in which orgasm occurs sooner than expected. This issue can lead to problems with fertility as well as a decrease in sexual pleasure for couples. Although it is not explicitly discussed due to the reluctance to address such issues, premature erection—like premature ejaculation—is commonly observed among men. If left untreated, premature erection can also lead to erectile dysfunction. The exact cause of premature ejaculation is not fully understood. However, the following factors can be listed:
- Serotonin deficiency
- Psychological issues
- Age
Treatment for premature ejaculation can be quite successful even in a single session. The most important aspect of treatment is for partners to support one another and undergo couples therapy. If medication or therapy is paused or discontinued, this problem may recur. The primary cause of sexual dysfunctions such as premature ejaculation is usually psychological; therefore, treatment conducted in collaboration with an effective, specialized doctor will play a major role in easily overcoming this problem.
Premature Erection
Premature erection, also known as erectile dysfunction, can be defined as the penis becoming erect too early—before entering the vagina—and then being unable to maintain that erection, resulting in its loss. If this situation does not occur frequently, a diagnosis of premature erection is not made. As with other sexual dysfunctions, men often struggle to discuss premature ejaculation and try to find solutions on their own. Premature ejaculation can result from illness, medication side effects, injury, and psychological issues. These can be listed as follows:
- Peyronie’s disease
- Cancer
- Surgery
- Spinal cord and pelvic injuries
- Hormonal disorders
- Depression
- Alcohol and tobacco addiction
- Anxiety about sexual performance
- Medications currently being taken
If premature ejaculation is a persistent problem, it is necessary to consult a doctor. When a man consults a doctor, detailed information is first gathered about his sexual life and overall lifestyle. Questions are asked to determine how frequently premature ejaculation occurs and when it began. Subsequently, he undergoes certain tests, and finally, the treatment method best suited to him is selected.
What Are Sexual Dysfunctions in Women
Sexual dysfunction in women generally manifests as arousal disorders, but it can also take the form of decreased or completely lost sexual desire, or aversion to sex.
Vaginismus
Vaginismus is the term used to describe a sexual dysfunction caused by involuntary contractions of the muscles in a woman’s vagina. Although the woman may wish to engage in sexual intercourse, the vagina contracts involuntarily, preventing the penis from entering. This condition is not related to the size of the vagina; it occurs solely due to involuntary muscle contractions during intercourse. Men with vaginismus typically keep their legs tightly closed and refuse to allow intercourse, or they experience severe pain during intercourse.
Vaginismus is classified into two types based on the stage of a woman’s sexual life.
- Primary Vaginismus: If vaginismus occurs during the first sexual intercourse, it is called primary vaginismus. In this type of vaginismus, women experience spasms not only in response to the penis but also to anything that might enter the vagina. They cannot undergo vaginal treatment and cannot allow anything like a suppository or medication to be inserted into the vagina. The underlying cause of primary vaginismus is usually “first-night fear.”
- Secondary Vaginismus: Also known as acquired vaginismus, secondary vaginismus refers to a type of vaginismus that develops in women who previously had a normal sexual life as a result of trauma caused by painful gynecological procedures, miscarriage, abortion, or a difficult childbirth. As with primary vaginismus, fear is at the root of this type of vaginismus. As women age, estrogen levels decline, leading to a decrease in vaginal moisture and a gradual loss of elasticity. Consequently, significant pain occurs during sexual intercourse. Over time, this sensation of pain can also lead to the development of vaginismus.
Based on this classification, vaginismus can be divided into two types: situational and spastic vaginismus. In situational vaginismus, the person does not allow anything other than a tampon to enter the vagina. In spastic vaginismus, the muscles in the vagina contract excessively. In individuals with spastic vaginismus, a contraction resembling a bladder spasm occurs in the vagina during foreplay. In addition to this classification, there is also a type known as complete vaginismus. Complete vaginismus is the most severe form, and no penetration of the vagina by the penis or any other object can occur at any level.
In cases of vaginismus, it is difficult to measure how frequently it occurs among women because, primarily due to social pressure, women are often forced to remain silent. Vaginismus affects approximately up to 20% of women.
The causes of vaginismus are divided into psychological and physical factors. Psychological causes account for nearly 90% of these cases. In many women, “first-night fear,” the excessive importance attributed to the hymen, the misuse of the concept of “honor” to constantly pressure women, societal judgments, and exaggerated statements about sexual intercourse are major contributing factors to the development of vaginismus. At the same time, experiencing severe pain and bleeding during a man’s first sexual encounter, being forced by a partner, and being raped are also major causes of vaginismus. In addition, witnessing sexual intercourse between parents or others—especially at a young age—and developing a fear of childbirth can cause trauma, which in turn leads to vaginismus. In addition to these psychological causes, certain physical factors can also contribute to vaginismus:
- A short vagina and a membrane inside the vagina
- Structural abnormalities, such as a hymen that is thicker and stiffer than normal, or one with higher edges
- Infections in the vagina
- A Bartholin’s cyst—a tender, soft, and painful lump located around the vaginal opening
- Diseases affecting the fallopian tubes and ovaries, known as pelvic inflammatory disease
- A condition causing pain during sexual intercourse, known as vulvar vestibulitis, which occurs at the edge of the hymen
To receive a diagnosis of vaginismus, it is crucial to be open with healthcare professionals and describe all symptoms accurately. Questions regarding when the condition was first noticed, how frequently it occurs, and what might trigger it are particularly important. During the physical examination and treatment of vaginismus, physicians must be as gentle and careful as possible. Any wounds or infections that may have developed in the genital area should also be examined during the examination.
Vaginismus is a treatable condition. First and foremost, the patient must acknowledge and confront this problem. The individual must accept treatment, let go of negative thoughts, and work in collaboration with a specialist gynecologist. In the initial phase of treatment, the vagina is examined to determine whether there is any physical discomfort. If the hymen is excessively thick or rigid, surgical intervention may be considered. In the next phase of treatment, the patient’s mental state and thoughts are evaluated with the support of a sex therapist, psychologist, and psychiatrist. Through psychotherapy administered by a qualified and successful team in this field, the patient is enabled to regain a trouble-free sex life.
How Are Sexual Dysfunctions Treated?
To treat sexual dysfunction, the patient must first be completely transparent with the specialist. The patient should provide detailed and open information about his entire life, particularly his sexual life. Based on this information, the specialist should identify the cause of the dysfunction and select the treatment method appropriate for the individual and his situation. If the patient’s sexual dysfunction is due to psychological causes, the specialist should refer the patient to sex therapists. The patient’s level of openness and comfort with the therapist influences the success of therapy. Significant improvements can often be seen even within a single session. Nevertheless, sessions must be conducted under the specialist’s supervision, and the patient should not take breaks from therapy on his own initiative. This is because the problem may recur as a result of such a break. If the sexual dysfunction stems from a physical cause, the patient may be prescribed certain exercises and medications depending on the cause. In some cases, surgery may also be performed.
A significant part of sexual health is healthy sexual functioning.
Sexual dysfunction affects one’s sexual life. Sexual life—including sexual pleasure, satisfaction, and intimacy—is a natural part of life that a person should be able to experience whenever he desires.
While there is no “right” way to live one’s sexual life, one of the most common misconceptions about sexuality is that it is driven solely by instinct.
Contrary to popular belief, there is established knowledge regarding sexuality, and learning and applying this knowledge enhances the quality of one’s sexual life. However, everyone has individual aspects of their own sexuality to discover. These can be experienced only to the extent that respect is shown for the sexual, physical, and emotional boundaries of others—and even of other living beings; in this regard, there is no universally accepted or defined “normal” in terms of sexual health.
In conclusion, sexuality is an essential function of a healthy life that should be experienced with pleasure, by thoroughly understanding and protecting our own bodily boundaries, respecting our partner’s boundaries, and acting with a sense of responsibility—and only when desired.
Once the underlying cause of sexual dysfunction has been identified (whether biological or psychological), treatment becomes easier. Sexual dysfunction is treatable.
Another common misconception regarding healthy sexuality is the belief that it must be experienced exclusively with a partner. Some people may wish to experience sexuality on their own as well. Even when practiced alone, a regular sexual life is beneficial for a person’s physical and mental health and for gaining a better understanding of his own body. It is important to understand that one’s sexual life, sexual pleasure, and sexual satisfaction are first and foremost the individual’s own responsibility; deriving satisfaction and pleasure from one’s partner’s sexual life comes second.
Sexual dysfunction can have a very negative impact on a person’s sexual life. To prevent sexual problems, individuals must have access to information, education, and medical care regarding sexual health. Healthcare professionals involved in this field include specialists in gynecology and obstetrics, urology, and psychiatry, as well as family physicians and midwives. Measures must be taken to prevent unwanted pregnancies and sexually transmitted infections; care and treatment should be available when needed.
