When I tell people what I do for a living, I often get asked what exactly my job entails. Apart from relationship counselling and expert opnion for media work, the biggest part of my job is assisting individuals and couples who suffer from sexual problems (known as sexual dysfunctions or disorders). Nobody likes to think about not being able to perform during sex, or experiencing pain such that they can’t even have sex. Yet sadly sexual dysfunctions are far more common than you think, and affect men and women of all ages. The first time I ever heard about sexual dysfunctions was in my final undergraduate year at university, and it made me realise that not enough is said about these topics! As I always say, life is too short for bad sex, and this includes bad sex what is due to a sexual problem.

When we have sex, we go through several sexual response phases. These include desire, arousal, orgasm and resolution (or recovery). We can experience problems in any of these areas, and these problems will probably happen persistently before you realise that there is something wrong. In order for something to be considered a dysfunction, there are certain criteria that have to be met, such as distress and that it happens either in a particular context or in all sexual situations.

There are four types of sexual dysfunctions:

  1. Desire disorders
  2. Arousal disorders
  3. Orgasm disorders
  4. Sexual pain disorders


Sexual dysfunctions can be caused by almost anything. Traumatic sexual experiences, anxiety or pressure to perform, feelings of inadequacy or lack of confidence, stress and illness, mental health or hormone problems, religious, cultural or social issues, age and relationship difficulties can all contribute to a sexual dysfunction. Not a pretty picture is it? This is not to say that you will suffer from a sexual dysfunction due to one of these factors, but if you do, it’s most likely that there is something in that list contributing to it.

The most common sexual dysfunction among women is desire/arousal disorder or loss of libido, and in men it’s erectile problems, such as erectile dysfunction, or premature ejaculation. So what sort sexual dysfunctions can we experience?

Women can suffer from the following sexual dysfunctions. Interestingly, you cannot separate out desire and arousal in women. They are inclusive of each other. A woman may experience desire and arousal on a mental level, but not be physical turned on, and similarly she might be physical aroused and desire sex, but her head is just not in it: Therefore, we start off with

Female desire/ arousal disorder:

Generally, when a woman has desire/ arousal disorder, there will be a deficiency or absence of sexual fantasies and desire for sexual activity, as well as the persistent inability to attain or maintain sexual arousal, which can include natural lubrication. Women produce natural lubrication when they become aroused, and this can be affected by the time of the month, medication or pregnancy. When a woman repeatedly does not become aroused by sexual fantasy or stimulation, then there might be more to it than wrong timing. However, just because she doesn’t feel like it a few times doesn’t mean she has a dysfunction. If she persistently avoids sex and isn’t interested, in most or all sexual contexts, then something could wrong.


Sexual aversion disorder

This disorder is again linked to desire/ arousal and is an aversion to and an active avoidance of all genital contact with a sexual partner and all sexual thoughts and feelings. This can even develop into phobia-like symptoms with fear, anxiety or even panic attacks at the thought or possibility of sexual contact.


Orgasm disorder:

Female orgasmic disorder is a persistent delay in, or absence of, orgasm following adequate sexual excitement and stimulation. There are some women who just cannot orgasm during sex, and are only able to reach that point through touching themselves (clitoral stimulation), oral sex or using a toy. There are also some women who cannot reach orgasm at all, or used to be able to and aren’t able to anymore. Orgasm is a learnt response for women; sort of a practice makes perfect kind of thing. Throughout life we learn what and how we like sexual stimulation, and what will help us reach orgasm. It’s unlikely a 20 year old, who’s only had one sexual partner and cannot orgasm has a disorder as it could simply be a matter of incorrect stimulation and lack of understanding of her own bodily response. So it’s important to not jump to the conclusion that there is a problem simply because you are yet to experience orgasm. Touch, experiment and learn what you like, but don’t put pressure on yourself. The more pressure you feel, the less likely you will find what you’re looking for. Relax, enjoy the sensations and let your body and mind enjoy themselves.


Pain disorders:

There are two sexual pain disorders in women that are often confused with one another.

Dyspareunia is genital pain that is associated with sexual intercourse; and is usually a deeper abdominal pain.

Vaginismus, however, means that penetration by a finger, penis or even tampon is extremely painful and difficult, because the outer third muscles of the vagina involuntary contract.

If you believe that you are suffering from a sexual dysfunction, contact a sexologist or your gynaecologist. No women should ever have to experience pain or the persistent inability to become aroused during sex, especially since the treatment methods we use in sexual therapy have been proven so effective.

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