Sexual functioning is effected by many influences, and that unfortunately means that healthy sexual functioning is highly susceptible to problems. Below is a list of commonly experienced sexual problems.

LITTLE OR NO SEXUAL DESIRE

The feeling of wanting sexual activity is a necessary part of a healthy person, but also of healthy sexuality. To have desire indicates a level of physical vitality. It is a problem when there is little or no desire for sexual

activity, especially when in a relationship with a partner who does have sexual desire. This discrepancy of desire between partners can lead to significant conflict and tension between partners. Lack of desire may

indicate an unhealthy physical condition, but also may be caused by numerous emotional conditions. Some people, but a small percentage, do, naturally, have little sexual desire without any accompanying health or emotional problems. Lack of sexual desire may also be accompanied by lack of sexual fantasies, lack of interested in others as sexual partners, and lack of a sexual response.

Some of the potential causes are:

▪️Relationship difficulties: If partners are not emotionally connected, it may lead to one or both partners having low desire.  Relationship conflict, lack of trust between partners, the build up of resentment, or feelings of anger between partners all can dampen or fully put out any flames of sexual desire.

▪️Stress, feeling overwhelmed, preoccupied, anxious and fatigued may all kill sexual desire.

▪️Having small children at home is one cause of reduced sexual desire in caregivers.

▪️Depression, which is often internalized anger or feelings of powerless usually will eliminate sexual desire.

▪️Anxiety, like it’s brother, depression, may reduce desire and cause a person to avoid closeness.  In some people anxiety tends to heighten sexual desire.  People who have strong feelings of shame regarding their sexuality may have anxiety which negatively impacts the ability to have sexual desire.

▪️Medications often have a negative effect on sexual response and functioning.  Many medications also reduce sexual desire.  Anti-depressant drugs are notorious for the reduced sexual desire side-effect.  Birth control pills also tend to reduce the user’s level of sexual desire.

▪️History of trauma or abuse tends to cause those traumatized to avoid closeness, and especially the intense closeness of sexual activity.

▪️Having had negative previous sexual experiences with the partner or previous partners that have caused frustration, disappointment or hopelessness about having a satisfying sexual experience.

▪️Physical causes may also contribute. There are many possible sources, of which I will not list here. If you suspect that a physical problem may contribute to your loss of sexual desire, consult your physician.

▪️Poor body image: if a person feels uncomfortable with their body, and thus would feel ashamed or embarrassed to reveal the body, this may result in having little or no desire to engage in sexual activity. This category can include feelings of shame associated with a person’s genitals and breasts.

▪️A history of participating in sex when one does not wish to be sexual. This includes one’s needs and feelings being unknown to or invalidated by he partner.

▪️When sex with the partner is dissatisfying because of lack of sexual education, lack of communication, lack of skill and lack of desired outcome, such as good sexual performance, emotional connection or orgasm.

See article on Low Female Sexual Desire

See article on: Curing the Sexless Marriage

LACK OF PHYSICAL AROUSAL

After partners have already begun to engage in sexual activity, whether it be talking about sex, kissing or even stimulating each other’s body or genitals, a physical arousal response is normal and healthy.  A distinction should be made between a physical and psychological arousal.  A person may feel aroused or turned-on, but not have the accompanying physical response. The opposite is also possible.

IN WOMEN this typically means an enlarging of her nipples, sometimes a red flush on her breasts, a swelling of her vulva due to a condition called vasocongestion and the presence of wetness, lubrication from within her vagina, which functions as lubrication for comfortable intercourse.  Lack of arousal may mean that the swelling of the vulva due to vasocongestion does not occur, the nipples do not enlarge, and lubrication is not produce within the vagina. The potential causes are several:

Physical causes which range from an unhealthy physical condition, hormone fluctuations, a past hysterectomy, or the onset or presence of menopause, which tends to reduce or eliminate the lubrication. If a women experiences pain during intercourse, or has in the past, this can prevent arousal. Such pain may or not be physical in nature.

Emotions may also interfere with arousal.  Any negative emotion such as anger, resentment, depression, anxiety, fear, etc.can have this effect. A history of trauma or abuse can result in reduced or absence of an arousal response.   

Medications or drugs may also eliminate arousal.

See article on: Tiny But Mighty: The Clitoris

IN MEN an arousal response usually creates a stiffening of the nipples, sometimes a red flush on the chest, and an enlargement of the penis in an erection. Loss of these physical responses may be caused by:

Physical causes which may include heart problems, low blood pressure,  problems with blood flow to the penis, the prostate and other conditions of poor health. For physical problems like these, consulting a urologist may be helpful.

Emotions related to anxiety and anger, especially if felt toward the sexual partner may prevent the arousal response which results in an erection.  One such emotional response is related to feelings of pressure to sexually perform well and results in the anxious condition called “performance anxiety” in which a man cannot achieve an erection due to the fear that he will not sexually please his partner.

Medications or drugs generally have a negative effect on sexual response and functioning including loss of an erection.

Lack of an erection may also be called erectile dysfunction.

See article on: Erectile Dysfunction

See also article: Pipeline to Pleasure

See article on erection medication: Viagra: Politics of the Little Blue Pill

PROBLEMS WITH AN ORGASMIC RESPONSE

Men and women can have difficulty with the achievement of orgasm.  The lack of an orgasmic response to stimulation during  sexual activity can cause frustration and disappointment, but also hurt feelings and conflict between sexual partners. Orgasm is an extremely pleasurable physical/emotional/spiritual reaction to enough stimulation in which physical tension is reduced and is accompanied by a pulsing of the muscles in the genital area.

WOMEN: As many as 30% of women have not yet been successful at achieving orgasm. Some women may believe that they are incapable of an orgasmic response. Unlike men, for whom an orgasm is a physical reflex for which no learning is required, women may have to focus their efforts to learn how to have an orgasm.  Some women may have orgasms, but may have difficulty achieving it, and the necessary amount of stimulation for orgasmic response may be significant require an half-hour or longer. For most women direct stimulation of the clitoris is essential for the achievement of orgasm. Roughly half of women do not achieve orgasm through the experience of intercourse.  Other factors may interfere with a woman’s ability to have an orgasm:

Physical conditions, such as health problems and physical discomfort may interfere with orgasm.

Emotions, which are mostly of the negative kind such as anger, resentment, fear or anxiety. A past which included experiences of physical, sexual, emotional, or verbal abuse and trauma may emotionally eliminate a woman’s ability to have an orgasm.

Inability to focus, relax or concentrate have a negative impact on achievement of orgasm.  If a woman cannot relax, or if she has difficulty eliminating stray thoughts, orgasm may not be possible.  A woman who feels uncomfortable with her body may be unable to relax sufficiently to have an orgasm.

Knowledge and experience play a part.  A woman who does not have much sexual experience, or is not familiar with her own body, sexual organs, or sexual response, and has not “practiced,” such as through the self-stimulation of masturbation to have an orgasm, may be unable to do so.

Medications or drugs commonly have a negative effect on a woman’s ability to achieve orgasm.  Medicine may reduce the orgasmic ability, slow the orgasmic response or eliminate it altogether.

See also article: Eroticism: What Turns Us On

See article on: For the Love of the Female Body

MEN: can have orgasmic difficulties and it is related to a man’s ability to have an ejaculation, or the expulsion of sperm from the urethra or opening at the tip of the penis.  Ejaculatory difficulties are problems with ejaculatory control in which a man may be unable to have sufficient control over the timing of the ejaculation. Some men have a problem of being unable to delay the ejaculation. Other men have a problem of delayed ejaculation.

Difficulties of ejaculating too soon, and of having no control to delay it are among the most common sexual problem, but for those men who experience this, feelings of inadequacy, shame, fear, embarrassment and powerlessness often are felt. Over time, sexual partners often grow very frustrated if this problem is not resolved. Learning to overcome this problem, and the painful associated feelings are often successful.

Causes may be related to use of medications or drugs, but often it is caused by inexperience, and the lack of opportunity to develop control.

Delayed or Inhibited ejaculation is a less publicized problem that some men experience.  This is problem some men have when they are unable to achieve ejaculation, or much time and much stimulation is required for ejaculation to be reached.

Causes of delayed ejaculation may be related to medication or drug use, but also physical health causes. Emotions can also play a part in inhibiting a man’s ejaculation. If a man is anxious or angry he may be unable to reach ejaculation. The inability to concentrate and focus on the body rather than the mind also can have a negative effect.  Men who are overly concerned with their partner’s sexual satisfaction, rather than their own are likely to experience delayed ejaculation.

See article on: Inhibited Ejaculation

See also article: Anatomically Different…Intimately

See article one: Men and Their Eroticism

PROBLEMS WITH PAIN

Women at times experience pain during intercourse, which is called dyspareunia. Pain is a problem and is not part of healthy sex. If pain is experienced routinely during intercourse, there exists a problem which is best addressed with a doctor or another professional. The feelings of pain may or may not have physical causes. Sometimes a simple solution may be the use of a lubricant, but this will only eliminate pain caused by dryness.  Physical causes may include yeast infections, the presence of a sexually transmitted disease (STD), skin irritations and possible a cut or tear in the opening of the vagina or the inner vaginal wall.  Such pain during intercourse may also have an emotional source.  Women who have experienced physical or sexual abuse may have painful emotions associated with sexual activity and may experience this as physical pain during intercourse.

A different pain-related problem is called vaginismus. This is also a condition that is experienced only by women. This occurs when the muscles surrounding the vaginal opening are tightly closed, and prevent penetration for sexual intercourse. Vaginismus may be caused by emotions often related to discomfort with sexual intercourse and possibly due to uncomfortable feelings such as anger, resentment, disrespect for the partner, or from emotions related to past trauma, such as sexual abuse or rape. A physical cause may be the consequence of a woman having experienced painful intercourse chronically for a long period of time. The vaginismus may be an anxiety reaction to the anticipation of pain.

See article on female problem with intercourse: Vaginismus: Painful and Harmful to Inctimacy

DISCREPANCY OF SEXUAL DESIRE

When sexual partners differ on the preferred frequency of sexual activity, tension may build between partners and even be the source of arguments. Unresolved, discrepancy of sexual desire may result in significant damage to the relationship and connection between partners, well beyond the arena of sex. As relationships transition through developmental phases, differences in sexual interest will increase and decrease causing tension due to frequency or infrequency.

See article: Sexual Desire and Men

See article on: Discrepancy of Sexual Desire

See article: Battling Desire Discrepancy

DISCREPANCY OF SEXUAL INTEREST

What each one of us defines as good or great sex varies from person to person. When sexual needs or interests vary widely, problems with sex are sure to follow.  Couples who easily and openly talk about sex may be able to resolve such a discrepancy, but most couples are not comfortable with talk of sex and do not engage in this kind of communication.  Unsolved, discrepancy of sexual interest may result in tension between partners, but also an accumulation of frustration, resentment and loss of interest in sex and infrequent sex.

See also article: Eroticism: What Turns Us On

See also article: Battling Bedroom Boredom

See article on: Curing the Sexless Marriage

SEX ADDICTION AND COMPULSIVE SEXUAL BEHAVIOR

As with any activity that is pleasurable, sex for some people becomes a preoccupation.  These people find that their desire and interest in sex is uncontrollable; that their impulses to be sexual are difficult if not impossible to resist. The severity of this problem ranges from mild to severe., Mild cases involve individuals who have difficulty controlling the frequency of their masturbatory experiences; or a person who has difficulty controlling online viewing of pornography. These people take mild risks, but do not damage their lives significantly. More extreme examples are individuals who, despite their better judgement, become involved in incessant risky, reckless sexual hook-ups, without regard for the spouses they hurt, the financial problems they create, the jobs they lose, etc.

While people with these kinds of sexual problems often regard their challenge as an addiction, and treat the problem through an addiction model of treatment, risky and impulsive sexual behaviors can also be viewed as a type of obsessive/compulsive disorder commonly associated with anxiety problems. Some argue that people who cannot stop themselves from behaving sexually are addicted to the pleasure and increase in the brain chemicals, endorphins and serotonin, or “feel good” chemicals.

Those who regard this problem as a problem of compulsivity address it by noting that people who seem unable to control their sexual impulses also have a need for love, acceptance, connection and intimacy; qualities usually absent within their lives when young.

Difficulty controlling sexual behaviors, and engaging in sex without any emotional connection, are actions of many people who have been sexually abused and sexually traumatized.

See article: Sexual Desire and Men

PORNOGRAPHY

In recent years, pornography has grown more common, accepted and mainstream.  Some regard this as objectionable while others embrace this change as evidence of a greater acceptance of sexuality.  Irregardless of how you view pornography, its increased availability is a reality with significant effects. While pornography is not a biologically or emotionally based sexual problem, its use may cause significant distress both in terms of perspective on sex and sexuality, sexual expectations, sexual values, and conflicts between sexual partners who have differing views on pornography’s place in their relationship. Pornography also may be used by those who embrace it positively as an opportunity and resource with which to explore individual and relational eroticism and sexual adventurousness.

The presence of pornography in a relationship in which both partners do not view it in a similar positive perspective may be extremely destructive.  Partners who do not embrace pornography as a sexual resource, but as an immoral sexual perversion, are often threatened by its use and presence, resulting in feelings of hurt and betrayal, which do cause the destruction of relationships.

Because the openness, sharing, honesty of intimacy are emotionally difficult, it is easier for many to seek their sexual gratification in less threatening ways, such as with the solo use of pornography along with masturbation. Pornography in many cases is used as a tool with which for one partner to distance him or herself, and his or her sexuality from the partner. If used in this fashion, pornography can be seriously destructive to the relationship and hurtful to the partner.

When used in this manner, another facet of it use is secrecy. It is common that pornography is hidden and use surreptitiously. The need to hide its use is a reaction to the anticipated, and usually correct, negative reaction to it by the partner.  But while the presence of the pornography is cause of distress, the secrecy employed creates a secondary level of damage to the relationship; betrayal and distrust.

See also article: Coping With the Porn Factor 

See article on: Erotic Material, AKA Porn

FETISHES

A fetish is an inanimate object or body part given tremendous erotic value, to the point of being an obsession, which is used as a sexual turn-on.  Someone with a specific fetish, such as feet, certain articles of clothing, clothing of the opposite sex, etc., is generally unable to achieve sexual satisfaction without that object being present. Given the great value placed upon the object by the person with the fetish, the partner may feel of secondary value, and that the fetish object comes first. This can produce negative feelings between partners and even result in relationship break-up.

TROUBLESOME TURN-ONS

What we each find erotic differs from person to person. What is erotic is that which causes arousal, and it can be the source of fascination, curiosity and even obsession.  But for some, what is erotic is also problematic, such as when an erotic interest is unappealing or offensive to the partner.  Such a situation may cause relationship distress.  For others, the source of eroticism is more extreme, including interests that violate ethics, morals and laws. Erotic interests that cause unhealthy risks or problems is referred to as troublesome turn-ons.

See also article: Eroticism: What Turns Us On

Andrew Aaron, LICSW