INTRODUCTION
Problems related to sex are common in the life of almost all individuals. Practically everyone has at sometime or the other experienced sex related problems. Most of these problems, fortunately, get sorted out by themselves. There are many others about which one may not bother and decide to live with the problem.
It has been said that it is easier to treat a sex problem than to admit that you have one. This attitude also results in many problems not coming to light.
Most sex problems are painless and are not life threatening. This, compounded by the fact that it requires certain amount of courage to approach a specialist and talk about one’s own sex problem, results in only a fraction of problems coming to the medical practitioners.Even if a person wishes to approach a doctor for help, he is not sure whom to approach.
Most clinics have hardly any privacy and most physicians are not well equipped to deal with such problems because hardly any training is imparted on this subject during studies. As a result of all this quacks who advertise in all media have a field day. They unfortunately add to the patients ‘misery.
CLASSIFICATIONS
If we take into consideration only the common sex problems seen in medical practice, they can be classified as follows:
1. Those where the individuals are afraid that they will not be able to perform.
2. Those where they are able to perform but want something more out of sex.
3. Those where they are actually not able to perform. From the-point of view of management of cases it is better to classify them as follows.
1. Those who need predominantly education
2. Those who need predominantly counselling.
3. Those who need predominantly therapy. Quite often it is essential to find out whether the cause of the problem is organic or psychological or mixed. It is observed that organic problems tend to get overlaid with an additional functional problem.
COMMON SEX PROBLEMS
Although its an axiom in sexology that sex problems are couple problems, quite often itis possible to identify one of the partners as needing greater professional attention. It must, the couple, however, be remembered that the couple, or marital unit, as it is called, is treated as a unit.
In a number of instances-only one of the partners is willing to come for therapy. There are also single or separated individuals where the question of involving the partner does not arise.
COMMON SEX PROBLEMS IN MALES
1. Problems arising out of Myths and Misconceptions-regarding loss of semen or ‘Datuk’ or what is popularly known as ‘Dhat syndrome’.
The person is usually a young man-who has severed anxiety about his ability to perform sexual intercourse.Some cases of suicide in the young are as a result of this phobia. They need a sympathetic listener and proper sex education with a lot of reassurance that they are normal.
It is often dangerous to rush them in to marriage, in the hope that once they get married everything will be all right.
2. Inhibited sexual drive: Absence of libido or diminished libido is one of the problem that is seen more often now. When asked a pointed question about sexual desire many males confess to having a low level of desire. It has recently been seen that patient who watch blue films on video almost daily are not interested in sex. Over-exposure to erotic material seems to kill the desire.Easy available of sex can also kill the desire in those whose main pleasure is in pursuit rather than in actual achievement. There are some others whose lack of desire is due to boredom with routine with the same partner.
Some individuals have strong homosexual tendencies which are suppressed due to social and cultural pressures. They have nitration or often definite repulsion sex. This manifests itself as inhibited sexual desire.
3. Erectile Dysfunctions: Failure to get an erection, stiff enough for penetration at the time of sexual intercourse is another common sex problem. In case the person has never had an erection the problem is called primary. This is uncommon.
Secondary erectile dysfunction where the person reports satisfactory erections in the past but has lost the ability later on is much more common. Secondary erectile dysfunction may be due to some organic causes such as inadequate filling of the corpora cavernosa, or rapid emptying of blood. this may be as a result of vascular blockage or venus lerk. It may be a part of other neurological or vascular disorders, especially as a complication of diabetes. The cause may be iatrogenic due to administration of certain drugs like antihypertensives or tranquilisers. Surgical operations in the perineal region may also be the cause.
4. Ejaculatory Dysfunctions: Ideally the male partner should ejaculate after the female partner has reached orgasm. Many would even prefer or insist that both partners should reach their orgasm simultaneously. this is not an impossibility since it is now known that females are multiorgasmic and can have several orgasms one after the other during a single sexual intercourse.
COMMON SEX PROBLEMS IN FEMALES
1.Inhibited Sexual Desire: Frigidity is a word commonly used to describe a female who has low sex desire. Since sex desire drive between two partners is a relative entity a woman who may be called frigid by one partner may be normal for another and over sexed for someone else. Sexual dissonance between the two partners on the matter of frequency of sexual activity is common.
2. Vaginismus: Fear of physical assault on any part of the body leads to a reflex contraction of the muscles of that part like the abdominal wall or the eyes. This is also true of the muscles around the outer third of vagina.
3. Anorgasmia: Inability to reach orgasm in a female is not uncommon. Many females report sexual activity as pleasurable but cinfide that they never climax. It is desirable to exclude all such factors like premature ejaculation in the male, dyspareunia due to any cause and various factors which may turn her off.