Behind Closed Doors

by LaSonya Roberts-Lopez, MD.

January 12, 2025

Welcome to Sex Ed 101. Can we start with some pillow talk? Either your interest has just peaked or you are about to scroll past this blog. Well, I recommend you hold on for the ride (no pun intended) because I want to share a little something. There should be no shame when it comes to sexual health. It’s part of our human existence, and trust me, it's here to stay. Ladies, I know many of us at some point have posed several questions about our bodies in relation to our romantic escapades. Please be aware that this happens more frequently than not. The majority of people think that our challenges under the sheets are solely caused by, as some would say, "the well running dry," but that is not always the case. And gentleman, I am sure many of you have attempted to figure out why “the man down" phenomenon is happening to you. There shouldn’t be any shame in either situation. These two scenarios may be one-time or twice stands, but more than likely they are not.

As a urogynecologist, I am tasked with being the "guardian"of the female pelvis. Part of that responsibility is centered around maximizing our sexual health. Because both intimacy and sex worries have the potential to negatively impact our quality of life and sense of self, they should not be dismissed. Patients who come to me with sexual health difficulties have to divulge extremely private information and it takes a lot of courage to do so. Growing up, discussions about sex were mostly reserved for a few weeks in health class or quiet conversations with uninformed friends. It appeared that discussing sex outside of certain settings was taboo and that avoiding the subject would eliminate the chance of it happening. As a result, many women and men are suffering in silence about potential problems they may be having with their current partners. There is no separating genders when it comes to the impact that this can have on an individual or relationship. I hear my patients asking this question rather frequently: "Is there something wrong with me?" They might have been advised that their symptoms are "just a part of aging," leaving them with the impression that there is nothing they can do but accept it. Because they are not properly educated, it is common for partners to not grasp what the other is going through. Marriages and other relationships may become strained as a result. After trying self-help measures that don't improve their encounters as planned, patients frequently become disappointed. The need for closeness may then soon disappear, leading a person to engage in sexual activity just for their partner's enjoyment. This goes against the definition of a healthy sexual life. In my opinion, it should be a pleasurable experience for everyone.

Before I respond to the question of what exactly constitutes sexual dysfunction, let me make it clear that this blog is not discussing the sexual experience as it relates to religion or any cultural beliefs. The information discussed here only focuses on the range of problems that can occur during any phase of the sexual response cycle and prevent an individual or couple from experiencing satisfaction from sexual activity. According to a study published in the Journal of Sexual Medicine, approximately 31% of men and 43% of women in the United States report some form of sexual dysfunction (1). Sisters, it is important to understand that sexual dysfunction is not limited to women in perimenopause or menopause. As a healthcare professional, I have seen patients of all ages who experience sexual health issues. These difficulties can stem from psychological barriers or biological factors, usually both. Some of the most frequent diagnoses that can contribute are clinical illnesses such as diabetes, cardiovascular disease, hormonal imbalance, mental health disorders, and chronic pain syndromes. Sexual dysfunction can also be a side effect of many medications: antidepressants, antipsychotics, chemotherapy, radiation, hormonal therapy, blood pressure medication, anti-seizure medications, and opioid pain medications are at the top of the list. Review article published in the Journal of Clinical Endocrinology and Metabolism in 2018.

A normal sexual response entails desire, arousal, orgasm and resolution. Let's review the definition of each stage. It's important to note that everyone's sexual response cycle is unique and can vary in terms of duration and intensity.

1. Desire: This is the stage when sexual interest or desire begins, which can be triggered by physical, psychological, or emotional stimuli.

2. Arousal: During this stage, physical or psychological stimulation leads to physical changes in the body, such as increased blood flow to the genitals, erection of the penis or clitoris, vaginal lubrication, and increased heart rate.

3. Orgasm: This is the peak of sexual pleasure and involves rhythmic contractions of the muscles in the genital area, followed by a feeling of release and relaxation.

4. Resolution: This is the final stage, during which the body returns to its pre-arousal state, including a decrease in heart rate and blood pressure, and relaxation of the muscles.

Let's now discuss some of the most common types of sexual health disorders.

Reduced sexual desire also known as hypoactive desire disorder (HSDD) is a type of sexual dysfunction characterized by a persistent or recurrent lack of sexual fantasies, desire, or interest in sexual activities that causes distress or interpersonal difficulties. HSDD can affect both men and women, although it's more commonly diagnosed in women. Treatment for HSDD may involve medication, lifestyle changes, or psychotherapy.

Arousal disorder or Female Sexual Arousal Disorder (FSAD): is characterized by a persistent or recurrent inability to achieve or maintain adequate vaginal lubrication and swelling response during sexual activity. This can make sexual activity uncomfortable, painful, or impossible. Treatment for arousal disorder may involve addressing underlying medical or psychological issues, as well as medication, vaginal lubricants, or other therapies.

Erectile dysfunction (ED) is the male presentation of an arousal disorder, which is the persistent or recurrent inability to achieve or maintain an erection that's firm enough for sexual activity. Treatment for ED may involve addressing underlying medical or psychological issues, as well as medication, lifestyle changes, psychotherapy or penile implants. Medications such as Viagra, Cialis, or Levitra may also be used to help improve blood flow to the penis and facilitate erections.

Anorgasmia: is when a person has difficulty or is unable to achieve orgasm, despite adequate sexual stimulation. Anorgasmia can occur in both men and women, and can be a primary condition or a secondary condition that arises due to underlying medical or psychological issues. Treatment for anorgasmia may involve addressing underlying medical or psychological issues, as well as therapy, counseling, or other techniques. During the orgasmic phase, the male sexual response may also experience other issues, such as delayed, premature, or painful ejaculation.

Primary anorgasmia, where a person has never experienced an orgasm.

Secondary anorgasmia, where a person has previously been able to achieve orgasm but can no longer do so.

Situational anorgasmia, where a person can only achieve orgasm in certain situations or with certain partners.

Resolution disorders present differently in men and women.

Female Presentation can be:

1. Persistent genital arousal disorder (PGAD): This is a rare condition in which a person experiences persistent and often uncontrollable genital arousal, which can occur without sexual stimulation and can lead to discomfort or pain. or

2. Difficulty achieving relaxation after orgasm: Some women may experience difficulty relaxing and returning to a normal state after orgasm, which can lead to discomfort or pain.

Male presentation:

1. Post-orgasmic illness syndrome (POIS): This refers to a rare condition in which a person experiences flu-like symptoms after orgasm, including fatigue, fever, and muscle aches.

Painful sex (dyspareunia): This refers to discomfort or pain experienced during sex, which can make it difficult to reach orgasm. Dyspareunia can occur in women during entry, deep penetration or after having intercourse. It may be caused by physical factors such as infections, injury, or anatomical abnormalities, or psychological factors such as anxiety, trauma, or relationship issues. Treatment for dyspareunia depends on the underlying cause and may involve a combination of medical and psychological interventions.

It is important to remember that sexual dysfunction can be a complicated issue, and the best therapy may differ based on the type of dysfunction. While there may be some overlap in suggested treatment methods for the various types of sexual dysfunction, effective management may require expertise from different medical specialists. Treatment may include medications, individual counseling, couples therapy and pelvic floor physical therapy. It is usually advised to make lifestyle adjustments that may include maintaining a healthy diet and exercise routine, reducing stress, and practicing healthy sleep habits. When suffering any signs of sexual dysfunction you should seek medical advice. These symptoms could be indicative of a more serious health condition. Sexual dysfunction is a prevalent issue that impacts both men and women to varying degrees. However, be assured that there are options available to help you attain a satisfying and healthy sex life. Sex Ed 101 is just the tip of the iceberg (I’m for real this time, no pun intended). Through self-education, you can become more empowered and break the cycle of silence.

Drop any questions or comments you may have. There will be more sex talk coming soon…..until next time!

References

1. "The Prevalence and Causes of Sexual Dysfunction in a Diverse U.S. Adult Population: Results From the National Survey of Sexual Health and Behavior," J Sex Med, 2019).

2. "Sexual Dysfunction in Women with Endocrine Disorders," J Clin Endocrinol Metab, 2018).

3. "Prevalence of Female Sexual Dysfunction: A Systematic Review and Meta-analysis of Observational Studies," J Sex Med, 2021 (3)