Tuesday 17 January 2017

Dear Mary: Let's start by explaining the eight sexual dysfunctions

Mary O'Conor

Published 20/02/2012 | 06:00

Image posed. Photo: Getty Images
Image posed. Photo: Getty Images

I want to begin by thanking all those people who have been in touch to wish me well in my work on this column. I really appreciated that you took the time to contact me.

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Quite a few people went on to ask me to explain the eight sexual dysfunctions that I mentioned in my interview last week, so I will briefly go through them. As Frankie Byrne was so fond of saying: "These may not be your problems right now but they could be some day!"

Masters and Johnson, who did so much pioneering work on the diagnosis and treatment of sexual disorders from the Fifties right through to the Nineties, classified the eight dysfunctions, and they still remain the same today.

The male ones are:

- Erectile dysfunction, where the man has difficulty either getting or maintaining an erection sufficient for penetration;

- Premature ejaculation, which is when the man ejaculates too quickly for either himself or his partner;

- Delayed ejaculation, which is at the other end of the spectrum, means the man has difficulty in actually ejaculating. This can cause problems particularly when he wants to father a child;

- Inhibited sexual desire -- in other words very little or no interest in being sexual. There is a perception out there that men are always ready, willing and able to have sex with just about anybody, but this is not actually the case.

There are also four female dysfunctions, the first of which is vaginismus, where a woman is unable to allow penetration of any kind, cannot use tampons and in a lot of cases cannot tolerate a medical examination of the genital area. This can obviously be a very big problem for a couple. Twenty years ago, it was often only discovered after the couple were married and it would then take them a long time to pluck up the courage to go somewhere to seek advice. In fact, they often did not know where to turn. Nowadays, as people live together before marriage, the problem comes to light much earlier. There is a very high success rate in treating vaginismus, so anybody with this problem should get help. What they see as an insurmountable problem can be overcome. It can take quite a long time but it is very much worth it.

Next is dyspareunia, where the woman is able to have intercourse but she finds it very painful and so therefore does not look forward to being sexual.

Then there are orgasmic difficulties, when the woman is unable to reach orgasm. In some cases, she cannot reach a climax when she is with a partner, and in other cases she cannot orgasm either on her own or with a partner. The fourth female dysfunction is, in common with the male, inhibited sexual desire. I always found this problem to be extremely complicated and multi-layered, as a lot of it has to do with what is going on in the woman's head at the time and also what is happening in the relationship.

This may seem like quite a clinical list, but there are real people behind each one of these problems, some of whom are deeply unhappy with what they see as their failure as a sexual being. There are many reasons why people experience sexual dysfunction, and to try to understand these reasons, a psychosexual therapist will do a detailed history-taking with the client, laying particular emphasis on factors such as what sort of family background they come from, actual events that may have happened in their lives which could contribute to the problem, and factors that are responsible for the problem continuing. I could go on for a long time about this subject, but that is not the purpose of this page. I merely want to highlight the fact that there are many sexual problems out there and there is lots of help available to overcome them. There are many different ways of dealing with these problems and while I would naturally favour the psychosexual route, the GP should always be the first port of call in order to ascertain if there is something physical contributing to the problem. If everything is all right medically, the GP will be able to help in finding a therapist.

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