Navigating the Complex Landscape of Sexual Dysfunctions

We’re back to discussing the sexually frustrating side of dating, relationships, and intimacy when something‚Ķ. doesn’t work. We’ve all been there of having a sexual experience and pause with confusion around what just happened. With just over 8 million people residing in NYC, it’s safe to say people are meeting, chemistry is building, and sex is happening. With sex comes the responsibility of sexual health, which may also include dysfunctions of sex. Sexual dysfunction is simply that sex is not working, or maybe it’s just not that enjoyable. Most people aim for mutually pleasurable sexual experiences, so when it’s anything less than exceptional, insecurity, anxiety, fear, and doubt are the first emotions to creep in. If only these issues were spoken about more often, we could normalize them, and people would feel less alone in these challenges. Let’s start with confronting some of the most common misconceptions around sexual dysfunctions, the first being that it’s only physical. Sexual dysfunctions are often multi-dimensional, and while physical conditions may be a contributor, emotional, mental, and situational factors are also at play. Another myth is that sexual dysfunctions only impact older people, which is far from the truth. Age is a risk factor for dysfunctions, although health issues, stress levels, medications, and relationship challenges affect people of all ages. The final most common myth is that sexual dysfunction is a direct indicator that a romantic relationship is struggling. While relationship challenges could be a contributor, the dysfunction is often multifaceted. While people may feel hopeless when struggling with a dysfunction, there is hope, considering most of the time, they’re treatable!

The most commonly reported sexual dysfunctions are as follows:

Delayed ejaculation – the inability to ejaculate at will, leading to taking longer than desired or not occurring at all.

Erectile disorder – the inability of a man to get or maintain an erection for the duration of a sexual experience.

Female orgasmic disorder – the reoccurring delay or absence of orgasm following adequate stimulation.

Female sexual interest/arousal disorder – having little to no interest in sex nor responding to sexual stimulation.

Genito-pelvic pain/penetration disorder – difficulty with attempted or completed vaginal penetration during sex.

Male hypoactive sexual desire disorder – a deficiency in sexual or erotic thoughts, fantasies, or desire for sexual experiences

Premature (early) ejaculation – is one of the most common, as about 1 out of 3 individuals report this in their lifetime. Semen leaves the body sooner than anticipated or desired during sex.

Substance/medication-induced sexual dysfunction – experiencing adverse side effects such as decreased libido, issues with erection lubrication, orgasm, etc., due to medication.

The presence of any of the above or other sexual dysfunctions can add significant strain on a relationship or dynamic between partners. Understanding the etiology behind these conditions gives us more context and understanding for others. Psychological conditions such as low self-esteem, body image, sexual traumas, anxiety, depression, stress, or even negative past sexual experiences may induce sexual dysfunction. Some of the most common physical conditions that may contribute to dysfunctions are high blood pressure, high cholesterol, substance use, alcoholism, neurological conditions, cancers, diabetes, chronic disorders, etc. Ruling out medical conditions as the primary cause is the first course of action for an evaluation of necessary medication, then assessing for the psychological contributors with a trained mental health professional to help guide you through managing any guilt, shame, fear, or anxiety, for a more fulfilling and successful sex life.

How do we brooch the topic with sensitivity, love, care, and directness? We can start by addressing it instead of being passive and ignoring the elephant in the bedroom. Ask your partner gently if they are open to talking about your shared sex life, ensuring that the talk is not happening during or following intimacy together. If they are reserved or appear anxious, offer comfort and reassurance that you want to understand and support them better. Be considerate of their reservations; this is a highly intimate and vulnerable topic; if they’re not ready to discuss it right away, give it some time and reapproach it when both parties feel ready. When the conversation begins, share your experience from your perspective, feelings, desires, expectations, or needs. Your partner is not a mind reader and will be consumed with their thoughts and interpretations of your sex life. It would also be helpful to prompt them to share how they interpret your shared sex life. Put yourself in your partner’s shoes and express compassion and empathy to understand better their experience and the complex emotions associated with sexual dysfunctions.

Understand your limitations with how you can help your partner. Encouraging them to see a medical provider for an evaluation is a great first step, and even a psychotherapist or seeking sex therapy can be incredibly useful. One of the main goals is to remain mindful of how your behaviors or language can negatively impact others, so we have to consider the “don’ts” during this process. It wouldn’t be conducive to blame your partner for a sexual dysfunction that is beyond their immediate control. It wouldn’t be supportive to control how they choose to navigate their process of seeking help. Directing your frustration or anger at them for their condition wouldn’t help. While these “don’ts” may seem obvious, you’d be surprised how many people catch themself unintentionally harming their partner through this process. Be flexible and as accommodating as possible through this journey while being open to integrating new forms of excitement into the bedroom. Re-introducing spontaneity in the bedroom can include novel types of foreplay, roleplaying, using toys, integrating lubrication, trying in new environments, sharing fantasies, exploring new positions, individual masturbation, etc. Engaging in newness in the bedroom will not directly resolve sexual dysfunctions but can take some of the pressure off the need to perform and shift it back to having fun. Spontaneity can also change the focus to the excitement around the newness and enjoying the experience without expectations. Mindfulness to encourage being present is a direct way to feel more connected to any sexual experience with a partner amidst the challenges of sexual dysfunctions.


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