Sexual function is important for good health. It promotes better mood and sleep, as well as a healthy heart and immune system. And it deserves the same priority as any essential body function. So don’t be shy if sex isn’t working the way you want it to.
Talk to your doctor, who’s there’s to help you understand the big picture of health, not just one or two body parts. “You’re coming in for all of you. That includes everything related to sex. If it’s not discussed, it’s not going to be addressed,” says Dr. Nichole Butler, an OB-GYN at the Women’s Health Center at Weiss Memorial Hospital in Chicago.
Here are six common sex problems and ways to cope with them.
Erectile Dysfunction (ED)
To get an erection, two things must happen. “Enough blood has to flow into the penis to cause it to get full and erect, and a series of valves have to close to hold the blood in,” explains Dr. Petar Bajic, a urologist in the Center for Men’s Health in the Glickman Urological and Kidney Institute at Cleveland Clinic.
When the tiny arteries that supply the penis become narrowed, erectile dysfunction can result. Bajic says cardiovascular disease is to blame 90% of the time, fueled by an unhealthy lifestyle, high cholesterol levels or high blood pressure.
About 10% of the time, Bajic says, ED is due to:
— Low levels of the hormone testosterone.
— Consequences of depression or anxiety.
— Side effects from medications, such as antidepressants or pain pills.
Reversing ED is all about improving blood flow. That requires treating underlying conditions, swapping out medications causing side effects and living a healthy lifestyle (eating a healthy diet, exercising daily, getting enough sleep and managing stress). Other options include medications that increase blood flow to the penis, such as sildenafil (Viagra) or tadalafil (Cialis) or testosterone replacement (if levels are low).
“There are many other options, such as vacuum devices, injectable medications, even implants that can be curative for ED,” Bajic says. “There is always a way to restore function.”
In this condition, a person with a penis experiences an orgasm sooner than the desired. “It’s most commonly associated with erectile dysfunction,” Bajic points out. “People who start to have early ED may unconsciously learn to orgasm more rapidly, before erections fade away.”
If premature ejaculation is bothersome, two treatments can help:
— A numbing agent such as such as benzocaine or lidocaine. “This is applied to the penis to reduce sensitivity,” Bajic says. Numbing agents are available in sprays, “wipes,” and condoms that are extra thick and contain medication.
— Certain antidepressants, such as selective serotonin reuptake inhibitors, or SSRIs. “These can be used on an as-needed or daily basis. We’re taking advantage of the side effect of SSRIs (which are antidepressants), which makes it more difficult to orgasm. The goal is making it harder to achieve an orgasm,” Bajic explains.
Arousal, Libido or Orgasm Dysfunction
Anyone can experience certain types of sexual dysfunction. Three common types include:
— Low libido or “sex drive.” You might not have the interest to have sex.
— Difficulty becoming aroused. You might be interested in having sex but find it difficult to be “turned on.”
— Difficulty having an orgasm. You might not be able to achieve an orgasm during foreplay or sexual intercourse, or it might be delayed.
These problems can be caused by a combination of health factors such as:
— Chronic stress. A chronic “fight or flight” response affects hormones, brain chemistry, concentration and body function. It can zap libido and arousal. “The first necessary building block of sex is arousal, which happens in the brain. If anything interferes, the subsequent response can be diminished,” Bajic says.
— Low hormones. As we age, we experience reduced levels of hormones that affect sexual health. For a person with a penis, the main hormone is testosterone. For someone with ovaries and a vagina, the main hormone is estrogen, which not only decreases with age but drops off sharply with menopause (when ovaries cease production). “With estrogen loss, the clitoris and vulva area become atrophied (shrink). It takes longer to become aroused. You have hot flashes, and you don’t sleep well and get more anxious,” Butler says.
— Underlying conditions. Many health conditions can affect libido, arousal and the ability to climax, such as endometriosis, infection, cancer, neurological conditions, diabetes, or even sleep apnea — pauses in breathing during sleep that keep you from getting restful sleep (and raise blood pressure). “Testosterone is produced during sleep,” Bajic notes.
— Medication side effects. Some medications, such as antidepressants, anticonvulsants or prescription pain pills, can dampen interest in sex and the ability to climax.
Treatment for arousal, libido or orgasm dysfunction starts with addressing underlying conditions, swapping out medications that might be affecting your sex drive and living a healthier lifestyle.
Hormone replacement therapy can help, but only if:
— Specific hormone levels are low (such as testosterone or estrogen).
— There isn’t a history of conditions that make replacement therapy risky, such as cancer or pulmonary embolism.
One prescription medication may help people with female sexual organs, who have low sexual desire with no clear cause, and who have not yet gone through menopause. Flibanserin (Addyi) may increase sexual desire by targeting brain chemicals.
If inability to climax is the problem, it might take some reframing of the situation. “It doesn’t mean you can’t have satisfying sexual relations. And sometimes it’s just a matter of educating the person about finding the focal point and what the partner can do to help with the response,” Butler says. Working with a sex therapist can also help.
For someone with a vagina, sex can be anything but pleasurable. This may be due to the changes that come with menopause, such as a lack of lubrication that results in too much friction with intercourse.
Other potential causes of painful sex include:
— Endometriosis (the overgrowth of tissue inside the uterus).
— Bladder infections.
— Yeast infections.
— Sexually transmitted disease.
— Vulvodynia (a condition that causes pain or burning at the opening of the vagina).
Don’t self-diagnose the cause of your pain. “The patient may think, ‘I have a bladder infection,’ and it turns out she’s had bladder dysfunction because of a uterine tumor pressing on the bladder, which causes her to have painful intercourse,” Butler says.
See your doctor for treatment, which must be carefully matched to the cause. If it’s due to low estrogen levels and a lack of lubrication, hormone replacement can help. But again, it must be tailored to the individual. “You can also give estrogen with a cream at a low dose without a significant systemic response,” Butler says. “It works only on the vagina.”
Over-the-counter vaginal lubricants (that are water-based) and vaginal moisturizers (which promote vaginal moisture) can also help reduce pain and friction during intercourse.
Don’t Give Up
Sexual dysfunction is common and it’s not your fault. Most importantly, you don’t have to go it alone. “We take a holistic view and consider sexual dysfunction to be an issue that affects the couple, not just the individual. We don’t just treat one partner because there may be issues that affect both.,” Bajic says.
And remember that it might take time to make improvements.
“It’s a process. It takes communication, follow-up, and tweaking the treatment once you’re on the road to recovery,” Butler says. “I’m not going to guarantee that you’ll have great sex in three to six months, but we can work toward it. And once we get started, you may not need my help. You can do a lot of work without my input.”
More from U.S. News