Decreased Sexual Interest. This refers to a loss of sexual desire along with a marked reduction in sexual activity.

Problems with Sexual Performance. In men, this typically involves difficulties in obtaining or sustaining a penile erection. Although performance problems in women are usually not as obvious, they can also experience problems with vaginal lubrication and swelling that is a normal part of the sexual response cycle.

It is important to understand that there are many factors which can contribute to these sexual problems. Following is a list of some of the factors which can lead to sexual problems:

Pain Sensations. Ongoing pain or other forms of physical discomfort can gradually erode sexual interest and desire. Furthermore, the physical movements during sexual intercourse may serve as pain triggers and cause acute pain exacerbations which, in turn, may disrupt erectile functioning in men or diminish sexual arousal in women. In the later case, it may be necessary to experiment with various positions to find those which are most comfortable and less likely to trigger increased pain.

Opioid Pain Relievers. Long term or heavy use of opioid analgesics can interfere with both sexual desire and sexual performance.

Other Types of Medication. Several types of medication used to treat pain and other medical conditions can have side effects which reduce sexual interest and/or disrupt sexual performance. These medications include tranquilizers, sedatives, hypnotics (sleep medication), antidepressants, anti-hypertensives and other medications used to treat cardiovascular conditions. Keep in mind that people can react differently to the same drug and dosage level. Therefore, if you think that these medications are interfering with your sexual functioning, you should inform your doctor since it is possible that an alternative medication or dose level may interfere less.

Certain Medical Conditions. A number of medical problems which affect the nervous system, endocrine system, or cardiovascular system can interfere with sexual interest and performance. For example, one of the complications of uncontrolled diabetes is sexual dysfunction. Men who have irreversible medical problems which prohibit penile erections can treated with prosthetic devices to simulate erections.

Depression and Physical Inactivity. Depression and inactivity go hand-in-hand, and often accompany chronic pain and disability. Depression is often associated with decreased sexual interest and prolonged physical inactivity can cause a decrease in sexual hormones. Fortunately, if depression and physical inactivity have contributed to your sexual problems, it is possible to do something it to get over the depression and increase your physical activity level.

Anxiety, Worry, & Fear. Being preoccupied with anxiety, worry, and fear can detract significantly from one's interest in sexual matters. If you are experiencing significant problems and stressors in your life, they can dampen your sexual interest.

Performance Worries. Men who have experienced problems with erections, may become very concerned about their sexual performance each time they are in a sexual situation. Rather than simply enjoying the sexual interaction, they become preoccupied with worries about getting or maintaining their erection. Such anxiety about sexual performance is probably the most common psychological cause of erection problems in men. These problems are also treatable by counselors trained in sexual dysfunction.

Relationship Problems. Decreased interest in having sex can be a symptom of problems in the relationship with one's partner. If so, efforts to improve the overall relationship can lead to improvements in sexual interaction.

Keep in mind that very often these potential causes of sexual problems do not act in isolation. Rather, it is quite possible for sexual problems to have multiple causes, including both physical and psychological factors.

It is also important to keep in mind that normal, healthy people vary considerably with regard to their degree of sexual desire and frequency of sexual activity. Some people have healthy, long-term, mutually-satisfying relationships, and yet engage in sexual intercourse infrequently. Furthermore, sexual functioning is often affected by the normal aging process. Although sexual activity can continue to a very old age, there are certain normal changes that frequently occur. For example, in older men, erections may take longer to occur (i.e., require more direct stimulation), the erections may be less firm, it may take longer to ejaculate, and it may take a longer time following ejaculation when another erection can occur. In older women, vaginal lubrication may take longer, vaginal secretions may be less, and orgasmic contractions may be less frequent and intense. In light of the variability in sexual interests and preferences and normal changes with aging, the range of what may be considered "normal" sex is quite broad.

Some people, especially men, have overly narrow ideas about what constitutes normal sexual interaction. In reality, there are a broad range of behaviors which can be used to express physical affection and bring physical pleasure to one's partner - holding, kissing, touching, rubbing, and caressing various body parts to name a few. Most of these behaviors are traditionally referred to as "foreplay." However, the very word foreplay is overly narrow in that it suggests that such behaviors are all a preliminary to the main event, sexual intercourse. Therefore, some people who have difficulties with intercourse (especially men with erection problems) end up avoiding all forms sexual/physical contact with their partners. This is unfortunate. If this has occurred with you, try talking to your partner and ask her what she thinks or seek professional help.

Is the Functioning of One's Sexual Organs Essential to Being a "Real Man" or "Real Woman?"

Some people (once again men are most often guilty) equate their sexual functioning with perceptions of "manhood" or "womanhood." For example, a man may say to himself, "if my penis doesn't work like it did before, I'm no longer a real man." This is why sexual performance problems can be very distressing and can even have devastating effects on one's feelings of self-worth.

But is it true that "normal" genital sexual functioning is essential to being a real man or a real woman? I believe that there are a whole host of behaviors that are associated with masculinity or femininity and that it is a real mistake to put too much emphasis on genital sexual functioning.

1.   Try to get a better understanding of what factors are contributing to your sexual problem. Talk to your doctor if you are concerned that medical factors or medication factors nay be contributing to your sexual problem. Find out if a change in medications may help. Talk to a psychological counselor if you think that mental, emotional, or relationship factors may be playing a contributing role.

2.   Identify and change distorted thoughts and beliefs about your sexual functioning. Examples may include, "If I can't always make love the way I used to, I'm no longer a real man" (polarized thinking, overgeneralization); "no woman would want to be with a man who sometimes loses his erection while making love" (overgeneralization, mind reading); "I should always be able to satisfy a woman whenever she wants" (shoulds).

3.   Talk the problem over with your sexual partner. Find out what he or she really wants or expects in the relationship and what his or her perception is of the sexual problem. If you feel unable to discuss these matters openly with your partner, seeing a marital counselor may help.

4.   Explore medical options and devices for remediating erectile dysfunction. An increasing number of options are now available.

5.   Find ways to express love, caring, physical affection, and sexual intimacy with your partner that do not necessarily require sexual intercourse.

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