Sexual medicine deals with humans sexuality and its disorders. This is why it overlaps with other fields of medicine and psychology. The tasks of sexual medicine include the detection, treatment and prevention of sexual disorders. The most usual problems are sexual dysfunctions that sometimes seriously affect one's health and quality of life. There are many causes for these disturbances.
Many physical illnesses such as diabetes or high blood pressure cause sexual difficulties. Furthermore, sexual problems often occur as a result of intake of certain medications or after a surgery. Some mental illnesses such as depression can also lead to the infringement of sexual experience. A common cause of sexual problems, even in otherwise healthy people, are fears, excessive expectations, false hopes and conflicts, which are outside of the sexuality area. Two other important areas / subsections of sexual medicine are the treatment of problems with sexual identity (transsexuality) as well as unusual sexual preferences, which are burdensome for the person or other people (paraphilia).
In order to comprehend the complexity of sexual disorders, it is important to holistically view both physical and psychological factors as well as relationships with the partner. The close cooperation with adjacent fields of medicine such as gynecology, urology, internal medicine and psychiatry is therefore of a high priority. Additionally, sexual medicine also draws on knowledge from the fields of psychology, social science and pedagogy.
Particularly in the area of sexuality, a close connection between bodily functions and the psyche can be observed. Especially the functional sexual disorders can be a sign of psychological problems or troubles in the relationships, but also of physical illnesses.
Apart from sexual dysfunctions, disorders of gender identity and sexual preference are most common sexual disorders.
Functional sexual disorders can manifest themselves in different phases of sexual intercourse. In any case it is important to investigate the cause. Subsequently, measures of the sexual therapy take place, which may include, for example, discussions with the partner.
Sexual dysfunctions are divided into disorders of sexual appetence, sexual arousal and interference of pain during sexual intercourse. A disturbance of sexual appetite can manifest itself in an increased or decreased willingness to have sex. Also, an aversion, i.e. a strong reluctance to have sex is possible. Appetite disorders also include a lack of satisfaction after sexual activity.
Disorders of sexual arousal are split into altered physical responses to sexual stimul and orgasmic disorders.
Pain related disorders during sexual intercourse mainly affect women. These include the vaginal muscle spasm (vaginismus) and generally a pronounced pain feeling in the vaginal area during sex (dyspareunia).
The frequency of occurrence of sexual dysfunction is very difficult to assess. The diagnosis is also highly dependent on the criteria used for each disorder. Additionally, it is often difficult to objectify the right diagnosis and severity assessment.
The estimated number of people suffering from sexual dysfunctions is probably very high. Many people are ashamed of disorders in sexual pleasure or sexual function, and only some of them seek medical attention.
Various studies in medical institutions have shown that more than 15 percent of patients suffer from sexual disorders, which need to be further clarified.
The disturbances usually occur in relations with a partner. Especially in this situation, however, it is difficult for many to talk about any kind of sexual disorders. In many cases, sex is still a taboo subject and a shallow sexual life is often concealed by those affected. Even though it is sometimes difficult for partners to talk, being open about such sensitive issues is an important step in the detection and treatment of usually curable sexual disorders.
Sexual dysfunctions can occur in both sexes, though the severity and frequency are different.
The most common sexual dysfunction in women is the lack of sexual desire, which is also called loss of libido or lack of sexual appetite in the specialist language. Also, many more women than men suffer from orgasmic disorders. Although the affected person does have pleasure feeling during sexual intercourse with the partner they do not experience orgasm.
Sexual dysfunction that causes pain during sexual intercourse mostly affects women, too. Both vaginismus and dyspareunia are rare but serious disorders of sexual arousal.
Men are especially likely to suffer from erectile dysfunctions and premature ejaculation (ejaculatio praecox). The term sexual impotence is often used to refer to sexual disorders in men. However, impotence and erectile dysfunction are not synonymous because the impotence can include infertility.
The development of sexual disorders is a frequently discussed topic. However, there is no reliable theory to associate any sexual dysfunction with a particular cause. This is partly due to the diversity of possible causes of sexual disorders. On the other hand, physical and psychological factors are often combined forming a very broad picture of different sexual disorders.
Today we know for sure that sexual development in the early childhood plays an important role in adult sexual behavior. Potential causes of sexual dysfunction include occupational stress, problems in a relationships, high (sexual) performance pressure, psychosexual traumas and physical illness.
The most common physical causes should be excluded in the first examination in order to treat the sexual disorder the best way possible. Physical causes are most common in male erectile dysfunction. In addition, physical disorders in women who experience pain during sex should be excluded.
When men have erection problems, physical causes and possible triggering medications must be ruled out in the first place. The most common physical causes are blood vessel diseases such as atherosclerosis, diabetes mellitus and hormonal disorders, for example hypothyroidism.
In women with dyspareunia, changes in normal anatomy of the vagina should be considered, especially in young women. In addition, inflammation of the vagina (vaginitis) and lack of moisture (lubrication), for example, due to an estrogen deficiency may cause pain during the intercourse. In dyspareunie a pathogen diagnosis should always be performed, too. Various diseases of the vagina such as fungal infections or bacterial vaginosis can cause increased sensitivity of the vagina during sex.
The manifestation of sexual disorders is very versatile. Important for the diagnosis is a pronounced psychological strain of the patient.
Especially in relationships with the partner, the lack or increase in sexual appetite often cause conflict and discrepancies. The patient's need for sexual activities differs significantly from that of the partner.
In sexual arousal disorders, the performance of sexual intercourse is affected. This can be an insufficiently rigid or completely absent erection in men. In women, the vagina is not sufficiently moist, which can make sex uncomfortable. In addition, a lack of psychic pleasure during sex may be a cause of unsatisfactory sexual intercourse.
Orgasmic disorder are mostly characterized by premature ejaculation in men. This often leads to unsatisfactory sex for the both sides. Quite commonly it creates a vicious cycle of high psychological pressure in the man and a diminished sexual desire in the woman. In women, orgasmic disorders are most likely to indicate that the orgasm is absent or requires a long time to occur. It is extremely difficult to define when it becomes a disruption. In case of persistent problems and high psychological stress, the diagnosis is made based on the medical assessment.
In vaginismus the pelvic floor muscles become cramped, narrowing the vaginal entrance. The penetration by the penis can thus become painful. Vaginismus often occurs after a sexual trauma. A fear of pain during sex can have a variety of reasons causing the convulsions. As a result, the growing fear of sexual activity creates a vicious circle that can usually only be interrupted by a psychotherapeutic treatment.
If patients feel that for some reason their or their partner's sex is not satisfying, they should seek a professional help. Often it is difficult for the patient to find out the cause of unsatisfactory sexual contact.
Mostly psychological factors are played down and dismissed, although they have an important role in the development of sexual disorders. The first contact person can already be your family doctor. On the one hand, they can rule out the most important physical causes and, on the other hand, forward the patient to an experienced therapist. For women it is important to visit a gynecologists to have the vagina examined for infections and other physical causes.
Psychotherapy plays an important role in the treatment of sexual disorders. However, the right contact person is not always a specialized sex therapist. When mental illnesses such as depression or anxiety disorders are the cause of a sexual dysfunction, a behavioral therapist or a psychoanalyst can also be the right person to talk to.
The treatment of physically induced sexual dysfunction always come down to the therapy of the primary disease. This can be the correction of blood pressure and blood sugar, but also the elimination of infections in the genital area.
If such treatment is consistent, a satisfied sex life usually returns after some time. Under certain circumstances, a sex therapist may be able to help for some time. Fears and insecurities that have occurred as a result of erectile dysfunction or pain during sex sometimes require psychotherapy in addition to adequate treatment of the underlying condition.
Mentally induced sexual disorders should be diagnosed and treated by experienced therapists. It depends on the cause and the nature of the disorder, whether a psychoanalyst, a behavioral therapist or a couple therapist should be visited. The therapist should always be a person whom the patient trusts and is open to. A good relationship of trust is as important part of the treatment as well as professionalism and experience of the therapist.
It is also important to note that sexual disorders usually do not affect only one partner. Rather, they are a manifestation of problems in a relationship, which is often significant for the both partners. This is why in the therapy of most sexual disorders the couple therapy is an important part of the treatment process.