Sexual Concerns

The "right way" to make love and the "right" number of times to have sex are simply what work best and are most satisfying for each couple. But anxiety and physical, emotional or relationship issues can interfere with a person's or couple's ability to enjoy or participate fully in sex. Various types of sexual problems (including decreased sex drive, problems with erection, lubrication and orgasm) can be a result of alcohol, recreational drugs or therapeutic medications.

Types of Sexual Concerns

Aging

Simply growing older brings changes in sexual function for both men and women. Most people don't have the same level of sexual desire at age 55 that they had when they were 20. Interest in sex usually declines slowly with age, although it seldom disappears totally.

As people grow older, both men and women usually need more time and more direct genital stimulation before reaching orgasm.

In older men, erections are usually not as firm as they once were and more time may be needed -- days rather than hours -- after ejaculation before they are able to have sex again.

Erectile Dysfunction

Erectile dysfunction occurs when a man is unable to achieve or maintain an erection for satisfactory intercourse. It can be caused by medications, or physical or psychological factors. Treatment will depend on the cause. If medications are the cause, your health care provider may be able to change medications or the dosage. Counseling, couples therapy and, if needed, medication can help with psychological causes. Medications such as Viagra, Levitra and Cialis or assistive devices may be used to achieve an erection.

Early or Late Ejaculation

Early, or premature, ejaculation is when a man reaches climax before desired. Delayed ejaculation is when the man cannot have an orgasm in what seems like a reasonable amount of time for himself and his partner. These problems often can be relieved by adjustments in lovemaking.

Painful Intercourse

Women may have pain during intercourse for a number of reasons.

• Vaginal dryness is the most common cause of painful intercourse for women. It can occur because of low levels of estrogen, especially after menopause, or because of illness, as a result of the side effects of medication, or for psychological reasons.

• A painful muscle spasm, called vaginismus, can occur during intercourse for some women.

• Vaginal scars from childbirth or surgery, by irritation of the vagina from condoms or spermicides, or by infection.

• Pain can also be caused by emotional problems, including fear of pregnancy or reaction to earlier sexual abuse.

Failure to Have an Orgasm

Although most women can have an orgasm with a partner, some have problems. There may be physical reasons for this, but more commonly it is the result of not knowing or being able to communicate the kind of touch that will bring her to orgasm.

For most women, orgasm is more likely with oral sex or by hand stimulation by herself or her partner. Women usually need stimulation of other parts of their bodies as well to become aroused enough to have an orgasm. Stroking and touching of the breasts and nipples and other sensitive areas is important.

During sex, women are more likely to have an orgasm if they can talk to their partners about what kind of touch is arousing. Some women are shy or embarrassed to talk about their sexual needs.

Some problems in coming to orgasm can have deeper emotional roots, such as reaction to sexual abuse or fear of pregnancy.

Use of alcohol or drugs or the side effects of some medications also can affect a woman's ability to have an orgasm.

Self-Care

• Talk. Good communication is the key to good sex and a good relationship. Tell and show your partner how you like to be touched. Talk through other problems and tensions in your relationship.

• If fast ejaculation is a problem, pause, change positions, or think about something else. Doing any one of these three things at the first sensation of ejaculation can allow a man to delay ejaculation.

• Remember, good sex is possible even without intercourse, even without orgasm. There are many ways that partners can give each other pleasure and increase the intimacy between them.

• Avoid alcohol and drugs that warn "may cause drowsiness." If you are having sexual problems, ask your doctor if any medication you are taking could be a cause.

Talking about sex can feel difficult or embarrassing, but it's important to get help if you can't solve these problems yourself. Your primary healthcare provider can help determine whether problems have a physical cause, like an infection or a medication, and provide treatment.  Couples therapists can help with relationship problems, and sex therapists can help with specific sexual issues.  Individual therapy can be helpful in resolving deep-seated concerns around sexuality.