The essential feature of sexual dysfunctions is inhibition in one or more of the phases including disturbance in the subjective sense of pleasure or desire or in the objective performance. Either type of disturbance can occur alone or in combination. They can be lifelong or acquired, generalized or situational, and may result from psychological factors, physiological factors, or combined factors.
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Sexual disorders can lead to or result from relational problems, and patients invariably develop an increasing fear of failure and self-consciousness about their sexual performance. Sexual dysfunctions are frequently associated with other mental disorders, such as depressive disorders, anxiety disorders and personality disorders. Sexual function can be adversely affected by stress of any kind, by emotional disorders, or by ignorance of sexual function and physiology. The dysfunction may be lifelong or acquired – that is, it can develop after a period of normal functioning. The dysfunction may be generalized or limited to a specific partner or a certain situation.
Abstinence from sex for a prolonged period sometimes results in suppression of sexual impulses. Loss of desire may also be an expression of hostility to a partner or the sign of a deteriorating relationship. In one study of young married couples who ceased having sexual relations for 2 months, marital discord was the reason most frequently given for the cessation or inhibition of sexual activity.
Increased prolactin can also be a reason again which can be treated. Sexual desire commonly decreases after major illness or surgery, particularly when the body image is affected after such procedures as mastectomy, ileostomy, hysterectomy and prostatectomy. Illnesses that deplete a person’s energy, chronic conditions that require physical and psychological adaptation, and serious illnesses that can cause a person to become depressed can all markedly lessen sexual desire in both men and women. A recent study found markedly lower levels of serum testosterone in men complaining of low desire than in normal controls in a sleep-laboratory situation. Drugs that depress the central nervous system (CNS) or decrease testosterone production can decrease desire.
Many neurotransmitters (chemicals in the brain: dopamine, epinephrine, norepinephrine, and serotonin) are produced in the brain and affect sexual function. For example, an increase in dopamine is presumed to increase libido. Serotonin, produced in the upper pons and midbrain, exerts an inhibitory effect on sexual function. Oxytocin is released with orgasm and is believed to reinforce pleasurable activities. Sexual arousal and climax are ultimately organized at the spinal level. Sensory stimuli related to sexual function are conveyed via various nerves like the pudendal, pelvic, and hypogastric nerves.
Phase I: Desire
The classification of the desire (or appetitive) phase, which is distinct from any phase identified solely through physiology, reflects the psychiatric concern with motivation towards sexual activity. This phase is characterized by sexual fantasies and the desire to have sexual activity.
Phase II: Excitement
The excitement and arousal phase, brought on by psychological stimulation (fantasy or the presence of a love object) or physiological stimulation (stroking or kissing) or a combination of the two, consists of a subjective sense of pleasure. During this phase, penile tumescence leads to erection in men and vaginal lubrication occurs in women. Various other changes occur in different parts of the body. Voluntary contractions of large muscle groups occur, heartbeat and respiration rates increase, and blood pressure rises. Heightened excitement lasts from 30 seconds to several minutes.
Phase III: Orgasm
The orgasm phase consists of a peaking of sexual pleasure, with the release of sexual tension and the rhythmic contraction of the perineal muscles and the pelvic reproductive organs.
A subjective sense of ejaculatory inevitability triggers men’s orgasms. The forceful emission of semen follows. The male orgasm is also associated with four to five rhythmic spasms of the prostate, seminal vesicles, vas, and urethra. In women, orgasm is characterized by 3 to 15 involuntary contractions of the lower third of the vagina and by strong sustained contractions of the uterus, flowing from the fundus downward to the cervix. Both men and women have involuntary contractions of the internal and external anal sphincters. Other manifestations include voluntary and involuntary movements of the large muscle groups, including facial grimacing and carpopedal spasm. Blood pressure rises 20 to 40 mm (both systolic and diastolic), and the heart rate increases up to 160 beats per minute. Orgasm lasts from 3 to 25 seconds and is associated with a slight clouding of consciousness.
Phase IV: Resolution
Resolution consists of the disgorgement of blood from the genitalia (detumescence) which brings the body back to its resting state. If orgasm occurs, resolution is rapid and is characterized by a subjective sense of well-being, general relaxation, and muscular relaxation.
If orgasm does not occur, resolution may take from 2 to 6 hours and may be associated with irritability and discomfort. After orgasm, men have a refractory period that may last from several minutes to many hours; in that period they cannot be stimulated to further orgasm. Women do not have a refractory period and are capable of multiple and successive orgasms.
Moral taboos against masturbation have generated myths that masturbation causes mental illness or decreased sexual potency. No scientific evidence supports such claims. Masturbation is a psychopathological symptom only when it becomes a compulsion beyond a person’s willful control. Then, it is a symptom of emotional disturbance, not because it is sexual but because it is compulsive. Masturbation is probably a universal aspect of psychosexual development and, in most cases, it is adaptive.