Sexual Dysfunctions. What May Hinder Pleasure?
Some sexual problems are not necessarily related to other physical limitations but do manifest physically, presenting challenges to your sexual relationship. These are known as sexual dysfunctions because they are expressly related to sexual behavior. However, they are often very manageable and are the kind of problem specifically dealt with by psycho sexual therapists. These are a kind of relationship counselor specializing in sexual issues.
Whether they have physical or psychological causes, or a combination of both, sexual dysfunctions can happen to anyone and are probably not related to the quality of your relationship or your sexual potential as a couple. They can occur at the beginning of a relationship or pop up unexpectedly after years with no problems at all. They can happen with all your partners or only one. Though those affected often assume the issue has only ever happened to them, or that there is no hope for dealing with it, read on and you will see how common and well recognized they can be.
Sexual dysfunctions. Pain and discomfort
Pelvic pain and penetration problems can be present throughout someone’s life, may develop over time or can come on suddenly. There are a number of reasons why they can occur, both physical and psychological . Often, a physical cause understandably leads to a psychological response, which can produce a debilitating and chronic condition. This is one of the reasons why it is so important to have all unusual symptoms medically checked as early as possible. So that more complicated and difficult problems can be avoided.
Sexual dysfunctions. Dyspareunia
Dyspareunia is the clinical term to describe painful intercourse in both men and women and is thought to be considerably more common than statistics suggest. Some women experience pain associated with ovulation at mid-month and even a small amount of spotting or bleeding can make deep penetration more uncomfortable. Post-menopausal pain during intercourse is discussed in the chapter on ageing and is common due to lack of natural lubrication. Unsurprisingly, pain leads to tension and the avoidance of intercourse in both sexes.
Sexual dysfunctions. Vaginismus
Women frequently, and involuntarily, tense their vaginal muscles in anticipation of pain. A condition which is sometimes referred to as vaginismus. It is now recognized that vaginismus is highly likely to develop as a response to dyspareunia and that vaginal tension will cause dyspareunia – therefore, the two conditions are seen as inextricably linked. But why do they occur? Some women are just plain terrified by the idea of inserting anything into the vagina, often having heard horror stories from thoughtless relatives or frightening playground rumours from friends when they were younger.
For other women and girls, a problem can begin with something as simple as a clumsy attempt at tampon insertion, difficulties caused by a particularly tough hymen or other rare congenital abnormalities where the vagina has not developed in the usual way. For some women, issues start after childbirth. There can be difficulty in diagnosis and treatment, especially as pain can be real or imagined/anticipated, and an injury or cause does not always become evident.
Sexual dysfunctions. Provoked vestibulodynia (PVD) and generalised vulvodynia
Some other conditions affect sensation in the female genital area. Provoked vestibulodynia involves vulvar discomfort, or even pain, which can feel like burning or stinging. The area near to the vaginal entrance, urethra and labia minora, the inner lips of the vagina, may become sore in response to any form of touch. This is unlike generalised vulvodynia, in which pain is not brought on by touching but just seems to occur of its own accord. It is not really understood what causes this, but it could be a combination of a number of factors.
The variety of hormonal changes, injuries – especially in childbirth – and infections that can occur make it unsurprising that a chronic response can develop, where the pain and discomfort is always troubling. Some women may also have congenital abnormalities or other problems which make the condition more likely. For instance, it is thought that pain receptors are particularly sensitive in those affected. Unfortunately, therefore, other painful conditions may coexist, including interstitial cystitis, a painful inflammatory condition of the bladder. Fibromyalgia – which causes fatigue, pain and stiffness all over the body – is also common, as is irritable bowel syndrome.
As with painful intercourse, the potential variety of causes makes PVD difficult to diagnose. Medical practitioners are likely to look first at simple causes, such as injury in childbirth, rather than to seek out multiple reasons for the symptoms. Consequently, many women suffer for years before getting a diagnosis, which can delay effective treatment significantly. Touching the affected area causes considerable tenderness and can make it difficult or impossible to insert tampons or enjoy intercourse. Indeed, the condition is often diagnosed by touching the affected area gently with a cotton bud, as this alone can provoke PVD. Fear of pain can cause women to tense the powerful vaginal muscles, making it even more painful and difficult to touch the vulval area at all, let alone attempt sexual touching or intercourse.
You may be one of the 20 per cent of those affected who experienced symptoms while still in your teens or even younger (primary PVD/vulvodynia). Or you may be among the majority for whom symptoms begin later (secondary PVD/vulvodynia). However long this has gone on, you may sometimes think you must be imagining the pain. This is sometimes suggested by friends, partners or even doctors, who cannot imagine the problem could just develop out of the blue. But the pain is very real and becomes more debilitating as time wears on. This is exhausting, making you less tolerant and increasingly frustrated as well as, sometimes, really angry. Your partner may assume you have gone off them or that you are exaggerating, especially if repeated medical consultations have not helped.
How sexual dysfunctions effect on relationships
Whatever the reason for genital/pelvic pain and penetration difficulties, they can have serious consequences for affected individuals and couples, made worse the longer you wait for help. However, these conditions are increasingly being recognized earlier and you should not give up trying to find a diagnosis and appropriate treatment.Living with the difficulty is bad enough in itself, but it can lead to the development of a very negative self-image and relationship problems. It isn’t just that some partners can be insensitive; your expectation that your partner may have a problem with your condition can be an issue in itself.
You may fear that, however understanding they are, your partner will get fed up and find someone else. You may even think you have a duty to be sexual, whatever the personal cost, and feel you have failed. Though this may seem silly on a good day, on a bad one it is easy to become worn down with the discomfort and feeling that you will never be a normally functioning woman. It can be very isolating if others are unable to understand how so many aspects of your life are being affected. At the extremes, some women react by completely shutting down and avoiding sex and any form of touching or intimacy, while others endure painful sex.
Sexual dysfunctions. Creative solutions
All genital pain conditions can lead to feelings of failure, isolation, difference and loss. Significantly, many women who have tense pelvic muscles can enjoy great sex without intercourse, and couples can be very creative sexually. Often, they only seek help if they want to start a family.
PVD, on the other hand, makes any form of genital touching very difficult, so erotic sexual touching may be limited to breasts and buttocks. Experimenting with other body touching to discover sensitive, erogenous areas can help. Many couples enjoy frottage, where the genitals are rubbed against an area of the partner’s body to produce orgasm. When clothed, this is often called ‘dry humping’. Movement of the mons, the padded area above the pubic bone, can sometimes stimulate the clitoris sufficiently to produce orgasm without touching or damaging the sensitive vulval area.
In the past, some gay women have reported reluctance to seek help in case there was an assumption that they wouldn’t be interested in penetration – whereas vaginal exploration, insertion and penetration may or may not be a valued part of their sexual repertoire. However, thoughtless assumptions about people’s sexual behavior are diminishing, so psycho sexual therapists and medical practitioners are much more interested now in individual needs and interests, rather than having fixed and stereotypical ideas.
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