by Cheryl Alkon
Dr. Virginia A. Sadock is the director of the Program in Human Sexuality and Sex
Therapy at New York University Medical Center and has been a physician for over
25 years. She has written numerous articles and book chapters on sexuality with
a focus on sexual disorders, and holds an M.D. from New York Medical College.
HealthGate spoke with Dr. Sadock about sexual dysfunctions and what people can
do to treat them.
HealthGate: What are some of the sexual problems you see in men and women?
Virginia Sadock: In both men and women, there is hypoactive sexual
desire, which is low desire. In women, there's anorgasmia, which is a lack of
ability to have an orgasm. There's inhibited excitement, and vaginismus, which
is a medical term describing a spasm of the muscle surrounding the vagina which
makes it impossible for penetration to occur. And dyspareunia is pain associated
with intercourse. Now, men can experience that too, but it is almost invariably
a physical problem when a man experiences that. For a woman, up to 30 percent of
the time, her problem is physical, but for women, there are a lot of
psychological issues.
HealthGate: Why don't you see psychological issues with men?
Virginia Sadock: Because most men demonstrate their psychological
issues with their ejaculation or erection problems.
HealthGate: It sounds like there's quite a range of potential problems. What are
the most common and why?
Virginia Sadock: Low desire for both sexes. In women, orgasm
problems, and in men, erectile problems. These areas are what seem to be where
men and women are most vulnerable. For one thing, a woman's lack of ability to
get excited doesn't stop the sex act. It may not make it pleasant, but it
doesn't stop it in terms of intercourse.
A man's inability to get an erection prevents intercourse and they are
vulnerable. Most men climax at least up to a certain age every time they have
intercourse. Some will ejaculate more quickly than they like, and about three
percent of men that I see have a problem with ejaculating, but most will
ejaculate.
HealthGate: What causes these problems to happen?
Virginia Sadock: Some are physiological causes, for instance,
following genito-urinary tract surgery. Certain medications can interfere with
the ability to get excited, even some over-the-counter medications. A woman may
feel excited in her head, but suppose she's taking an antihistamine? The same
way it dries out the mucous membranes of the nose and the mouth, it can dry out
the vagina. Also, some antidepressants, antianxiety agents, and
antihypertensives can interfere.
If a woman goes through menopause and is not taking any kind of hormone
replacements, she will take much longer to lubricate and her vaginal wall is
actually thin. Men past age 55 or 60 take a longer time to get excited. It
doesn't mean they won't, it just takes a longer time. It's the same way that
they can't run as fast. Some men may have very subtle vascular problems. What
causes an erection is blood flow into the penis. If there's a problem with the
flow in, or it leaks out, that can also cause problems.
There are also psychological problems. Those can be intra-psychic; by that I
mean because of something that happened in the person's development. They may
feel inhibited about their sexuality. Or sometimes they grew up and had no
problems with their sexuality but they're going through a depression, either
male or female. And one of the first things to disappear with a serious
depression is libido. Desire drops. Sometimes it's a reflection of difficulty in
the relationship.
Most of the dysfunctions are the result of an inhibition that comes either
because of the way one was brought up, where sex was associated with sin, or
connected with guilt or considered dirty or taboo under certain circumstances.
HealthGate: How do you treat different dysfunctions?
Virginia Sadock In terms of men, premature ejaculation is the
easiest to treat, partially because it seems to be a learned dysfunction. When a
young boy is masturbating or having sex, what's the point of prolonging it? He
learns to do it quickly if he's having sex in situations that would be
embarrassing if he were caught.
The other thing that's easy to treat is if a woman has had orgasms in the past,
but now, for some reason, does not. It's not something you forget how to do, so
once you know how to do it, you know how to do it. But if something is blocking
it, you can work on what is blocking it.
Low desire is a harder one to deal with: it's more complicated. And many
dysfunctions are inhibitions of function. So, it's not being able to do
something that you were able to do before, or that a lot of people can do.
Hypersexuality, or compulsive sexuality, or sexual addiction, is hard to treat.
It's not just a strong sex drive, which is fine, but it's when the need to have
sex interferes with the rest of your life. For instance, there is the impulse to
climax frequently, like five or six times a day, so you leave your work, and go
to the rest room, or you get up at four in the morning so you can masturbate.
And that is sex not just for the pleasure of sex or the intimate bonding that
occurs with it, but it's usually to relieve painful feelings, whether they are
anxiety or depression.
HealthGate: What should people look for if they feel they need to see a sex
therapist?
Virginia Sadock: The best thing would be to look for physicians
that are accredited and affiliated with a medical center. There are certifying
sex therapy organizations, such as the Academy of Male Sexual Health, the
American Association of Sex Educators, Counselors and Therapists (AASECT), and
the Sex Information and Education Council of the United States (SIECUS). Ask
your family physician, internist, or general practitioner. Don't just go to
anybody off the street, because anybody can put up a shingle and say, "I am a
sex therapist."
By and large, most people feel initially comfortable with the same sex people,
but some men do not feel comfortable about talking to other men about their
sexual inadequacies. What is important is what the patient is feeling. Who does
the patient feel comfortable with?
HealthGate: To sum up, can you pinpoint the different ways men and women respond
sexually?
Virginia Sadock: Women are more complex -- they just are! In one
study, men and women were asked what turned them on visually in terms of movie
scenes. Almost all the men said that explicit pornography would turn them on.
Most women felt that a physical scene, accompanied by romance and a hero of some
type, would turn them on.
The men and the women were hooked up to physiological monitors. The men that
said they would be turned on by pornography were turned on. And the women who
said they would be turned on to the romantic scenes sometimes were and sometimes
weren't. When they were shown pornography -- which they said they would not be
turned on -- physiologically, they were turned on to it, but in their heads,
they still weren't. So, it doesn't matter if the woman's body is saying yes, if
her head is saying no. So women are more complex.
To give you another example: most men don't mind if you go directly for their
genitalia in terms of stimulation. Most women do; they'd rather be kissed, held,
caressed, stroked first. It's just different.
If you would like further information about certain sexual dysfunctions and
treatment, the following HealthGate articles are also available:
- Advances in the treatment of male impotence
- When Love Hurts: Causes and Cures for Painful Sex
- Sex Therapy: Is It For You?
- Disorders of Desire
- Prescription Drugs and Sex: Not Always a Good Mix