Why Diagnosing Sexual Problems Is So Difficult

There is no set definition of what a "normal" sex life is. Individuals and couples vary widely in terms of how often they have sex and what that encounter involves. For some couples, once a week or month or even a few times a year may be perfectly normal. A sexual encounter may not always include intercourse, and each partner may not have an orgasm every time. And nearly everyone goes through periods when interest in sex or the ability to perform is hindered. This lack of a clear standard can make it difficult to diagnose whether or not someone has a "problem.".

The Merck Manual of Diagnosis and Therapy uses three phrases that can be helpful in judging whether a difficulty you're experiencing is actually a problem with sex:

• Persistent or recurrent: It isn't an isolated or occasional event but persists a long time.
• Causes personal distress: It upsets you and causes unusual anxiety.
• Causes interpersonal problems: It hurts your relationship with your sexual partner.

The latter two categories are the most important. Many people may experience levels of desire or changes in function that don't cause distress and do not impact their relationships. These changes would not then be considered a problem. However, these same changes may be very stressful for other people or couples and would be considered a sexual problem. Problems vary from person to person.

Another complicating factor is that most sexual problems cannot be traced to one specific cause. Rather, they result from a combination of the physical and the psychological. Proper sexual functioning depends on the sexual response cycle, which includes:

• An initial mindset or state of desire.
• The flow of blood to the genital areas (erection in men and swelling and lubrication in women) in response to arousal.
• Orgasm.
• Resolution, or a general sense of pleasure and well-being.

A breakdown in one of the cycle's phases can be responsible for a sexual problem, and that breakdown can stem from a variety of causes.

Role of diabetes, smoking and other problems

According to the American Medical Association, sexual problems often result from physical conditions such as:

• Diabetes
• Heart disease
• Neurological disorders (such as stroke, brain or spinal cord injury, or multiple sclerosis)
• Pelvic surgery or trauma
• Side effects of medications
• Chronic diseases such as kidney or liver failure
• Hormonal imbalances
• Alcoholism and drug abuse
• Heavy smoking
• The effects of aging

Psychological causes might include:

• Stress or anxiety at work
• Concern about performance, marital or relationship problems
• Underlying mental disorders such as depression and anxiety
• Previous traumatic sexual experience

These sets of causes often "play off" one another. Certain illnesses or diseases can cause people to feel anxious about their sexual performance, which, in turn, can make the problem worse.

When doctors suspect a sexual problem, they usually run a series of diagnostic tests to see if there is any physical cause such as certain medication, hormonal imbalance, neurological problem or other illness or some other mental disorder such as depression, anxiety or trauma. If any of these causes are found, then treatment will begin. If such underlying problems are ruled out, then the nature of the relationship between the two people must be considered. A sexual problem may be "situational." That is, the issues are specific to encounters with a certain person in a particular situation. In such cases, therapy is usually recommended for the couple.