American Medical Association Family Medical Guide - American Medical Association [261]
Symptoms, Diagnosis, and Treatment
In women, symptoms of dyspareunia include pain or discomfort in the external part of the genitals or deep inside the pelvic area. Men usually experience pain in the penis.
Your doctor will be able to find the cause of your discomfort by performing a physical examination of your reproductive organs and ordering tests to detect an infection or an underlying medical condition. Treatment of dyspareunia depends on the underlying cause.
Lack of Interest in Sex
A lack of interest in sex is the second most common sexual problem (after erection problems) and affects both men and women. The problem can involve both a lack of desire for one’s partner and the inability to become sexually aroused during sexual activity. Fatigue and stress are common causes of lack of interest in sex. Physical causes include a hormonal imbalance, infection, anemia, genital pain, or a long-term illness such as cancer or heart disease. Disinterest in sex sometimes masks another sexual problem, such as premature ejaculation (see previous page) or a woman’s inability to have an orgasm (see previous page). After the birth of a baby, some women feel a lack of desire for sex. Pain and bleeding from a recent delivery, sleep deprivation, postpartum depression (see page 540), and fear of another pregnancy can contribute to a decreased desire for sexual activity at this time. Other causes of decreased desire in both men and women include:
• Anxiety after a traumatic life event, such as death of a family member, financial problems, or losing a job
• Anger
• Depression
• A traumatic sexual experience in childhood
• Use of alcohol or other drugs such as narcotics or tranquilizers
The male sex hormone testosterone stimulates the male sex drive. If your testosterone levels are low, your sexual interest and capacity for arousal are also likely to be low. The condition underlying a drop in testosterone level may be physical, such as liver, kidney, or pituitary disease, or it may be a side effect of a drug you are taking. Other sexual disorders, such as erection problems (see page 486), can interfere with the enjoyment of intercourse and cause a man to lose interest in sex or avoid sex.
In some cases, poor communication causes a woman to receive less than adequate sexual stimulation from her partner. In other cases, a partner may forget or ignore a woman’s request for a certain type of foreplay. All of these factors can contribute to a loss of sexual desire in women.
Diagnosis and Treatment
Your doctor will examine you to rule out any physical cause for your lack of interest in sex. If no obvious physical cause is found, your doctor probably will recommend sex therapy for you and your partner. Sex therapists usually prescribe psychological therapy sessions and progressive exercises to do at home, to teach both partners how to get more in touch with their body. The goal of the process is to resolve old conflicts and rekindle a desire for sexual activity.
MY STORY Lack of Interest in Sex
I’m 36 years old and haven’t been interested in having sex with my husband since our second baby was born 1 year ago. At first I thought I was just recovering from the delivery and pain from my episiotomy. Also, my husband, Pete, and I felt like zombies because we were getting along on very little sleep. He was traveling a lot on business, so sometimes I felt like a single parent when I was here alone with the kids. I told myself that when things settled down, my sex drive would return to normal. But after 6 months or so I still felt no desire for sex.
Having an infant and a toddler raises the stress level incredibly. The same thing happened with our