Sexual Dysfunction

Some people feel deep sexual desire and want to make love with their partners but experience little or no physical response (erection or vaginal lubrication and swelling) to sexual stimulation. Sexual arousal disorders are diagnosed when there is recurrent or persistent failure by a woman to attain or maintain the lubrication and swelling response or failure by a man to attain erection during sexual activity. Such a diagnosis is made only when the clinician is sure that the difficulty does not stem from physical disorders or medication and when the amount of sexual stimulation provided should be adequate to produce vasocongestion. Sometimes failure to respond results from insufficient stimulation rather than from inhibition of excitement.

Women's reactions to an inability to respond to erotic stimulation show much greater variation than do men's responses. Most men react to erectile dysfunction as if it were a disaster, whereas women's responses range from anxiety or distress to casual acceptance of the difficulty. To some extent, cultural expectations are responsible for these differences. In most cultures, men are expected to be sexually active and to perform satisfactorily. Women are not generally subjected to the same performance pressures and, in some cultures, are not expected to be sexually responsive. The restrictiveness of a culture is linked to the incidence of difficulties in a man's getting or maintaining an erection. In an examination of thirty preindustrial and industrializing countries, Michael Welch and Pamela Kartub (1978) found that the more restrictive a society was regarding such behaviors as premarital, marital, and extramarital sex, the greater was the number of reported problems with erectile functioning.

Erectile dysfunction is generally the most common complaint among men seeking sex therapy. In a more representative sample, however, about 10 percent of men report experiencing erectile dysfunction (Laumann et al. 1994). Some men with erectile dysfunction never have more than a partial erection during sexual activity. Others become erect, only to lose firmness when they attempt to have intercourse. Some men have erection problems with one partner but not with another.

Most men who experience problems with erection after a period of normal responsiveness respond well to treatment. The prognosis is not so good for men who have never been able to attain or maintain an erection with a partner.

About 20 percent of women and 10 percent of men aged eighteen to fifty-four in the general population reported arousal problems in 1992. Often the problem stems from the combination of widespread ignorance in our culture regarding women's sexual anatomy and the socialization of women to attend more to others' needs then to their own.