Sexual Dysfunction

Some people have orgasms within minutes of sexual interaction. Others engage in sexual stimulation for an hour or more before having orgasm. Some people never have orgasms. Nowhere else is the problem of defining sexual dysfunction more evident. In fact, except in extreme cases involving orgasm within seconds or no orgasm at all, the main difficulty is a difference in the speed of the partners' responsiveness rather than any dysfunction.

The fact that one person responds quickly and his or her partner responds more slowly does not necessarily imply that either is dysfunctional. Although orgasmic and ejaculatory dysfunctions do exist in some people, simple differences between partners in the timing of orgasmic release are not necessarily problematic or indicative of sexual dysfunction.

Perhaps the most useful definition of premature ejaculation is ejaculation before the man wants it to occur. Speed of ejaculation is related to age (older men have fewer problems with ejaculatory control than do younger men, particularly adolescents), sexual inexperience, and novelty of the sexual partner.

The diagnosis of premature ejaculation is not appropriate unless the speed of a man's ejaculation becomes a regular, unwanted aspect of a couple's sexual activity. Ejaculation is a reflex that is difficult to control once it has been activated. The key to learning control is to recognize the signals that occur just before ejaculation, an awareness that can be difficult for young, inexperienced men. Roughly 30 percent of men report that they ejaculate more rapidly than they would like. Some men who continue to have problems with premature ejaculation after they have become sexually experienced may be hypersensitive to penile arousal and predisposed to early ejaculation (Slob, Van Berkel, and van der Werff ten Bosch 2000).

In clinical studies, inhibited male orgasm (also known as retarded ejaculation or ejaculatory incompetence) accounts for about 3 to 8 percent of men seeking treatment, and this rarer form of sexual dysfunction has been found to occur in about 3 to 10 percent of men in nonclinical samples (Simons and Carey 2001). The inhibition of orgasm may include delayed ejaculation or a total inability to ejaculate despite adequate periods of sexual excitement. As with the other dysfunctions, a diagnosis of inhibited male orgasms is not made when the problem stems from side effects of medication or some physical disorder.

In a physical condition known as retrograde ejaculation, the usual expulsion of ejaculate through the urethra is reversed. The neck of the bladder does not contract, so the semen is expelled into the bladder rather than out through the urethral opening in the penis. The condition usually results from surgery involving the genitourinary system or can be a side effect of some medications.

Some women suffer from inhibited orgasm, a condition that prevents them from having orgasm despite adequate sexual stimulation. Difficulty with orgasm is one of the most common sexual concerns among women

Women with this dysfunction may look forward to sex, and many experience high levels of sexual excitement with vaginal swelling and lubrication, but they are usually unable to have orgasm. Sexual arousal causes congestion of the pelvic blood vessels, and without orgasm, the congested blood remains for a while (analogous to the congestion in the testes associated with the absence of orgasmic release in highly aroused men). Consistent arousal in women without orgasmic release can result in cramps, backache, and irritation. Prevalence rates have ranged between 4 and 24 percent in European and U.S. studies (Simons and Carey 2001)

It is debatable whether a dysfunction exists when a woman does not have orgasm during coitus but does climax during other kinds of stimulation—oral or manual stimulation, for example. Calling this pattern a sexual dysfunction and assuming that it requires sex therapy would dictate treatment for a large number of women, given that fewer than 50 percent of women consistently have orgasm during coitus.