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Sexuality is not just about sexual intercourse. Sexuality spans an enormous range of human experiences and describes the whole way a person understands and expresses himself or herself as a sexual being. This section provides you with an overview about sexuality and sheds light on some of the most common sexual problems being experienced by men and women today.

Whether it’s with a partner, health care provider, or friends, talking about sexual difficulties can be daunting. The good news is that many sexual problems are highly treatable. By learning more about male sexual dysfunction and female sexual dysfunction, it can give you the confidence you need to discuss what you’re experiencing, seek treatment and better enjoy your sex life.

As you enter midlife, physical changes, medical conditions and emotional issues can influence your sexual desire and capabilities. To find out more about which aspects of your sexual life are likely to change as you age, and how you and your partner can adapt, see Sexuality in Midlife and Beyond.

Finally, if you’d like more information about sexuality and sexual health, the Support and Resources section contains links to a range of other up-to-date and credible sources.

What is sexuality?

In its broadest sense, sexuality describes the whole way a person understands and expresses himself or herself as a sexual being. Sexuality spans an enormous range of human experiences including family relationships, dating, sexual behaviour, physical development, sensuality, sexualisation, reproduction, gender, body image and more. It is a fundamental and natural part of being human, for people of all ages. Sexuality also plays a role in one's need for affection, love and intimacy. We are all involved in a lifelong learning process about our sexuality. As we age, our sexual needs, sexual capabilities, and our desire for intimacy and closeness changes.

Sex and sexuality

Sexuality is not just about sexual intercourse. It is about who you are, your sense of identity as a man or woman, how you express yourself sexually, as well as your sexual feelings for others. Sexuality involves and is shaped by many things, including values and beliefs, attitudes, experiences, physical attributes, sexual characteristics and societal expectations. Sexuality differs from person to person. It is influenced by many factors, such as religion, culture, age and situation. Our sexuality has many dimensions, and it is only sometimes that our sexuality is expressed in the specific act of sexual intercourse. 

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Female sexual dysfunction refers to a problem during any phase of the sexual response cycle that prevents a woman from experiencing satisfaction from sexual activity. The sexual response cycle has four phases: desire, arousal, orgasm, and resolution.

These problems may have physical or psychological causes. Physical causes can include conditions like diabetes, heart disease, nerve disorders, or hormone problems. Some medications such as antidepressants, antihistamines and chemotherapy drugs can also decrease your sex drive and your body's ability to experience orgasm. Psychological causes may include untreated anxiety or depression, or the effects of past sexual trauma. Cultural and religious issues, as well as longstanding conflicts with your partner can diminish your sexual responsiveness as well.

Many women experience problems with sexual function at some point in their lives. It can occur at all stages of life, and may be ongoing or happen only once in a while. Fortunately, female sexual dysfunction is treatable.

Types of female sexual dysfunction include:

  • Low libido: This is characterised as the absence of sexual fantasies or a lack of desire for sexual activity – so much so that it causes personal distress. Because the level of libido varies widely from person to person, diminished sex drive is the most elusive sexual dysfunction to diagnose. Sex therapy and medical treatments are available to treat low sexual desire.
  • Sexual arousal disorder: Sexual arousal disorder is when your desire for sex is intact, but you have difficulty or are unable to become aroused or maintain arousal during sexual activity. Vaginal dryness is a common cause of sexual arousal disorder and can make intercourse uncomfortable. Several different treatments are available to treat this disorder, ranging from over-the-counter lubricants to prescription hormone treatments. 
  • Orgasmic disorder: This is when you have persistent or recurrent difficulty in achieving orgasm after sufficient sexual arousal and ongoing stimulation. It can be caused by a woman's sexual inhibition, inexperience, and psychological factors such as guilt, anxiety, or a past sexual trauma. Other factors can include side effects of certain medications, nerve damage or chronic diseases. To treat orgasmic disorder, a combination of education, counselling and sex therapy may be used—often along with directed exercises to increase stimulation and decrease inhibitions—either for the individual or for the couple. 
  • Sexual pain disorder: Sexual pain disorder is when you experience pain associated with sexual stimulation or vaginal contact. The pain can be diffuse and intermittent, it may appear when pressure is applied to certain areas, or it may emerge only when a woman is attempting sexual intercourse. Treatment of sexual pain disorder depends on the root of the problem. Medications, sex therapy and physical therapy are all forms of treatment that can assist with easing symptoms and managing pain.
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Male sexual dysfunction is one of the most common health problems affecting men today. Physical conditions such as diabetes, hormonal imbalances and heart disease may cause male sexual dysfunction. Alcohol and drug abuse, as well as side effects of certain medications, can affect sexual desire and function as well.

Male sexual dysfunction may also be caused by psychological problems, including work-related stress and anxiety, concern about sexual performance, marital or relationship problems, depression, feelings of guilt, and the effects of a past sexual trauma.

According to Cleveland Clinic , the three most common problems related to sexual dysfunction in men are erectile dysfunction, ejaculation disorders and inhibited sexual desire.

  • Erectile dysfunction: also known as impotence, is the inability to achieve and/or maintain an erection suitable for intercourse. Causes include medications, chronic illnesses, poor blood flow to the penis, drinking too much alcohol, or being too tired.
  • Ejaculation disorders: There are different types of ejaculation disorders, including:
    • Premature ejaculation: This refers to ejaculation that occurs before or soon after penetration. Premature ejaculation is the most common form of sexual dysfunction in men, and is often due to performance anxiety during sex.
    • Inhibited or retarded ejaculation: This is when ejaculation does not occur.
    • Retrograde ejaculation: This occurs when, at orgasm, the ejaculate is forced back into the bladder rather than through the urethra and out the end of the penis.
  • Inhibited sexual desire or loss of libido, is characterised by a decrease in desire for or interest in sexual activity. Reduced libido can result from physical or psychological factors, and has been associated with low levels of the hormone testosterone.

The good news is that male sexual dysfunction is treatable. Prescription medications or hormonal treatment, such as testosterone replacement therapy, may help with erectile dysfunction and hormone imbalances. If your sexual problems result from psychological causes, the Journal of the American Medical Association recommends professional counselling with a sex therapist – either individually or as a couple. 

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Sexual health is important at any age. As you enter midlife however physical changes, medical conditions and emotional issues can influence your sexual desire and capabilities. While sex may not be the same as it was in your 20s, it can still be as fulfilling as ever. Learn more about which aspects of your sexual life are likely to change as you age, and how you and your partner can adapt.

  • Changes in physiology and sexual response: The hormones that most affect sexual physiology, estrogen and testosterone, gradually decline during midlife and beyond. As estrogen levels decrease, women more often contend with issues of vaginal dryness and experience slower sexual arousal. At the same time, decreased testosterone levels in men may cause the penis to take longer to become erect, erections may not be as firm, and it may take more time to achieve full arousal and to have orgasmic and ejaculatory experiences. Erectile dysfunction also becomes more common. In the face of changing sexual needs and abilities, try experimenting and finding new ways to enjoy sexual contact and intimacy. In addition, there are several medications and treatments available to help men achieve or sustain an adequate erection for sexual activity.
  • Loss of sexual desire (libido): Hallmarks of aging such as hormonal declines or lifestyle and relationship transitions can all affect a person's sex drive. So too can illness and the presence of other sexual problems, such as erectile dysfunction or vaginal dryness and discomfort. If diminished sex drive is causing you trouble, both medical and non-medical treatments are available. A health professional can help you address where the problem stems from and choose the correct treatment for you.
  • Medical issues: Any condition that affects your general health and well-being may also affect your sexual health. Illnesses that involve the cardiovascular system, high blood pressure, diabetes, hormonal problems, depression or anxiety — and the medications used to treat these conditions — can pose challenges to being sexually active. If you're experiencing sexual side effects from a medication, consult your doctor. It may be possible to switch to a different medication with fewer sexual side effects. Also keep in mind that your sexual well-being goes hand in hand with your overall mental, physical, and emotional health. Therefore, the same healthy habits you rely on to keep your body in shape, such as exercising and eating a healthy diet, can also improve your sex life.
  • Body image and self-esteem: At midlife, it is common to experience changes in weight, fitness, appearance and mood causing you to feel less desirable and, as a result, less interested in sex. The challenge is to do what is reasonable to improve health and appearance, and then learn to accept and embrace yourself as you enter this new phase of life. Mayo Clinic also suggests directing your attention, instead, to the experience of giving and receiving pleasure during sex. This can help you shift your focus away from your perceived flaws, and find the confidence to surrender yourself to the experience.
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