Sex and its Problems... A Crash Course!!

Sexual problems are badly taught in medical school curricula despite their common prevalence, which represent the top of the ice-burg since many choose not to seek medical advice out of embarrassment or lack of awareness.

For example, one large US survey found that 43% of women and 31% of men between the ages of 18-59 complained of some form of sexual problems during the preceding 12 months. Whereas 2/3rds of men referrals were due to erectile dysfunction, women complained of loss of desire and impaired sexual interest, which commonly co-existed with relationship problems and other problems with arousal.

Hence the purpose of this brief report is to raise educational awareness of these problems and outline a general framework for a differential. First, we illustrate how 'sex' normally works in this post followed by an exploration of related problems in a second post later. So keep tuned!!!

The sexual response consists of 4 essential steps as shown in the diagram;

1/ DESIRE; it is the energy that allows an individual to initiate a response to sexual stimulation

2/ AROUSAL; this is the physical and emotional stimulation leading to breast and genital vasodilatation and clitorial enlargement.

3/ ORGASM; Physical and emotional stimulation maximized allowing the individual to relinquish their sense of control

4/ RESOLUTION; most of congestion and tension resolves within seconds. Complete resolution may take up to 60 minutes.

If you look at the diagram - The frontal cerebral cortex, the thinking part of your brain, feeds positive cognitive stimuli into the limbic system, the seat of your emotions!! ie this loop is where sexual DESIRE is coordinated and governed by individual's attitudes fears and experiences. Through spinal neuronal circuits, the limbic system exerts its stimulating/inhibiting influences on sexual AROUSAL represented by peripheral arousal (respiratory and cardiovascular effects) and genital responses. In order for the individual to know that arousal has taken place, a sensory feedback system sends information to the brain establishing that physical effects of arousal occurred. Tactile/sensory stimulation stimulates the limbic system through spinal centers, and that contributes to ORGASM. Therefore, functional availability of the limbic system and spinal centers are prerequisite for orgasm.

Now, it's easier to think of sexual disorders generally as problems of desire, arousal or orgasm. We'll explore this part next.

Reference

John Bancroft. Human sexuality and its problems. 3rd edition. 2009. Edinburgh