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Sexual Problems

Sexual Problems

Painful Intercourse (Women)


Why do I experience pain during intercourse? Sex should never be painful. If you are having pain during sex, stop. Sex is supposed to be pleasurable, and pain indicates that something is wrong. In many cases, your partner's actions can cause pain, such as going too fast or penetrating from an awkward position. Never hesitate to ask your partner to slow down or move to make you more comfortable.


Another common cause of pain during sex is the lack of natural lubrication in the vagina. If you are not aroused during sex, you may experience this, although women often do not produce enough lubrication on their own. Try using a water-based lubricant or purchase lubricated condoms if you think this is the problem.


Failure of the vagina and uterus to respond to sexual arousal can also cause discomfort. The vagina may be too snug for intercourse or the uterus may not be raised so that the penis comes in contact with the cervix during penetration.


The muscles near the vaginal opening may also be the cause of some discomfort during intercourse. Various problems can occur depending on the state of these muscles. Vaginismus is a condition in which these muscles are extremely tight which causes intercourse to be painful and in some cases impossible. The way to check to see if vaginismus is a problem is for the woman to examine herself with her fingers. If she feels that the vaginal walls are much tighter than normal, then it may be vaginismus. Vaginismus is described in more detail below.


Any inflammation of the vagina has the potential to cause problems during sexual intercourse. Infections of the vaginal region due to yeast, herpes, etc. can make intercourse uncomfortable. Creams, fabric or perfumes may also cause irritation which makes intercourse painful. It is best to examine the vaginal area or the products that are being used to determine whether they are causing this problem.


Difficulty with intercourse may also be experienced by women for whom it is the first time having sex. Breakage of the hymen and other sensitive tissue can cause discomfort during penetration. The best advice is to take it slow, or begin with forms of penetration other than intercourse.


Vaginismus

Vaginismus is spasm of the muscles around the opening to the vagina. The muscles surrounding the vagina and the muscles of the lower vagina are involved. Vaginismus affects females of all ages. Appropriate health care includes:  Doctor's treatment. Your doctor or nurse will probably teach you how to dilate the vaginal opening gently and gradually with rubber or glass dilators.  Psychotherapy or counselling, if medical treatment is unsuccessful.


What are the signs and symptoms? Involuntary contraction of the muscles around the vagina and rectum. The vagina closes so tightly that the penis cannot penetrate for sexual intercourse.


What are the causes? An unconscious desire to prevent penile penetration because of emotional or psychological factors. These may include fear, anxiety, hostility, anger, or a distaste for sex. An insensitive sexual partner, insufficient or unskillful foreplay, or inadequate vaginal lubrication prior to attempted penetration. Physical disorders (rare), such as infections, allergic reactions, or a rigid, non-perforated hymen.


What are the problems that can occur as a consequence? Psychological trauma caused by guilt, anxiety, loss of self-esteem, and feelings of inadequacy, or interpersonal problems resulting from the disorder. Painful intercourse for sexual partner.


Can this be treated? Usually curable if the underlying cause can be cured or a coping method can be developed through medical treatment and psychological counselling.

Learn dilation techniques and practice twice daily at home. Prior to dilation exercises or attempted intercourse, sit in a tub of hot water for 10 to 15 minutes. Baths often relax muscles and relieve discomfort. Repeat baths as often as is helpful. Before attempting intercourse, you and your partner should use a lubricant, such as KY Lubricating Jelly or baby oil.

Premature Ejaculation

What is premature ejaculation? Premature ejaculation is one of the most common sexual problems. The condition is most often described as being an inability to delay ejaculation to a point when it is mutually desirable for both partners. The definition of when ejaculation is premature is subjective. While some men have trouble controlling their orgasm upon entry, others consider 5-10 minutes of copulation too little time. How long a man is able to last is not the important factor in diagnosing premature ejaculation. The crucial issue is if a man is satisfied with the length of coitus.


How is premature ejaculation caused? Most men have experienced this problem at some time in their life. Premature ejaculation was once thought to be caused by drugs or certain infections such as urethritis, but popular wisdom suggests it is more psychological in nature. Counselling can be very helpful in resolving any underlying issues that may be causing this problem.


Premature ejaculation often occurs during the first experiences with sex, and in this case is most commonly attributed to anxiety. The majority of men gradually learn to control their orgasm, and have no lasting effect. Some men will develop a longer-term anxiety toward sex, which can cause a prolonged experience with premature ejaculation.


Sexual behaviour is also a factor. The longer the period since last ejaculating, the quicker young men typically reach orgasm. Younger men tend to ejaculate more quickly than older men, as experience seems to be associated with ejaculatory control.


What can I do to delay ejaculation? (Masters and Johnson method) The best way to fighting premature ejaculation is learning how to identify and control the sensations leading up to orgasm. The Masters and Johnson method does just that. The Masters and Johnson method requires a great deal of patience and practice, but is very effective. Follow the steps below.


You may want to start with masturbation. Begin by bringing yourself to a point relatively close to climax, and stop, allowing yourself to relax before starting again. Each time you do this, bring yourself closer and closer to orgasm until you cannot control it any longer. Repeating this procedure a number of times on different occasions will help you learn where your point of climax is.


Once you have an idea about your ‘point of no return’ you should be able to direct stimulation from your partner leading up to orgasm. The best way to practice this method is with a caring lover, although you can try to prepare by yourself. With your partner, engage in non-coital stimulation (like masturbation or oral sex) and gradually allow yourself to reach that point just before ejaculation. At that point, signal your partner to stop (often this is done with a light squeeze or sound) and allow yourself to partially lose your erection. Repeat these steps several times to get the hang of it. You should practice these steps for several days before you attempt intercourse.


Once you are ready to try intercourse, lay on your back and direct your partner to slowly allow you to penetrate. As soon as you feel that you are about to climax, signal to your partner or give a gentle push upward. Relax for a bit, then begin again. You should soon be able to control your ejaculation and enjoy having sex.


Although the method is extremely effective, it could take weeks before you get it just right. Remember, be patient and try not to put too much pressure on the situation. If you don’t get it the first time, shrug it off and remember that you are working towards something that takes time. If you still have trouble, don’t hesitate to contact a sex therapist for guidance.


Squeeze technique The squeeze technique is really just a variation of the Masters and Johnson method, except that the assisting partner squeezes the tip or base of the penis just before the point of climax to essentially cancel the orgasm. The ‘squeeze’ forces blood out of the penis and reduces the erection. You may want to use the squeeze technique if the Masters and Johnson method alone is not working.

Other Techniques


Desensitising creams are products which purport to lessen the sensations felt by men during intercourse so that they can last longer. The limitation that many men feel these creams have is that they make intercourse less pleasurable by decreasing stimulation.


Masturbation is a technique used by many young men to increase their level of control. It is thought that masturbation before sexual activity will lessen the amount of desire a man feels thereby increasing control. This technique is not very effective, however, as level of arousal is only part of what contributes to the condition.


Condoms are an effective means of reducing the amount of stimulation experienced during sex. Some men find that a condom helps them prevent premature ejaculation by lowering their arousal. If one condom does not decrease the stimulation enough, then put on one more. Condoms provide excellent protection against STD's and pregnancy, so they’re certainly worth a try.


Sexual positions can affect a man's ability to control his ejaculation. The typical ‘missionary’ position (on top of your partner) is not the best position while attempting to control ejaculation. Try laying on your back, allowing the partner to control copulation. In this position you are more relaxed, and can guide your partner easily.

Impotence and Erectile Failure

What is impotence? Impotence is the failure to achieve an erection, a condition faced by an increasing number of men. In order to diagnose the potential problems that lead to this condition, it is useful to describe what conditions must be present for erection to take place. The first component you need to achieve an erection is a normal, intact male sexual organ. Secondly, a normal amount of circulating hormones is necessary. Third, a man must have an intact nerve supply and blood flow to the male sex organ. Finally, normal erections require a healthy psychological response to the arousing stimuli, coupled with a relaxed state of mind. A failure of one or more of these components is the most likely the cause of erectile failure, however the most common causes are psychological. Impotence is often curable, counselling can be very helpful in resolving any underlying issues that may be causing the problem.


What Causes Erectile Failure?

Psychological causes Psychological causes of erectile failure are often mistaken for physiological disorders. By far, the most likely causes of erectile failure are related to mental or emotional problems. The most common of these is performance anxiety. When a man feels pressured to achieve an erection (often spurred by occasional difficulty), he will commonly become anxious and nervous when in a sexually demanding situation. Anxiety conflicts with the ability to achieve an erection, and thus failure results, perpetuating further anxiety. If you still find it impossible to break free of this cycle, it is strongly recommended you find a counsellor to help you and your partner learn how to overcome this reversible problem.


Neurological disorders. Any neurological disorder which interrupts the nerve supply to the erectile tissues will generally cause an erectile failure. There is little known about the nerves which cause erection and therefore it is difficult to predict how damage to certain nerves will affect erectile capacity.


Blood Flow. If the blood flow to the genitals is halted or impeded, then erectile failure may occur. Vascular disease can cause the blockage or constriction of the arteries in the pelvis and/or penis. The blood that normally rushes to the penis is partially stopped. Vascular disease may also be the cause of leaks in the arteries or veins; this too can cause an erectile problem.


Peyronie's disease. Peyronie's disease is a fibrous scarring which develops from an inflammatory process. The cause of this process is not yet understood. When an erection does occur, there is a bending of the penis which can often be quite painful. It may interfere with ejaculation and in some cases erectile capacity. There is an effective treatment available if the bending is only to one side. This is called Nesbit's operation. Please consult your doctor to determine whether Nesbit's operation will be effective for you.


Priapism. Priapism is a condition in which a man develops a permanent erection. All of the causes of this condition are not yet known, however some potential contributors are diseases which thicken the blood and certain medications used improperly for achieving an erection. Priapism is an uncomfortable, sometimes painful condition which often requires surgery to relieve. If your erection lasts for an unusual period of time, go directly to the emergency department of the nearest hospital. Although this can be embarrassing, waiting to long to correct priapism can result in permanent damage.


Hormonal Deficiency. Hormonal deficiency is another potential cause for erectile failure. In younger men, this deficiency is typically caused by psychological rather than physical failure to produce androgen. In later life, the pituitary gland may fail to produce the stimulating hormones that encourage testosterone output by the testicles. Furthermore, there may be associated failure of thyroid and adrenal gland hormone production. This may cause impotence and low level of sexual interest. This hormone deficiency in older men can normally be corrected by hormone injections.


Infection. Infection of the penis and surrounding tissues can limit a man's ability to achieve erection. These infections are more pronounced in older men but have caused temporary impotency for men of all ages. A viral infection of the testes may cause discomfort and also prevent a successful erection. As well, bacteria can inflame the urethra and surrounding skin which can interfere with an erection. Finally, the prostate gland can become inflamed during an infection, which causes a lot of pain in the genital region. The prostate can be treated by massage and antibiotics in cases of infection and inflammation. Discomfort in the prostate area may be indicative of more serious illnesses; consult your doctor immediately.


Diabetes. Diabetes can also cause erectile failure. Impotence may be closely associated with a high blood sugar level, and if this level is lowered, the patient will see an improvement in sexual potency.

Inability to Achieve Orgasm

Why do some women have difficulty in achieving orgasm? The scientific community does not understand how the mechanisms in the brain act to allow an orgasm to take place. Consequently, there is little scientific data available to describe why some women cannot achieve an orgasm.

What Can I Do to Better My Chances?

Know yourself. Being comfortable with your body is the first step to becoming orgasmic. You may want to try masturbating if you’ve never done it before.


Make sure that you are in the mood. You should feel relaxed and comfortable so that you can fully appreciate sexual intimacy with yourself or your partner. If you find that you are angry at your partner, it may not be the best time to engage in sexual intimacy.


Communicate with your partner. Tell him/her what you find sexually stimulating. Many women can not achieve orgasm from intercourse. This is not a sexual dysfunction, it just means that your partner has to explore what you find most pleasurable. Constant clitoral stimulation is required by many women to achieve orgasm, so be sure to tell your partner to continue stimulation if need be.


Be adventurous. Oral sex or manual stimulation of the clitoris may be too infrequent for some women to achieve orgasm so an alternative method of stimulation is advised. Vibrators are a good way to massage the clitoris during intercourse.


Be positive. Some women go through a stage of arousal where they are not becoming further excited. Many feel that this is where their arousal will end and that they will not be able to achieve an orgasm. Once a woman believes that she is not going to be able to have an orgasm, that is often exactly what happens.


Touch yourself. It is okay for you to touch yourself during sexual intimacy with a partner. Self stimulation is encouraged, and often accentuates the feeling of intercourse.

Delayed Ejaculation

What is delayed ejaculation? While many men seek to rid themselves of premature ejaculation, there are others who have a very different problem; the inability to ejaculate soon enough. This problem does not carry the same social stigma as that of premature ejaculation, however it can be as frustrating. It can take the pleasure out of sex and may turn some men off sex altogether. If you suffer from this condition, then it would be helpful to see your doctor because it could be a physical problem. If your physician can not solve this problem then a counsellor may be helpful.

Painful Intercourse (Men)

What can cause painful intercourse in men? Discomfort during intercourse for men can be attributed to a number of causes. One cause could be a result of snugly fitting foreskin. Occasionally during a man's first attempt at intercourse, tight foreskin will cause retraction to be painful. After a while, the foreskin loosens, and intercourse is more comfortable. Secondly, any lesion on the skin of the penis can make intercourse painful. These lesions may be due to unlubricated masturbation, rapid intercourse or STDs. The blisters caused by herpes can also make intercourse extremely painful. Finally, conditions like Peyronie's disease which cause a bending of the penis may also make intercourse painful. If you can not determine why intercourse is painful then please consult your doctor.

Loss of Desire

What causes loss of sexual desire? One cannot generalize as to why someone is experiencing a low level of sexual desire. Loss of libido can have a variety of causes, some psychological, some not.


Stress and fatigue Perhaps the leading cause of lost sexual desire is stress and fatigue. Most often, the condition is temporary and returns when the stressful period ends, or the person is able to get appropriate rest.


Anxiety Sex can arouse a lot of anxiety in some people who are unsure of the themselves or fear humiliation. For someone who has never had sex or has had a bad experience with sex, the anxiety level can be overwhelming. One may fear that they will not be able to become aroused or excited and fail their partner. Alternatively, one might fear the consequences of sexual activity (pregnancy or STD's). Fear of the sexual situation because of failure or negative consequences can decrease their interest in sexual activity.


Estrangement from partner One who is angry at their partner can express this frustration through a lack of sexual desire. It may be difficult to engage in sexual activity when unresolved conflicts continue to loom. Any negative feelings towards your partner may be incompatible with the prospect of sexual intimacy which decreases your level of arousal.


Misdirected sexual desire This phenomenon often occurs in the case of ‘closeted’ gay men and women. While actual sexual desire may be quite high for members of their appropriate sexual orientation, many people ashamed or insecure about their sexuality will still force themselves to desire the wrong sex. Often closeted individuals marry and have children while still suffering from lack of sexual desire for their spouses. Others may be disturbed by their fantasies or fetishes and may wish to forget them by repressing their sexual desire.


Loss of erotic associations The loss of libido can be a psychological process whereby the brain systematically re-labels stimuli which were once erotic as non-erotic. Sexually appealing stimuli in the environment are no longer associated with arousal. With the help of a counsellor, this psychological condition can often be overcome.


Physiological causes Not all the causes of low sexual desire are psychological in nature. Low sexual desire in older men can be caused by a low level of the hormone androgen. Hormonal deficiency can sometimes be treated with hormone injections. Consult your doctor or counsellor for all the answers. Anything that adversely affects your metabolism will undoubtedly cause some lack of sexual desire. This may include an accident, trauma or illness that causes a metabolic disturbance. Different drugs have different effects on sexual desire. You should read the label or ask your doctor or pharmacist about the effects of any pharmaceutical products on your libido.

What can I do about loss of sexual desire?

If you have experienced loss of desire for only a short time, it may take care of itself. Getting out of stressful or anxious situations may also alleviate the condition. Try to think about what the cause may be for you personally. It could be your partner, your environment, or a number of other factors listed above. If the loss of desire persists, seek help from your doctor and a counsellor.

Primary or Secondary Problems?

There are certain matters that need clarifying before you can pinpoint your problem. It can be useful to ask yourself some of the following questions:


 Is it a primary or secondary problem? The counsellor will want to know if it is a life-long problem or whether it has started more recently. If you are a man who has never been able to maintain an erection or a woman who has never had an orgasm or has suffered from vaginismus and been unable to have sexual intercourse, then the problem is a primary one. These problems are most successfully dealt with by counselling and can be hard to overcome on your own. If these or other problems have only arisen lately then your problem is more likely to be secondary. Sometimes they are connected to other problems in your relationship, which need to be sorted out first.


How is the rest of your relationship? Whether your problems are primary or secondary, to be treated successfully your relationship must be stable and “good enough”. Working on your sexual relationship can be stressful, and if there are other difficulties within your relationship, they will start to show. A counsellor who realises that there are other problems will usually suggest relationship counselling before you tackle the sex side. If you can acknowledge that there are other problems you will benefit from reading the page on relationship problems before concentrating on the sexual difficulties.


Could there be a physical cause of your problem? Certain medical conditions can affect your sex life. There might be real physical reasons why a man or woman has pain on intercourse, and some illnesses affect a man's ability to achieve an erection. Certain prescribed drugs have side effects that can stop a man getting an erection, or can reduce desire and arousal in both men and women. Sometimes a counsellor will suggest a physical checkup or will ask the doctor if a prescription can be changed to a drug without such side effects. You should check with your own doctor about possible medical causes before you assume that your problem is purely a sexual one. A counsellor will also ask about how much you drink. Alcohol affects a man's capacity to get an erection. Other drugs such as marijuana, heroin and so on,  also affect sexual functioning.


A woman's hormones can affect levels of sexual interest and arousal, especially during the menopause. Hormone levels fluctuate before you experience some of the more obvious symptoms of the menopause such as missed periods or hot flushes. Some, whose sex lives have been adversely affected by the menopause find that Hormone Replacement Therapy restores desire. During pregnancy and the months after the birth hormone levels as well as other factors can cause you to lose interest in sex.


A counsellor would also want to know if one or other of you is clinically depressed, not just feeling low. This too needs attention be sexual problem can be tackled.


Sometimes a physical cause is uncovered that will mean sex can never be the way it was between you; for instance, a man might have a condition that means he is not likely to get an erection again. Therapy is also useful here, it teaches that penetration is not the be-all and end-all of sex, and that it is perfectly possible to have and satisfying sex life without it.


Many sexual problems are discussed further down on this page.


 How motivated are you? Feeling dissatisfied about your sex life is one thing, but are you prepared to put the effort into making it better? Bringing satisfaction back into your sex life takes time and will involve both of you changing some of your patterns of behaviour.


Have you got the time - and the place? Whether you are seeking to improve your sex life through sex therapy or on your own, you do need to make the time to carry out the work properly. Counselling involves a weekly meeting with your therapist, as well as time at home to practice. It also means having a place where you can be private can make warm and welcoming.


What do you want from your sex life? In therapy the counsellor will ask both partners to say what it is they want from the sessions. It is a chance for the counsellor to help the couple clarify what they want from their sex life. Saying you want it to be “better” is too woolly. The counsellor and the couple need to see if their expectations are realistic. For instance, if the couple want the woman to come to orgasm with penile thrusting alone, it is pointed out that statistics show that the majority of woman, while getting pleasurable sensations from penile thrusting, need some touching of the clitoris at the same time, to reach orgasm.

Are you unhappy with your sex life?


Painful Intercourse (Women)     Painful Intercourse (Men)     Vaginismus

Impotence and Erectile Failure   Premature Ejaculation

 Inability to Achieve Orgasm      Delayed Ejaculation      Loss of Desire

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