Sexual pain disorder

Vaginismus

Vaginismus is a sexual problem that causes much distress to the couple. When you go to consultation is baffled and does not understand what is happening. Adequate information and aid reassures, creating a good base for treatment. Vaginismus call to the extreme difficulty or inability to achieve vaginal penetration, due to the contraction of muscles that surround the entrance to the vagina. The spasm is an involuntary response that many women do not recognize, suffer its consequences, but they do not know why it happens. When a woman is sexually aroused experiencing a vaginal relaxation of muscles. In vaginismus, however, the muscle contracture is such that it prevents penetration.

It seems that there is an association of vaginal intercourse with a sense of danger, it is as if the defensive system was extremely active, so any attempt to produce this response reflects penetration. On many occasions, have no easy explanation for the woman who has it, because at the moment his desire and his ideas are to have a full and satisfactory coital. However, it is as if there was a warrant scheduled, an alarm system that enabled women can not control. The internalization of maternal and paternal mandates and follow strictly the social conventions in sexual matters may cause misalignments between what we want and what you can do. In addition, the rapid changes in sexual habits have led to that there is no correlation between what is done and what is allowed to be done, especially in adolescence and youth. This trend may create confusion and insecurity in sexual performance and result in a maladjusted as is vaginismus.

Some women are beginning to notice that something's going on in the penetration when menstruation in trying to get a tampon and realize that they do not succeed. That does not mean that all women who have difficulty in putting on a tampon toilet going to have problems in their sexual relationships, but if that difficulty is accompanied by irrational ideas on the penetration, anguish and fear, may be an indicator to consider. Vaginismus suffer it between 2% and 4% of women and comprises approximately 10% of sexual problems.

Women who have this disorder feel great anxiety at the thought of entering an object into the vagina, can not even try it with a finger or a tampon. In this way is developing a kind of fear of vaginal penetration and is presumed to be painful. Any attempt to penetrate the tense places, it seems to have a hypersensitivity to vaginal relaxation. This tension produces a response that has three typical signs: arqueamiento of the back (lordosis), closure of legs (contraction of the adductor muscles of the thighs) and involuntary spasms of muscles surrounding the vagina. In these circumstances, the penetration is very difficult. If the woman is lying on your back, as is customary in the first attempts to penetrate the entrance to the vagina is not in a position properly. Coupled with this, the tension in the thighs drives her to close her legs, it remains a movement of withdrawal, go crawling backwards, leaving the man paralyzed by a denial so physically forceful, but it leaves the mouth yes.

Attempts to scan gynecological also produce the same effect. The woman who was treated could not be recognized because his phobia prevents it. In some cases, the specialist who has failed to introduce the speculum may recommend an examination under anesthesia. As expected, is not found nothing abnormal in exploration because the contraction does not occur because women are unconscious. While the woman is asleep is introducing an expansion stems Hegar or any other instrument. When he wakes up is reassuring, explaining the intervention and saying that from now on there will be no problem. However, this procedure does not provide any results because the woman continues to show strength when it is conscious. We do not recommend this protocol, since it is not useful to rule out physical abnormalities and, moreover, vaginismus is quite reliable keys to the specialist can make a diagnosis on a positive basis without resorting to further tests to Interventions and much less aggressive than nothing We bring. Respect for the body must always be taken into account, especially in women who consult on this issue.

In sex therapy, especially in cases of vaginismus, it is very important educational work. These women have great ignorance of his body and the body of another, especially in the genitals. Furthermore, strict censorship of female sexuality has contributed to the lack of standardization in speech colloquial erógenas their areas. When the word penis was quite normal to us, of the vulva it was not so much. And they still are often used euphemisms or derogatory names to refer to this part of the body. Faced with that little or no sex education, the perception of one's genitals can be distorted. The vast majority of women who suffer from vaginismus are under the impression that her vagina is very small and its coming very close, so it is very difficult for the penis can enter. We also think that the vagina is closed by the hymen. The idea of this membrane is very confusing, even in women with a university education, despite the profusion of books explanatory. The hymen does not close the vagina of women and non-coats nothing. He is only the entrance of the vagina that ends in a membrane. Some people are very aware of the idea that something has to break, believe that the hymen is found in the vaginal canal. These beliefs about the hymen is found in postgraduate training courses in sexology, where students are graduates in medicine and psychology. This corroborates the limited information about female sexuality.

The hymen is a membrane that is at the entrance to the vagina. About membrane were so insignificant has created a multitude of literature, with many inaccuracies. First, it's not like a fabric that has to be broken, simply being at the entrance to the vagina. In some women, with the first penetrations entry is a bit bigger and sometimes it produces a small incision in the membrane and can leave a little blood, but the vagina is not sealed, by leaving her menstrual flow and other secretions . Nor is the hymen in the vagina, as a sort of wall. He is only the retreat of the post.

Treatment

In the treatment of vaginismus is very important that the couple understands that his case is not unique, but surmountable.

Dr. Simms was the first who described the syndrome in 1862, calling it vaginismus. Although at the time recommended surgical treatment, we now know that the cause of vaginismus is always a source of psychological and surgical interventions are a wrong treatment. Even so, it is still possible to find a specialist who, acting outside the scientific community, makes this type of intervention. The diagnosis of vaginismus can be done easily and their treatment is an example of integrative approach which covers the exploration of deep psychological reasons, the description of environmental and socio-educational work with the body and, of course, the relationship couple.

The couple of women with vaginismus

In vaginismus, as in other sexual problems, is a good prognostic factor that the couple go to consult together. The presence of the couple favored treatment in most cases. It is very important psychological support for the companion; analysis of the sexual myths; general information on sexuality and especially female sexuality. This information has to aboerdar so wide, with particular aspects and socio-emotional. Knowing the problem provides greater security and enhanced self-esteem, factors that favor a good prognosis. Thus, a companion secure, non-anxious and ready to test and accept the challenges and constraints, is an excellent partner in the treatment of vaginismus and support for your partner.

It should be noted that vaginismus is not a product of lack of information and can occur at any socioeconomic level: teachers, butchers, administrative, psychologists, journalists, lawyers and architects are the professions of some of the women treated with vaginismus. Though ostensibly looks like a very serious disorder, the scientific literature on the subject says it is a disorder that usually has a good prognosis.

Dyspareunia

Dyspareunia is the pain they can suffer, both men and women in the pelvic area during or shortly after the sexual relationship. The pain can be filed at the time of penetration, erection or ejaculation. If the pain persists, the person may lose interest in any sexual activity. It is important to note that to be successful intercourse must give the necessary physiological conditions. Both men and women have to be sufficiently stimulated and this means vaginal lubrication and erection of the penis. An indication that the man was carrying out a satisfactory relationship is the issue of the glands of the urethra by Cooper, a few drops of clear liquid that flows through the urinary meatus and acts as a natural lubricant. Women, meanwhile, note how the vagina is moistened. The pain can be felt during penetration or with the movements of the penis into the vagina, and it usually goes after a more or less long period of sex without problems.

Circumstantial causes of dyspareunia

Inadequate lubrication for erotic stimulation insufficient In these cases it is very important to enhance the stimulation with games and caresses. It is necessary for blood to flow in sexual organs to maintain a penile erection and lubricate the vagina.

Vaginal dryness

The vaginal mucosa loses its natural moisture. Often happens often with menopause. To facilitate the lubrication exist in pharmacies vaginal gels with soy isoflavones, with moisturizing properties and lubricants, which give a very good result.

Sex too soon after surgery or childbirth

In the case of childbirth is considered advisable to wait at least 6 weeks after the birth of the baby to restart sexual activity.

Genital irritation by soaps, detergents, showers or feminine hygiene products An effort to clean misunderstood can cause irritations frequent. It must be borne in mind that the vulva has its natural flow and its odor is distinctive and healthy.

Allergies to latex condoms or diaphragms

Causes of dyspareunia who need medical consultation Phimosis

Difficulty or impossibility for the retraction of the skin preputial, ie the skin that covers the tip or glans penis.

Frenulum

The frenulum is the small sheet of skin below the glans linking him with the foreskin. In an erect penis, if the frenulum is too short causes the foreskin will automatically slide forward and can cause pain, discomfort and injury.

Prostatitis

Inflammation of the prostate Endometriosis Endometriosis is a benign disease that affects women during their reproductive life. It occurs when endometrial cells, identical to their sisters who make up the endometrium (the tissue that is inside the uterus and is renewed every month after menstruation) outside the uterus, for example in the fallopian tubes, ovaries or anywhere in the abdominal cavity. Therefore outside of your site behave like their "sisters" on the inside of the uterus and evolve (proliferating and secreting) following the female hormone cycles. It is possible that the woman did not know you have endometriosis and only perceived to have pain during deep penetration. Hemorrhoids dilation of the veins of the venous plexus of the lining of the rectum or anus. Genital herpes, genital warts or other sexually transmitted diseases.

Vaginal infections

Infeccionesdel urinary tract, such as cystitis. It also must go to the doctor if you have other symptoms related to the painful, such as bleeding, genital lesions, irregular menstrual periods and discharge from the penis or vagina.

Causes that require consultation sexological

If no cause is found to justify the pain sexological consultation is recommended. In this therapy, it may be necessary to address the relationship, feelings of guilt, internal conflicts or unresolved feelings about mistreatment in the past, as history of sexual abuse or rape. It is estimated highly desirable that the patient or the patient go with your partner.

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Treatment of deeper psychological causes

As the fear of romantic success, fear of commitment, fear of intimacy, the ambivalence to the couple, requiring the strategies and expertise of a trained sex therapist.

Resources pharmacological

The search for the medicine that solves the problem is the aspiration of both the doctor and the man who comes to consultation. However, we must clarify that although there are drugs that slow squirting mirroring, no drug cures premature ejaculation. It is therefore a drug that handling on a temporary basis may be helpful for delaying ejaculation, but they have proved of little use unless it is integrated into a broader framework of sexological treatment. If we make an exclusive drug treatment for premature ejaculation, we run the risk of relapse, while having obtained an initial improvement in the situation, both for awareness and tolerance to the drug, such as, above all, by the persistence of untreated psychological factors.

In fact, an outstanding issue in the literature on drug treatment only for delaying orgasm is when and how to finish it. That should not discourage towards its use, although not to miss good resources is essential if drugs are used, integrate successfully into a sex therapy. However, some men, the least they can find a solution to the drug concerned when they find that they have a product that can take the day I want to be able to experience an increase in its latency squirting. In short, is the attentive interview which will detect if this is a man with these characteristics, which will be enough to recommend the drug for use situational.

Ejaculation delayed

This problem, much less common for premature ejaculation, is presented clinically as its antithesis. Although it is difficult for many of the boys as contemplated as a problem, as they are worried for their precocity, greater disorder that involves premature ejaculation. The man with delayed ejaculation is usually presented with an element of discomfort far greater than those suffering from premature ejaculation, and it is not unusual to get immersed in a query box incipient depressive. Delayed ejaculation is manifested with varying degrees of severity in each man. Some suffer feeling that they need to strive to get to ejaculate, remaining in doubt about whether it will succeed every time. For others it can never happen ejaculate with sexual intercourse, and even even before his partner, so that some do after masturbating. In more severe cases, the man comes to having no say never or almost never ejaculated. In the male homosexual can be manifested from retardation to ejaculate in the anal or oral intercourse, inability to ejaculate up with the couple, regardless of the type of sexual interaction maintained.

Diagnostic evaluation

As well as premature ejaculation at the beginning of the interview focusing our attention on determining the existence or not of true premature ejaculation, in the interview by ejaculation delayed diagnosis is usually easy and immediate. The distinction between organic or psychogenic etiology of squirting delay will be delayed further. If the delay is situational, ie, no show at all times when the subject ejaculate in their sexual relationships, something very common, has no problem when she masturbates, we can absolutely rule out the medical causes, as it relates to psychological reasons.

Organizational causes

Ejaculation delayed appears after a period of normality Squirting. In general is due to:

- Adverse effects of drugs that may become the treatment of the reverse problem (premature ejaculation). This is the case of psychotropic drugs; central depressants such as alcohol hypotensives alpha-blockers; antiandrogens.

- Neurological damage: spinal injuries (tumors, trauma, multiple sclerosis ...), interventions such as lumbar sympathectomy; neuropathies consistent with alcoholism, diabetes, uremia ...

Psychological Causes

The delay is usually squirting primary, that is, the more often the profile of a young man with obsessive personality traits, which always has been experiencing the delay or inability to ejaculate during intercourse or any form of sexual interaction. Among the psychological causes which lead to delayed ejaculation are behavioral mechanisms like self-observation obsessive or inordinate attention on the sexual partner; relational factors as the ambivalence toward the couple, and perhaps compared to women in general, or psychological causes more as a deep fear of intimacy, fear of compromise or conflict with the orientation of sexual desire, namely conflict of acceptance of homosexuality.

Treatment

Treatment depends on the severity of the table. When the orgasmic inhibition is not very severe and presents with any delays squirting, but the subject tends to ejaculate or does so after their own, usually enough to implement a systematic desensitization in vivo. Is to establish the man with a hierarchy of situations, from the least to the most dreaded ansiógena, usually intravaginal ejaculation. To do so, for example, he proposes to a man who gradually goes into having sex that will squirt the increasingly close to your partner: in the same house, in the same room, in physical contact with her, that is as she masturbates ... to verify that it is ready to experience intercourse without paralyzing anxiety levels.

Retrograde ejaculation

Not to expel foreign semen is not worrying as long as the patient knows who is due to retrograde ejaculation suffers It was well known to orgasm that does not produce an expulsion of semen to the outside due to reflux of ejaculated into the bladder. The removal of the prostate is the most common cause of this happening. The failure to expel foreign semen is not worrisome, provided that the patient is informed of what happens, so no wonder and fear, or doubt about whether the operation has left him impotent. Not ejaculate abroad is not an impotence, erection of the penis does not have to have been lost. In fact, the ejaculate is produced and, if observed under a microscope urine collection after feeling the orgasm, the sperm can be seen in it. Ultimately, the man orgasms and ejaculate, what happens is that there is abroad where the semen is ejected, but reflue his own bladder.

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Solutions

Knowledge of the body

First, to achieve orgasm depends on the knowledge that women have of their bodies and the skill that has developed for sexually aroused. Orgasm can be induced by erotic genital stimulation and not genital. There are women who can orgasm by caressing the breasts. Others relate orgasms during sleep. The whole area of the clitoris and the anterior vaginal wall are areas of high excitability.

Adequate conditions

Sexual arousal is influenced by the physical condition: fatigue, illness, convalescence; mood: fatigue, distraction, anger, concerns and other factors are undoubtedly important as hormone levels, making contraceptives, age, or the use of drugs. Also the specific situation determines the ability to feel pleasure. The first experiments in cars or in stressful situations, such as those who have to live so many young people, are hardly suitable for beginners to satisfactorily in sexual pleasure. Both for them and for them. Self-esteem and self - It is important to the ability to feel comfortable with it. A large number of women feel dissatisfied with any part of your body and often those concerns influence how to meet them, in general, and as sexual beings, in particular. Learning to read and to have influence over one's body lets start enjoying the sex of the richness of sensory and emotional experience that can provide. This means becoming a very responsible for their own sexuality.

Attitudes to sexuality

The values related to sexuality and emotional transmitted in the family environment can influence one's attitude toward sex. It is common for women to grow in a society (as is the traditional western and much of the so-called third world countries) in which the model of sexuality is not respectful of women. In some cases, the mother and respectable women appear as asexual beings, if not clearly antisexuales.

Sexual history and loving

The feelings about current or past relationships, both emotionally and sexually, influence the orgasmic experience. Women with difficulty to feel orgasms have had sexual experiences or unpleasant little stimulant. Have been able to live unhappy love affairs, so that they fear being let go and dependent on the person with whom you share sexual pleasure, and that it leaves them and make them suffer. The feelings about the past or present relationships, both emotional or sexual, influence the orgasmic experience

Model improper sexual relationship

Another frequent cause of Anorgasmia are the patterns of inappropriate sexual relationship. The model of relationship where there is little caresses and no preamble makes it difficult for women is sufficiently excited to have an orgasm. On the other hand, that kind of encounter ends when men ejaculate, which is usually very soon, especially if there has been no preamble. So it is very difficult, almost impossible, for women having an orgasm in that scene. In this situation the woman is often at the beginning of the relationship, confused, frustrated, uncomfortable and tense. And over time, if you have not been able to change the picture, the accumulation of frustration coupled with the resignation takes her wish that he finished as soon as possible and not bother the most. Over time, this Anorgasmia becomes so hopeless in lack of desire.

Fears

They are so varied that everyone can add his own, and are very effective in inhibiting the pleasure and block the response. The fear of pregnancy, fear of being caught, fear of pain, mistrust to the couple, particularly at the early-relationship, afraid to look bad, shame ...

Learning to have orgasms

Learning to have orgasms or take them more easily is just one part of a process of evolution that sexual extends throughout life. Knowing one's own body and its reactions to help calm down, but knowing what's wrong or the cause that leads to the difficulty in reaching orgasm is not enough to bring about change. This change is an active process that involves, among other things, made a very responsible for their own sexuality. The sexual growth and cultivation of a form of sexual expression more pleasant, with or without a partner, they have to start with the knowledge of the same. The treatment of orgasm is designed to intervene in cases that have difficulty orgasmic. Much of the Anorgasmia have to do with the body's ignorance and lack of ability of women to provide stimulation, so that masturbation is very effective for direct treatment. The majority of women do not orgasm usually do not have other sexual problems and lack of orgasm is the result of little or no sex education for the pleasure. Therefore, the self helps women who have difficulties or are unable to achieve orgasm.

Premature ejaculation

Along with erectile dysfunction, premature ejaculation (PE) is the male complaint of a sexual nature more frequent in consultation sexological. Data collected by Carrobles and Sanz (1991) show that the prevalence varies according to authors, between 15% and 40% of the male population. However, it has been noticed that in recent years, the incidence decreases. In what we call premature ejaculation. There is talk of premature ejaculation when a response before squirting a minimal sexual stimulation before, during or shortly after penetration, and before the person you want, but at that point must be borne in mind that some men, partly because of limited information appropriate sex, they have unrealistic expectations about the response squirting male. The reference models that offer pornography is as unrealistic as some novels of romantic love.

In response squirting must take into account factors influencing the duration of phase excitation, such as age, is not the same as the response of a young, much-faster-novelty to a new partner is usually add the own nervousness of the situation, with increasing excitement at the novelty of the stimulus, or the lack of practice time if you do not have had sex, the threshold of excitation can be so sensitive that it can trigger a response inversely proportional to win that has the man to "get well" and enjoy the moment. It is therefore very important to consider that a rapid response, including ultra-fast in those circumstances, it is simply a response commensurate with the circumstances and not a sexual problem. However, many men feel insecure in their physiological response, particularly by the false belief that when men ejaculate ends the act of love. The linking of sex with an exclusive reproduction is responsible for this misunderstanding. If a man has ejaculated seems to continue the meeting makes no sense. This false belief has done much harm to the relationship, focusing on loving encounter on an exclusive and introducing coitus in its final ejaculation in men.

Data from Kinsey

In our culture, at least not until many years ago, the idea of pleasure was something unique to the male and female sexuality was denied. In that context, worry about early ejaculation was insopechable. In fact, in 1948 Kinsey found that three quarters of married men who believed in the ejaculate that used the first two minutes after vaginal penetration.

Definition of Masters and Johnson

In 1966, Masters and Johnson define premature ejaculation as the "inability to delay squirting mirroring during the penetration long enough to satisfy your partner in 50% of the experience of intercourse." This assertion reflects a subtle change in the point of view: "the pleasure of women is a thing of men."

Occurs widely in society and the recognition of female sexuality. While retaining the role of men as responsible for the orgasm of women, paradoxically star of the performance makes him defenseless victim. It is the era in which they say phrases like "no women frígidas but inexperienced men." It opens the door to legions of men feel guilty, dysfunctional, in sum sick because your partner does not reach orgasm during intercourse and, even more terrible call, do not do this simultaneously with them.

Other definitions

Followed proposed definitions of premature ejaculation based on quantitative criteria of minimum. It was estimated the minimum duration of intercourse, which was to range between 30 seconds and 2 minutes, or the number of intra preeyaculatorios pelvic movements, which should be between 3 to 5 minimum to rule out early. All these attempts to objectify a definition of premature ejaculation have been sterile and sometimes even have contributed to generate dissatisfaction and frustration in much of the population.

Contributions of Kaplan

In 1974 Kaplan received a key to premature ejaculation was the lack of awareness of the erotic sensations once the subject is intensely excited. Then defined as those early ejaculation in which "the man is unable to exert voluntary control over your reflection ejaculated, with the result that after being sexually excited very quickly reaches orgasm." This definition implies that "the pleasure of men is a thing of the man."

Though comprises an achievement to point out that in the sexual pleasure itself is personal responsibility of each individual involved. This definition has been interpreted so confused by many health professionals as a description of quantitative ceilings. Thus, it is still possible to find professionals who say that the duration of intercourse should be all that man wants, and not being so, this is an early ejaculated. Again this is the paradoxical figure of the healer as a generator of anxiety and discomfort. Psychological factors are most frequent in the suffering of premature ejaculation, on learning of abnormal sexuality, for anxiety or fear Kaplan, the same work in 1974, contributing to the evolution of the concept of early unintentionally in a direct way when he says, referring to female sexuality, that the fact of not having vaginal orgasms might represent "a normal variant of female sexuality ".

Both women and men can relax, and hence, to be closer to the non-pleasure of feeling the pressure of an often frustrating requirement of female orgasm coital. Ultimately, it remains useful to the definition of Kaplan, "orgasm or ejaculation before the person you want," but adding, as a clarifier nuance, something that Kaplan had to clarify itself in a text devoted to premature ejaculation (Kaplan, 1990). Thus, as of early diagnostic codes used the phrase "Man with the absence of a reasonable control of their reflection squirting." With "reasonable" to emphasize that this is a problem pluricausal, so that should be taken into account in each case, the factors that may be an impact on the earliness of the response. With all these considerations, premature ejaculation is a sexual problem that usually has a very favorable prognosis, especially in young men. It's very rare that the organic component is relevant. The vast majority of cases are primary and respond to psychological causes. A good portion of the cases of premature ejaculation can be resolved or improved significantly with proper intervention sexological.

Psychological factors

Psychological factors are, without doubt, the most frequent.

As noted, it is not unusual in young people, but with time many are learning to make a reasonable control over their ejaculation. Some of the most common psychological factors are:

Learning anomalous

Are frequent stories of masturbation early followed by guilt; antisexuales messages in childhood or inflated expectations. Occasionally you have had early sexual experiences problems with prostitutes or in situations where the rapidity in intercourse has been the pattern.

Anxiety

By having an anxious personality. In some cases, premature ejaculation is given by a significant degree of anxiety himself as a person anxious.

Associated with sexual behavior

When anxiety is associated with sexual behavior may appear premature ejaculation. It is very common in young people the insecurity early in the sexual role, especially the lower self-esteem. Feed anxiety, feelings of shame or guilt after the repeated experience of precocity. It's a common mistake to think that can be resolved anxiolytica with premature ejaculation or local anesthetics (associated with condom, gel, cream, etc.).

Some men use distracting thoughts or even self to distract attention. These practices are absolutely contraindicated and start from the wrong approach, because the sexual activity requires activation of the general. To the extent that man is going to relax or diminish their sensory perception, is far from an effective provision to sexual pleasure. Sex requires activation in our central nervous system of circuits linked to pleasure and not linked to the stress or anxiety, whose start-up interferes in the first. This happens in some cases where the fear has just derailed early experience into something worse, erectile dysfunction.

Fear

Fear mobilizes anxiety.

ny form of fear that is associated at the time of the sexual experience can act early advocate. Can be profound fears, the commitment to privacy, or just the fear of re-experience early, which often leads him to become its own viewer, auto discussed since early in the game sex, so that, unintentionally, Derailments in anxiety for the performance instead of pleasure. Sometimes, fear plays a significant role inhibitor that can lead to avoidance of sexual encounters with the suffering they may pose.

Factors organic

The causes are turned off by organizational problems among all men affected by premature ejaculation. These are neurological or urological problems. They are usually given when premature ejaculation is secondary, that is, arises after a period of normalcy, understood as a reasonable control of squirting. In these cases may be due to the presence of infectious and inflammatory processes in the prostate and / or urethra. Also neuropathies affecting the orgasmic reflex, peripheral, in spinal cord or universities can be causes of boxes "incontinence squirting" secondary, which is found in multiple sclerosis or other degenerative neurological disorders.

Treatment

We will expose the resources used in general in the sex therapy for premature ejaculation problems. Improve the communication of the couple Have a proper place for sexual relations, in time for privacy and control concept of the event, allowing improving the pace of ejaculation The couple is affected when this is premature ejaculation. It is important to address the malaise of the couple, so often did not interview the man only dysfunctional. The mere mention both in consultation to discuss their concerns often exert a powerful effect that leads to improvement of its communication. Other aspects that the interview with both partners allows exploring and could be decisive for the intervention is the vulnerability of man's attitude towards the couple and, in short, the situation of the same: from more or less an accomplice to degrees Major hostility and conflict, in which the concern about a precocious allows them not to confront the real issues between them. All this while most elementary aspects in appearance, such as the provision of a suitable place for sex, provision of time for intimate as lovers, the fear of pregnancy or the decision on contraceptive method to use.

Behavioral prescriptions

A technical resource frequent intervention with sexual dysfunction, also with premature ejaculation, the call is focalising sensory. These exercises are usually correct errors in dropping the couple dysfunctional, as the game erotic restricted and the avoidance of sexual relations. In essence is to launch a program to caress in the privacy, aimed at the couple discovered that key to solving the problem.

This program usually include information such as: In the early stages, usually forbidden intercourse, to remove the source of anxiety in the sexual partner. In its place are proposing, by way of games, forms of close physical progressing in terms of the genitalia to behave. Always depending on the case, techniques such as stop-start. Like the man has been able to do alone, when it is stimulated by her partner, you must tell when you notice that it has approached the point of no return, and this will stop the stimulation. This is repeated several times until it frees ejaculation.

Clamping

A variant more severe and rarely needed is to stop the stimulation and also clamping the glans, thereby dramatically interrupted the progress of excitement. In a state of erection, clamping a maneuver is not painful when done in an appropriate manner. The technique of stop-start often referred to offer equivalent results.

Paradoxical prescriptions

On one occasion, faced with a precocious recalcitrant males, and always be their partner agrees, which is prescribed along a given time, one week, for example, be as early as possible. This kind of prescription can be raised in an appropriate way to unlock and dramatically advancing the clinical situation.

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Alterations in Orgasm

Anorgasmia male

In disorders of the male orgasm should consider the physical aspects (biological or medical) and psychological.

Physiology of the male orgasm

Of the physiology of the male orgasm phase of interest to emphasize that consists of three sub-phases: issuance sperm, formation of the pressure chamber and seminal expulsion. In the release, muscle contraction internal genital (deferens, seminal vesicles, prostate glands and assistants) carries the whole sperm (sperm and other components of seminal plasma) to the posterior urethra. Then, by stimulating sympathetic shrink the internal and external urethral sphincters, while the urethra relax inframontanal form the so-called pressure chamber, which contains the semen secreted there.

Finally contraction tonic-clonic seizure of the perineal muscles periurethral and increases pressure sperm accumulated in the posterior urethra, which would force the opening and relaxation of the external urethral sphincter sperm stripe and projected to the outside between 3 and 5 strokes. During the broadcast, most men experience a sense of immediacy squirting or subjective point of no return. The consciousness or not this sensation is an interesting aspect to consider in the treatment of premature ejaculation.

Psychological aspects to take into account

The lack of male sexual physiology and false beliefs about control squirting can lead to some men autocalifiquen of eyaculadores early. For this reason many of the men who arrive in consultation expressing complaints about the speed of their response will not respond to a diagnosis of sexual dysfunction, but that may have inflated expectations about its control squirting. The symptoms show a degree of sexual intensity quite different, and different circumstances in which they can manifest itself in greater or lesser extent. For this must assess the extent to which the man or the couple have one or more sexual dysfunction or just need information, clarification reassuring. In particular, to premature ejaculation can we meet with couples or young boys, with little experience and inflated expectations about sexual performance.

Consideration to the sexual orientation of the desire of man

Like the rest of the sexual dysfunctions, disorders of orgasm occur in relationships and / or heterosexual and homosexual couples. Learning to read and to have influence over one's body lets enjoy sex and implies responsibility for their own sexuality In the male orgasmic dysfunction or premature ejaculation is delayed or, refers basically to the intrusion intravaginal (heterosexual) for being the most frequent complaint, both as the majority heterosexual population and because the practice of anal intercourse is not so widespread within the same heterosexual relations, and we may even find that the dysfunction is present only to vaginal intercourse, but not in the anal or oral. In the gay male homosexual relations, the dysfunction of the male orgasm comes before the anal intercourse. We may also find that, without the possibility or the vaginal or anal penetration, the man feels that his response was too quick to interfere in the sexual encounter, but it does not involve penetration. The keys to the diagnosis and treatment are the same whether it is heterosexual or homosexual, as if dysfunction is brought before vaginal intercourse, the anal, is widespread in all forms of coition or occurs in other sexual practices.

Failure of the sequence-ejaculation-orgasmic pleasure

It is generally identified with ejaculation orgasm, although it can not produce pleasurable ejaculations without any medical explanation. It is believed that the main reason is that the brain does not perceive the sensation of ejaculation, and if the recipient does not translate as pleasure. The control of ejaculation is one of the concerns of the man when it faces the amorous encounter. We use the word "facing" because in many cases is the one that best reflects the initiation of romantic relationships, to be living more like a challenge than a pleasure to find Share. Thus, the precise time of ejaculation, or very soon, premature ejaculation, or too late, delayed ejaculation, becomes a predominant concern, which can lead to distress. Interference in this process impacting negatively on the man, undermining their self-esteem and often coming to deteriorate the whole of the couple relationship

Anorgasmia female

The female orgasm is a complex process that has biological, psychological and social. The latter are key to such an extent that anthropological studies show that in those cultures where women are allowed to enjoy sex as it does men, women have orgasms while in cultures that censorship female pleasure, the Women have many more difficulties to reach orgasm. Not surprisingly, the human mind receives sexual stimulation of the body, but the process is not something mechanical. The response to those stimuli is processed according to rules of custom and usage learned and practiced. If women have positive feelings toward sex, enjoy it. Conversely, if a conscious or unconscious considers sex as something dangerous and dirty, you'll have it very difficult to enjoy. The Anorgasmia is the absence of orgasm after an appropriate stage of arousal in sexual activity. This is a problem that can be diagnosed and treated, and in most cases, cured.

Causes of Anorgasmia

The lack of orgasm can last a lifetime if they are not means to remedy it. At the moment there has been a very important step: the women claimed their need, their taste and their right to sexual pleasure. Therefore, at present, the female orgasm has become a cause recurrent when talking about sex. However, they have been so many years that have been denied their existence or their right that is not strange that a guy as a minority of women do not make it very difficult to get an orgasm on a regular basis or even has not experienced any occasion .

This sexual dysfunction is related to the ignorance of one's own genital anatomy and function, in particular the role of the clitoris and the effectiveness of the stimulation. In the traditional way has been considered the man responsible for pleasure, an approach that has harmed female sexuality and the couple, because, besides offering a vision of male sexuality, sex limited to intercourse. However, according to studies, sexual intercourse is not the most effective way to bring about the female orgasm. The direct stimulation of the clitoris and the surrounding area could lead to an orgasm without penetration of the vagina.

This is what happens with masturbation and in the manual and oral with a partner. Since then, the orgasm can also occur during intercourse, because at the moment the clitoris is stimulated in an indirect way: the movement into and out of the penis are a drag on the cap of the clitoris, thereby stimulating the body. In addition, with the movements of the couple, the area clitórica comes into contact with the man's pubic bone. Anyway, the woman does not live an orgasm during intercourse does not mean that they enjoy no penetration. Vaginal penetration is often a very enjoyable and fulfilling experience, though not reach orgasm through it.

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ALTERATIONS IN SEXUAL EXCITATION

It is highly desirable that instead of putting our energy in dealing with problems when they are already present, we were able to go ahead and organize our lives in each of the evolutionary stages in a healthy way, promoting healthy habits instead of going after desperately trying to "extinguish fires", addressing problems as they arise, or worse, trying to deny them even aware that time is not only not resolved, quite the contrary. In this spirit, we propose a series of steps that anyone can be taking in order to preserve their sexual health, in the case of men, erectile response capacity.

The erection is unintentional

The man can not have an erection or remove at will. You can only get carried away by a stimulant from a sexual point of view, and their autonomic nervous system will implement the relevant mechanisms. And, curiously, the more you strive for a man to have an erection and most of it is outstanding, the easier it does not appear or be interrupted. Good sex is not always intercourse (vaginal penetration) It is educational for any couple to enjoy the pleasure accomplice shared without intercourse as a sexual dish on the menu. Caresses of all kinds, with hands, mouth, skin, sex toys, the fellatio, cunnilingus the ... are many alternatives that allow to discover that both can enjoy sexual pleasure without the participation of the penis erect. It's a good educational practice against the crippling impact that a possible "Gatillazo" cause in men and couples who, in addition to not wait, have not developed alternative strategies for enjoyment. They run the risk of experiencing lack or loss of erection as the absence or loss of sexual pleasure. In sum, if any man, at one point, it is found to be too much of its erection, it is better to let the idea of penetrating and enjoy a pleasure that does not require an erect penis. It is not true that there will be time The sexual encounters can be programmed, it is not necessary that sex is spontaneous: Do not do it either better or more authentic It is also very educational to go on a regular basis to explore the possibility of introducing or questioning, although apparently small changes in our lifestyle. Know and realize the powerful influence that stress, overwork or her addiction has on our sexuality.

The pleasure requires your time, put on the agenda. Forget the myth of spontaneity. We need to be spontaneous within the agreed times the pleasure. Otherwise, the multiple obligations prevented leave space-time for pleasure. It's what you always tend to sacrifice, with the delusion that there will be time, that if we expect to emerge from spontaneously is better, more authentic. But not usually the case, awaiting the spontaneous outburst, suddenly the days are weeks, even months ... And "body that is not working atrophy," something that happens also to sexual intercourse. The pioneering research on sexual behavior by Alfred Kinsey allowed him to observe that people most often enjoyed sex during capability that kept more years of enjoyment. In contrast, the more sparsely people enjoy sex, it tends to be spaced more and more promptly abandoned in adulthood. The erection, if not stone, you can enjoy.

The penis maintains its ability to feel pleasure but not rigidly erect. Moreover, with a willingness on the part of the couple, you may also enter the flaccid penis or vagina in almost flaccid. There are ways to enjoy genital sensations without the "requirement" of rigidity, a frequent cause of their inability paradoxical. Caring for the health care sexuality Another aspect within the lifestyle changes is that of the general healthy habits. Sexual health is an aspect of global health. We have already mentioned that problems with erection are symptoms sentries that there are other diseases such as hypertension, atherosclerosis, diabetes and so on. In fact, every time we have more evidence of the similarities between the heart and the erectile tissue.

The healthy practices for him so too are for it. Anyone who wishes to maintain their health, too sexual, including the erectile response capacity, should leave the snuff and other drugs, drink in moderation and pay attention to drugs that are prescribed. Each time we know more about the possible adverse effects of some antisexuales. If difficulties arise sexual being medicated, we must consult with the doctor in this regard. And who is suffering from any systemic disease control and follow medical advice is to look after their health, too sexual.

Erectile dysfunction

The difficulty or inability to achieve or maintain an erection sufficient to carry out penetration and make intercourse has been historically known by the name of impotence.

This name, with a large negative charge, seemed to describe both the physical impossibility as the frustration of the patient and health professionals who had to deal with these cases very few resources. Fortunately, today we talk about erectile dysfunction. This represents more than a name change. There are new therapies, new pharmacological and surgical remedies that have banished the gloom of this sexual problem and allow clinical response to this that sexual dysfunction is estimated that can affect almost two million Spanish. In fact, erectile dysfunction and premature ejaculation are the problems of a sexual nature more frequent among boys, impacting on the quality of life of those who suffer as a partner.

Erectile dysfunction and premature ejaculation are the problems of a sexual nature more frequent among boys Another consideration relevant to the need to address the response capacity of man's erection is that it can behave like a sentinel symptom of other underlying diseases, such as hypertension, atherosclerosis, diabetes and so on.

The first major study on the incidence among the population of this problem was the so-called MMAS (Massachusetts Male Aging Study) conducted in the United States in 1994 in 1290 men aged between 40 and 70 years. The prevalence of erectile dysfunction of any degree was 52% of the male population. Subsequently, Spain (1999) the survey was conducted EDEM (Epidemiology of erectile dysfunction Men's), which was assessed at 2476 Spanish men, between 25 and 70 years of age. We found some degree of erectile dysfunction in 12.1% of cases. In the Spanish case, if we look at the range that includes men between 40-70 years, 24.6% suffer from erectile dysfunction, which shows that the prevalence of erectile dysfunction in our country is less than that detected in the MMAS. Both studies showed that those sexologists constatábamos in our daily consultations: the incidence of erectile dysfunction increases with age .

However, it is not uncommon for a man to have temporary erection problems at some point in their lives. If you ever happen to be isolated should not be cause for concern. Erectile dysfunction by age From the perspective of the causes and the most suitable type of treatment, age is a factor. Erectile dysfunction is most frequent causes in different periods of human evolution. In the young "A year ago that I am powerless. Has been since I have a girlfriend and we wanted to have sex. I do not know what's happening, but I avoid that we are alone and I apologize for giving such a situation does not happen. It is increasingly difficult to convince I am not that nothing happens. " This is the case of John, who with scarcely 18 years and experienced the frustration and anguish of a man who is seen as powerless. "As we started to leave, not the friends stopped to tell 'Already you've pulled?" and so on. ante conceal them, but I felt compelled to do with it as soon as possible. Although it was not quite sure what they wanted to do when she and I were alone the first few times. " Juan erectile dysfunction is due to the psychological pressure that it causes the responsibility that he himself is attributed to "get it right as a man." The idea of meeting a guy who has not had sexual experience after serving as a slab, although they do not know exactly what needs to be met, feels that the pleasure of your girl is his responsibility and foremost the responsibility of his penis.

These cases are quickly and easily treatable. In the young adult "Since a few months ago I can not get an erection. My wife and I work, get home late and tired, barely forces as something for dinner and tombs to rest and sleep. In the company things are going well, what happens is I have a lot of work, and I like it, but it is much. The truth is that long ago that sex is merely a kind of obligation over, comes the weekend and plays. Many times I really wanted to rest . If we go out to dinner and a drink, what I really want to do is sleep later, but if we do not do is not normal. Now, since I have no erection, things are much worse. Haunts me the idea of sex, the weekend. She notes that, and avoid being more aggressive with me.

We are discussing more for anything. " The sex therapy progresses faster and more effective if both partners are involved in the process Luis, 32, works at a company in which he is appreciated for his dedication and professional success. It has no conflict with Rose (29 years, his wife) but work stress, lack of time for them, and now their difficulties in bed, have begun a process that, not having been consulted, their relationship rapidly deteriorate . Work-related stress, the feeling of being overwhelmed, is the initial trigger of their erectile dysfunction.

These failures erection occurs when there are labor problems or job loss. In many cases, the processes depression triggered by the situations of unemployment caused erectile dysfunction. Not surprisingly, the depressive states are very harmful on the sexual response. Even at times, lack of erection associated with lack of sexual desire is the first and perhaps the only manifestation of the depressive disorder. The treatment of these cases of erectile dysfunction may involve simultaneous tables coping with anxiety, depression and other psychological conflict of basic or partner (table DE3), so at times, and for a brief and transitory, may require the use of drugs such as antidepressants or anxiolytics in the process of sex therapy.

Thus, it provides that the patient will enjoy the self-sufficient and to focus specifically on the sexual problem, where the involvement of your partner will be key to facilitating the resolution of the problem. One factor that contributes to a possible depression or anxious is that, in addition, there is a separation or divorce. On other occasions, the man has no partner and precisely their fear of failure makes autosabotee any fledgling relationship in sight that could end in sex. The fear of not being able to size it increasingly moving away from social relations. In all cases where men have no partner, the sex therapy is even more important and decisive. Obviously, the process of therapy is typically more prolonged and there is addressed to support their self-esteem.

In middle-aged adults "Since a few months ago I do not have erections with my wife. I've tried but did not get, I get nervous, because before I started thinking that I can not succeed. I have 54 years, until a year ago had ever lost an erection. We gave no importance, but now, not stand erection. If you do not ejaculate soon, I lose the erection. At first, my wife told me not to worry, but I see ever more distant. I had come to ask whether there is another. Not I know how to convince them that I do not understand what happens. " Adolfo, smoking a packet and a half of snuff daily, with an office job that you get a sedentary life, without sufficient physical exercise, with a few pounds over, a slightly high blood pressure and with some "cholesterol" is suffering from a mild ailment in its vascular system.

The mechanism of penile erection is part of that system so that everything that affects the circulation, affects the erection. Not that I can not get an erection by all the things that physically happen, but if it adds to the concern and to have it self, completing the circle of factors that have recently deteriorated erect their response. Addressing the problem of Adolfo is relatively fast if it has to start with the collaboration of his accomplice wife. The therapy sexual advances always faster and more effective if both partners are involved in the process. It is clear that improving their quality of life is also crucial to improve their erection during the next few years, which will require the treatment of medical problems and, in a predictable manner, with the help of a group of drugs prosexuales, the PDE5 inhibitors (Viagra, Cialis, Levitra).

It should warn that drugs that are cited have to be taken under medical prescription. This is a drug that is not safe if ingested without the supervision of a physician and with the appropriate dosage. In addition, for those who might be tempted to increase its power thanks to them, it should warn you that it is not. As a drug that is, cure a disease but will not be used for other faculties.

In the older man

The elderly is not a disease. Fortunately, more and more men arrive at a certain age in a healthy state. In this situation, there was no reason to expect any problems with sexual response. There is no retirement age sex. However, today too many men who accumulate factors that impair their health and sexuality is a fundamental aspect of health, so it will be increasing cases of erectile dysfunction with age .

The more the disease will manifest itself, especially those that affect the circulatory and nervous systems, the more likely it is that this will translate into factors that reduce capacity for erection in men. Other factors that often are in addition to those who degrade the quality of erections are the same drugs that treat such diseases, which often have side effects such as disruption of the ability of erection of the penis with a greater or lesser intensity. The vast majority of cases of erectile dysfunction are easily diagnosable when addressing the medical, psychological and social The treatment of erectile dysfunction in the older man passes the medical care of the disease or diseases that make it appear. Often the treatment of these cases also benefits from the use of PDE5 inhibitor above (Viagra, Cialis, Levitra), which, as a sort of "chemical crutches," are useful, either at the beginning of the recovery of the erectile capacity or are a drug support more or less permanently to humans, depending on your overall state of health.

The success is the proper integration of these resources and medical pharmacology in the process of sex therapy, which, if any, benefits from the involvement of the couple, as usually happens in the treatment of sexual problems.

Solutions

Fortunately, today the vast majority of cases of erectile dysfunction are easily diagnosable when addressing the medical aspects (his physical condition, disease, drugs, drugs, etc..), Psychological (how it is and how it is impacting the partner, if any) and social (the context in which they lived and the problem) that may be implicated in the onset of dysfunction. The sex therapy has been aided by the integration of psychotherapeutic resources for the increasing development of the sexual pharmacology, which provides medicines whose optimal management is in the hands of the medical sexologist at the appropriate therapeutic intervention for each case.

As in almost every sexual dysfunction, the prognosis is better in cases involving a couple with no major conflicts and with a willingness to active collaboration between the two. Major medical causes of erectile dysfunction

Source: Consensus on Erectile Dysfunction.

Prepared by 12 scientists. 2002 Conflicts Couples Problems with self-image Low self-esteem Stress Problems in the social environment or labor Factors of development and sex education - Neuropathy: very prohibitive education about sex.

- Beliefs neuropathy sex wrong.

- Sexual Trauma neuropathy in childhood or early experiences.

- Neuropathy Sexual abuse in childhood.

- Fear neuropathy excessive pregnancy and sexually transmitted infections.

Other sexual disorders and sexual identity

- Paraphilias

- Issues of sexual identity

- Issues of sexual orientation

- Premature ejaculation

- Disorders of sexual desire Anxiety performance and attitude of spectator Psychiatric Disorders - Depression

- Anxiety

- Psycho Sexual and psychological causes of erectile dysfunction

Source: Consensus on Erectile Dysfunction. Prepared by 12 scientists. 2002 Vascular causes: 60-80% Neurological causes: 10-20%

Hormonal causes: 5-10% Generic pathologies

- Generic Pathologies

- Arteriosclerosis

- Snuff

- Hyperlipidemia

- HTA

- Diabetes

- Peyronie's Disease

- Pelvic Fractures

- Injuries perineal

- Fracture chambers

- Kidney transplant heterotopic

- Leriche syndrome

- Bypass aortoiliaco or aortofemoral

- Aftermath of the Radiotherapy

- Aftermath of priapism Of the central nervous system

- Stroke

- Sleep apnea syndrome

- Alzheimer's Disease

- Parkinson's disease

- Brain tumor Of the spinal cord

- Injuries

- Cause compressive (Herniated Disc)

- Demyelinating disease (Escl. Multiple)

- Cause tumor (medullary tumor)

- Vascular Disease (Medullary Infarction)

- Infectious Disease (Tabes dorsal)

- Myelomeningocele

- Degenerative diseases Iatrogenia Peripheral nerves

- Diabetic neuropathy

- Alcoholic Neuropathy

- Aftermath postsurgical

- Prostatectomy

- Cystoprostatectomy

- Transurethral resection of prostate

- Surgery of the spinal cord

- Rectal Amputation Excess estrogen

- Latrogénico exogenous

- Liver Diseases

- Tumor

- Producing estradiol or HCG Hyperprolactinemia

- Latrogénica by drugs

- Pituitary tumor Hypogonadism

- Hypogonadism

- Hipergonadotróficos Thyroid dysfunction

- Hyperthyroidism

- Hypothyroidism Malfunctioning adrenal

- Cushing's syndrome and disease

- Adrenal insufficiency Hiponutriciones severe

Major causes resulting from the ingestion of erectile dysfunction drugs

Source: Consensus on Erectile Dysfunction.

Prepared by 12 scientists. 2002 Drugs with hormonal action

- Reduce or inhibit the action of testosterone: antiandrogens, estrogens, anabolic steroids, spironolactone, ketoconazole, digoxin, clofibrato, cimetidine.

- Increase levels of prolactin, a hormone whose main function is to stimulate milk production in nursing mothers, although it is present in all people, both men and women: cimetidine, metoclopramide, phenothiazines, opiates, endorphins, haloperidol, Tricyclic antidepressants, methyldopa. Psychotropic drugs

- Antipsychotics and neuroleptic: phenothiazines, tioxantinas, thioridazine, butirofenonas.

-Antidepressants: Tricyclic tetracíclicos, IMAOs, SSRIs.

- Anxiety: benzodiazepines. Antihypertensive drugs

- Sympatholytic: clonidine, methyldopa, reserpine, guanethidine.

- Beta-adrenergic blockers: propranolol, pindolol, atenolol, metoprolol.

- Diuretics: spironolactone, thiazides.

Difficulties with vaginal lubrication

Defines the disorder of the female sexual arousal such as persistent or recurrent inability to achieve or sustain arousal. The symptom that sees women and that it best describes the disorder is difficult to lubricate your vagina in response to a proper sexual stimulation. It has the feeling of staying dry so that the penetration, attempted penetration or the mere manipulation of the vulva it is frankly uncomfortable or annoying. It is less or not at all significant for a woman to the fact that this decline in the genital swelling adequate (or clitoridiana lip) and lack of elongation, vaginal dilation and excitement. The specific prevalence of the disorder has not been well defined.

The studies in this regard include among all the female sexual dysfunction, so that describes a prevalence ranging from 25% to 63% of the female population. In any case, the disorder of the female sexual arousal is a key factor in the woman's age. This disorder is usually presented especially after menopause, whether surgical or physiological. With the cessation of the rule (menopause) is common to see this problem, which is triggered by lack of estrogen in women, as discussed in the chapter devoted to sexuality in menopause and menopause. Other medical causes, much less frequent, can be anything from certain illnesses, the very fabric of genital atrophy (kraurosis), usually at an advanced age, and can be a side effect of some drugs, such as the repeated use of Certain creams with steroids.

When the arousal disorder appears in younger women, who have not yet reached its climacteric, usually due to psychological causes, mostly related with concern and fear about the sexual experience itself immediately: fear of pregnancy, infection, to be discovered to be rejected by the couple, and so on. In the younger girls is not uncommon that it is a simple technique of bad sexual stimulation. The little game prior to sexual intercourse which prevents the vagina is lubricated adequately, so that both attempts at penetration as the same penetration are upset, something that disconnects even more to women in their process of arousal, which in turn away the possibility that its response to flow lubrication.

Vaginal dryness

It is the main annoyance of women with sexual arousal disorder. It is important that every woman, especially one that is at its start to feel menopause and vaginal dryness, know how to avoid this to be an insurmountable obstacle to their sexual enjoyment. Of entry Any woman who begins to receive vaginal dryness and/or insufficient lubrication during sexual intercourse, regardless of their age, should devote special attention to the enjoyment of non-coital sexual game, that is, fondling of all kinds, which although they are key to the enjoyment of any partner in such cases can make the difference between feeling pleasure or annoyance. It is very important to take care of the vulva and vagina, like any other part of our body. If we provide to our skin care creams, the vulva and vagina also require attention when displayed vaginal dryness. In the pharmacy can be found without the need for a prescription, gels containing soy isoflavones, moisturizing and softening properties that help prevent vaginal dryness.

Isoflavones tablets, capsules Evening primrose oil and vitamins A and E also improve the status of full-body skin and mucous membranes. In the chapter on sexuality in menopause and menopause are commented on the criteria on the appropriateness of hormone replacement therapy (HRT), as well as the constraints that must be followed during the treatment of hormone replacement with estrogen and progestins. Whether the woman uses HRT, more particularly, if you do not, it is remarkable the advantage, in terms of quality of life and ease to continue to enjoy their sexuality, the use of vaginal lubricants and gels above. In the case of the use of lubricants, it is preferable that they are water-based or water-soluble. Lubricants that do not dissolve in water coming from oil, so fundamental is the Vaseline and other mineral oils. These, because of its indissoluble in water, they adhere to the vaginal mucosa, which can facilitate the development of germs and infections disguise until they are too advanced. It is desirable that the lubricant has a slightly acidic pH, no higher than 5.0, similar to normal vagina and that allows the best defense against infections or imbalances in the vaginal bacterial flora.

It is preferable to a gel light, easy to implement. There is less risk of vaginal irritation as possible when the lubricant has no substance to it in taste, smell or color. Better if its effect is long-lasting lubricant. This facilitates the spontaneity in the sexual encounter by not needing to be outstanding at the time of its application prior to intercourse. The gels isoflavones fulfilled that role. Finally, it is recommended that the lubricant is easily removed with washing, which also occurs in the more soluble in water. The gels isoflavones do not require washing because they act as a moisturizer and softener.

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Introduction

To understand the sexual problems should be from the conception of sexuality as a power with psychological components, biological and social. In fact, the unrest may affect the physical response, the psychological balance, and even social relationships. The latter aspect is often collide, but there are many men with erectile dysfunction or premature ejaculation who feel very uncomfortable when your friends talk about sex, which leads them to fear and dodging encounters distended. Not all people the implications are the same and not all sexual problems have the same causes.

There are those that affect so clear to the organ function, resulting from disease or consumption of drugs or other substances, and other content more psychological, a product of a weak and often inadequate sex education. Also controladasy stressful circumstances do not play their role, because these sexual problems are coping mechanisms to reduce anxiety. Seems to lie that happen, but we live in a society in which sex can still be viewed as something ugly and dirty, that's just talking about sensible way. Sometimes we have to remember that we are many millions of people throughout the world, that all or almost all, if we exclude the insemination, we were born of a sexual intercourse, from contact between male and female genitalia. Our reproduction is, therefore, sexual, but sexuality is something healthy and intrinsic to human beings, is not restricted to playback, however important it may be. It is also a form of privileged communication, both between people of different sex, as the same, and even seeks contact with oneself. The sex provides pleasure and satisfaction and is linked to a healthy life, as the World Health Organization (WHO) has been in charge of enacting.

The sexologists William Masters, Virginia Johnson and Robert Kolodny listed some of the ways it can restrict eroticism. To make this guide we have expanded and revised, as our clinical experience: - The custom of having sexual relations "only at the right time."

- Lack of privacy.

- The limits of time and tiredness, and being unable to include in our "agenda" erotic encounters.

- Be solely responsible for the relationship, thinking that the pleasure of others depend only on me.

- At the other extreme, do not take into consideration the other. "I'm what I like and do not share." - The attitude of confronting the sexual relationship, instead of enjoying sex.

- Believing that sexual satisfaction is only for people young and attractive.

- To think, worry or distracted during sex.

- Be angry with the couple, without telling, but acting accordingly, distilling malaise. These and other elements of eroticism blockers may evolve into situations of greater severity, and lead to sexual problems that impact negatively on the desire, arousal or orgasm / ejaculation. Sexual problems can be categorized by their appearance. So, are called "primary" when they are present from the beginning of the erotic life. There is talk of secondary sexual problems when they appear after a period of proper functioning. For its main etiology, sexual problems can be especially organic, psychological or basically have a sociocultural basis. In all cases, the biological, psychological and social partners have their importance, as they relate to each other. But it is very important to define good cause to conduct a proper and effective treatment.

LACK OF SEXUAL DESIRE

The incidence and prevalence of the problems of desire are difficult to establish. Different studies authors and do not match, especially by differences in diagnostic criteria, and are often confused with the tables of lack of sexual desire and dislikes. With them there is consensus that the lack of desire is the most common sexual problem in women and that, to date, the lack of desire affects more women (prevalence, according to authors, between 22% and 51% of the female population) than men (prevalence, according to authors, between 10% and 15% of males). People who have this problem often make excuses to avoid a sexual relationship with her partner.

Almost never goes to the time your partner, always have some excuse not yet collect the kitchen, a very interesting program on TV, an urgent work ... Sometimes that means they escape a feeling of guilt for not responding to an implicit commitment and increase the nerves to the extent that dilates the meeting. It can be a lifelong disorder (primary) or acquired (secondary), generalized (with all the couples) or situational (with a couple specific). Inhibited sexual desire in the absence of erotic feelings leads to see sex as something unpleasant, even a punishment. This problem is widespread in the absence of sexual interest towards any person or circumstance, and if you do not see situational interest in the couple, but the person is encouraged to others or to masturbation. Sometimes, rather than a desire inhibited, there may be just a discrepancy in the levels of sexual interest between the two partners who own levels of interest within the normal limit. The complaint about the lack of sexual desire is very common.

As most frequent cause appointing a high degree of stress to which humans are subjected to daily life, where everything is usually scheduled, unless the enjoyment of the relationship and sexual intimacy with the couple.

Causes

Domestic responsibilities

Domestic life has its conditions and the theory of gender equity, in which men and women shared rights and responsibilities, works out to more doors in the privacy of home. These reminiscences of the patriarchal model is the basis of this conflict of roles and make many men feel unsafe in their role and disappointed by not having a woman that they resolve the issue home. The women, for their part, complain about his dual role. In particular, those with higher job skills and economic independence posed a clear lack of enthusiasm for a couple living together, fearing the burden of responsibility for the family, of which so many men know how escaquearse.

Data from the Institute of Women on the division of housework suggest that the man spends on average 1 hour and 32 minutes on household chores, compared to 4 hours 2 minutes devoted to women a day. But, what is all this? Do you not talking of inhibited sexual desire? Certainly, but this is one of the most recurrent issues in sex therapy when it comes to the lack of desire. We believe therefore that it is worth devoting a few lines to reflect on the most immediate, sometimes so close neither of us realize, but it represents a big influence on our sex lives. Relationship problems and poor choice of a partner other times, lack of desire is due to relationship problems as if any member of the couple does not feel intimately connected to the partner.

There are people who have serious difficulties linked to emotionally, proximity to them and scares the merger involving the sexual act gives you vertigo. These people often have stormy relations with large bronzes and reconciliation, without which there is no logic, since the emotional seesaw was due to the internal need of proximity and distance. Do not confuse the temporary absence of desire to have sex with the lack of sexual desire, which is a physical disorder, with roots and / or psychological In other couples there are power struggles, in which the couple seems to be married against one another, rather than with the other. Rather than add, subtract. They are in continual conflict and his house is not home, but a minefield in which one can not lower our guard. Under these conditions it is a miracle that flourish sexual desire. In these cases may be intermittent episodes of inhibited sexual desire. Another cause of the lack of desire is the inappropriate choice of partner. Although we seem incredible, some people are married and are matched with those who just do not wake up any passion.

We can not forget that appetite involves passion, strong desire for one thing and also suffering. Many people are not willing to suffering because it represents the passion if not passionately craves, loss, if it is not a trauma. On many occasions, people tend to have suffered some disappointment in love and people associated with attractive from a sexual point of view, as dangerous, and that can make them suffer. Inadequate sex education or traumatic experiences Inadequate sex education, with negative attitudes and manifestations sexofóbicas, with fear of sin and sex associated with dirty generates a difficult terrain for the healthy expression of sexuality because they hamper the erotic imagery, antechamber of sexual desire.

The traumatic sexual experiences and negative, such as sexual abuse in childhood, rape, sexual harassment and other attacks against sexual freedom can have an impact on some faults of desire. It should be noted that sexual abuse of children suffer both girls and boys and may have negative repercussions in adulthood of men and women.

Treatment

The problems of inhibited sexual desire often need care sexologists, which includes working predisposing factors related to the history and erotic sex education, as well as others that have to do with deeper aspects and relate well with the ties with parents and mothers with fear or to engage in an emotional level. The lack of desire often have a significant impact on the couple relationship, especially if he is the man who suffers from this lack.

The woman may feel rejected and unattractive, causing great uncertainty with regard to the relationship. Men tend to make this situation better, thanks to gender stereotypes that lead to a vision of women less willing to enjoy sex, while men often appear more willing. It is very important to talk to the couple in the decline of desire, making it clear that he has nothing to do with it is less attractive and has lost interest in the relationship. Addressing the means of pleasure To address the lack of sexual desire is essential to work pathways of pleasure. By way of explanation, we think that there are neural pathways associated with pleasure and sexual desire. And so that everything works well, the transit of desire to pleasure has to be an attractive path full of pleasant stimuli, as is supposed to be the erotic encounter. People who have problems with desire not find the way. And when they find it, is fraught with obstacles saboteurs. Call fault, strange feelings of discomfort, overwhelmed ...

Instead of enjoying a beautiful landscape, confronted with the fear of the tunnel unexpected and overwhelming. The treatment involves, metaphorically, out of the tunnel and retrieve, or enjoy for the first time, a smooth and enjoyable sexuality in its entirety: desire, arousal, orgasm and resolution. Do not confuse the temporary absence of sexual desire with the problem to which we refer. It is considered a disorder where a lack of desire is persistent and recurrent and going for at least 6 months. The step-by-moment point and time should not be worried, but they come very well the positive reinforcement and devote some time and mimarnos guard. Each has its own source of pleasure. A massage, a dinner at the candlelight, a walk in the countryside, go to the hairdresser or a good aromatic bath are small details that carry our energy and provide us with small doses of pleasure, which is also a vaccine against depression and anxiety. And, in addition to these reinforcements, it is necessary to promote the erotic inclination by providing appropriate incentives. The temporary decline in the desire to have sexual intercourse or masturbation is normal. Mainly due to excess activity, to be convalescing from a medical condition, to disputes between couples or any other circumstance. Or you can simply go through periods of reduced appetite, as happens to us with food.

The person with a lack of desire do not perceive the enjoyment of sex and sabotages so unconscious with a thousand inconveniences. And it is easy, because in this society we have an overload of stimuli with a limited time: work, household chores, personal care, shopping, child care, social relationships, family commitments, travel, movies, music, reading, video games, TV at all hours and in addition, computers connected to the Internet. Who has time for sex? There are too many things to do. So life is the person with a lack of desire, who has time for everything, less to maintain relations of sexual intimacy with another person or with itself, deprived of a gift, a privilege of human nature and depriving a person love of complicity that involves the sharing sexual pleasure. And it happens that there is discomfort for the person who suffers and for the couple.

To combat it, the first step is to want to overcome it, because if you are willing to educate the desire and explore the sensations, gradually discovering ways and means of entering the mood of a sexual encounter. One way is to read erotic literature, movies, using the imagination, or have fantasies. The dosage and the content of these stimuli is inversely proportional to the inhibition that the person has, because if the inhibition is very large, it may be counterproductive and find unpleasant stimuli. For this reason it has to be a smooth path, where the sexologist came to help and remove the fears, being aware of the needs and conditions of the patient and providing it to realize its limitations car while he was showing its potential.

Treatment with testosterone

Has been related testosterone, a hormone typically considered masculine, with the maintenance of the desire and female sexual response. Especially when this lack of sexual response coincides with the onset of menopause. Some specialists recommend treatment with testosterone patches, the desire to improve and prolong the sexual life of women who file sexual desire disorder hypoactivity. However, the results of studies funded by the pharmaceutical industry have been answered by other professionals who feel that the responses obtained with medication, in which women have to spend 3 to 5 relations per month on average, do not justify their side effects. Such effects highlight the altered cholesterol levels, the development of exaggerated musculature, voice changes or acne, or presence of hair on his face and other body parts. In this regard, it has been pointed out that the key to ensure security is to establish a minimum effective dose, since the administration of testosterone replacement therapy is an attempt to restore the natural hormonal balance. If it passes the peak, there are adverse effects.

Taking into account these side effects, patients require monitoring to include at least one examination on the onset or worsening of hirsutism (presence of hair), acne or masculinization (such as change of voice or growth of the clitoris) breast exam and the extraction of a blood sample to assess fat and glucose and an analysis of liver function. The treatment of any sexual problem entails taking into account all the resources, including medications. It is essential for a diagnosis personalized benefit of all resources with minimal side effects. For now it appears that treatment with testosterone is not the first option to a lack of female desire, especially since in most cases the disorder can have psychological causes and characteristic of the relationship.

Sexual Aversion

An extreme form of sexual disorder is sexual aversion. It consists of the rejection intense, persistent and recurrent sexual contact. Supposed to avoid any intimate relationship with the couple, sometimes not only genital contact, but any other type of stroke that is interpreted as a preamble intercourse. This causes a change discomfort and is often accused hinder interpersonal relationships, especially for couples. The sexual aversion disorder occurs from time to time in men and much more often in women. The patients complain of anxiety, fear or disgust with regard to sexual situations. It can be a lifelong disorder (primary) or acquired (secondary), generalized (all couples) or situational (with a couple specific).

In the extreme form of sexual aversion, the person not only lacks sexual desire, but can also find sex repulsive, disgusting and repulsive. If there ever since, the aversion to sexual contact may be a sexual trauma such as incest, sexual abuse or rape. It may also be the result of a very repressive atmosphere, sometimes enhanced by a rigid and orthodox religious training, or it may have started after some early attempts at intercourse that occurred dyspareunia, ie pain in intercourse. In the latter case, even after disappearing dyspareunia, remains the memory of pain. When it comes to a disorder acquired, after a period of normal operation, its origin may be in a partnership or a traumatic experience.

The aversion can generate a response fóbica (even anxiety) in which case they may also be present unrealistic fears of domination or less aware of bodily harm. Situational sexual aversion may occur in people who attempt or expect to have relationships inconsistent with their sexual orientation, for example, in some cases of homosexuality is not accepted, in which, for social or family pressure, imposing relationships with the opposite sex in order to normalize their lives.

Treatment

The treatment of sexual aversion and phobia is designed to enable the person to dramatically improve their sexual communication. Whenever possible, is aimed at removing the causes that triggered the disorder. The intervention involves integrating sexological explore:

1 - The predisposing factors, namely those having to do with the history of that person, such as sex education, the love story, or sexually traumatic situations.

2 - The precipitating factors. At what point is true and what may have been triggered.

3 - The factors maintainers, related to the present time, what makes the episode to be repeated and what the attitude of the couple at the situation. Sometimes it will be necessary to support drug research. The tables in distress can be treated with tricyclic antidepressants, selective reuptake inhibitors of serotonin, monoamine inhibitors or benzodiazepines. Favoring his erotic imagery, to help them find their own model of sexual enjoyment is indicated in a special way in these people.

Each person should listen to themselves and choose what you like and you feel like, and what you do not encourage. The problem is that these people have some very poor concerning erotic and we must help them, always respecting their preferences. Consideration should be given to the world of erotic preferences is very broad and that what is challenging for one person to another may be repulsive. The sexologist is mindful of this precept and must accompany the person or the couple to develop their own field of sexual expression, which can feel comfortable and enjoy the potential of pleasure that sexuality offers.

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