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Can Sexual Problems Be ‘All in Your Head’?

Nov. 4, 2010
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How do you know when a sexual problem (e.g. lack of desire or premature ejaculation) is a psychological problem or a physical one?

In the United States, we tend to view our bodies and our minds as separate entities rather than as a whole. Thus, health problems are often seen as either physical or psychological, not both. However, for sexual issues especially, it's often hard to extricate the two. Our sexual performance is linked to our sexual self-image and confidence, so our mental state can end up having an impact on our physical bodies. In addition, some health issues, such as depression, are viewed as psychological, but have substantial effects on our physical well-being, including sexual desire.

For example, stress is a notorious libido-killer, whether it's from our jobs, relationship issues, parenting, school, or anything else in our busy lives. While stress is an external factor that we can control to some extent and not a "disease" in the classic sense of the word, stress can have a very real impact on our physical and mental health and can be the root cause of lack of sexual desire.

That said, the only way to sort out what might be going on with sexual problems such as lack of desire or premature ejaculation is to talk to a health care provider and/or counselor. There may be a physical cause for lack of desire, such as diabetes, low testosterone levels, clinical depression, or medication such as birth control pills or antidepressants, and a visit to a doctor or nurse practitioner can help rule out or confirm these causes. Premature ejaculation can have some of these same physical causes, although rarely. Don't be afraid to talk to a health care provider about these issues, as they are incredibly common, and the majority of people have experienced them at some point in their lives.

It's more likely that sexual problems are caused by psychological issues or that it will be impossible to pin down exactly where problems stem from. Unless there is a specific, treatable physical condition that is behind a sexual problem, it's more important to think about what can be done to change the problem than it is to sort out exactly where it's coming from. Premature ejaculation, for example, can be caused by anxiety, depression, specific sexual situations, not having ejaculated recently, new sexual partners or learned behavior (especially in younger men who may have taught themselves to ejaculate quickly when masturbating). Whatever the cause, doctors or counselors are likely to suggest practicing techniques during masturbation or sex that are designed for men to gain a greater awareness of their own bodily sensations and when the "point of no return" happens for them. For example, the "stop-start" technique involves starting sexual stimulation, then stopping when a man begins to feel close to ejaculation, taking a short break, and then starting stimulation again, repeating this cycle to help improve sexual communication with a partner and self-awareness.

Health problems in our society are often treated as "quick fix" issues that only require popping a pill to treat. However, with sexual issues, it's more likely that some work rather than medication is what will be needed to right the problem. Counseling, reducing stress, getting more sleep, reducing alcohol and drug use, increasing a sense of intimacy and trust with our sexual partners, and practicing different types of sexual stimulation techniques are the types of lifestyle changes that will have the biggest impact on revving up your sex life again.

Want Laura to answer your questions in SEXpress? Send them to
laura@shepex.com. Not all questions received will be answered in the column, and Laura cannot provide personal answers to questions that do not appear here. Questions sent to this address may be reproduced in this column, both in print and online, and may be edited for clarity and content.

Laura Anne Stuart has a master’s degree in public health and has worked as a sexuality educator for more than a decade. She owns the
Tool Shed, an erotic boutique on Milwaukee’s East Side.


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