Intimacy issues may cause sexual dysfunction

Maria Endah Hulupi, The Jakarta Post, Jakarta

Premature ejaculation? Ashamed of your penis size? Do you consider yourself frigid? No problem.

Now you can find medication, pills, tablets, herbal concoctions and other treatments, claiming to "improve" sexual performance or even cure sexual dysfunction on offer over the counter.

Despite the wide choice of treatments, however, sex experts advise people who have a sexual dysfunction to avoid trying to treat the problem by themselves. They said the problems might stem from different phases of sexual intercourse that might require different treatments, depending on the cause.

"Further diagnosis is needed to determine the cause of sexual dysfunction, which can affect both men and women. This way, the problem can be treated properly," said Akmal Taher, a urologist from the University of Indonesia, during a recent symposium to mark the 52nd anniversary of the university's School of Medicine.

Akmal explained that the causes of sexual dysfunction needed to be distinguished, based on the phases of intercourse from libido, arousal, ejaculation (for men), to orgasm, during which the problem might occur.

Most over-the-counter cures claim only to improve overall sexual performance but they cannot deal with specific problems in each of those sex phases.

"People with lack of libido don't need treatment for inability to ejaculate, for example," Akmal explained.

In the initial phase, the problem that affects men and women is mainly the loss of libido, which result in a reduced sexual appetite. This condition can arise because of hormonal changes, stress or depression, a traumatic sex history or after prostectomy.

In the arousal phase, men may suffer from erectile dysfunction, which renders them unable to have or sustain an erection for vaginal penetration. It can be triggered by organic problems, caused by vascular disease, diabetes mellitus, hypertension, certain medications, or psychological problems, such as marital difficulties or stress.

"It's also advisable to quit smoking because people who smoke are also prone to develop erectile dysfunction," Akmal warned.

He also identified another rare factor, priapism, (abnormal and often painful erection, even without erotic stimulus). This is usually caused by disease.

Sexual arousal disorder in women is "dry vagina" or inability to obtain adequate lubrication, which makes penetration painful. Akmal said this condition often occurred with postmenopausal women.

Women may also develop sexual pain disorders caused by dyspareunia (a genital pain that makes intercourse almost impossible) and vaginismus (involuntary spasms in the perineal muscles that hamper penetration).

In the ejaculation phase for men, problems that may arise are either premature, inhibited or retrograde ejaculation. The latter is a term for a condition in which the ejaculate is propelled back into the bladder rather than through the urethra. It is often suffered by men with diabetes.

And at the end of the phase is failure to reach orgasm. This condition affects both men and women and can be a result of surgery, hormonal deficiencies or trauma, among other things.

Estimating that the national total of people with sexual dysfunction was about 6 million people, Akmal said, however, that the number seeking professional help was very low.

"Many people are still reluctant to consult anyone over sex- related problems, and many blamed their situation on a stressful routine and thought that their sexual performance would automatically improve when the stress was over," he added.

According to another speaker, sex expert Wendie Pangkahila, problems in sexual intercourse have prompted many people to resort to ridiculous and often dangerous acts in their attempt to please their partner.

Desperate men think that soaking their penis in lukewarm tea, drinking certain potions, having a silicon or collagen injection or pumping their penis to enlarge it is the solution to their sexual problems. Other men have been reported to use penis accessories, or place something, like a pearl, under their penis or insert a goat feather onto the frenulum, the membrane supporting the penis, to satisfy their partner.

Women also commit similar acts. As vaginal lubrication is considered dirty by local men, frustrated women have been reported to insert herbs, wooden sticks or cleanse the vagina in their attempt to become "dry". "They are not aware that their actions could expose them to painful infection," Wendi explained.

He said that boredom could lead to sexual problems. But that could be prevented through a little creativity and variety, to create something different in the surroundings, the erotic stimulus, new positions or even appearance. "Anything pleasant but not dangerous that has been mutually agreed to can be done," he said.

Wendi also advised sexually active people to maintain their physical health (especially that of their sexual organs) by not trying to cure themselves without prior consultation.

Another piece of advice includes never to consider sex as routine, don't bring other problems to the bedroom and if you have sexual problems don't expect them to disappear overnight.