In men, the main problem lies in the disorder (dysfunction) of erection, i.e., difficulty in achieving or maintaining an erection sufficient to have satisfactory sexual intercourse. If in some cases an erection occurs normally, for example, during masturbation, while sleeping or with another partner, then the cause of the violation is likely to be psychogenic. In other cases, the correct diagnosis of erectile dysfunction (dysfunction) of an inorganic nature depends on special studies or reactions to psychotherapy.
Diagnostic criteria. In men, an attempt at sexual contact does not result in an erection sufficient for engaging in sexual intercourse, and the violation of erectile function occurs in one of the following options:
a) an erection occurs in the early stages of sexual contact, disappearing partially or completely when attempting to perform sexual intercourse (before the onset of ejaculation);
b) an erection occurs only outside the situation of sexual intercourse;
c) the arising erection is incomplete (partial) and insufficient for carrying out coitus;
d) an erection is completely absent.
– psychogenic impotence.
Excluded (this category does not apply):
– impotence of organic origin.
In women, the main problem is the dryness of the vagina or the absence of its moisture (lubrication). The reason may be psychogenic or organic (for example, infectious), or it is a question of estrogenic deficiency (for example, after the onset of menopause). Women rarely complain of primary vaginal dryness, unless it appears as a symptom of postmenopausal estrogen deficiency.
– violation of genital reactions (lack of physiological signs of sexual arousal) is manifested in one of the following options:
a) lekurbation is absent in all relevant situations;
b) lubrication may appear at the beginning, being insufficient to provide subjectively pleasant insertions of the penis and / or frictions;
c) lubrication occurs normally only in certain situations (for example, with a certain partner, during masturbation, outside of sexual intercourse).
– Disorder of sexual arousal in women.
K. Imielinsky (1986) attributes this type of disorders to disorders of the sexual readiness complex, that is, the physiological provision of a woman’s readiness for coitus. At the same time, inadequate hydration of the vagina and relaxation of its muscles impede the introitus and the entire course of sexual intercourse. Most often, disorders of the sexual readiness complex occur as a result of “rejection” of the partner and lack of desire for intimacy or insufficient sexual arousal in cases of inadequate or too short stimulation from the partner, generalized reduction (absence) of libido, as well as in an unfavorable situation causing the woman various concerns.
Disorders of the sexual readiness complex during the period of sexual intercourse are usually manifested by the cessation of vaginal secretion, which is equivalent to the loss of an erection in a man during coital frictions before ejaculation. The resulting dryness of the vaginal mucosa complicates frictional movements, which are accompanied by strong friction and cause painful sensations in both women and. at the man. This disorder is associated with the predominance of inhibition processes over sexual arousal. It is observed in situations involving the experience of fear of unwanted pregnancy; during a prolonged coitus, during which a woman, despite her aspiration, did not reach orgasm; with inadequate sexual stimulation from a partner during sexual intercourse; sometimes after a woman has an orgasm, if a man continues sexual intercourse. The frequency of disorders of the genital reaction in women is usually underestimated. According to the NHSLS survey (1994), 19% of women reported having problems with moisturizing the vagina.
The overwhelming majority of cases of seeking sexual help due to insufficiency or absence of a genital reaction are in men. Erectile dysfunction – the most common male sexual dysfunction. The frequency of erection disorders increases with age, reaching 5–8% in young men and reaching 75–80% by the age of 80. In the study of aging men in Massachusetts (MMAS), 1,709 men aged 40 to 70 years were subjected to a multidisciplinary survey. Of the total number of 1290 people surveyed, they fully answered all questions concerning their sexual life.
The following data on the prevalence of erection dysfunctions in middle and old age were obtained: minimal erectile dysfunction – 17%; moderate violations – 25% and total impotence – 10%. (N. Feldman, I. Goldstein, 1994). The causes of erection dysfunctions are very numerous and are associated with disorders of various systems that provide genital reactions (mental sphere, nervous, endocrine, urogenital, vascular), or their combination. Organic (biological) factors in the etiology of erectile dysfunctions, according to various estimates, range from 20-25% to 50-60%, and their proportion increases markedly in men older than 40-45 years.