SEXUAL PERFORMANCE PROBLEMS: AROUSAL PROBLEMS

With the matters of sex drive differences and sexual response as a backdrop, let us turn now to discussion of various problems that occasionally interfere with full sexual relating. As you read on, remember that most of us experience each of these forms of sexual problems sometime. The important question is whether you or your partner is experiencing any of these intimacy-squelching sexual patterns consistently.
Some people have adequate levels of sex drive but simply have difficulty becoming sexually aroused. Despite high levels of desire, some men find that their penises just will not get erect or stay erect, and some women find that their vaginas just will not become lubricated.
In men this problem is called impotence, and it can occur in various forms. Some men cannot attain any degree of erection. Others are able to experience erection but complain that their erections are not hard enough for intercourse. Still other men are able to get erect during foreplay but lose their erections (without experiencing orgasm or ejaculation) before or shortly after beginning intercourse. A special form of impotence that affects a small percentage of men involves being able to ejaculate without an erection. This is possible because erection and ejaculation are controlled by different aspects of the central nervous system.
Finally, some men are able to enjoy full erections throughout the sexual response cycle in certain situations but not during intercourse. For example, some men have no difficulty with erection while masturbating or while receiving manual or oral stimulation from their partner, but they are unable to maintain erection once intercourse begins.
Female sexual arousal difficulties are less evident, for obvious reasons. A man's degree of erection is more easily measured than are the degrees of vaginal lubrication and swelling that signal female arousal. It is therefore more difficult to be exact in describing the variations of arousal problems experienced by women. Let it suffice to say that many women, too, experience high levels of sexual desire but no cooperation from their genitals in response to sexual stimulation. Some such women are able to have reflexive orgasms in response to sexual stimulation, but—like men who ejaculate without erection—they get only limited gratification from this pattern of sexual response.
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TAKING ESTROGEN

With the onset of menopause, many women suffer from hot flashes and night sweats. Arlene March, 56, a Los Angeles psychotherapist, says she started getting hot flashes 5 years ago. “I’d be working,” she recalls, “and suddenly feel intense heat all over my body. I’d break out in a sweat. I’d have to stop work. Then Dr. Mishell prescribed estrogen pills, and I’ve not had a day of discomfort.”
Some women experience a drying and thinning of vaginal tissues in the absence of estrogen, making sex painful. They also might suffer urinary tract infections and incontinence. Estrogen therapy often helps.
Among the physicians consulted, the most cautious was Dr. Morris Notelovitz, founder of the nation’s first Menopause Center, at the University of Florida, and head of the Women’s Medical and Diagnostic Center in Gainesville, Florida. He says each symptom needs a different treatment and advises that genital tract problems be given estrogen treatment for a couple of years at most. He also urges special measurements of the bones before prescribing estrogen therapy for osteoporosis.
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WOMEN’S HEALTH

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