The essential feature of the sexual dysfunctions is inhibition in one or more of the phases, including disturbance in the subjective sense of pleasure or desire or in the objective performance. Either type of disturbance can occur alone or in combination. They can be lifelong or acquired, generalized or situational, and result from psychological factors, physiological factors, or combined factors. Sexual disorders can lead to or result from relational problems, and patients invariably develop an increasing fear of failure and self-consciousness about their sexual performance. Sexual dysfunctions are frequently associated with other mental disorders, such as depressive disorders, anxiety disorders and personality disorders etc. Sexual function can be adversely affected by stress of any kind, by emotional disorders, or by ignorance of sexual function and physiology. The dysfunction may be lifelong or acquired that is, it can develop after a period of normal functioning. The dysfunction may be generalized or limited to a specific partner or a certain situation.

Testosterone increases libido in both men and women, although estrogen is a key factor in the lubrication involved in female arousal and may increase sensitivity in the woman to stimulation. Progesterone mildly depresses desire in men and women as do excessive prolactin and cortisol. Oxytocin is involved in pleasurable sensations during sex and is found in higher levels in men and women following orgasm.

Masturbation is usually a normal precursor of object-related sexual behaviour. No other form of sexual activity has been more frequently discussed, more roundly condemned, and more universally practiced than masturbation. With the approach of puberty, the upsurge of sex hormones, and the development of secondary sex characteristics, there is an increase in sexual curiosity and masturbation. Adolescents are physically capable of coitus and orgasm, but are usually inhibited by social restraints. The dual and often conflicting pressures of establishing their sexual identities and controlling their sexual impulses produce a strong physiological sexual tension in teenagers that demands release, and masturbation is a normal way to reduce sexual tensions.Moral taboos against masturbation have generated myths that masturbation causes mental illness or decreased sexual potency. No scientific evidence supports such claims. Masturbation is a psychopathological symptom only when it becomes a compulsion beyond a person’s willful control. Then, it is a symptom of emotional disturbance, not because it is sexual but because it is compulsive. Masturbation is probably a universal aspect of psychosexual development and, in most cases, it is adaptive.

There are many professionals trained to talk about sex and help people to explore and overcome sexual dysfunction. Psychosexual therapists in particular are very knowledgeable about a wide range of sex problems and have proven successful in helping individuals and couples of all ages, health and sexuality to realize their sexual needs and desires and work through any negative thoughts that may be affecting their ability to enjoy sex and sexual intimacy.
Psychosexual therapy may involve exploring family myths and cultural taboos that have impacted on the way someone associates with sex and sexual intimacy. Questions that may be asked are: “If sex was once enjoyable, what happened to change that?” and “What feels good and what feels disappointing?”. These encourage the re-examination of deep-set sexual assumptions and beliefs, and in a good therapeutic relationship between client and therapist, there will be the opportunity to find answers and develop a healthier relationship with sex and sexual intimacy. For example, generalized anxiety disorder, psychosis or depression may be the underlying cause. If there is a primary psychiatric problem, it is treated with psychotherapy and appropriate medications.

Arousal is triggered by both psychological and physical stimuli; levels of tension are experienced both physiologically and emotionally; and, with orgasm, normally a subjective perception of a peak of physical reaction and release occurs. Psychosexual development, psychological attitudes towards sexuality, and attitudes towards one’s sexual partner are directly involved with, and affect, the physiology of human sexual response. Every normal human being has four-phase sexual response cycle.

‍Phase I: Desire
The classification of the desire (or appetitive) phase, which is distinct from any phase identified solely through physiology, reflects the psychiatric concern with motivation towards sexual activity. This phase is characterized by sexual fantasies and the desire to have sexual activity.

‍Phase II: Excitement
The excitement and arousal phase, brought on by psychological stimulation (fantasy or the presence of a love object) or physiological stimulation (stroking or kissing) or a combination of the two, consists of a subjective sense of pleasure. During this phase, penile tumescence leads to erection in men and vaginal lubrication occurs in women. Various other changes occur in different parts of the body. Voluntary contractions of large muscle groups occur, heartbeat and respiration rates increase, and blood pressure rises. Heightened excitement lasts from 30 seconds to several minutes.

‍Phase III: Orgasm
The orgasm phase consists of a peaking of sexual pleasure, with the release of sexual tension and the rhythmic contraction of the perineal muscles and the pelvic reproductive organs.
A subjective sense of ejaculatory inevitability triggers men’s orgasms. The forceful emission of semen follows. The male orgasm is also associated with four to five rhythmic spasms of the prostate, seminal vesicles, vas, and urethra. In women, orgasm is characterized by 3 to 15 involuntary contractions of the lower third of the vagina and by strong sustained contractions of the uterus, flowing from the fundus downward to the cervix. Both men and women have involuntary contractions of the internal and external anal sphincters. Other manifestations include voluntary and involuntary movements of the large muscle groups, including facial grimacing and carpopedal spasm. Blood pressure rises 20 to 40 mm (both systolic and diastolic), and the heart rate increases up to 160 beats per minute. Orgasm lasts from 3 to 25 seconds and is associated with a slight clouding of consciousness.

‍Phase IV: Resolution
Resolution consists of the disgorgement of blood from the genitalia (detumescence) which brings the body back to its resting state. If orgasm occurs, resolution is rapid and is characterized by a subjective sense of well-being, general relaxation, and muscular relaxation.
If orgasm does not occur, resolution may take from 2 to 6 hours and may be associated with irritability and discomfort. After orgasm, men have a refractory period that may last from several minutes to many hours; in that period they cannot be stimulated to further orgasm. Women do not have a refractory period and are capable of multiple and successive orgasms.

For some men, being stressed may just make you irritable, but for others, too much stress can cause sexual problems, such as erectile dysfunction. For these men, learning to relax and ease stress is all that may be needed to treat ED.
‍1.Jacobson’s relaxation technique, also known as progressive relaxation therapy, is a type of therapy that focuses on tightening and relaxing specific muscle groups in sequence. By concentrating on specific areas and tensing and then relaxing them, you can become more aware of your body and physical sensations. General instructions for Jacobson’s technique involve tightening one muscle group while keeping the rest of the body relaxed, and then releasing the tension.
‍2.Rhythmic breathing: If your breathing is short and hurried, slow it down by taking long, slow breaths. Inhale slowly then exhale slowly. Count slowly to five as you inhale, and then count slowly to five as you exhale. As you exhale slowly, pay attention to how your body naturally relaxes. Recognizing this change will help you to relax even more.
‍3.Deep breathing: Imagine a spot just below your navel. Breathe into that spot, filling your abdomen with air. Let the air fill you from the abdomen up, then let it out, like deflating a balloon. With every long, slow exhalation, you should feel more relaxed.
‍4.Visualized breathing: Find a comfortable place where you can close your eyes and combine slowed breathing with your imagination. Picture relaxation entering your body and tension leaving your body. Breathe deeply, but in a natural rhythm. Visualize your breath coming into your nostrils, going into the lungs and expanding the chest and abdomen. Then, visualize your breath going out the same way. Continue breathing, but each time you inhale, imagine that you are breathing in more relaxation. Each time you exhale imagine that you are getting rid of a little more tension.
5.Progressive muscle relaxation: Switch your thoughts to yourself and your breathing. Take a few deep breaths, exhaling slowly. Mentally scan your body. Notice areas that feel tense or cramped. Quickly loosen up these areas. Let go of as much tension as you can. Rotate your head in a smooth, circular motion once or twice (Stop any movements that cause pain). Roll your shoulders forward and backward several times. Let all of your muscles completely relax. Recall a pleasant thought for a few seconds. Take another deep breath and exhale slowly. You should feel relaxed.
6.Relax to music: Combine relaxation exercises with your favorite music in the background. Select the type of music that lifts your mood or that you find soothing or calming. Some people find it easier to relax while listening to specially designed relaxation audio tapes, which provide music and relaxation instructions.
7.Mental imagery relaxation: Mental imagery relaxation, or guided imagery, is a proven form of focused relaxation that helps create harmony between the mind and body. Guided imagery coaches you in creating calm, peaceful images in your mind — a “mental escape.” Identify self-talk, that is, what you say to yourself about any problems you have. It is important to identify negative self-talk and develop healthy, positive self-talk. By making affirmations, you can counteract negative thoughts and emotions. Here are some positive statements you can practice.

The aim of Sensate Focus is to build trust and intimacy within your relationship, helping you to give and receive pleasure. It emphasizes positive emotions, physical feelings and responses while reducing any negative reactions. The program can help overcome any fear of failure that may have existed previously, building a more satisfying sexual relationship in which both partners feel able to ask for what they want and are able to give and receive pleasure. Continuous reinforcement is needed to overcome negative reactions to intimacy. How long you spend on the program is up to you. Typically, sessions last twenty to sixty minutes, two to three times a week, spread over six or more weeks

The aim of Sensate Focus is to build trust and intimacy within your relationship, helping you to give and receive pleasure. It emphasizes positive emotions, physical feelings and responses while reducing any negative reactions. The program can help overcome any fear of failure that may have existed previously, building a more satisfying sexual relationship in which both partners feel able to ask for what they want and are able to give and receive pleasure. Continuous reinforcement is needed to overcome negative reactions to intimacy. How long you spend on the program is up to you. Typically, sessions last twenty to sixty minutes, two to three times a week, spread over six or more weeks

Kegels are exercises you can do to strengthen your pelvic floor muscles – the muscles that support your urethra, bladder, uterus, and rectum. Strengthening your pelvic floor muscles may help prevent or treat urinary stress incontinence, a problem that affects up to 70 percent of women during or after pregnancy. Kegel exercises may also help reduce the risk of anal incontinence. Kegel’s improves circulation to your rectal and vaginal area, they may help keep hemorrhoids at bay and possibly speed healing after anepisiotomy or tear during childbirth. Finally, continuing to do Kegel exercises regularly after giving birth not only helps you maintain bladder control, it also improves the muscle tone of your vagina, making sex more enjoyable.

This method is based on exploring positive ways of viewing sex and sexuality to eliminate negative thoughts and attitudes about sex that interfere with sexual interest, pleasure, and performance. As positive sexual fantasies are associated with positive effects, general physiological arousal, and sexual arousal, cognitive behavior therapists encourage their use by asking the patient to deliberately identify arousing sexual fantasies.

The efficiency of directed masturbation as an adjunct to the treatment of primary orgasmic dysfunction was evaluated. The directed masturbation procedure consists of a gradual series of assignments that are to be practiced by the patient. The test of the effectiveness of directed masturbation is conducted with couples who have not benefited from a sexual treatment program modeled after that of Masters and Johnson. The results have indicated that directed masturbation holds promise as an effective adjunct to sexual counseling.

Pre-IVF and Pre-IUI counselling is essential to couples going for the IVF and IUI programme. Pre-IVF and Pre-IUI counselling can be done at our clinic prior to starting the programme. Psychological counselling is offered to all couples considering an IVF and IUI programme, as there are many important issues to be considered in the psychological welfare of the couple during what can be an extremely emotional and stressful time in their lives.

Vacuum pumps are mechanical devices that patients without vascular disease can use to obtain erections. The blood drawn into the penis following the creation of the vacuum is kept there by a ring placed around the base of the penis. This device has no adverse effects, but it is cumbersome, and partners must be willing to accept its use. Some women complain that the penis is redder and cooler than when erection is produced by natural circumstances, and they find the process and the result objectionable.

In male patients with arteriosclerosis (especially of the distal aorta, known as Leriche’s syndrome), the erection may be lost during active pelvic thrusting. The need for increased blood in the gluteal muscles and others served by the ilial or hypogastric arteries takes blood away (steals) from the pudendal artery and, thus, interferes with penile blood flow. Relief may be obtained by decreasing pelvic thrusting, which is also aided by the woman’s superior coital position.

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