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Special Concerns about Dysfunction
among Different Population Groups
Many
women have concerns about their sexuality, wondering if they are “normal”
or “oversexed,” why they have difficulty achieving orgasm, whether
they enjoy sex as much as other women do, and why sexual intercourse is
sometimes not satisfying. Other concerns a woman might have include the
way her body may react spontaneously (e.g., during an erotic dream) or
during sexual activity, as well as fear of pregnancy and fear of STIs.
Opportunities to teach women
about their bodies and the wide range of sexual expression possible is
vital in helping women learn to trust and enjoy their sexuality, enhance
sexual pleasure, communicate their desires to their partners, and make
informed decisions about celibacy, partnering, and parenting.
Men also have concerns about
their sexuality. They may wonder why they are not always able to have
an erection or why they have an erection at an inappropriate time, whether
they have erectile dysfunction, why they reach orgasm sooner than they
would like to, or why they have orgasm with one partner or during masturbation,
but not with another partner.
Again, opportunities to teach
men about their bodies and the wide range of sexual expression possible
is vital in helping men understand how various factors can affect their
sexual function, how to communicate their desires more effectively with
their partners, and how to maximize their sexual pleasure. Unbiased information
can help men to make more informed decisions about celibacy, partnering,
and parenting.
Unfortunately, researchers
know relatively little about adolescent sexuality, despite the relevance
of sexual behavior to adolescent health. In comparison with the health
status of children and adults, adolescent health in general has largely
been ignored.
One of the most common concerns
that adolescents have is whether or not they are “normal.” They
have concerns about their bodily changes during puberty, about being sexually
attracted to others, about sexual identity and orientation, about having
sexual feelings, and about how to handle those feelings. Adolescents are
also very curious about masturbation, sexual fantasies, sexual function,
and sexual satisfaction.
In environments where adolescent
sexuality is considered inappropriate, young people are faced with tremendous
barriers to accessing accurate information, trustworthy health care, counseling,
and confidential health services. The conflict between adolescents’
environment and their needs often leaves them feeling isolated, lonely,
emotionally vulnerable, and at risk of sexually transmitted diseases and
unintended pregnancy. In these environments, adolescents may seek information
from their peers, who might be equally uninformed or incorrectly informed.
Poor communication skills and authority dynamics within families often
act as a barrier to open discussions about sexuality between parents and
adolescents.
Sociocultural and health consequences
of unprotected adolescent sexual behavior are more severe for adolescent
women than for adolescent men. These consequences are mainly associated
with unintended pregnancy, early parenting, STIs (including HIV infection),
unsafe abortion, forced termination of education, reduced opportunity
for economic achievement, and social ostracism by the community.
Because of all these factors
putting adolescents’ health at risk and compromising their quality
of life, there is critical need for adolescent-focused information and
services. When considering adolescent sexuality and health needs, keep
in mind that the needs of easier-to-reach, in-school youth—though
there may be teacher and parental resistance—may not be different
from those youth who are out of school.
Many women fear that menopause
signals the end of their sexual desirability and pleasure. This fear can
be reinforced in certain cultural settings where the common stereotype
of older women is one of being unattractive and asexual. In some cultural
settings, menopausal or postmenopausal women are considered resources
of sexual wisdom who fill a vital role in advising younger women and couples.
Menopause is defined as the
permanent termination of menstruation; this can be determined only after
the completion of one year without menses. However, hormonal changes do
occur for several years leading up to the ending of menses. During these
transition years, menstrual cycles may become irregular, but contraception
is still necessary if unplanned pregnancies are to be avoided. Women in
the perimenopausal period are at high risk for unintended pregnancy because
they may consider themselves no longer able to become pregnant and fail
to take the appropriate precautions.
Although the hormonal shifts
experienced during menopause bring physical changes and a slowing down
of sexual responses, women do not need to expect a reduction in sexual
activity and satisfaction during this period. Some women discover a reawakening
of sexual interest once they no longer need be concerned about pregnancy.
The changes that take place during this period of life offer opportunities
to explore new and different experiences: increased focus on sensuality,
intimacy, and communication can help a sexual relationship become more
satisfying than before.
Certain contraceptives may
offer benefits beyond pregnancy prevention to the perimenopausal woman.
For example, combined oral contraceptives relieve the cyclic irregularity
of the transitional years to menopause, reduce the risk of endometrial
cancer, provide protection against ovarian cancer, and diminish menstrual
flow.
© 2007 EngenderHealth
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