Secondary vaginismus is when the woman once was able to achieve penetration but now cannot. Trauma from childbirth or a yeast infection can be causative. Menopause and vaginal dryness can play a role in vaginismus. There are many psychological factors involved, including a fear of losing control, sexual assault, denial of sexuality, or lack of trust in one’s partner. The treatment is more successful with secondary vaginismus than it is with primary vaginismus. Desensitization may or may not help. Because of the high risk of childhood sexual trauma in the disorder, psychological treatment related to that can be helpful. Vaginal dilators and Kegel exercises along with lubricants can sometimes help. Botox is being investigated and has been shown to be successful in some cases. Antidepressants and anti-anxiety drugs can help the anxiety.
ERECTILE DYSFUNCTION Erectile dysfunction or ED was once known as impotence. It is seen when a man cannot attain an erection or cannot maintain an erection during sex. Men who have it can develop low self-esteem and relationship problems. About 80 percent of the time, the disorder is found to be physical, with the rest being purely psychological or a combination of physical and psychological causes. The problem must be present for three months to be called erectile dysfunction. There are numerous physical causes of erectile dysfunction, including many types of prescription drugs, such as beta blockers, SSRIs, diuretics, and certain hormonal treatments. Neurological causes include diabetes, Parkinson’s disease, multiple sclerosis, temporal lobe epilepsy, and multiple system atrophy. There can be anatomic problems with the penis, high prolactin levels, surgery to the pelvis, cardiovascular disease, kidney failure, smoking, and general aging that can contribute to the problem. Nerve damage from cycling can cause erectile dysfunction. Purely psychological causes of erectile dysfunction happen in 10 percent of cases. Any type of psychological or psychiatric problem can contribute to the problem, and both stress and performance anxiety can be causative.
95
