There is no cure for bipolar depression. That’s the bad news, and now it’s out of the way. Now we can explore the fact that you aren’t at the mercy of this illness. You don’t need a bipolar depression cure to take charge and live a life of mental health and wellbeing.

Either way, you can have both bipolar depression and mental health. They’re not either-or conditions. It’s a matter of reshaping your thoughts about what these terms mean to you.

Depression creates a slew of automatic negative thoughts that distort the way we think. One example is black-and-white or all-or-nothing thinking. It might seem that either you have bipolar depression, or you have mental health. There’s nothing in-between. By extension, it can seem that because there’s no cure for bipolar depression, you are doomed to a life of suffering and misery. Both statements are faulty logic caused by bipolar depression (it needs to stay relevant, so it creates thoughts like this to keep you close).

The truth is that mental health is in reach of everyone. It’s unconditional. You can live with a lifetime illness like bipolar depression and have mental health, too.

No Cure for Bipolar Depression? No Problem!

Consider an important question: What do mental health, wellbeing, and a quality life mean to you? Exploring this helps you begin to think of yourself and your life as meaningful. Bipolar depression symptoms will come and go, sometimes in remission and other times creeping back, but you have a meaningful life of your own regardless of your symptoms.  

Part of a mentally healthy life means knowing what is important to you. The other part is living intentionally, in ways that move you toward your values. It’s a combination of being and doing that doesn’t depend on the absence of bipolar depression.

When you’re in the throes of bipolar depression, thinking of mentally healthy actions despite the illness can be daunting. That’s because depression clouds thinking makes concentration difficult, and makes the idea of doing anything seem too exhausting to try. Therefore, use the following ideas as a guide and starting point for ideas of your own.

How to Create Mental Health, Wellbeing When There’s No Cure for Bipolar Depression

Even though there’s no bipolar depression cure, this collection of actions and attitudes can help you manage your symptoms of bipolar depression when they strike and keep depression at bay for long stretches at a time.

• Take your medication as prescribed, even when you feel better
• Engage in mental health therapy to build skills and change automatic negative thoughts
• Create and follow daily routines because routines help you keep doing what you need to do even when depression tries to keep you down
• Make rituals, such as sitting mindfully with a cup of tea every morning or evening, because rituals are comforting
• Exercise even when the only thing you can do is walk slowly from one room to the next in your house; every little bit brings benefits, but do stretch yourself just a little bit more each day
• Feed your brain well, avoiding processed, unhealthy foods and eating fruits, vegetables, whole grains, proteins, and other healthy foods
• Identify interests and passions, and do them regardless of what your depression is up to
• Find and appreciate beauty; when nothing seems beautiful, look anyway, and when you do notice beauty in your world, love it fully
• Create goals
• Practice mindfulness, using your senses to pay attention to the present moment

Another powerful mindset for a life with bipolar depression is acceptance. It’s tempting to want to fight your symptoms, but when you struggle with something, your focus and energy are on the very thing you want to go. When you practice acceptance, a key component of acceptance and commitment therapy, you aren’t giving in and resigning yourself to a lifetime of bipolar depression. Instead, you are letting go of the fight to focus on better things.

There is no bipolar depression cure. There will be, however, long periods of remission. With the above tips to guide you, whether your symptoms are present or absent, you’ll be mentally healthy and live a life well-lived.

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Drinking alcohol can affect bipolar depression medications—and bipolar depression itself—in dire ways. Despite the dangers, many people living with bipolar disorder drink alcohol. The Alcohol Rehab Guide (2018) reports that at some point in their lifetime, most people with bipolar disorder will have an alcohol use disorder; further, at any given time, about 43 percent of people with bipolar disorder have an alcohol use disorder. There are reasons for the strong link between bipolar depression and alcohol use despite the dangers. Let’s explore the connection because the more you know, the safer your choices can be.

Bipolar Depression and Alcohol: A Vicious Cycle

Bipolar depression can be difficult to live with. Dealing with the symptoms of despair, fatigue, lack of motivation, changes in sleeping and eating, and a general disruption of life, habits, and relationships can be almost too much to bear. It can seem like medication for bipolar depression isn’t working fast enough or well enough. When that happens, people sometimes turn to alcohol in an attempt to make things better, easier. This is sometimes referred to as self-medication.

Unfortunately, sometimes drinking helps. It’s only temporary, so people drink more to try to regain the relief. As is the case with drinking, crashes occur when the effects of alcohol wear off. This crash mimics the symptoms of depression, so to fix that, people frequently begin to drink more alcohol. It becomes a vicious cycle of wrestling with bipolar depression and drinking alcohol in which each worsens the symptoms of the other.

Alcohol deepens depression and affects judgment; many times, people stop taking prescribed medications for bipolar depression. This makes everything worse and increases mood swings, deepens depression, and increases suicidal ideation. Bipolar depression treatment becomes extremely difficult. Medication becomes more crucial than ever. The problem, though, is that drinking alcohol negatively affects bipolar depression medication.

Why and How Drinking Alcohol Affects Bipolar Depression Medication

Bipolar depression medications and alcohol both work in the central nervous system (CNS), including the brain and its chemistry. This means that alcohol can and does worsen the side-effects of bipolar medications. Alcohol is also a CNS depressant, so the experience of depression is also worsened.

Alcohol interacts with bipolar depression medication, decreasing or halting its effectiveness and creating side-effects that range from mild and annoying to potentially deadly.

Dangerous or deadly effects of combining alcohol and bipolar depression medication include:

• Deep drowsiness that can be perilous in certain circumstances
• Poor judgment
• Depressed breathing
• Convulsions
• Irregular heart rhythm
• Increased effects of alcohol
• Increased risk of medication toxicity and overdose
• Intensified bipolar depression symptoms

Another alarming effect of drinking alcohol while taking bipolar depression medications is the increased risk of suicide. Citing research conducted at the Medical University of South Carolina, Purse (2019) asserts that suicide attempts occur twice as often in people with bipolar depression who also have an alcohol use disorder than in people who have bipolar disorder and don’t drink alcohol.

If you are experiencing suicidal thoughts, go to the hospital right away or contact the National Suicide Prevention Lifeline at 1-800-273-8255.

Drinking alcohol affects bipolar depression medications in milder, but still serious, ways as well. Other effects of combining alcohol with these medications include:

• Dizziness
• Restlessness
• Confusion
• Memory problems
• Decreased motor control
• Increased risk of injuries and falls
• Tremors
• Stomach discomfort
• Loss of appetite
• Muscle and joint pain

Alcohol interacts with bipolar depression medications with critical consequences. In addition to wreaking havoc on medication, alcohol also negatively impacts bipolar depression itself.

How Alcohol Affects Bipolar Depression

Even small amounts of alcohol can create big problems for someone living with bipolar depression. Alcohol destabilizes mood in people with bipolar. Therefore, someone already experiencing a depressive episode can find themselves spiraling downward with symptoms deepening as they descend.

As a CNS depressant, alcohol further increases feelings of lethargy and apathy. It also decreases inhibition which can increase the likelihood that someone will act on suicidal thoughts.

Alcohol also makes bipolar depression harder to treat and in general worsens the course of the illness.  This helps explain why drinking alcohol increases the need for hospitalization. It takes more intense treatment to make depression manageable.

The takeaway is two-fold. Alcohol has frightening effects on bipolar depression and bipolar depression medication. However, this is something within your control. When you choose not to use alcohol, you improve your experience with bipolar depression, and you help your medications work.

If you do drink and need help stopping, talk with your doctor or therapist, or call a hotline such as the SAMHSA National Helpline at 1-800-662-HELP (4357).

Bipolar depression is tough, and self-medicating with alcohol is common. Alcohol makes things worse, which means that you will make things better without alcohol.

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PTSD from domestic violence, also known as intimate partner violence (IPV), is particularly damaging. Both physical abuse and emotional abuse at the hand of an intimate partner have a serious effect on the way the abused person thinks, feels, and interacts with the world (Effects of Domestic Violence, Abuse on Women and Children). PTSD can result from any type of trauma, but for unique reasons, PTSD from domestic violence, physical or emotional abuse, can be a pervasive, long-term struggle (PTSD Treatments: PTSD Therapy, PTSD Medications Can Help).

• Rather than occurring as a single traumatic event, domestic violence and emotional abuse tend to be chronic, repeated over time. Chronic exposure to the trauma of intimate partner violence leads to chronic (often years-long) PTSD; the effects of both the abuse and PTSD are never allowed to diminish.
• Because the perpetrator of the violence and abuse is someone who is supposed to be nurturing, safe, and trustworthy, domestic abuse is particularly damaging to someone’s psyche, and the resulting feelings of abandonment and betrayal are entwined with the other symptoms of PTSD.
• Domestic violence is part of someone’s daily life; there’s no break; therefore, the effects of PTSD are intensified.

Domestic Violence, Emotional Abuse, and PTSD

Both men and women can be victims of an abusive relationship, and both can develop PTSD. Women, though, are far more likely to suffer intimate partner abuse. The National Center for PTSD (2015) reports that approximately 27 percent of women and 10 percent of men say that they have been harmed by intimate partner violence.

Domestic violence is traumatic. It is often about power and control; one partner continuously exerts power over the other and takes away her sense of control over herself and her life. Physical or emotional abuse at the hand of an intimate partner can cause PTSD (Babbel, 2011; Powell & Smith, 2011).

Emotional abuse can be as damaging as physical abuse, and intimate partner violence doesn’t have to be life-threatening in order to cause PTSD (Hughes & Jones, 2000). Specific types of domestic abuse that can lead to PTSD include:

• Sexual abuse/rape
• Physical abuse
• Psychological/emotional abuse
• Intimidation, threats
• Economic deprivation/financial abuse
• Verbal Abuse
• Stalking

PTSD: Effects of Domestic Violence and Emotional Abuse

Trauma from domestic violence impacts someone’s entire being: mind, body, spirit, and sense of self and others. PTSD that develops because of intimate partner violence chips away at physical, mental, and emotional wellbeing. These long-lasting effects of PTSD are common in someone living through abuse:

• Intrusive thoughts and images
• Flashbacks
• Nightmares and other sleep problems
• Anxiety and/or emotional numbing
• Heightened arousal (such as jumpiness and feeling tense, on alert)
• Avoidance of triggers
• Dissociative symptoms
• Difficulties with other relationships
• Shame, guilt, worthlessness
• Depression
• Thoughts of suicide
• Substance use

These can all be part of PTSD, the body and mind’s reaction to extreme trauma such as the trauma of domestic violence and emotional abuse (Living With PTSD Can Be A Nightmare).

PTSD From Childhood Abuse

Child abuse has profound effects, effects that last well into adulthood and can involve PTSD. Child abuse can cause PTSD to develop while the abuse is occurring; PTSD symptoms of avoidance and dissociation are particularly common in abused children (Kronenberger & Meyer, 2001).

Childhood abuse, especially child sexual abuse, increases the likelihood of PTSD in adulthood. Childhood abuse is physically and emotionally damaging, and it disrupts the healthy development of the child. This can make someone vulnerable to future abusive relationships and further exacerbate PTSD (PTSD in Children: Symptoms, Causes, Effects, Treatments).

While childhood abuse doesn’t guarantee that someone will experience PTSD in adulthood and/or become involved in a relationship of domestic violence, someone who experienced childhood abuse is at greater risk for these things.

PTSD and Domestic Violence, Emotional Abuse Are Not Your Fault

No one deserves abuse, and no one does anything to cause their abuse.

Self-blame is a common thought/feeling resulting from intimate partner abuse. This can lead to another common feeling: guilt and shame. Self-blame, guilt, and shame all prevent healing from abuse and PTSD.

Think of PTSD from domestic violence and emotional abuse as a call to action. Noticing the effects PTSD has on you and knowing that they are not personal weaknesses but instead natural responses to trauma and abuse are important early steps in regaining the sense of control that you deserve. Draw on social support networks (before you're thinking of leaving the violent and/or emotionally abusive relationship and after), let people help you get professional help, and take back yourself and your life (Coping with PTSD is Easier with These Coping Skills).

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The differences between depression (major depressive disorder or unipolar depression) and bipolar depression treatment are related to the mood swings that are part of bipolar disorder. Bipolar depression occurs alongside manic or hypomanic symptoms that can more easily land the person in the hospital.

Treatments that may work for unipolar depression can cause complications for bipolar disorder and depression. Talk therapy for situational depression can be very successful. Unfortunately, the same therapy has less success in severe mood disorders, unless the physiological symptoms of the illness are addressed first. A therapist experienced in treating mood disorders can improve bipolar depression treatment outcomes.

Symptoms that Make Treatment of Bipolar Depression Challenging

Bipolar depression treatment may be complicated by intense anxiety symptoms:

• Racing, worried thoughts
• Trouble breathing, physical agitation
• Fear of going out in public
• Feeling like something is going to go wrong or cause harm
• Feeling like life is spinning out of control
• Obsessive worries over having done something wrong or needing to repeatedly check on something

Psychosis symptoms are more common during bipolar mania but they may still complicate, or appear with, bipolar depression. Examples include:

• Hearing voices
• Seeing things that aren't there
• Belief that objects such as radios or billboards are sending special messages
• Intense physical agitation,
• Seeing yourself getting killed
• Feeling that someone is following you or talking about you (paranoia)

Detailed information on bipolar psychosis.

Rapid cycling also complicates treatment of bipolar depression. More than three mood swings per year is called rapid cycling. Rapid cycling is a very concerning symptom of bipolar disorder and depression and once it's present, it's difficult to treat and often remains for the life of the illness.

Impact of Mania on Bipolar Depression Treatment

Bipolar depression often comes after a manic episode. The bipolar depression that comes after a serious mania can be very intense and often create suicidal thoughts and yet, unless the person understands mania and what happened, they will get help for the depression only. It's critical, though, that bipolar depression treatment take mania into account in order to select effective treatment and not make the manic symptoms worse.

Vigilant monitoring for mania or hypomania is essential with any bipolar depression treatment plan, especially by family members and healthcare professionals. A mixed episode (the presence of depressive and manic symptoms simultaneously; can include psychosis) can create intense treatment difficulties as well. When a mixed episode includes aggression, treatment is even more complicated.

Bipolar Disorder and Depression vs. Unipolar Depression

All bipolar depression treatment must address the above symptoms. Looking for these symptoms can help healthcare professionals make a correct diagnosis between depression and bipolar depression and start appropriate treatment.

If you were a healthcare professional seeing a client with depression for the first time, here are the questions you have to answer in order to determine the correct depression diagnosis:

• Is the depressed person tired all of the time?
• Have they gained unexpected weight?
• Do they have trouble sleeping that doesn't sound like insomnia?
• Have they tried antidepressants without success?
• Does the depression come and go without a specific trigger?
• Has the person experienced mania, even if it's a mild hypomanic day?
• Is there a family history of Bipolar Disorder?

These questions need to be asked of all people who experience depression so that the correct diagnosis is made and the patient can move on to a comprehensive bipolar depression treatment plan.

It's stressful caring for a bipolar family member. These coping tips should help.

Supporting Someone with Bipolar - For Family and Friends

Education
It is imperative that you seek out and learn all you possibly can about bipolar disorder. Like a general fighting a battle you are going to need all the ammunition you can garner at your disposal. There are many different sources of information...books, films, internet, support groups and others. Take from as many as you can and learn.

Communication
Do all you can to keep communication lines open between you and your ill relative. Assure him you are there for him and that you know he is sick but will get well again. Try to be a part of his wellness, but not a part of his illness. Encourage every effort to get better and go with him, rather than send him for help if he wishes. Try to project positive thoughts about his recovery.

Network
Lessen the burden on the family by broadening the network of people who can help in a crisis. Another person who has been through this, a concerned friend or professional may offer respite when you need it most.

Live Your Own Life
One of the hardest things for family members to do sometimes, but one of the most important. It is imperative that you realize that your life doesn't stop to revolve around your ill relative. Take care of your own health and your own needs or you may not have the strength to cope.

Know the Warning Signals
Know the warning signals that may trigger an episode in your family member. Be prepared to act before they worsen and get out of control. Tragically, suicide is an all too common result of bipolar disorder. Learn about it and what you should watch for. Denying the possibility could end in tragedy. Be prepared. Educate yourself about suicide.

Don't Expect Too Much of Yourself
Surprise. Surprise. You are not superman (or woman) and there are limits to what you can handle. It is natural for your emotions to vary. You are dealing with a serious situation. It's natural to feel angry, frustrated, exhausted. These are valid feelings and ones shared by all families of bipolars. So cut a little kindness to yourself into the equation.

Don't Blame Yourself
In the throes of illness your relative may try to blame you for the way he is feeling. Don't listen. You have educated yourself and know that he has a chemical imbalance. But neither will arguing with him at this point help much. Tell him that you will not accept what he is saying and that you know it is the illness talking. Don't let him hurt you.

Talk About Your Situation
It is hard sometimes to talk to others about how out of control things have become in your life. You don't want gossip or pity - you don't want lasting stigma - but you do need to talk to someone. Find a self-help group in your area if there is one - if there isn't, start one. You'd be amazed at how many others face the same issue - or talk to a close friend.

Seek Counseling
If you are having trouble coping, never be afraid or ashamed to seek help for yourself.

DON'T GIVE UP
Don't give up too soon. Recovery from an episode is not often a straight path. Relapses are common. Wellness is achievable and has been achieved by many.

NEXT TIME
I know you don't want to hear this. But chances are very good that there will be another episode. Try to be prepared. Have telephone numbers - doctor, emergency, admitting hospital, support, advice, etc., readily available. Ensure insurance is in place and the best that you can manage for psychiatric illness. Support others going through a crisis - as they will support you. The more prepared you are, the easier it will be for you to get active and to cope. Consider having advanced directives in place prior to another episode.

Therapy for bipolar depression can help you not only manage your symptoms of this difficult illness but move forward into the quality life you create. Imagine having a conversation with someone who is safe and nonjudgmental.  What if that person fully listened, so you knew that you were heard and accepted? Imagine being able to explore what is wrong while placing the biggest emphasis on what is, and will be, right. Imagine, too, engaging in problem-solving with someone who gently guides and does not give you orders. Therapy for bipolar depression in general provides these conditions and more. Let’s explore what therapy is and how it helps bipolar depression.

Therapy for Bipolar Depression: Purpose and Types

Therapy for bipolar depression has a focused purpose: to help you develop skills to transcend depression and, while you’re doing that, to start living your best life right now. Within that greater purpose are other reasons therapy can help you with bipolar depression. In working with a therapist, you can:

• Discover your triggers—events, situations, and people that might start a downward mood spiral
• Develop coping skills to use to get through a day and beyond
• Increase awareness of changing moods so you can prevent, or minimize, swings
• Follow your treatment plan more easily
• Decrease negative behaviors that are perpetuating depression symptoms

Research shows that bipolar depression responds well to therapy. There are numerous types of therapy, and when it comes to depression, they’re not all equal. Four therapeutic approaches have been deemed particularly helpful for bipolar depression:  

• Cognitive Behavior Therapy (CBT)
• Dialectical Behavior Therapy (DBT)
• Interpersonal and Social Rhythm Therapy
• Family Therapy

Cognitive behavior therapy is a counseling approach that focuses on thoughts and actions. Understanding, reframing, and modifying thoughts changes the ideas that contribute to bipolar depression. Working with a cognitive behavior therapist, people identify automatic thought patterns that perpetuate depression and, the best part, learn to replace them with healthier ones. This works very well to replace self-defeating thoughts. (“I’m worthless,” becomes “I have strengths, like caring, that I can use in my life.”)

Dialectical behavior therapy is a type of CBT that is designed to help people manage moods and conflicts. Thoughts and actions are key, just as they are in CBT, but they’re shaped to address emotional behavior. While DBT was initially designed to help people deal with borderline personality disorder, it can help with bipolar depression, too. Skills like mindfulness, distress tolerance, emotion regulation, and communication help people turn around despair and lack of motivation and create a better life experience.

Interpersonal and social rhythm therapy is a structured approach that helps people take control of their lives. Bipolar depression makes it difficult for people to stick to routines, schedules, and methods of organization. This lack of routine, in turn, worsens depression. It can be a self-perpetuating downward spiral. In interpersonal and social rhythm therapy, people develop skills needed to create and keep a regular schedule for their days. All major activities are incorporated into the schedule: waking up in the morning, going to bed at night, eating, exercising, self-care breaks, cleaning—anything you do can be incorporated into the schedule. It empowers by setting people up for success.

Family therapy is therapy for the person living with bipolar depression and their family. Ideally, everyone in the household will attend the sessions. Extended family members sometimes attend as well. This type of therapy helps family members build communication skills, discuss family goals, express concerns safely, learn positive problem-solving skills, and be educated about bipolar depression and its treatments.

Getting the Most Out of Therapy for Bipolar Depression

Therapy for bipolar depression can help you immensely. People do have different degrees of success with it. To ensure that therapy is helpful for you, consider these factors:

• Therapy should be done in addition to taking bipolar disorder medication; it isn’t a replacement for medication
• Perhaps the most important component of therapy is the relationship you have with your counselor; if you don’t connect well, it’s okay to find a different counselor
• Approach it as a partnership, with both you and your therapist taking an active role
• Practice; do your homework because doing the work is how you advance
• Patience; it can work, but it’s a process. Be kind to yourself and celebrate even small successes

Therapy for bipolar depression can indeed help. Combined with medication, it’s effective in overcoming bipolar depression.

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Many people want to know what causes bipolar disorder in kids. This is understandable for so many reasons, not the least of which being parents wanting to know if they can prevent it in their child. After all, bipolar disorder in kids can be very debilitating. But the causes of childhood bipolar disorder are complex and not well understood.

Overall Causes of Bipolar Disorder in Children

Genetic factors play a big role in pediatric bipolar disorder. If a child has bipolar disorder, it is highly likely that a first-degree relative (mother, father, sister, brother) also has bipolar disorder. This does not mean that bipolar disorder in children is entirely genetic, however.

There are also environmental factors that play a role in childhood bipolar disorder. While no single factor is the cause, per se, each factor is known to be associated with bipolar disorder in children.

• Poor parent-child relationships
• Lower socioeconomic status
• Abuse of psychoactive drugs
• Occurrence of attention-deficit/hyperactivity disorder
• Decreased behavior inhibition and decreased frustration tolerance present at preschool age
• Early developmental delays in language, social and motor development may occur 10-18 years before an official, diagnosable bipolar symptoms
• A lower intelligent quotient (IQ) corresponding to the severity of the illness
• Parental smoking

It’s worth noting that many incarcerated youth have mental illnesses. It’s common for a youth that experiences a severe bipolar mania (a highly elevated mood), for example, to have legal problems due to the disinhibition that occurs in this state. This can lead to public disorderly content, verbal and physical altercations, theft and drug seeking or use, to name just a few of the concerns.

Of course, any child can experience one or more of these factors and not have or develop childhood bipolar disorder. It is likely that many of these factors work together to cause bipolar disorder in children.

Some of the above factors can be mitigated by parents, but as genetics is the biggest factor in developing bipolar disorder (about 65%, according to studies on identical twins), it is unlikely that bipolar disorder can be prevented.

Risk of Passing Bipolar from Parent to Child

If a parent has bipolar disorder, his or her offspring are at a high risk of serious mental illness. This includes an elevated risk for bipolar disorder, major depressive disorder, anxiety disorder, sleep disorder and substance use disorder.

This risk that a parent with bipolar disorder will pass it on to a child is 30-35%. If both parents have bipolar disorder, the risk is approximately 70-75%.

This doesn’t necessarily mean that the child will develop bipolar disorder in childhood, however. He or she may develop it in adolescence or adulthood.

Is Childhood Bipolar Disorder Related to Trauma?

Childhood trauma is associated with a greater risk for bipolar disorder. Moreover, it is related to an earlier onset and a more severe course of symptoms as well as increased risk for suicide and substance use disorders. This means that those who have experienced early life trauma are more likely to develop childhood bipolar disorder and they are also more likely to develop it during their lifetime overall.

Dealing with the Risks of Childhood Bipolar Disorder

While all this can seem bleak for some children, it’s important to remember that risk factors are just that – risk factors. One or more can be present in anyone and that person may not develop bipolar disorder at any time in his or her life.

Now that we have arrived at the new millennium, it is time to take a fresh look at an old sexual problem common in the lives of many women; namely no orgasm during intercourse. This results in concern and disappointment especially to the woman who looks to sex for pleasure and emotional gratification. Since this is a troubling issue to a majority of women let us examine its significant aspects. Many women wonder and sometimes even worry about why they are missing something so important, as coitus reaches its peak moment. Why don't they have an orgasm, a sensation that is normal and should be enjoyed at that time? Occasionally even the partner may comment. An explanation regarded as medically accurate in the past was that this is due to female "frigidity," a word now banned from the vocabulary of writers and speakers on the subject of sex.

In years past this would have definitely been a "hush-hush" topic. But the time is now and the door has been opened to allow and even encourage efforts to understand the psychological complications that can get in the way of a happy, satisfying sex life. By taking a look at some of the trip-up spots in a woman's journey to full sexual pleasure, it may very well be possible to uncover and toss away a few of them.

It is an accepted fact that a woman is capable of having an orgasm. The question is what are the obstacles. Unnecessary limits that may have been implanted in our thoughts can have the power to determine how we act. Let us consider a few of these possible restrictions to see what can be done to reduce their damage. A major problem obviously can be the quality of the relationship existing between the partners. In the situations about to be described, we shall assume that love does exist in order to focus solely upon sex. If not, the issue is the relationship and not the sex. In the case of women who worry about being "normal" because at times they do have an orgasm but never during intercourse, it is important for them to understand that orgasm is the peak response to stimulation however it is reached. The manner by which that climax is achieved is of much less importance than the pleasure and relaxation that follow.

Stimulation can be arrived at through a variety of actions, some at times more enjoyable than others; but many women are reluctant to express their preferences. The path to orgasm can be freed of stumbling blocks by informing the partner of what gives real pleasure. Additionally, general body caressing is an important prelude to moving toward the vaginal area and should be encouraged by words or body responses. My clinical experience has also suggested that varying positions from time to time maintains a level of interest in intercourse that prevents it from becoming just the same old routine.

Anxieties and distractions are intruders during love-making. Taking them to bed guarantees no orgasm. Questions and concerns deserve attention, but at a time and place where a useful answer is available. Worrying about "what's wrong with me" will only prolong the problem. To the worriers, I urge starting in a relaxed state.

Then there is the old baggage all of us automatically cart along. It is not heavy, but it can certainly weigh us down at times. Unfortunately, a prime location for being weighed down can be the bedroom. Parents who instill in us the rules for "proper" behavior sometimes hide in an unseen nook in that room. Their voices can be heard whispering just at the moment a woman is about to try relaxing into the sexual activity going on. This often occurs without any conscious awareness. Unfortunately, Mom or perhaps Dad neglected to mention when and where it is o.k. to let loose and that it might even be a good idea.

Orgasm requires letting go. Worrying about being normal, about conflicts in the relationship, and especially the cautioning voices of parents, inevitably cause a woman to tighten up emotionally and physically. Telling your partner what feels good, experimenting with different positions and focusing only on the moment at hand are the freeing-up tactics. Let go of expectations and drift on to thoughts about loving, being loved and to whatever else peaks the excitement. Then let the flame flare.

Dorothy Strauss, Ph.D., has published chapters in medical textbooks and papers on sexuality and relationship problems. She has served as Associate Professor of Psychiatry for the State University of New York. She currently has a private practice and teaches seminars.

he following answers come from Sallie Foley, MSW, Sally A. Kope, MSW, and Dennis P. Sugrue, PhD - authors of Sex Matters For Women: A Complete Guide to Taking Care of Your Sexual Self.

1. Did the sexual revolution of the 1970's result in sexual satisfaction and comfort for women?

2. At what age is masturbation normal?

3. Is there such a thing as too much sex education?

4. Is there a G spot, and if so, how do I find mine?

5. Why does it seem easy to orgasm from clitoral stimulation but so hard from intercourse alone?

6. Are all women capable of having multiple orgasms?

7. Is it safe to have intercourse during menstruation?

8. Can having sexual intercourse during pregnancy hurt the baby?

9. Can having sexual intercourse start labor during pregnancy?

10. Can infertility treatment have an impact on sexual functioning?

11. Does "use it or lose it" apply more to men or women?

12. Does anorexia or bulimia affect sexual functioning?

13. Why is it that when my weight is down I feel sexy and interested, but the more I weigh, the less I desire?

14. Does exercise have any sexual benefits?

15. I exercise and I'm not really overweight, but I hate my body. What can I do about that?

16. I have cancer-how do I get good information about my sex life in this circumstance?

17. I have a chronic illness, and my treatment has affected my sexual arousal; I don't lubricate. Is there any hope?

18. I am in a wheelchair. I am pretty, witty-and I've never been on a date. Why am I seen as asexual?

19. I have a spinal cord injury. Is it possible for me to have an orgasm?

20. How do I deal with my developmentally disabled daughter's emerging sexuality?

21. I have severe pain with intercourse. Is there anything I can do except give up sex altogether?

22. I have a condition called Vaginismus. I'm told it is in my head, but talking to my therapist about it hasn't helped. Any suggestions?

23. Why does the United States have one of the highest rates of sexually transmitted diseases (STDs) in the industrialized world?

24. I've heard women are more susceptible to STDs than men. Is this true?

25. Can trauma other than sexual abuse cause sexual problems later? My mother used to have explosive rages when she was drinking, and now I find I can't relax with my partner sexually, even though I want to.

26. Is there sex after kids?

27. Isn't fantasizing a form of cheating?

28. Shouldn't people who have a satisfying sexual relationship give up masturbation?

29. What if one partner wants sex a lot more than the other?

30. When my doctor gives me only a few minutes to ask questions, how can I bring up embarrassing sexual problems?

31. In this age of advanced technology and media availability, how can I tell if the information I'm getting about sex is sound and accurate?

32. Isn't it true that sexual problems are primarily in one's head?

33. How do I know if I have low sexual desire? My partner wants to have sex much more often than I do, and suggests it is my problem.

34. Since I've been taking medication for depression, my sexual desire has hit the basement! Do I have to choose between my mental and sexual health?

35. Is there a Viagra for women?

36. I have noticed a recent difference in my ability to lubricate. What should I consider in evaluating this problem?

37. I don't have orgasms with sexual intercourse. Is this a sexual problem?

38. I often feel very close to an orgasm that never happens, and this is frustrating for me and my partner. Do other women experience this?

39. I can have an orgasm with a vibrator, but my partner worries that the vibrator is replacing him. He tells me that if I rely on a vibrator it will be the only way I'll respond sexually. True?

40. How do I determine if I am a lesbian?

41. What is sex therapy?

42. How do I find a sex therapist?

Answers

1. Did the sexual revolution of the 1970's result in sexual satisfaction and comfort for women?
   No. Instead of experiencing sexual liberation, many women found a paradoxical gap between unlimited sexual choices and equally limitless sexual dilemmas. (Introduction)

2. At what age is masturbation normal?
   Any age is "normal" for masturbation. Very young children find and explore their genitals. At times, small girls will masturbate to orgasm. Some girls masturbate at puberty, and some when they are adults. Fewer girls masturbate than boys. It is normal for a woman to masturbate even when she is in a satisfying sexual relationship. A third or more of all women and men over the age of 70 masturbate. (Chapter 1 and 12)

3. Is there such a thing as too much sex education?
   Ideally, sex education is an on-going process with questions and answers coming when children are ready for the information. Sex education does not lead to premature sexual experimentation, as we can see from European countries where sex education is more extensive and teen pregnancy, abortion, and STD's are lower than in the United States. Also, although it may not seem so, children do listen to their parents' values about sexuality. (Introduction)

4. Is there a G spot, and if so, how do I find mine?
   The G spot is a small area of tissue (possibly erectile tissue similar to nipples or the clitoris) located on the front/upper wall of the vagina between the opening and the cervix. It appears to enlarge and become highly sensitive in response to direct sexual stimulation. (Chapter 3 and 4)

5. Why does it seem easy to orgasm from clitoral stimulation but so hard from intercourse alone?
   Even though sexual intercourse can be very arousing and satisfying in itself, many or even most women do not orgasm from the stimulation of intercourse alone. This is because neither the clitoris nor the G spot typically receives stimulation that is sustained and intense enough for orgasm. (Chapter 4)

6. Are all women capable of having multiple orgasms?
   No, nor should this be considered the premier standard of sexual responsiveness. Some women are so physically sensitive after an orgasm that further stimulation can be uncomfortable rather than pleasurable. Some women are very satisfied with one orgasm, and some women are very satisfied without orgasm during sexual activity. (Chapter 4)

7. Is it safe to have intercourse during menstruation?
   Yes. Having sexual intercourse, including ejaculation, is safe and quite normal during menstruation. You can also use a vibrator or have oral sex if you choose. It is entirely a personal choice between you and your partner. (Chapter 5)

8. Can having sexual intercourse during pregnancy hurt the baby?
   No. A developing fetus is well-protected against physical sensations from the outside, and the cervix has a mucus plug that blocks any direct passage of foreign material into the uterus. You should follow your healthcare provider's instructions, however, for what is healthy and safe during your pregnancy. (Chapter 5)

9. Can having sexual intercourse start labor during pregnancy?
   Orgasm causes uterine contractions, but it is important to note that uterine contractions are present throughout pregnancy. Labor is not going to start because of the uterine contractions of orgasm unless the body is ready to go into labor anyway. If you are full term and "ripe" for delivery, however, semen coming in contact with the cervix can "cue" the body to begin labor. Semen contains a large amount of prostaglandin, a hormone associated with the onset of labor. Your healthcare provider should have the last word when it comes to sexual intercourse and pregnancy, especially during the final stage of pregnancy. (Chapter 5)

10. Can infertility treatment have an impact on sexual functioning?
    Yes. It is common for a woman - and often her partner - to complain of temporary sexual difficulties during infertility treatment. Having sex on demand can be daunting. Some treatment procedures are invasive and can temporarily create sexual avoidance. It's also difficult to maintain a positive sense of self and body in the midst of infinitesimal medical assessments of what is going wrong. (Chapter 5)

11. Does "use it or lose it" apply more to men or women?
    Women. After menopause, vaginal and vulvar tissue thin because of the loss of estrogen and diminished blood flow to these tissues. Regular sexual activity stimulates lubrication and blood flow to these vulnerable areas, and regular penetration with a penis, fingers, vibrators, or dildos can help keep the vagina from narrowing. (Chapters 2, 3, 4, and 5)

12. Does anorexia or bulimia affect sexual functioning?
    Yes. Eating disorders are devastating to sexuality. The closer a woman comes to paring off all of her body fat, the lower her sex hormones. Not only can her reproductive system shut down (for example, menses cease), but also sexual desire decreases or becomes non-existent. These disorders are often associated with body hatred or self-consciousness, which can further dampen sexual interest. (Chapter 6)

13. Why is it that when my weight is down I feel sexy and interested, but the more I weigh, the less I desire?
    This is a complex problem. Genitals, brains, hormones, and nerve endings don't shut down with additional weight. A woman's sexual desire often emanates from how desirable she sees herself rather than from what she finds desirable. In our culture, it's a challenge for a woman to feel desirable when her weight goes up. The media reinforces in our minds the connection between perfect bodies and good sex. Encouraging body dissatisfaction sells beauty and fashion products. Keeping women dissatisfied with their bodies is good for business but bad for sex. (Chapter 6)

14. Does exercise have any sexual benefits?
    Yes. Exercise serves as an "on switch" for hormones. It increases energy and self-esteem. Improved pelvic muscle tone enhances orgasms and sexual response. (Chapter 6)

15. I exercise and I'm not really overweight, but I hate my body. What can I do about that?
    First, ask yourself what you your life would be like if you had the body you yearn for. If you ponder this question long and far enough, you may become aware that physical appearance is not the road to personal fulfillment. It's important to stop negative thinking about our bodies, but it takes practice. You have to identify the self-defeating thoughts, catch yourself when you slip into using them, and substitute encouraging thoughts for the negative ones. (Chapter 6)

16. I have cancer-how do I get good information about my sex life in this circumstance?
    Don't give up; it's essential that you get educated about your illness and how it and your treatment impact sexuality. Ask your nurse or social worker where you get your medical treatment about resources and recommendations. Join an Internet chat group that can connect you with other women who have been through similar circumstances. (Chapter 7)

17. I have a chronic illness, and my treatment has affected my sexual arousal; I don't lubricate. Is there any hope?
    Yes. Ask your doctor to discuss all aspects of your treatment and how they impact genital blood flow. Illness, medications, and treatment can contribute to the situation. Pay attention to whether there are symptoms of depression, which can also dampen arousal and contribute to fatigue. A number of herbal supplements, medications, and devices are being studied for their effectiveness in increasing sexual arousal. Viagra, for example, may help pelvic blood flow in cases like yours, although studies are continuing and at this point Viagra is not FDA approved for women. (Chapters 7 and 13)

18. I am in a wheelchair. I am pretty, witty, and I've never been on a date. Why am I seen as asexual? You know you are sexual despite challenges. Unfortunately, our culture overidealizes perfect bodies. You may be marginalized from the sexual mainstream because your situation may threaten others with the disturbing awareness of their own vulnerability. You don't have to settle for this: get educated and connected through support groups, the Internet, and other resources in your community. (Chapter 7)

19. I have a spinal cord injury. Is it possible for me to have an orgasm?
    Very possible. About 50% of women with spinal cord injury, even with complete injury, continue to be orgasmic. Drs. Whipple and Komisaruk have researched this phenomenon extensively and propose that the vagus nerve may provide a sensory pathway from the cervix and vagina to the brain that bypasses the spinal cord. (Chapter 7)

20. How do I deal with my developmentally disabled daughter's emerging sexuality?
    Sexuality and developmental disability are equated with vulnerability. As a result, parents are often over-protective, which can create even more vulnerability. A young woman with cognitive limitations needs more, not less sexual education. She won't be a perpetual child, no matter how much you would wish it. Help her to make non-sexual decisions in her life as early as possible, so she will be prepared for more discriminating decisions as her life progresses. (Chapter 7)

21. I have severe pain with intercourse. Is there anything I can do except give up sex altogether?
    Yes. First get medical help ASAP; pain during sex requires a comprehensive evaluation. If a healthcare provider minimizes your problem (a common response may be "I can't find anything wrong-just try relaxing"), keep looking for a medical professional who will take you seriously. Medication, physical therapy, medical treatment, and specialized counseling can be enormously effective. (Chapter 8 and Resources)

22. I have a condition called Vaginismus. I'm told it is in my head, but talking to my therapist about it hasn't helped. Any suggestions?
    Vaginismus (the involuntary tightening or spasming of the pelvic floor muscles near the opening of the vagina) is happening in your body, even if the cause was psychological in the first place. This symptom is stubborn but highly treatable. It requires a specialized approach combining medical evaluation, sex therapy, and, ideally, physical therapy. (Chapter 8 and Resources)

23. Why does the United States have one of the highest rates of sexually transmitted diseases (STDs) in the industrialized world?
    It's ironic that in an age of supposed sexual enlightenment, STDs are rampant even though transmission in most cases is preventable. Sex education is failing: in a 1995 Gallup study, 26% of adults and 42% of teen respondents could not name an STD other than HIV/AIDS. Legislators avoid dealing aggressively with STDs because it isn't politically correct to do so, and television - one of the greatest educators of modern times - virtually ignores STDS. (Chapter 9)

24. I've heard women are more susceptible to STDs than men. Is this true?
    Yes. STDs are spread through physical contact. These organisms enter the body through mucous membranes, areas of skin that are moist, warm, and hospitable to bacteria and viruses. Because a woman's genitals contain more mucous membranes and can retain body fluids from another person for a longer time, a woman is more at risk than a man for contracting a sexually transmitted disease. (Chapter 9)

25. Can trauma other than sexual abuse cause sexual problems later?
    My mother used to have explosive rages when she was drinking, and now I find I can't relax with my partner sexually, even though I want to. Yes, non-sexual trauma can cause sexual problems. When you are exposed to trauma (in some cases even witnessing trauma), your body and brain go into a self-protective state of emergency. Unfortunately, long after the original event, certain triggers can prompt your brain to revert to this emergency state. This state of hypervigilance can make relaxation during sex very challenging. (Chapter 10)

26. Is there sex after kids?
    Yes - if sex is a priority. In order to sustain a satisfying sex life after kids, couples need to apply the same creativity and ingenuity that they use to manage their family's hectic schedule. They realize that the belief Spontaneity is necessary for great sex is a myth. They find time for sex by pre-planning because if they waited for it to occur spontaneously, sex could become non-existent. (Chapter 12)

27. Isn't fantasizing a form of cheating?
    No. Sexual fantasies - the thoughts, ideas, and images that you find exciting - are perfectly normal and part of the sexual experience of people everywhere. It's important to remember that fantasies are not necessarily wishes. As a matter of fact, research has shown that people often fantasize about things that they would never act on in real life, even if the opportunity presented itself. Sexual fantasies provide a valuable way to keep attention focused during a sexual experience. Using fantasy to intensify your own excitement doesn't detract from the basic significance of your lovemaking- that you are freely choosing to share with your partner one of the most personal and intimate ways of experiencing pleasure. (Chapter 12)

28. Shouldn't people who have a satisfying sexual relationship give up masturbation?
    No, not if they don't want to. Masturbation has been seen as a social taboo, which is unfortunate. Self-pleasuring is a positive thing to be enjoyed and valued. Depending on the study, between forty and seventy percent of married women and men masturbate even though they have sexual partners. And many of these people report having wonderful, satisfying sexual relationships with their partners. Emotionally, masturbation may not compete with the joy of making love to your partner, but that doesn't mean that masturbation can't be enjoyed in its own right. (Chapter 12)

29. What if one partner wants sex a lot more than the other?
    First, it's important to acknowledge that two people can have normal sex drives that differ dramatically. There are many reasons why two people may differ in how frequently they want to have sex. The discrepancy may be just one more example of the normal differences that can exist between people. It may be due to fluctuations that occur in time and circumstances. It may be due to problems in the relationship. It may be the result of one partner having a greater need for reassurance or for distance. Having sex with your partner out of a sense of obligation is not the answer-resentment will surely be the long-term result. Likewise, shaming and trying to make the partner with the less-intense sex drive feel guilty will inevitably create tension in the relationship. Solutions vary according to the cause, but for starters it is important to remember that any disagreement, whether it involves sex, money, in-laws, or parenting, can be better handled when the communication is marked by honesty, sensitivity, and mutual respect. (Chapter 12)

30. When my doctor gives me only a few minutes to ask questions, how can I bring up embarrassing sexual problems?
    When you go for your appointment, have your questions about the sexual problem written down. Mention to the medical assistant who puts you in the exam room that you have several important questions for the healthcare provider and would like to ask them while you're still dressed in street clothes. Remaining dressed until you've discussed your questions offers a number of advantages. It will help you feel more comfortable while discussing your sexual concerns. It will let the healthcare provider know right from the start that you have concerns you wish to discuss. And it will prevent you and the healthcare provider from dashing over the questions because they were left to the final moments of the appointment. Be prepared to answer the following: what is the problem, including when you first experienced the problem and under what circumstances; what is your understanding of the problem; and what have you done about it? If you have had relevant tests in the past, be sure to bring those results to the present appointment. (Chapter 13).

31. In this age of advanced technology and media availability, how can I tell if the information I'm getting about sex is sound and accurate? Every day dozens of television talk shows do features on sexual issues. But remember, their prime objective is to entertain, not to educate, so the information is not always reliable or helpful.. Internet websites and self-help books can be important resources, but readers and surfers should look for the credentials of the authors or the authenticity of the website source. Things to look for in so-called sexperts are advanced degrees in relevant fields like medicine, nursing, psychology, social work, etc.; professional certification as sex educators or therapists; and/or affiliation with a reputable university. (Chapter 13)

32. Isn't it true that sexual problems are primarily in one's head?
    Looking at it another way, the solution, not the problem, may be in one's head. After a comprehensive look at the medical aspects of the problem, it is important that a person reviews his or her own sexual beliefs and values. Negative attitudes and misinformation can create or contribute to sexual problems, but those negatives can be replaced with positives, and misinformation can be corrected. Knowledge and a healthy acceptance of your sexuality can eliminate many problems and reduce the severity of those problems that have a medical cause. (Chapter 13)

33. How do I know if I have low sexual desire? My partner wants to have sex much more often than I do, and suggests it is my problem. Although low sexual desire is a common sexual problem, it is difficult to measure. Ask yourself if you ever have sexual thoughts or interest in being sexually aroused. If you thoughtfully answer yes, rather than you having low sexual desire, you and your partner may have a sexual discrepancy issue in your relationship. (Chapter 14)

34. Since I've been taking medication for depression, my sexual desire has hit the basement! Do I have to choose between my mental and sexual health?
    No. Some antidepressant medications may decrease sexual desire, while a substitute medication may leave sexual desire intact. Or your physician may decrease your dosage or prescribe an additional medication that offsets the medication side effects. Be persistent to find a solution. (Chapter 14)

35. Is there a for women?
    Studies are being done right now on drugs that may help increase blood engorgement of vulvar tissues, genital sensitivity, and lubrication. Viagra is a vasodilator (a medication that dilates blood vessels) that may be helpful for some women who have arousal problems due to illness or menopause, but at this time the FDA has not approved Viagra for women. Testosterone and herbal remedies such as ginkgo biloba, ginseng, DHEA, dong quai, and L-Arginine also have been reported to help with problems of low sexual arousal. (Chapter 15)

36. I have noticed a recent difference in my ability to lubricate. What should I consider in evaluating this problem?
    First, have a medical examination to see if there are any medical factors interfering with lubrication. Review whether in recent months you have felt sexual desire. Monitor what happens in your body if you are sexually stimulated. Consider whether you can maintain a focus on sexual activity and relax enough to let go. These insights will help you determine whether the problem is primarily physical or emotional/relational. (Chapter 15)

37. I don't have orgasms with sexual intercourse. Is this a sexual problem?
    No, not unless you think it is a problem. If you're enjoying sex, no orgasm is no problem. If you decide orgasms are something you want, there are resources to help you achieve this goal. It may be important to know that many, if not most, women do not have orgasms from sexual intercourse alone. (Chapter 16)

38. I often feel very close to an orgasm that never happens, and this is frustrating for me and my partner. Do other women experience this?
    Yes. You (or your partner) are probably watching obsessively for signs of a pending orgasm. We call this "orgasm watching." Arousal gets replaced with being a spectator in your own sexual experience, so that you are not sufficiently focused on the eroticism of the moment. This distraction can prevent full arousal and orgasm. (Chapter 16)

39. I can have an orgasm with a vibrator, but my partner worries that the vibrator is replacing him. He tells me that if I rely on a vibrator it will be the only way I'll respond sexually. True?
    False. There is no scientific foundation for the concern that you could become dependent on or addicted to your vibrator. A vibrator can enhance sexual pleasure and help women with low arousal, but most women will state that a vibrator will never replace the closeness and sensation they feel with their partner. (Chapter 16)

40. How do I determine if I am a lesbian?
    For some women, sexual orientation can take some time to unfold. The very fact that you have asked this question implies that you will need time, experience, and reflection to determine the answer for yourself. In this process of discovery, consider these questions: 1) Were you attracted to heterosexual images as you were maturing? 2) Did you date guys? If yes, was it to prove your attraction to males? 3) Are you comfortable with your sexuality? 4) Are you primarily attracted to women, but fear rejection by others? 5) Are women, men, or both the subject of your sexual fantasies? (Appendix)

41. What is sex therapy?
    Sex therapy, like most forms of therapy, is designed to be both a healing and a growth process. What makes it distinct from other forms of psychotherapy is that what brings the person through the office door is a sexual problem, as opposed to anxiety, depression, or stress. Even so, sex therapy doesn't focus solely on sex. Our sexuality is woven into our lives, making it impossible to isolate the focus of therapy on sex alone. Through the process of sex therapy the client or the couple is encouraged to find pleasure in their sexuality and to become more comfortable giving and receiving pleasure. Treatment will include identifying and examining feelings, gaining insight into reasons for maladaptive behavior, improving communication, learning new ways to approach old problems, and building on the client's or couple's inherent strengths. (Chapter 17)

42. How do I find a sex therapist?
    The American Association of Sex Educators, Counselors and therapists (AASECT) is a national organization that certifies sex therapists. They maintain a current roster of certified sex therapists and will provide you with a list of sex therapists in your area. Phone 804-644-3288 or log on to www.aasect.org. (Chapter 17)

back to the questions

For more detailed information on the above subjects, click to purchase the book - Sex Matters For Women: A Complete Guide to Taking Care of Your Sexual Self.

There is no set definition of what a "normal" sex life is. Individuals and couples vary widely in terms of how often they have sex and what that encounter involves. For some couples, once a week or month or even a few times a year may be perfectly normal. A sexual encounter may not always include intercourse, and each partner may not have an orgasm every time. And nearly everyone goes through periods when interest in sex or the ability to perform is hindered. This lack of a clear standard can make it difficult to diagnose whether or not someone has a "problem.".

The Merck Manual of Diagnosis and Therapy uses three phrases that can be helpful in judging whether a difficulty you're experiencing is actually a problem with sex:

• Persistent or recurrent: It isn't an isolated or occasional event but persists a long time.
• Causes personal distress: It upsets you and causes unusual anxiety.
• Causes interpersonal problems: It hurts your relationship with your sexual partner.

The latter two categories are the most important. Many people may experience levels of desire or changes in function that don't cause distress and do not impact their relationships. These changes would not then be considered a problem. However, these same changes may be very stressful for other people or couples and would be considered a sexual problem. Problems vary from person to person.

Another complicating factor is that most sexual problems cannot be traced to one specific cause. Rather, they result from a combination of the physical and the psychological. Proper sexual functioning depends on the sexual response cycle, which includes:

• An initial mindset or state of desire.
• The flow of blood to the genital areas (erection in men and swelling and lubrication in women) in response to arousal.
• Orgasm.
• Resolution, or a general sense of pleasure and well-being.

A breakdown in one of the cycle's phases can be responsible for a sexual problem, and that breakdown can stem from a variety of causes.

Role of diabetes, smoking and other problemss

According to the American Medical Association, sexual problems often result from physical conditions such as:

• Diabetes
• Heart disease
• Neurological disorders (such as stroke, brain or spinal cord injury, or multiple sclerosis)
• Pelvic surgery or trauma
• Side effects of medications
• Chronic diseases such as kidney or liver failure
• Hormonal imbalances
• Alcoholism and drug abuse
• Heavy smoking
• The effects of aging

Psychological causes might include:

• Stress or anxiety at work
• Concern about performance, marital or relationship problems
• Underlying mental disorders such as depression and anxiety
• Previous traumatic sexual experience

These sets of causes often "play off" one another. Certain illnesses or diseases can cause people to feel anxious about their sexual performance, which, in turn, can make the problem worse.

When doctors suspect a sexual problem, they usually run a series of diagnostic tests to see if there is any physical cause such as a certain medication, hormonal imbalance, neurological problem or other illness or some other mental disorder such as depression, anxiety or trauma. If any of these causes are found, then treatment will begin. If such underlying problems are ruled out, then the nature of the relationship between the two people must be considered. A sexual problem may be "situational." That is, the issues are specific to encounters with a certain person in a particular situation. In such cases, therapy is usually recommended for the couple.