In this section, we consider some of the specific problems that people encounter with desire, excitement, orgasm, and pain during intercourse. In reality, the line between “normal” and a “disorder” is not clearly defined in clinical practice (Althof et al., 2005). For example, how many times would a man need to have difficulty with his erections to have erectile disorder? In what context would not being able to become erect be normal instead of an indication of a problem? In addition, there is often considerable overlap: Problems with desire and arousal also affect orgasm, and orgasm difficulties can easily affect a person’s interest and ability to become aroused. For example, about 44% of men who have problems with experiencing erections also frequently ejaculate rapidly (Fisher et al., 2006).
The sexual problems that we will discuss also vary in duration and focus from one person to another. A specific difficulty can occur throughout life (lifelong sexual disorder) or be acquired at a specific time (acquired sexual disorder). A person can experience the problem in all situations with all partners (generalized type) or only in specific situations or with specific partners (situational type) (American Psychiatric Association, 2000). The categories and labels for the problems that we discuss come from the Second International Consultation on Sexual Medicine: Sexual Dysfunctions in Men and Women (Lue, Basson, et al., 2004), A New View of Women’s Sexual Problems (Kaschak & Tiefer, 2002), and from the International Society of Sexual Medicine, and the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-IV and DSM-5); we have added a few categories and labels of our own.