CAMAGUEY.- If someone had told me that I had to tackle this subject, I would have smiled.  In our society, in spite of the enormous efforts to turn it more and more cultured an prepared, there are still reminiscence of the past, and the chauvinism does not escape from this, but as life changes whether you like it or not, the situation is other.  That´s the way I got to Dr. Arcilia María Artola Silva, specialist in Integral General Medicine (MGI) and in Psychiatry. 

She works in the Psychiatric Hospital René Vallejo, in this city.  She holds a Master Degree in Social Psychiatry, and in Satisfying Longevity, and she is an Assistant Professor.  With great kindness, she used a bit of her limited time to see us and to explain us some issues related with sexual dysfunction, an issue that everybody have heard about it at least one time, but we do not always tackle it without prejudice. 

Sexual dysfunction consist of the inability which a person has to enjoy a relation of this kind despite having all conditions to achieve it, like material and physical conditions, the adequate place, the feeling of loving your partner.  This can be present during any stage of the sexual act (that includes desire, preference, arousal and orgasm) and prevents the individual or couple to achieve a full enjoyment, according to Dr. Arcilia. 

Sexual dysfunction may be classified into: difficulties in attraction and desire, which happens to a person with lack of sexual desire though the person is healthy, loves his partner and feels attracted to her.  There is also the sexual refusal, in cases where people feels at the same time eagerness and repulsion towards the act. 

- Is it more frequent in men or women? 

- This problem appears either in women or in men.  In the feminine sex appears difficulties in the desire, arousal, orgasm and dyspareunia – painful intercourse, in women as well as in men, though the last ones are less frequent – and it is defined as pain or an inconvenience before, after or during the sexual union; the difficulties with the vaginal lubrication, and the vaginismus - pain to the sexual contact due to difficulty in the muscles - and absence of orgasm; in the masculine case, difficulties in the erection and in the ejaculation when it is precocious, mainly, because these are no only ones. 

- What do you mean with not organic? 

- We take care of the psychic part and to having detected an organic damage; the patients have to go to other specialists. 

- Earlier we listened people talking about frigidity in the woman …

- This concept was abolished, it is treated as absence of vaginal lubrication, both in the youngest and in the age of the menopause for hormones absence. 

- Anyone has a stumble in the sexual contact, but: when must the person or the couple begin to worry and go to the doctor? 

- When it turns into a long event.  A limit time is not defined, it is perceived when displeasure is produced in the couple.  For example, in case of the erectile sexual malfunction, in an occasion the man may not get the erection for several factors.  For instance, the man does not like his partner, the ambience is not the suitable one, he is worried, there has been some discussion between them earlier and that does not mean that he should go to the doctor; on the contrary, if it is continuous, it recurs, he must go. 

- How and to what doctor the person has to go? 

- The ways are different.  We open a sexuality consultation every Monday in the Psychiatric Hospital René Vallejo, at 30 after 8 in the morning.  In addition, they can go to his family doctor who will indicate him what to do, since sometimes they resolve in the consultation of Psychology of the area of Health. 

- What are the causes that originates this suffering? 

- Multiple.  Inside our specialty, we are discarding them, sometimes we have to diagnose the patient and in other cases, the couple says it because she knows what happens to him, but she does not know how to remedy it. 

“Among these, we find a bad sex education, the girls who have been violated or they suffered from lewd abuse, something that can happen in the males, but it is seen more frequently in women, or the first relations have been very traumatic, at early ages, without knowing well their couple, without feeling love, in epoch of student they do it in public places and in a rapid way to avoid that someone see them.  Things like those cause with frequency premature ejaculation, they get accustomed to this rapidity, and it becomes a habit. 

“We cannot forget the social causes, as: houses shared by several members of the family, lack of ventilation in the rooms, children who sleep in the same pieces as their parents”. 

- Anyway, a major number of cases comes to you for a cause than for others …

- Certainly.  The erectile sexual malfunction is the more frequent one; the man goes alone, without his couple.  We still stumble over taboos about the topic and they are ashamed, or they do not have a stable partner; nevertheless, others come to us for mistake.  I attended to a couple because he was thinking that he was suffering from premature ejaculation and she did not have this criterion, she was feeling satisfied. 

“The most treated ones are the men over 60 for erectile sexual malfunction.  Also those of about forty; and the women for lack of orgasms, almost always the young people treated are the males in full youth due to premature ejaculation, in this order”. 

- If the sexual initiation happens in very early ages, can any malfunction be provoked in this sense? 

- Sure.  They are not prepared, they do not know each other very well, even nor do they feel love.  They see each other, go out and can face a premature ejaculation, an absence of orgasm, and although it is not the topic they can face pregnancy in the adolescence.  They rush; they do not live the nice epoch of engagement. 

- Let’s imagine that the person is already in consultation: does it solve his problem? 

- Yes, because it is functional or psychic, not for organic damage. 

- In these consultations, I always say that we do not mention medicines, but: do you apply any treatment that does not take them implicitly? 

- Yes, in couples as well as alone.  Every case needs its method, we do not have a formula for all equally.  Among those that we order to do the treatment in couple is the erectile sexual malfunction.  That is, we send them to "date" for one week as in the old times, like giving her flowers, going to certain places, saying pretty things to each other, all this without penetration not even touching the erogenous areas.  In the second week, they can play sexual games, touch and continue without penetration.  When they are in the third one, after this agreeable preamble they can end with the penetration. 

“We offer service to persons of the third age, they think that they can continue the same way as when they were younger, and it is not like that, in this stage of the life they need much more caresses, kisses, a pretty communication in every respect. 

“We have a medicine that is taken 30 minutes before the sexual act, but it is not a miraculous tablet, this man cannot walk up and down all the time and come and that´s it, no, the caresses are necessary...

“In case of the premature ejaculation - it appears quickly of an inevitable and inopportune form - we indicate exercises in couple, and the absence of orgasm alone and in couple.  In these cases, we verify lack of sex education, the orgasm is almost learned.  Every person must know how he or she feels better, he or she is unique and every person feels it in his or her own way to reach the climax and to know what he or she desires.  The female should not please the male, no, it is mutual, to be aware of your own body and sexual answers is something fundamental so that it takes place”. 

- Do the young people use this medicine? 

- They shouldn´t; nevertheless, they obtain it and use it. 

- But if they have no problems with the erection …

- The tablets are a powerful vasodilator, the time of the erection gets longer, the performance. 

- Can it hurt them? 

- Of course, it can provoke them high blood pressure, something very dangerous in the young people.  It is not convenient to take medicines without medical prescription; this is a principle we must not break. 

- If the cause is linked to those social problems referred to the housings and rooms shared by many, issues that are not solved so quickly: what to do? 

- We indicate variants as to look for a schedule in which the children are in the school, for example, people receive advices so that the daily routine does not bore them, they do not take such a rigid life, to go to other places.  The couple needs a time for themselves and it has to look for it and to find it. 

- Is the masturbation normal? 

- Completely.  Both in the male and in the female.  If the person does it, he or she knows his or her body and they will be able to guide their couple.  What would not be accepted is that this act goes so far as to constitute a compulsion, which does it continuously, or in case of the men in public places. 

- Can it happen that someone comes to the psychiatrist and is sent to another specialist? 

- Yes.  In fact, this consultation is multidisciplinary because it discards if the ailment is for an organic reason. 

- Organic cause: how? 

- The diabetes mellitus, the menopause age, venous insufficiency in the men, among others. 

- If you verified that the person endures some of these or other causes: what do you do? 

- We send the person to the specialist that corresponds. 

- Do you feel that the patient goes away satisfied? 

- Of course, and later on we continue to follow the case for a time.  The interested party has to put on his part, almost all the patients need psychotherapy. 

- Do you think that in Cuba the persons come to the doctor for this phenomenon in an uninhibited way? 

- No, we are sure that there are more sexual malfunctions in the street, without medical attention, that the treated ones; nevertheless, if they would come to the doctor they would solve their problem.  Obviating it makes them unhappy, they feel shame, that is a reality and there is machismo.  Sometimes we advise the masturbation, especially to the woman and they recount that it gives them disgust, how they feel disgusted of themselves and that is real.  There is lack of culture of the matter and this is a brake. 

- A recommendation? 

-Especially to the adolescents, I will say to them that before the sexual relations, first they need to know themselves, to go so far as to practice them for love and that it must happen with protection, this way the worries diminish, and to do it in a suitable ambience.  They must not consume medicine if they do not need it and if it is indicated by the doctor; if he or she presents some conflict should not be ashamed, just go to the specialist and for sure he or she will go out forward and happily. 

“And for all ages I will say to them that love is like a garden, if you do not take care of it, it dies”.