Editing Sexual intercourse (section)

==Health effects==

==={{anchor|Benefits}}Benefits===
In humans, sexual intercourse and sexual activity in general have been reported as having health benefits as varied as increased [[immune system|immunity]] by increasing the body's production of [[antibodies]] and subsequent lower [[blood pressure]],<ref name="Steptoe">{{cite book| author = Andrew Steptoe| author2 = Kenneth Freedland| author3 = J. Richard Jennings| author4 = Maria M. Llabre| author5 = Stephen B Manuck| author6 = Elizabeth J. Susman|author-link=Andrew Steptoe |author5-link=Stephen Manuck |title =Handbook of Behavioral Medicine: Methods and Applications| publisher = [[Springer Science & Business Media]] | year = 2010 | pages = 60–61 | access-date = December 7, 2014 |isbn = 978-0-387-09488-5| url =https://books.google.com/books?id=Si9TtI5AGIEC&pg=PA60}}</ref><ref name="Hornstein">{{cite book| author = Theresa Hornstein| author2 = Jeri Schwerin|title =Biology of Women| publisher = [[Cengage Learning]] | year = 2012 | page = 205 | access-date = December 7, 2014 |isbn = 978-1-285-40102-7| url =https://books.google.com/books?id=ibgKAAAAQBAJ&pg=PA205}}</ref> and decreased risk of [[prostate cancer]].<ref name="Steptoe"/> Sexual intimacy and orgasms increase levels of the hormone [[oxytocin]] (also known as "the love hormone"), which can help people bond and build trust.<ref name="Hornstein"/><ref name="Sigelman">{{cite book| author = Carol Sigelman| author2 = Elizabeth Rider|title =Life-Span Human Development| publisher = [[Cengage Learning]] | year = 2011 | page = 452 | access-date = December 7, 2014 |isbn = 978-1-111-34273-9| url =https://books.google.com/books?id=8smBuRecmDsC&pg=PT480}}</ref> Oxytocin is believed to have a more significant impact on women than on men, which may be why women associate sexual attraction or sexual activity with romance and love more than men do.<ref name="Freberg"/> A long-term study of 3,500 people between ages 18 and 102 by clinical [[neuropsychologist]] David Weeks indicated that, based on impartial ratings of the subjects' photographs, sex on a regular basis is associated with people looking significantly chronologically younger. However this does not imply causality.<ref>{{cite book|last=Northrup|first=Christiane|author-link=Christiane Northrup|title=Women's Bodies, Women's Wisdom: Creating Physical and Emotional Health and Healing|year=2010|publisher=Bantam|isbn=978-0-553-80793-6|page=232|url=https://books.google.com/books?id=V9S3keMnie8C&pg=PA232|access-date=October 21, 2015}}</ref>

Vaginal intercourse for the first time increases vaginal immune activity.<ref name="10.7554/eLife.78565">{{cite journal |last1=Hughes |first1=Sean M |last2=Levy |first2=Claire N |last3=Calienes |first3=Fernanda L |last4=Martinez |first4=Katie A |last5=Selke |first5=Stacy |last6=Tapia |first6=Kenneth |last7=Chohan |first7=Bhavna H |last8=Oluoch |first8=Lynda |last9=Kiptinness |first9=Catherine |last10=Wald |first10=Anna |last11=Ghosh |first11=Mimi |last12=Hardy |first12=Liselotte |last13=Ngure |first13=Kenneth |last14=Mugo |first14=Nelly R |last15=Hladik |first15=Florian |last16=Roxby |first16=Alison C |title=Starting to have sexual intercourse is associated with increases in cervicovaginal immune mediators in young women: a prospective study and meta-analysis |journal=eLife |date=October 25, 2022 |volume=11 |pages=e78565 |doi=10.7554/eLife.78565 |pmid=36281966 |pmc=9596159 |doi-access=free }}</ref>

===Risks{{anchor|General risks}}===
[[Sexually transmitted infection]]s (STIs) are [[bacteria]], [[virus]]es or [[parasites]] that are [[Transmission (medicine)|spread]] by sexual contact, especially vaginal, anal, or oral intercourse, or [[unprotected sex]].<ref name="Hoeger">{{cite book|vauthors=Hoeger W, HS, FA, HC|title=Principles and Labs for Fitness and Wellness| publisher = [[Cengage Learning]] | year = 2016 | pages = 538–540|isbn = 978-1-337-09997-4| url =https://books.google.com/books?id=wdq5DQAAQBAJ}}</ref><ref name=Women2017>{{Cite web|url=https://www.womenshealth.gov/a-z-topics/sexually-transmitted-infections|title=Sexually transmitted infections|website=womenshealth.gov|language=en|access-date=December 8, 2017|date=February 22, 2017}}{{PD-notice}}</ref> Oral sex is less risky than vaginal or anal intercourse.<ref name="Gulanick">{{cite book|vauthors=Gulanick M, Myers JL |title=Nursing Care Plans - E-Book: Diagnoses, Interventions, and Outcomes| publisher=[[Elsevier Health Sciences]] |year=2016 |page=725|isbn=978-0-323-42810-1| url=https://books.google.com/books?id=NK2ADQAAQBAJ}}</ref> Many times, STIs initially do not cause symptoms, increasing the risk of unknowingly passing the infection on to a sex partner or others.<ref>{{cite book|vauthors=Murray PR, Rosenthal KS, Pfaller MA|title=Medical microbiology|date=2013|publisher=Mosby|location=St. Louis, MO|isbn=978-0-323-08692-9 |page=418|edition=7th|url=https://books.google.com/books?id=RBEVsFmR2yQC&pg=PA418 |url-status=live |archive-url=https://web.archive.org/web/20151201070705/https://books.google.com/books?id=RBEVsFmR2yQC&pg=PA418 |archive-date=December 1, 2015}}</ref><ref>{{cite book|last1=Goering|first1=Richard V.|title=Mims' medical microbiology |date=2012 |publisher=Saunders|location=Edinburgh|isbn=978-0-7234-3601-0 |page=245 |edition=5th |url=https://books.google.com/books?id=pzQayLEQ5mQC&pg=PA245}}</ref>

There are 19 million new cases of sexually transmitted infections every year in the U.S.,<ref>{{cite web|title=STD Trends in the United States: 2010 National Data for Gonorrhea, Chlamydia, and Syphilis |url=https://www.cdc.gov/std/stats10/trends.htm |publisher=[[Centers for Disease Control and Prevention]] |url-status=dead |archive-url=https://web.archive.org/web/20120326175627/https://www.cdc.gov/std/stats10/trends.htm |archive-date=March 26, 2012 |access-date=September 23, 2023}}</ref> and, in 2005, the World Health Organization (WHO) estimated that 448 million people aged 15–49 were infected per year with curable STIs (such as [[syphilis]], [[gonorrhea]] and [[chlamydia]]).<ref name="WHO 2015">{{cite web| title=Sexually transmitted infections (STIs)|publisher=World Health Organization| url =https://www.who.int/mediacentre/factsheets/fs110/en/| access-date = June 20, 2015}}</ref> Some STIs can cause a [[genital ulcer]]; even if they do not, they increase the risk of both acquiring and passing on HIV up to ten-fold.<ref name="WHO 2015"/> [[Hepatitis B]] can also be transmitted through sexual contact.<ref>[https://www.cdc.gov/hepatitis/HBV/HBVfaq.htm#treatment CDC Hepatitis B Information for Health Professionals] Accessed May 27, 2010</ref> Globally, there are about 257 million chronic carriers of hepatitis B.<ref>{{cite web|title=Hepatitis B|url=https://www.who.int/news-room/fact-sheets/detail/hepatitis-b |publisher=[[World Health Organization]] |date=July 18, 2018}}</ref> HIV is one of the world's leading infectious killers; in 2010, approximately 30 million people were estimated to have died because of it since the beginning of the epidemic. Of the 2.7 million new [[Epidemiology of HIV/AIDS|HIV infections]] estimated to occur worldwide in 2010, 1.9 million (70%) were in [[HIV/AIDS in Africa|Africa]]. The World Health Organization also stated that the "estimated 1.2 million Africans who died of HIV-related illnesses in 2010 comprised 69% of the global total of 1.8 million deaths attributable to the epidemic."<ref name=WHO-HIV>{{cite web|title=HIV/AIDS|publisher=[[World Health Organization]] |url=https://www.who.int/gho/hiv/en/index.html|access-date=September 15, 2012}}</ref> It is [[Diagnosis of HIV/AIDS|diagnosed by blood tests]], and while no cure has been found, it can be controlled by management [[Management of HIV/AIDS|through antiretroviral drugs for the disease]], and patients can enjoy healthy and productive lives.<ref name=WHO-2012>{{cite web|title=HIV/AIDS|url=https://www.who.int/mediacentre/factsheets/fs360/en/index.html|work=Fact sheet N° 360|publisher=[[World Health Organization]]|access-date=September 8, 2012|date=July 2012}}</ref>

In cases where infection is suspected, early medical intervention is highly beneficial in all cases. The CDC stated "the risk of HIV transmission from an infected partner through oral sex is much less than the risk of HIV transmission from anal or vaginal sex," but that "measuring the exact risk of HIV transmission as a result of oral sex is very difficult" and that this is "because most sexually active individuals practice oral sex in addition to other forms of sex, such as vaginal or anal sex, when transmission occurs, it is difficult to determine whether it occurred as a result of oral sex or other more risky sexual activities". They added that "several co-factors may increase the risk of HIV transmission through oral sex"; this includes ulcers, [[Bleeding on probing|bleeding gums]], genital sores, and the presence of other STIs.<ref name="CDC, oral sex"/>

In 2005, the World Health Organization estimated that 123 million women become pregnant worldwide each year, and around 87 million of those pregnancies or 70.7% are unintentional. Approximately 46 million pregnancies per year reportedly end in induced [[abortion]].<ref>{{cite web|title=Not Every Pregnancy is Welcome|url=https://www.who.int/whr/2005/chapter3/en/index3.html|archive-url=https://web.archive.org/web/20050414233054/http://www.who.int/whr/2005/chapter3/en/index3.html|url-status=dead|archive-date=April 14, 2005|work=The world health report 2005&nbsp;– make every mother and child count|publisher=[[World Health Organization]]|access-date=December 6, 2011}}</ref> Approximately 6 million U.S. women become pregnant per year. Out of known pregnancies, two-thirds result in live births and roughly 25% in abortions; the remainder end in miscarriage. However, many more women become pregnant and miscarry without even realizing it, instead mistaking the miscarriage for an unusually heavy [[menstruation]].<ref name="Guttmacher 0">{{cite web|title=Get "In the Know": 20 Questions About Pregnancy, Contraception and Abortion |publisher=[[Guttmacher Institute]] |year=2005 |access-date=March 4, 2011 |url=http://www.guttmacher.org/in-the-know/index.html |url-status=deviated |archive-url=https://web.archive.org/web/20091223093547/http://www.guttmacher.org/in-the-know/index.html |archive-date=December 23, 2009 }}</ref> The U.S. [[teenage pregnancy]] rate fell by 27 percent between 1990 and 2000, from 116.3 pregnancies per 1,000 girls aged 15–19 to 84.5. This data includes live births, abortions, and fetal losses. Almost 1 million American teenage women, 10% of all women aged 15–19 and 19% of those who report having had intercourse, become pregnant each year.<ref name="Ventura">{{cite web|author=Ventura, SJ|author2=Abma, JC|author3=Mosher, WD|author4=Henshaw, S.|name-list-style=amp|title=Estimated pregnancy rates for the United States, 1990–2000: An Update. National Vital Statistics Reports, 52 (23)|publisher=[[Centers for Disease Control and Prevention]]|date=November 16, 2007|access-date=March 4, 2011|url=https://www.cdc.gov/nchs/data/nvsr/nvsr52/nvsr52_23.pdf}}</ref>

Sexual activity can increase the expression of a [[gene transcription]] factor called [[ΔFosB]] (delta FosB) in the [[nucleus accumbens|brain's reward center]];<ref name="ΔFosB reward">{{cite journal |vauthors=Blum K, Werner T, Carnes S, Carnes P, Bowirrat A, Giordano J, Oscar-Berman M, Gold M | title = Sex, drugs, and rock 'n' roll: hypothesizing common mesolimbic activation as a function of reward gene polymorphisms | journal = Journal of Psychoactive Drugs | volume = 44 | issue = 1 | pages = 38–55 | year = 2012 | pmid = 22641964 | pmc = 4040958 | doi = 10.1080/02791072.2012.662112}}</ref><ref name="Natural and drug addictions">{{cite journal | author = Olsen CM | title = Natural rewards, neuroplasticity, and non-drug addictions | journal = Neuropharmacology | volume = 61 | issue = 7 | pages = 1109–1122 |date=December 2011 | pmid = 21459101 | pmc = 3139704 | doi = 10.1016/j.neuropharm.2011.03.010 }}</ref><ref name="Amph and sex addiction"><!--Supplemental primary source-->{{cite journal |vauthors=Pitchers KK, Vialou V, [[Eric J. Nestler|Nestler EJ]], Laviolette SR, Lehman MN, Coolen LM | title = Natural and drug rewards act on common neural plasticity mechanisms with ΔFosB as a key mediator | journal = J. Neurosci. | volume = 33 | issue = 8 | pages = 3434–42 |date=February 2013 | pmid = 23426671 | pmc = 3865508 | doi = 10.1523/JNEUROSCI.4881-12.2013 }}</ref> consequently excessively frequent engagement in sexual activity on a regular (daily) basis can lead to the overexpression of ΔFosB, inducing an addiction to sexual activity.<ref name="ΔFosB reward" /><ref name="Natural and drug addictions" /><ref name="Amph and sex addiction" /> [[Sexual addiction]] or [[hypersexuality]] is often considered an impulse control disorder or a behavioral addiction. It has been linked to atypical levels of dopamine, a neurotransmitter. This behavior is characterized by a fixation on sexual intercourse and disinhibition. It was proposed that this 'addictive behavior' be classified in [[DSM-5]] as an impulsive–compulsive behavioral disorder. Addiction to sexual intercourse is thought to be genetically linked. Those having an addiction to sexual intercourse have a higher response to visual sexual cues in the brain. Those seeking [[Psychiatric treatment|treatment]] will typically see a physician for pharmacological management and therapy.<ref name="Probstvan Eimeren2013">{{cite journal|last1=Probst |first1=Catharina C.|last2=van Eimeren|first2=Thilo|title=The Functional Anatomy of Impulse Control Disorders|journal=Current Neurology and Neuroscience Reports|volume=13|issue=10|pages=386|year=2013 |issn=1528-4042|doi=10.1007/s11910-013-0386-8|pmid=23963609|pmc=3779310}}</ref> One form of hypersexuality is [[Kleine–Levin syndrome]]. It is manifested by [[hypersomnia]] and hypersexuality and remains relatively rare.<ref name="GuilleminaultMiglis2014">{{cite journal|last1=Guilleminault|first1=Christian|last2=Miglis|first2=Mitchell|author1-link=Christian Guilleminault|title=Kleine-Levin syndrome: a review|journal=Nature and Science of Sleep|volume=6|pages=19–26|year=2014|issn=1179-1608|doi=10.2147/NSS.S44750|pmid=24470783|pmc=3901778 |doi-access=free }}</ref>

[[Death during consensual sex|Sexual activity can directly cause death]], particularly due to [[coronary circulation]] complications, which is sometimes called ''coital death,'' ''coital sudden death'' or ''coital coronary.''<ref name="Kahn, Fawcett"/><ref name="Kipshidze">{{Cite book|author= Nicolas Kipshidze|author2= Jawad Fareed|author3= Patrick W. Serruys|author4= Jeff Moses | title = Textbook of Interventional Cardiovascular Pharmacology| year = 2007 | publisher = [[CRC Press]] |page=505 | isbn = 978-0-203-46304-8| url=https://books.google.com/books?id=13g_niZy0usC&pg=PA505| access-date=October 21, 2015}}</ref><ref name="Dahabreh">{{cite journal|last=Dahabreh|first=Issa J. |title=Association of Episodic Physical and Sexual Activity With Triggering of Acute Cardiac Events. Systematic Review and Meta-analysis |journal=JAMA: The Journal of the American Medical Association|date=March 23, 2011|volume=305 |issue=12|pages=1225–33|doi=10.1001/jama.2011.336|pmid=21427375|pmc=5479331|quote=Acute cardiac events were significantly associated with episodic physical and sexual activity; this association was attenuated among persons with high levels of habitual physical activity.}}</ref> However, coital deaths are significantly rare.<ref name="Kipshidze"/> People, especially those who get little or no physical exercise, have a slightly increased risk of triggering a [[heart attack]] or [[sudden cardiac death]] when they engage in sexual intercourse or any vigorous physical exercise that is engaged in on a sporadic basis.<ref name="Dahabreh"/> Regular exercise reduces, but does not eliminate, the increased risk.<ref name="Dahabreh"/>

===Duration and genital complications===
{{see also|Intravaginal ejaculation latency time|Coitus reservatus}}

Sexual intercourse, when involving a male participant, often ends when the male has ejaculated, and thus the partner might not have time to reach [[orgasm]].<ref name="Wincze">{{Cite book|author= John Wincze | title = Enhancing Sexuality : A Problem-Solving Approach to Treating Dysfunction| year = 2009 | publisher = [[Oxford University Press]] |pages=56–60 | isbn = 978-0-19-971802-3| url=https://books.google.com/books?id=8YxbeHsgiGMC&pg=PA56}}</ref> In addition, [[premature ejaculation]] (PE) is common, and women often require a substantially longer duration of stimulation with a sexual partner than men do before reaching an orgasm.<ref name="Weiten, 2011" /><ref name="Porst">{{cite book |author = Hartmut Porst |author2 = Jacques Buvat|title =Standard Practice in Sexual Medicine| publisher = [[John Wiley & Sons]] | year = 2008|access-date=October 22, 2013 | page = 189|isbn = 978-1-4051-7872-3 |url=https://books.google.com/books?id=S4GJio79XOUC&pg=PA189}}</ref><ref name="Emmanuele">{{cite book|author1-link=Emmanuele A. Jannini|author = Emmanuele A. Jannini |author2 = Chris G. McMahon |author3 = Marcel D. Waldinger|title =Premature Ejaculation: From Etiology to Diagnosis and Treatment| publisher = [[Springer Publishing|Springer]] | year = 2012|access-date=October 22, 2013 | pages = 159–162|isbn = 978-88-470-2646-9 |url=https://books.google.com/books?id=iCXF3sWtgegC&pg=PA159}}</ref> Scholars, such as Weiten et al., state that "many couples are locked into the idea that orgasms should be achieved only through intercourse [penile-vaginal sex]," that "the word ''foreplay'' suggests that any other form of sexual stimulation is merely preparation for the 'main event'" and that "because women reach orgasm through intercourse less consistently than men," they are likelier than men to [[Fake orgasm|fake an orgasm]] to satisfy their sexual partners.<ref name="Weiten, 2011" />
[[File:Indiaerotic8.jpg|thumb|left|Painting of a couple (an Indian prince and lady) prolonging sexual intercourse]]
In 1991, scholars from the Kinsey Institute stated, "The truth is that the time between penetration and ejaculation varies not only from man to man, but from one time to the next for the same man." They added that the appropriate length for sexual intercourse is the length of time it takes for both partners to be mutually satisfied, emphasizing that [[Alfred Kinsey|Kinsey]] "found that 75 percent of men ejaculated within two minutes of penetration. But he didn't ask if the men or their partners considered two minutes mutually satisfying" and "more recent research reports slightly longer times for intercourse".<ref name="Reinisch">{{cite book | title = The Kinsey Institute New Report On Sex| publisher = [[Macmillan Publishers|Macmillan]] | year = 1991 | pages = 129–130| access-date = August 30, 2012 |isbn = 978-0-312-06386-3| url = https://books.google.com/books?id=KsW6wPiXEd0C&pg=PA129 |author1=June M. Reinisch |author2=Ruth Beasley |author1-link=June Reinisch }}</ref> A 2008 survey of Canadian and American [[sex therapists]] stated that the average time for heterosexual intercourse (coitus) was 7 minutes and that 1 to 2 minutes was too short, 3 to 7 minutes was adequate and 7 to 13 minutes desirable, while 10 to 30 minutes was too long.<ref name="Carroll"/><ref>{{cite journal |vauthors=Corty EW, Guardiani JM | title = Canadian and American Sex Therapists' Perceptions of Normal and Abnormal Ejaculatory Latencies: How Long Should Intercourse Last? | journal = The Journal of Sexual Medicine | volume = 5 | issue = 5 | pages = 1251–1256 | year = 2008 | pmid = 18331255 | doi = 10.1111/j.1743-6109.2008.00797.x }}</ref>

[[Anorgasmia]] is regular difficulty reaching orgasm after ample sexual stimulation, causing personal distress.<ref name="Bullough">{{cite book |author=Vern L Bullough |author2=Bonnie Bullough |author-link=Vern Bullough |author2-link=Bonnie Bullough | title = Human Sexuality: An Encyclopedia | publisher =[[Routledge]]|page=32|year = 2014|access-date=December 6, 2014| isbn = 978-1-135-82502-7 |url =https://books.google.com/books?id=-cqlAgAAQBAJ&pg=PA32}}</ref> This is significantly more common in women than in men,<ref name="Rosenthal">{{cite book |first=Martha |last= Rosenthal| title = Human Sexuality: From Cells to Society | publisher =[[Cengage Learning]]|year = 2012|page=150|access-date=October 22, 2013| isbn = 978-0-618-75571-4 |url =https://books.google.com/books?id=d58z5hgQ2gsC&pg=PT170}}</ref><ref name="Weiner2">{{cite book |author =Irving B. Weiner |author2 =George Stricker |author3 =Thomas A. Widiger |author3-link=Thomas Widiger|title =Handbook of Psychology, Clinical Psychology| publisher = [[John Wiley & Sons]] | year = 2012|access-date=October 22, 2013| pages = 172–175|isbn = 978-1-118-40443-0|url=https://books.google.com/books?id=A_NaK3cwQSsC&pg=PA172}}</ref> which has been attributed to the lack of [[sex education]] with regard to women's bodies, especially in [[Antisexualism|sex-negative]] cultures, such as clitoral stimulation usually being key for women to orgasm.<ref name="Weiner2"/> The physical structure of coitus favors penile stimulation over clitoral stimulation; the location of the clitoris then usually necessitates manual or oral stimulation in order for the woman to achieve orgasm.<ref name="Weiten, 2011"/> Approximately 25% of women report difficulties with orgasm,<ref name="Carroll"/> 10% of women have never had an orgasm,<ref name="Plotnik">{{cite book |author1=Rod Plotnik |author2=Haig Kouyoumdjian |title =Introduction to Psychology| publisher = [[Cengage Learning]] | year = 2010 | page = 344|isbn = 978-0-495-90344-4| quote= Inhibited female orgasm refers to a persistent delay or absence of orgasm after becoming aroused and excited. About 10% of women never reach orgasm...}}</ref> and 40% or 40–50% have either complained about sexual dissatisfaction or experienced difficulty becoming sexually aroused at some point in their lives.<ref name="Knoepp">{{cite journal |vauthors=Knoepp LR, Shippey SH, Chen CC, Cundiff GW, Derogatis LR, Handa VL | title = Sexual complaints, pelvic floor symptoms, and sexual distress in women over forty | journal = [[The Journal of Sexual Medicine]] | volume = 7 | issue = 11 | pages = 3675–82 | year = 2010 | pmid = 20704643 | pmc = 3163299 | doi = 10.1111/j.1743-6109.2010.01955.x }}</ref>

[[Vaginismus]] is involuntary tensing of the pelvic floor musculature, making coitus, or any form of penetration of the vagina, distressing, painful and sometimes impossible for women. It is a conditioned reflex of the pubococcygeus muscle, and is sometimes referred to as the ''PC muscle.'' Vaginismus can be hard to overcome because if a woman expects to experience pain during sexual intercourse, this can cause a muscle spasm, which results in painful sexual intercourse.<ref name="Weiner2"/><ref name="Ferri">{{cite book|author=Fred F. Ferri|title=Ferri's Clinical Advisor 2013,5 Books in 1, Expert Consult&nbsp;— Online and Print,1: Ferri's Clinical Advisor 2013|publisher=[[Elsevier Health Sciences]]|isbn=978-0-323-08373-7|year=2012|page=1134|access-date=November 29, 2014|url=https://books.google.com/books?id=OR3VERnvzzEC&pg=PA1134}}</ref> Treatment of vaginismus often includes both psychological and behavioral techniques, including the use of [[vaginal dilators]].<ref name="Goldman">{{cite book |author= Marlene B. Goldman |author2= Rebecca Troisi |author2-link=Rebecca J. Troisi |author3= Kathryn M. Rexrode| title = Women and Health | publisher =[[Academic Press]]|page=351|year = 2012|access-date=December 6, 2014| isbn = 978-0-12-384979-3 |url =https://books.google.com/books?id=mavb4v8w8bsC&pg=PA351}}</ref> Additionally, the use of [[Botox]] as a medical treatment for vaginismus has been tested and administered.<ref name="Comer">{{cite book |author= Ronald J. Comer| title = Fundamentals of Abnormal Psychology | publisher =[[Macmillan Publishers|Macmillan]]|page=338|year = 2010|access-date=December 6, 2014| isbn = 978-1-4292-1633-3 |url =https://books.google.com/books?id=y-FUzkLQ7GsC&pg=PA338}}</ref> Painful or uncomfortable sexual intercourse may also be categorized as [[dyspareunia]].<ref name="Goldman"/>

Approximately 40% of males reportedly have some form of [[erectile dysfunction]] (ED) or impotence, at least occasionally.<ref name="Schouten">{{cite journal |vauthors=Schouten BW, Bohnen AM, Groeneveld FP, Dohle GR, Thomas S, Bosch JL | title = Erectile dysfunction in the community: trends over time in incidence, prevalence, GP consultation and medication use—the Krimpen study: trends in ED | journal = J Sex Med | volume = 7 | issue = 7 | pages = 2547–53 | date = July 2010 | pmid = 20497307 | doi = 10.1111/j.1743-6109.2010.01849.x }}</ref> Premature ejaculation has been reported to be more common than erectile dysfunction, although some estimates suggest otherwise.<ref name="Porst"/><ref name="Emmanuele"/><ref name="Schouten" /> Due to various meanings of the disorder, estimates for the prevalence of premature ejaculation vary significantly more than for erectile dysfunction.<ref name="Porst" /><ref name="Emmanuele" /> For example, the [[Mayo Clinic]] states, "Estimates vary, but as many as 1 out of 3 men may be affected by [premature ejaculation] at some time."<ref name="Premature ejaculation">{{cite web|url=http://www.mayoclinic.com/health/premature-ejaculation/DS00578|title=Premature ejaculation|publisher=[[Mayo Clinic]].com|access-date=March 2, 2007}}</ref> Further, "Masters and Johnson speculated that premature ejaculation is the most common sexual dysfunction, even though more men seek therapy for erectile difficulties" and that this is because "although an estimated 15 percent to 20 percent of men experience difficulty controlling rapid ejaculation, most do not consider it a problem requiring help, and many women have difficulty expressing their sexual needs".<ref name="Reinisch"/> The [[American Urological Association]] (AUA) estimates that premature ejaculation could affect 21 percent of men in the United States.<ref name="auanet.org">{{cite web|title=Guideline on the pharmacologic management of premature ejaculation|publisher=[[American Urological Association]]|year=2004|access-date=October 12, 2013|url=http://www.auanet.org/common/pdf/education/clinical-guidance/Premature-Ejaculation.pdf|url-status=dead|archive-url=https://web.archive.org/web/20160303170443/http://www.auanet.org/common/pdf/education/clinical-guidance/Premature-Ejaculation.pdf|archive-date=March 3, 2016}}</ref>

For those whose impotence is caused by medical conditions, prescription drugs such as [[Viagra]], [[Cialis]], and [[Levitra]] are available. However, doctors caution against the unnecessary use of these drugs because they are accompanied by serious risks such as increased chance of heart attack.<ref name="Greenberg ED">{{cite book |author= Jerrold S Greenberg |author2= Clint E. Bruess |author3=Sara B. Oswalt | title = Exploring the Dimensions of Human Sexuality | publisher =[[Jones & Bartlett Publishers]]|page=633|year = 2010|access-date=December 8, 2014| isbn = 978-0-7637-9740-9 |url = https://books.google.com/books?id=6b36v8JHznIC&pg=PA633}}</ref> The [[selective serotonin reuptake inhibitor]] (SSRI) and antidepressant drug [[dapoxetine]] has been used to treat premature ejaculation.<ref name="Balon">{{cite book |author=Richard Balon |author2=Robert Taylor Segraves| title = Clinical Manual of Sexual Disorders | publisher =[[American Psychiatric Pub]]|page=292|year = 2009|access-date=December 6, 2014| isbn = 978-1-58562-905-3 |url =https://books.google.com/books?id=YuP3Hb0TMLQC&pg=PA292}}</ref> In clinical trials, those with PE who took dapoxetine experienced sexual intercourse three to four times longer before orgasm than without the drug.<ref name="Architectural Press">{{cite book| title = The Architects' Journal |volume=221 |issue=17–21 | publisher =[[Architectural Press]]|page=16|year = 2005|access-date=December 6, 2014|url =https://books.google.com/books?id=7HlNAAAAYAAJ&q=The+Architects%27+Journal,+Volume+221,+Issues+17-21}}</ref> Another ejaculation-related disorder is [[delayed ejaculation]], which can be caused as an unwanted side effect of antidepressant medications such as [[fluvoxamine]]; however, all SSRIs have ejaculation-delaying effects, and fluvoxamine has the least ejaculation-delaying effects.<ref name="Balon2">{{cite book |author= Richard Balon |author2= Robert Taylor Segraves| title = Clinical Manual of Sexual Disorders | publisher =[[American Psychiatric Pub]]|page=281|year = 2009|access-date=December 6, 2014| isbn = 978-1-58562-905-3 |url =https://books.google.com/books?id=YuP3Hb0TMLQC&pg=PA281}}</ref>

Sexual intercourse often remains possible after major medical treatment of the reproductive organs and structures. This is especially true for women. Even after extensive gynecological surgical procedures (such as [[hysterectomy]], [[oophorectomy]], [[salpingectomy]], [[dilation and curettage]], [[hymenotomy]], [[Bartholin gland]] surgery, abscess removal, [[vestibulectomy]], [[labia minora]] reduction, [[cervical conization]], [[surgical]] and radiological cancer treatments and chemotherapy), sexual intercourse can continue. Reconstructive surgery remains an option for women who have experienced benign and malignant conditions.<ref name="Hoffman2012">{{cite book | last = Hoffman | first = Barbara | title = Williams gynecology | edition = 2nd | publisher = McGraw-Hill Medical |page=65 |location = New York | year = 2012 | isbn = 978-0-07-171672-7 }}</ref> Men and women who have undergone extensive surgery should consult their medical team to understand how their treatment or surgery affects sex and how long they should wait before having sexual intercourse after a surgery.<ref>{{Cite web |date=2017-09-22 |title=Sexual Health Issues in Men and Cancer Treatment - Side Effects - NCI |url=https://www.cancer.gov/about-cancer/treatment/side-effects/sexuality-men |access-date=2024-10-21 |website=www.cancer.gov |language=en}}</ref><ref>{{Cite web |title=Sexuality and intimacy |url=https://www.cancer.org.au/cancer-information/cancer-side-effects/sexuality-and-intimacy |access-date=2024-10-21 |website=www.cancer.org.au}}</ref><!--pages 1020-1348-->

===Disabilities and other complications===
{{main| Sexuality and disability}}

Obstacles that those with [[disabilities]] face with regard to engaging in sexual intercourse include pain, [[Depression (mood)|depression]], fatigue, [[negative body image]], stiffness, functional impairment, anxiety, reduced [[libido]], hormonal imbalance, and drug treatment or side effects. Sexual functioning has been regularly identified as a neglected area of the quality of life in patients with [[rheumatoid arthritis]].<ref name="Tristano2014">{{cite journal|last1=Tristano|first1=Antonio G|title=Impact of rheumatoid arthritis on sexual function|journal=World Journal of Orthopedics|volume=5|issue=2|pages=107–11|year=2014|issn=2218-5836|doi=10.5312/wjo.v5.i2.107|pmid=24829873|pmc=4017303 |doi-access=free }}</ref> For those that must take opioids for pain control, sexual intercourse can become more difficult.<ref name="DeyoVon Korff2015">{{cite journal|last1=Deyo|first1=R. A.|last2=Von Korff|first2=M.|last3=Duhrkoop|first3=D.|title=Opioids for low back pain|journal=BMJ|volume=350|issue= |year=2015|pages=g6380|issn=1756-1833|doi=10.1136/bmj.g6380|pmid=25561513|pmc=6882374}}</ref> Having a [[stroke]] can also largely impact on the ability to engage in sexual intercourse.<ref name="HersonPalmateer2012">{{cite journal|last1=Herson|first1=Paco S.|last2=Palmateer|first2=Julie|last3=Hurn|first3=Patricia D.|title=Biological Sex and Mechanisms of Ischemic Brain Injury|journal=Translational Stroke Research|volume=4|issue=4|year=2012|pages=413–419|issn=1868-4483|doi=10.1007/s12975-012-0238-x|pmc=3733393|pmid=23930140}}</ref> Although disability-related pain, including as a result of [[cancer]], and mobility impairment can hamper sexual intercourse, in many cases, the most significant impediments to sexual intercourse for individuals with a disability are psychological.<ref name="Falvo">{{cite book |author=Donna Falvo| title = Medical and Psychosocial Aspects of Chronic Illness and Disability | publisher =[[Jones & Bartlett Publishers]]|page=367|year = 2013|access-date=December 7, 2014| isbn = 978-1-4496-9442-5 |url =https://books.google.com/books?id=SdM6FsykfWAC&pg=PA367}}</ref> In particular, people who have a disability can find sexual intercourse daunting due to issues involving their [[self-concept]] as a sexual being, or a partner's discomfort or perceived discomfort.<ref name="Falvo"/> Temporary difficulties can arise with [[alcohol and sex]], as alcohol can initially increase interest through disinhibition but decrease capacity with greater intake; however, disinhibition can vary depending on the culture.<ref name="WHO Risks">{{cite book|title=Alcohol Use and Sexual Risk Behaviour: A Cross-cultural Study in Eight Countries|publisher=[[World Health Organization]]|year=2005|pages=135 pages|access-date = March 30, 2013 |isbn = 978-92-4-156289-8| url =https://books.google.com/books?id=fZ1eBPIIr48C }}</ref><ref name="Aggleton">{{cite book |author=Peter Aggleton |author2=Andrew Ball |author3=Purnima Mane |author3-link=Purnima Mane | title = Sex, Drugs and Young People: International Perspectives | publisher =[[Routledge]]|pages=130–133|year = 2013|access-date=December 7, 2014| isbn = 978-1-134-33309-7 |url = https://books.google.com/books?id=dWknAAAAQBAJ&pg=PA130}}</ref>

People with [[mental disabilities]] also are subject to challenges in participating in sexual intercourse. This can include the lack of a knowledgeable healthcare provider trained and experienced in counseling those with [[intellectual disabilities]] on sexual intercourse. Those with intellectual disabilities may have hesitations regarding the discussion of the topic of sex, a lack of sexual knowledge and limited opportunities for sex education.<ref>{{cite journal |last1=Medina-Rico |first1=Mauricio |last2=López-Ramos |first2=Hugo |last3=Quiñonez |first3=Andrés |title=Sexuality in People with Intellectual Disability: Review of Literature |journal=Sexuality and Disability |date=September 1, 2018 |volume=36 |issue=3 |pages=231–248 |doi=10.1007/s11195-017-9508-6 |s2cid=255009541 |url=https://link.springer.com/article/10.1007/s11195-017-9508-6 |language=en |issn=1573-6717}}</ref> In addition there are other barriers such as a higher prevalence of sexual abuse and assault. These crimes often remain underreported. There remains a lack of "dialogue around this population's human right to consensual sexual expression, undertreatment of menstrual disorders, and legal and systemic barriers". Women with intellectual disability may lack sexual health care and sex education. They may not recognize sexual abuse. Consensual sexual intercourse is not always an option for some. Those with intellectual disability may have limited knowledge and access to contraception, screening for sexually transmitted infections and cervical cancer.<ref name="GreenwoodWilkinson2013">{{cite journal|last1=Greenwood|first1=Nechama W.|last2=Wilkinson|first2=Joanne|title=Sexual and Reproductive Health Care for Women with Intellectual Disabilities: A Primary Care Perspective|journal=International Journal of Family Medicine|volume=2013|year=2013|pages=1–8|issn=2090-2042|doi=10.1155/2013/642472|pmid=24455249|pmc=3876698|doi-access=free}}</ref>