The selective serotonin reuptake inhibitor (SSRI) and antidepressant drug dapoxetine has been used to treat premature ejaculation. In clinical trials, those with PE who took dapoxetine experienced sexual intercourse three to four times longer before orgasm than without the drug. 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. Sexual intercourse 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), coitus can continue. Reconstructive surgery remains an option for women who have experienced benign and malignant conditions. Disabilities and other complications Obstacles that those with disabilities face with regard to engaging in sexual intercourse include pain, 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. For those that must take opioids for pain control, sexual intercourse can become more difficult. Having a stroke can also largely impact on the ability to engage in sexual intercourse. 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. 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. 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. People with mental disabilities also are subject to challenges in participating in sexual intercourse. Women with intellectual disabilities (ID) are often presented with situations that prevent sexual intercourse. This can include the lack of a knowledgeable healthcare provider trained and experienced in counseling those with ID on sexual intercourse. Those with ID may have hesitations regarding the discussion of the topic of sex, a lack of sexual knowledge and limited opportunities for sex education. In addition