Sexual dysfunction

Overview

Sexual dysfunction affects both men and women equally. Because sex is such a vital aspect of your health and quality of life, coping with sexual dysfunction may be physically and emotionally taxing. Sexual issues are fairly prevalent, and they are usually curable.

Sexuality definition

Sexuality is a multifaceted interaction of anatomical, physiological, psychological, developmental, cultural, and relational elements. All of these, to varied degrees, contribute to an individual's sexuality at any moment in time, as well as evolving and changing during the life cycle. Adult sexuality is comprised of seven components:

• Gender identity
• Orientation
• Intention
• Desire
• Arousal
• Orgasm
• Emotional satisfaction

Sexual identity is comprised of gender identity, orientation, and intention, whereas sexual function is comprised of desire, arousal, and orgasm. The interaction of the first six components contributes to the experience's emotional fulfillment. In addition to the numerous aspects involved in sexuality, there is the added complication of the partner's sexuality. The expression of a person's sexuality is inextricably linked to the sexuality of his or her partner.

Sexual response cycle

Desire, arousal, orgasm, and resolution are the four stages of the sexual response cycle.

The first stage is Desire is made up of three components:

• Sexual drive, 
• Sexual motivation, and
• Sexual wish.

These, in turn, represent the biological, psychological, and social elements of desire. Sexual urge is generated by psychoneuroendocrine systems. Sexual desire is thought to be influenced by the limbic system and the preoptic region of the anterior-medial hypothalamus. Hormones, pharmaceuticals (e.g., antihypertensive meds, dopaminergic chemicals to treat Parkinson's disease), and legal and illicit substances all have a strong impact on drive (e.g., alcohol, cocaine).

The second phase is Arousal is caused by psychological and/or physiological stimuli. Men and women go through a series of physiological changes that prepare them for orgasm, which are mostly caused by vasocongestion. Erection, penile color changes, and testicular elevation are all caused by increased blood flow in men. In women, vaginal lubrication, clitoral tumescence, and labial color changes result from vasocongestion. During this phase, heart rate, blood pressure, and respiration rate all rise, as does myotonia in several muscle groups.

The third phase, orgasm, is characterized by a sustained increase in respiration rate, pulse rate, and blood pressure, as well as the voluntary and involuntary contraction of several muscle groups. The contraction of the urethra, vas, seminal vesicles, and prostate in males keeps ejaculation going. The uterus and bottom portion of the vagina contract involuntarily in women.

The duration of the final phase, resolution, is heavily influenced by whether orgasm was attained. If orgasm is not obtained, anger and pain might occur, which can linger for several hours. If orgasm is reached, resolution may last 10 to 15 minutes, accompanied by a sensation of peace and relaxation. Respiratory rate, heart rate, and blood pressure return to normal, and vasoconstriction subsides. Women can experience numerous orgasms in a row due to a lack of a refractory period. Following orgasm, the great majority of men have a refractory phase during which further orgasm is impossible.

What is Sexual dysfunction?

Sexual dysfunction is a problem that can emerge at any stage of sexual engagement. This might be a difficulty with partner desire, arousal, penetration, the act of sex itself, or attaining climax during intimacy.

As men and women become older, sexual issues become increasingly widespread. Other variables can contribute to it in young individuals. Sexual dysfunction can be exacerbated by stress, sickness, medications, or mental issues.

Sexual dysfunctions can include:

• Hypoactive Sexual Desire Disorder
• Erectile Dysfunction (ED)
• Orgasm Disorder
• Vulvodynia
• Genital Arousal Disorder
• Premature Ejaculation

Causes of Sexual Dysfunction

Sexual dysfunction does not usually occur overnight. Pain during intercourse or ejaculatory/orgasmic problems, for example, are often caused by other health issues. The following are some of the most common reasons of sexual dysfunction.

• Health Changes

When the body suffers from serious ailments such as diabetes, heart disease, or blood vessel problems, sexual functioning might suffer. This is found in situations such as erectile dysfunction7 and arousal problems in women.

Hyperthyroidism and high prolactin production (hyperprolactinemia) can both induce delayed ejaculation. Similarly, chronic health issues such as kidney or liver disease might impair sexual function.

• Hormonal Imbalance

Hormones play an important part in sexual health and wellness. As a result, variations in their production might have an impact on performance and enjoyment during sexual activities.

Male libido has been linked to low testosterone levels. Similarly, comparable effects may be observed in estrogen-deficient women. This might explain why menopausal women with changing hormone levels have vaginal dryness and less enthusiasm in sex.

• Gynecologic Causes

Women with vaginal disorders such as endometriosis, cysts, and fibroids may find sex to be a painful activity. 

• Psychological Factors 

Work deadlines, school projects, concern about forthcoming commitments, or even performance during sex can all lead to difficulties during intimate moments. Depression, body image concerns, and guilt about sexual interactions can all lead to sexual dysfunction. 

Erectile Dysfunction (ED)

Erectile dysfunction (ED), sometimes known as impotence, is the inability to generate or sustain a hard penile erection adequate for sexual intercourse. While no time duration is specified in this description, some have stated that the condition must last for six months. It is a prevalent condition in males over the age of 40, with the frequency rising dramatically with age and associated co-morbidities.

Erectile dysfunction can be a symptom of a variety of underlying diseases and is a significant yet neglected risk factor for cardiovascular disease. Erectile dysfunction can be caused by any disease condition that affects the penile arteries, nerves, hormone levels, smooth muscle tissue, corporal endothelium, or tunica albuginea. Erectile dysfunction is well recognised to be directly associated to cardiovascular disease, diabetes mellitus, hyperlipidemia, and hypertension, among other illnesses. The other common mechanism in these patients appears to be endothelial dysfunction.

While the great majority of patients with ED will have physical illness, some, particularly younger men, may have a fundamental psychological condition. Even though the underlying reason is organic, ED nearly always has psychological ramifications in terms of marriage and interpersonal troubles, societal norms and expectations, loss of self-esteem, embarrassment, anxiety, and depression, among other things. Erectile dysfunction may have a severe emotional impact on both the patient and their spouse, as well as a substantial influence on their quality of life. Erectile dysfunction, on the other hand, is virtually usually curable.

Psychogenic ED and Mental Health

It is extremely useful in distinguishing between evident psychological and organic reasons of ED, as well as confirming that the patient has erectile dysfunction and not another sort of sexual illness such as premature ejaculation. Careful inquiry should reveal if the patient has intrinsic erectile rigidity failure or another sexual condition. Items in the history that suggest a psychological etiology include: sudden onset of erectile dysfunction (especially if associated with a new partner or a major life-changing event), situational ED, normal erections with masturbation or a different partner, the presence of good morning erections, and high daily variability in erectile rigidity.

Cases with obvious psychogenic ED should be referred to a mental health expert. Even if there are no obvious psychological issues, involving mental health professionals can help with related issues such as reducing performance anxiety, promoting treatment adherence, improving relationship issues, identifying interpersonal conflicts, and setting realistic expectations for the couple.

Blood Testing

There are no mandatory tests for the initial examination of an ED, although many physicians may request basic blood tests such as a complete blood count and electrolytes, as well as baseline renal and liver function tests, HgbA1c to screen for diabetes mellitus, and a lipid profile. a morning testosterone level is not necessarily required unless there are other symptoms suggestive of hypogonadism, such as lack of sexual desire or testicular shrinkage on physical inspection. If individuals fail to respond to oral PDE-5 ED medication, a morning testosterone level should be examined to rule out hypogonadism.

Other blood tests that may be required include LH and prolactin (if hypogonadism is discovered) and sickle cell in African/Caribbean patients. Thyroid function (TSH) can also be tested if desired.

Patients who have abnormal laboratory results are sent back to their primary care physician for additional assessment and treatment.

Erectile Dysfunction Treatment 

The first step in therapy is to improve overall health through lifestyle changes. This not only improves erectile function but also lowers the risk of cardiovascular disease. Increased physical activity, moving to a Mediterranean diet and/or nutritional advice, quitting smoking, drugs, and alcohol, and improving diabetes, lipids, and cholesterol management are all recommended lifestyle changes. To eliminate or change the dosage of any problematic drugs, the patient's drug history should be thoroughly evaluated.

Men suffering from a psychiatric condition should be provided psychosexual therapy. With the patient's permission, this should also be provided to the spouse.

PDE-5 inhibitors, such as sildenafil and tadalafil, are typically used as the first-line therapy for erectile dysfunction. They work in a variety of conditions, including cardiovascular disease, diabetes, and hypogonadism. They work by inhibiting phosphodiesterase, which reduces the breakdown of cyclic GMP and so enhances the relaxation of cavernosal smooth muscle and cavernosal arterial blood flow.

It's worth noting that PDE-5 inhibitors don't start the erectile response. Sexual stimulation is essential to initiate the erectile process by releasing nitric oxide from the vascular endothelium and penile nerve terminals. PDE-5 inhibitors are quite successful, with an overall success rate of up to 76%. 

Premature Ejaculation

Premature ejaculation occurs when a person achieves an orgasm sooner than they or their partner would want. Ejaculation can occur before or immediately after penetration.

There is no predetermined amount of time for a person to "last" during sex. When a person experiences an orgasm before they want to, they lose their erection and are unable to continue with intercourse. Premature ejaculation may be both frustrating and humiliating. You could believe that you don't have enough time to enjoy sex. You could have trouble pleasing your lover. For some people, humiliation over premature ejaculation can cause intimacy issues and harm their relationships.

A prevalent issue is premature ejaculation. This issue affects up to 40% of people at some point in their life.

How is premature ejaculation diagnosed?

Consult your doctor if premature ejaculation is interfering with your sexual life. They will do a physical examination and quiz you. Based on your responses, your doctor may conduct test work and make a diagnosis. They will also be able to answer your concerns and comfort you that you are not alone in experiencing this issue.

Can premature ejaculation be prevented or avoided?

Premature ejaculation can be avoided or prevented, depending on the cause. The behavioral measures suggested below will usually work to avoid it.

Treatment for premature ejaculation

Seeking therapy from a doctor or sex therapist for premature ejaculation is a good idea. Treatment for premature ejaculation will differ based on the etiology and whether it is lifelong or acquired. Among the therapies are:

Behavioral techniques include 'stop-start' technique developed by Semans and the'squeeze' technique developed by Masters and Johnson. Learning to manage sensations prior to ejaculation is part of the Semans method. The goal is to get yourself near to ejaculation on many occasions, then stop and relax. To reduce the impulse to ejaculate, the Masters and Johnson technique includes squeezing the end of the penis right before ejaculation. These exercises may be performed either alone or with a partner.

• Kegel exercises are exercises that are used to strengthen the pelvic floor. Stop urinating in midway to identify the muscles of your pelvic floor. When your bladder is empty, you must perform this activity. Tighten the muscles and hold them for 10 seconds. Rep 10 times, three times every day.
• Psychotherapy and counselling - under the supervision of a professional sex therapist, any underlying sex fears can be investigated and alleviated.
• Reducing penile sensation by using local anaesthetic sprays and creams, which should be administered 30 minutes before sexual intercourse. To avoid absorption by your partner, use these treatments in conjunction with a condom. Using two condoms may also assist in reducing feeling.
• SSRIs (selective serotonin reuptake inhibitors) and tricyclic antidepressants have the adverse effect of slowing ejaculation. This effect may be beneficial in men who ejaculate prematurely, and these medications can be used in combination with counseling. Other negative effects of SSRIs include reduced libido (sex desire), nausea, sweating, bowel disruption, and exhaustion. Only one SSRI (dapoxetine) has been licensed for the treatment of premature ejaculation, and it is administered as needed before to sexual intercourse.
• If the premature ejaculation is caused by erectile dysfunction, erectile dysfunction medications such as PDE5 inhibitors (Viagra, Cialis, Levitra) can help restore ejaculation control.

Orgasm Disorder

Women frequently experience difficulties achieving orgasm. Three out of every four women believe they can't orgasm just through vaginal penetration. However, there is a distinction between an occasional difficulty and a more permanent issue—female orgasmic dysfunction, or FOD.

A large percentage of women are affected by this issue. The prevalence of FOD was estimated to be at 21% in the biggest US research on female sexual dysfunction, which included answers from over 30,000 women.

What causes female orgasmic dysfunction (FOD)?

There are many physical and psychological factors that may be involved in FOD.

• Certain medical issues might make it more difficult for a woman to have orgasm. Conditions affecting the neural system, such as multiple sclerosis or spinal cord injuries affecting the pelvic nerves, might make attaining orgasm more difficult. FAD has also been linked to arthritis, thyroid issues, and asthma. However, research has discovered that it is frequently not just the medical issue that has an impact on a woman's mental well-being; it is also the stress of managing a chronic disease and discomfort.
• Certain drugs might interfere with a woman's capacity to have orgasm. Some of the medicines that may impede orgasm in women include antidepressants (particularly serotonin reuptake inhibitors, or SSRIs), antipsychotics, antihistamines, and blood pressure medications.
• A woman's capacity to orgasm might be influenced by a variety of psychological variables. Fatigue, stress, worry, and depression can all play a role in the condition. Poor body image can also create anxiety and pain, as well as impair a woman's ability to achieve orgasm.
• Another typical factor is relationship problems. Relationship issues such as anger and distrust, communication issues, or other sexual issues can all interfere with sexual enjoyment and orgasm.
• Cultural or religious beliefs of a woman may have a role. A woman, for example, may have been reared with the assumption that she should not seek out or enjoy sex and may feel embarrassed or guilty about doing so.

How can it be treated?

The treatment will be determined by the cause of the condition. If a medical condition or medicine is to blame, a healthcare professional can investigate strategies to address the underlying problem or investigate prescription changes. When psychological or relational difficulties constitute the root of the problem, therapy or counseling may be the solution. Sex therapy can help you better understand your own body and discover what gives you pleasure.

Couples counseling may also help couples improve their communication skills and resolve any disputes that may arise when trust and intimacy are involved. Couples may also consider sensate focus, which consists of a series of exercises that focus on both nonsexual and sexual touching in order to improve intimacy and understand what causes pleasure in each partner.

There are several actions any woman may take toward a happier sex life if she is having difficulty reaching orgasm:

• Communicate. Make it a point to tell your partner what you enjoy and what makes you happy.
• Experiment. See what gets you going and what sort of clitoral stimulation you prefer. To achieve orgasm, most women require some direct clitoral stimulation. As part of the experiment, use sex toys or vibrators with or without a partner.
• Make use of mental images and fancy. Fantasy may be a powerful motivator and aid in the production of orgasm.
• Expectations must be abandoned. While achieving orgasm is a terrific and necessary objective, concentrating just on orgasm can cause pressure and anxiety, making it more difficult to attain. Instead, make mutual pleasure and closeness your aim.

Hypoactive Sexual Desire Disorder

You desire sex when you want it and when you don't. That is typical. Every woman has her own level of "normalcy" based on her own experiences and biological drive. However, if a woman has a low libido or low sexual desire and is troubled by her lack of interest in sex, she may have hypoactive sexual desire disorder (HSDD)

HSDD is characterized as a lack of sexual ideas and thoughts, as well as a desire for or responsiveness to sexual action, which creates personal anguish or issues in her relationship. This distress is a significant factor. After all, some women with low libido may not experience any anxiety or troubles with a partner as a result.

While prevalence figures vary, the Society for Women's Health Research believes that around one in every ten women suffers with HSDD, making it one of the most frequent female sexual disorders.

What causes HSDD?

There are many potential causes, both physical and psychological.

• HSDD is connected with a range of health diseases, including breast cancer, diabetes, depression, urine incontinence, thyroid difficulties, and multiple sclerosis, among others.
• The culprit might be an imbalance of neurotransmitters (hormones) in the brain, since the chemicals that generate (or prevent) sexual desire and excitement may be out of balance.
• Certain drugs, particularly those used to treat depression, anxiety, and high blood pressure, as well as some pain relievers, may cause decreased libido.
• Some women may be affected by relationship troubles. Women may lose interest in sex with a partner if there is conflict or a lack of trust in their relationship. 
• Depression, anxiety, and low self-esteem are among psychiatric problems that may be linked to the development of HSDD.

Can HSDD be treated?

Because HSDD is curable and controlled, the first step if you are concerned about a lack of desire in sex is to consult with a healthcare specialist to learn about your alternatives.

Sex therapy or counseling, either alone or with a woman's partner, may be used to treat any mental health or relationship concerns that may be present. Medication as a contributory component may be explored, and underlying medical issues may be treated.

Vulvodynia

Vulvodynia is defined as vulvar discomfort that lasts at least three months and has no obvious, identifiable cause, but may have possible linked causes. It is an idiopathic pain disease with an exclusion diagnosis.

Vulvodynia has an unknown etiology. Research is being conducted to determine what factors contribute to the illness. Injury or irritation to the nerves that transmit pain from the vulva to the spinal cord, an increase in the number and sensitivity of nerve fibers in the vulva, elevated levels of inflammatory substances such as cytokines in the vulva, abnormal response to environmental factors, genetic susceptibility, and pelvic floor muscle weakness, spasm, or instability are all possible contributing causes.

Treatment Modalities

• Vulvar self-care: Avoid irritants, directly or through diet
• Oral "pain-blocking" medications: These may be helpful in relieving vulvodynia discomfort. Tricyclic antidepressants (TCAs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and anticonvulsants are the pharmacological classes. TCAs are the most regularly utilized, with amitriptyline and nortriptyline being the most commonly used. Nortriptyline is typically the first option since it has fewer negative effects. The dose is less than that used to treat depression. Due to the possibility of adverse effects, it is best to start with extremely low dosages and gradually increase. Duloxetine and venlafaxine are the most regularly used SNRIs, whereas gabapentin, pregabalin, lamotrigine, oxcarbazepine, and topiramate are the most often used anticonvulsants.
• As long as the ointments do not contain allergens, topical drugs administered directly to the vulva can relieve discomfort. These are typically combined. Lidocaine, estrogen, testosterone, and gabapentin are examples of drugs that can be combined or taken alone.
• Physical therapy for women's health has proven to be a beneficial supplement to the treatment of vulvodynia. Most individuals should be referred for pelvic floor muscle weakness and spasm examination and therapy. Exercises, massage, soft tissue work, and joint mobilization are all part of the treatment.
• Treatment may also include nerve block, psychotherapy, mindfulness, yoga, and neurostimulation.
• Surgery is only performed on certain patients. It is used to treat induced vestibular vulvodynia. Vaginal advancement entails removing the vestibule as well as the affected portion of the vagina. Physical treatment is advised, as is the use of dilators following therapy.

Can Sexual Dysfunction in Men and Women be Prevented or Avoided?

The aging process cannot be avoided. However, there are several things that both men and women may do to lessen the impact of sexual dysfunction. This involves discovering more about your body and how it functions. Also:

• Inquire with your doctor about the potential adverse effects of the medications you are taking. Discuss surgeries and medical problems with him or her. Treatment of underlying health issues, such as diabetes, may be beneficial.
• If you are sad, worried, or having relationship problems, speak with a counselor or mental health expert.
• Reduce your alcohol intake, eat healthily, and exercise on a regular basis.
• Discuss with your spouse what you enjoy and dislike about your sexual connection.
• Experiment with "sensate attention" activities. This is where one partner massages the other while saying what feels wonderful and requesting modifications (for example, "lighter," "faster,"). Fantasizing may heighten your desire.
• Kegel exercises (squeezing and releasing the vaginal muscles) may boost arousal in women.
• Massage, oral sex, or masturbation are examples of sexual activities other than intercourse.
• Do not experiment with drugs or misuse painkillers.

Conclusion 

Sexual dysfunction refers to any condition that affects any of the phases of sexual response and prevents one or both partners from achieving sexual fulfillment. The sexual cycle is divided into four stages: excitation, plateau, orgasm, and resolution. Erectile dysfunction, orgasm/ejaculation problems, and priapism (painful erections) are all manifestations of male sexual dysfunction. Female sexual issues include a loss of interest in sex, trouble attaining orgasm, negative thoughts during sex, and vaginal dryness and stiffness, which causes painful intercourse.