Sexual dysfunction in simple term refers to unsatisfied or a problem occur during the sexual response that prevents an individual or couple from having satisfaction from the sexual activity. The sexual response includes excitement, arousal, desire, and orgasm. Even though the sexual dysfunction is common in both male and female, many of them have difficulty expressing it. It is a topic that many people are hesitant to discuss or just deny. Different Kinds of treatment and therapy has been evolved and are available. So it is very important to share your thoughts, concerns, experience, and problems with your respective partner and health care provider.
Some of the sexual disorder are:
- Arousal disorder: Refers to inability to become physically aroused or excited
- Desire disorder: lack of interest in sexual activity
- Orgasm disorder: delay in achieving orgasm or pleasure (climax) usually in female
- Pain disorder: painful intercourse
Erectile dysfunction also referred as “impotence” is a common type of male sexual dysfunction. It is the inability to achieve or maintain a firm erect penis. Erectile dysfunction becomes more common as you age but it’s not a natural part of aging. More than half of men 40 to 70years of age are unable to attain or maintain an erection sufficient for satisfactory sexual performance.
The physiology of erection and ejaculation is complex and involves sympathetic parasympathetic components. Erection involves the release of nitric oxide into the corpus cavernosum during sexual stimulation. Along with its release activates cyclic guanosine monophosphate, causing smooth muscle relaxation. This allows a flow of blood into the corpus cavernosum, resulting in an erection. This is the normal physiology of erection whereas any interrupt in between the process due to the psychogenic and organic factors cause erectile dysfunction.
What causes Sexual Dysfunction?
Erectile dysfunction has both psychogenic and organic causes:
Psychogenic or psychological factor
- Anxiety and stress
- Pressure to perform sexually
- Trust and relationships/ marital issues
- Negative body image
- Absence of desire
- History of sexual trauma ( sexual abuse or rape)
- Feeling of guilt.
Organic or physical factors / medical conditions
- Cardiovascular (heart and blood vessels) disease
- Neurological disorder (neuropathy, paralysis, spinal cord injury)
- Endocrine disorder (diabetes, pituitary tumors, testosterone deficiency, hyper, and hypothyroidism)
- Genitourinary conditions (pelvic surgery, prostate cancer)
- Chronic renal and liver disease
- Hematologic conditions (lymphoma, leukemia)
- Trauma to the pelvic or genital area
- Alcoholism and smoking
- Drug abuse and side effects of some medication can affect sexual function (refer to the Medication Associated with erectile dysfunction)
How can we diagnose or assess Sexual Dysfunction?
The diagnosis of erectile dysfunction requires a sexual and medical history; including the physical examination, Neurologic examination, detail information of all medication ( prescribed and used), alcohol or any other substances. Nocturnal penile tumescence tests are conducted in a sleep laboratory to monitor changes in penile circumference. This test is done to determine if erectile dysfunction is physically or psychologically caused. However, lab test has a minimal role. A person has to be evaluated for contributing factors (anxiety, guilt, sexual history, interest or desire, opposite-sex preference) which will be very efficient to recognize the underlying cause of a problem. The healthcare provider has to make an appropriate recommendation of treatment as per the problem.
Treatment of Sexual Dysfunction
Mostly erectile dysfunction can be improved or corrected by treating the underlying causes whether it is physical or psychological. Treatment can be medical, surgical or both depending on the cause. Erectile dysfunction associated with Alcoholism, diabetes or drug abuse may need therapy with adjustment of medications. Insufficient penile blood flow may be treated with vascular surgery. Erectile dysfunction caused by psychological factors are referred to a health care provider or a therapist specializing in sexual dysfunction. The dysfunction caused by physical cause may have penile implants and vacuum devices. The pharmacologic therapy includes oral medications such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis). The medications are taken about 1hour before the sexual intercourse, they are effective in producing an erection with sexual stimulation; the erection can last about 1 to 2 hours. The common side effects of these medications are
The following medications are contraindicated in several cases so Make sure to consult your doctor about its use and side effects before taking it.
Premature ejaculation (PE) is defined as the occurrence of ejaculation sooner or shortly after penetration, causing distress to either one or both the partners. It is one of the most common complaints of men or couples. According to the research, the average lasting time men with PE was 1.8 minute whereas ‘normal’ men lasted for 7.3 minutes. PE does matter in relationship and affairs since it can ruin the couples sex life.
A variety of forms of PE have been identified:
- Lifelong PE causes by Neurological or genetic conditions
- Acquired PE (medical or psychological)
- Natural variable PE ( normal )
- Ejaculatory dysfunction (delayed or retarded)
Retrograde ejaculation occurs when semen travels toward the bladder instead of exiting through the penis, resulting in infertile. It may occur after prior prostate or urethral surgery or if a person is under the diabetic and antihypertensive medications.
The treatment of PE includes both pharmacologic and behavioral therapy which depends on the nature and severity of PE and perceived distress. Pharmacologic therapy: includes selective serotonin reuptake inhibitors, alpha-adrenoceptor antagonist, the tricyclic antidepressants clomipramine (Anafranil) and topical anesthetics.
It involves counseling, sex therapy, psychoeducation, couples therapy, healthy sex habits. It often involves both the man and his sexual partner.
Awareness and education about sex and sexual problems allow an individual or a group to seek help and overcome his anxiety about sexual dysfunction. An open conversation with your partner about your concern and problem may help to overcome the fear and barrier to healthy sex life.
Erectile (sexual) dysfunction or premature ejaculation is not a taboo or a thing to be ashamed of. It is a common problem which can happen to anyone. So rather handle it seriously and the one must seek help.