Sexual dysfunction: in detail

Sexual dysfunction or sexual malfunction is difficulty during any stage of the sexual act (which includes desire, arousal, orgasm, and resolution) that prevents the individual or couple from enjoying sexual activity.

Emotional factors affecting sex include both interpersonal problems (such as marital/relationship problems, or lack of trust and open communication between partners) and psychological problems within the individual (depression, sexual fears or guilt, past sexual trauma, and so on).

For both men and women, these conditions can manifest as an aversion to, and avoidance of, sexual contact with a partner. In men, there may be partial or complete failure to attain or maintain an erection, or a lack of sexual excitement and pleasure in sexual activity.

Sexual pain disorders affect women almost exclusively and are known as dyspareunia (painful intercourse) and vaginismus (an involuntary spasm of the muscles of the vaginal wall that interferes with intercourse). Dyspareunia may be caused by insufficient lubrication (vaginal dryness) in women.

Poor lubrication may result from insufficient excitement and stimulation, or from hormonal changes caused by menopause, pregnancy, or breast-feeding. Irritation from contraceptive creams and foams can also cause dryness, as can fear and anxiety about sex.

It is unclear exactly what causes vaginismus, but it is thought that past sexual trauma (such as rape or abuse) may play a role. Another female sexual pain disorder is called vulvodynia or vulvar vestibulitis. In this condition, women experience burning pain during sex which seems to be related to problems with the skin in the vulvar and vaginal areas. The cause is unknown.

Erectile dysfunction

A recent study estimates that 30 million men suffer from various degrees of erectile dysfunction. This can range from mild to severe. It is clearly an age-related phenomenon with the prevalence of erectile dysfunction increasing significantly with age. Surprisingly, by the time men reach 40, 5% of them are completely impotent never achieving an erection rigid enough for penetration. Approximately 15% have significant problems achieving or maintaining an erection.

Erections can change over time, sometimes stronger or weaker than other times. When men are in their teens they often have little control over their erections and obtain erections when not in a sexual situation. For most men this stops in their late teens to early twenties. As men get older, erections may not always be obtained when they want one. Almost every man has the occasional time when their erection is less strong than they would like but sometimes it becomes a problem.

Many medications cause problems with sexual function, including drugs for high blood pressure, depression, heart disease and prostate cancer.

Erectile dysfunction can occur suddenly or gradually. Some men slowly lose the firmness of their erections or how long the erections last. In other men, especially those whose impotence is largely caused by psychological factors, the problem may occur unpredictably and can improve at any time. Despite their difficulties with erections, men with impotence often continue to have normal orgasm and ejaculation.

How long your erectile dysfunction lasts depends upon what causes it and how quickly your treatment starts to work. The important thing to remember is that erectile dysfunction is treatable in all age groups.

Little is known about how to prevent erectile dysfunction. However, avoiding cigarette smoking and maintaining normal blood pressure and cholesterol levels can help because smoking and high cholesterol can affect blood vessels. Men with diabetes should strive to keep blood sugar levels under control. Because certain medications have been associated with erectile dysfunction, ask your doctor about possible side effects before you start using any new prescription.

Sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) drugs can cause minor side effects such as flushing and headache, but they have been shown to be safe in most men, including those with heart disease. However, these drugs can interact with other medications and cause dangerously low blood pressure. In particular, they should never be taken with nitroglycerin or other nitrate medications commonly used to treat heart disease. Men with enlarged prostates who take alpha-blocker drugs such tamsulosin (Flomax) or doxazosin (Cardura) should probably avoid PDE5 drugs.

Men who do not benefit from medical or psychological treatment often have success with mechanical or prosthetic devices. External products, known as vacuum erection devices, are safe and highly effective, but many men and their partners find them unappealing. Another option is a surgically placed penile implant. However, because implants require surgery (with the risk of surgical complications), only 10 percent of men with erectile dysfunction choose this option. Vascular (blood vessel) surgery sometimes is recommended for young, healthy men who develop impotence after trauma to the groin.

Definitions and terms

Anxiety

• A state of uneasiness and apprehension, as about future uncertainties.


• Worry or tension in response to real or imagined stress, danger, or dreaded situations. Physical reactions such as fast pulse, sweating, trembling, fatigue, and weakness may accompany anxiety.

Impotence

• The inability to achieve and sustain penile erections.

Thyroid

• A gland in the throat that produces hormones that regulate growth and metabolism.


• A large gland in the neck that functions in the endocrine system. The thyroid secretes hormones that regulate growth and metabolism.

Antihistamines

• A drug used to counteract the physiological effects of histamine production in allergic reactions and colds.

Antihypertensives

• Reducing or controlling high blood pressure.

Depression

• In psychiatry, a symptom of mood disorder characterized by intense feelings of loss, sadness, hopelessness, failure, and rejection.

Ejaculation

• The expulsion of seminal fluid from the urethra of the penis during orgasm.


• The process of ejecting semen from the penis, and is usually accompanied by orgasm as a result of sexual stimulation.

Erection

• The firm and enlarged condition of a body organ or part when the erectile tissue surrounding it becomes filled with blood, especially such a condition of the penis or clitoris.

Estrogen

• Any of several steroid hormones produced chiefly by the ovaries and responsible for promoting estrus and the development and maintenance of female secondary sex characteristics.


• Any one of a group of hormones synthesized by the reproductive organs and adrenal glands in females and, in lesser quantities, in males.

Frigidity

• The state of marked or abnormal sexual indifference.


• Sexual unresponsiveness (especially of women) and inability to achieve orgasm during intercourse.

Hormone

• A substance, usually a peptide or steroid, produced by one tissue and conveyed by the bloodstream to another to effect physiological activity, such as growth or metabolism.

Orgasm

• The peak of sexual excitement, characterized by strong feelings of pleasure and by a series of involuntary contractions of the muscles of the genitals, usually accompanied by the ejaculation of semen by the male.


• The highest point of sexual excitement, marked by strong feelings of pleasure and marked normally by ejaculation of semen by the male and by vaginal contractions within the female.

Paraplegics

• Complete paralysis of the lower half of the body including both legs, usually caused by damage to the spinal cord.

Penis

• The male organ of copulation in higher vertebrates, homologous with the clitoris. In mammals, it also serves as the male organ of urinary excretion.


• The organ of the male reproductive system through which semen passes out of the body during sexual intercourse. The penis is also an organ of urination.

Prostate

• Gland in males that surrounds the urine tube (urethra) at the base of the bladder.


• A firm partly muscular chestnut sized gland in males at the neck of the urethra; produces a viscid secretion that is the fluid part of semen.

Stress

• A state of extreme difficulty, pressure, or strain.


• A physical and psychological response that results from being exposed to a demand or pressure.

Testosterone

• A white crystalline steroid hormone, C19H28O2, produced primarily in the testes and responsible for the development and maintenance of male secondary sex characteristics. It is also produced synthetically for use in medical treatment.

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