Overview of Disorders, Symptoms, and Causes
Sexual dysfunction is an umbrella name for a variety of problems that people may experience during any stage of sexual activity. Sexual dysfunctions may affect sexual desire, sexual arousal, and/or the ability to achieve climax (orgasm). Clinically speaking, there are four primary categories of sexual dysfunction, as they are approached in Western medicine: sexual desire disorder, arousal disorder, orgasm disorder, and pain disorder.
Sexual Desire Disorders
Sexual desire disorders generally include hypoactive and hyperactive versions. By far the most common one is known as Hypoactive Sexual Desire Disorder, and it manifests as a lowered libido—a decrease or an absence of desire for sexual activity, either in general, or for a current partner, that is unusual for one’s age and life circumstances. It is important to note that it is considered a disorder only if and when it causes distress for the person experiencing the low libido, or when it creates problems in partnerships.
There are many reasons for a lowered libido. Biomedical causes often involve hormones, and include a decreased production of estrogen in women and testosterone in both genders. But plenty of other causes may contribute: aging, stress, lack of adequate sleep, fatigue, depression, anxiety, as well as psychoactive medications (especially the SSRIs).
On the other end of the spectrum lies Hyperactive Sexual Desire Disorder, that used to be known as nymphomania in women and satyrisis is men. The disorder involves a compulsion to engage in sexual behavior at a clinically significant high level. It may involve by an overwhelming desire for sexual intercourse that, nevertheless, frequently fails to result in sustained physical or emotional satisfaction. One a biophysical level this disorder may stem from imbalances in brain chemicals and androgens, and various brain abnormalities. It is also associated with obsessive-compulsive disorder by some psychiatrists, while others relate it to impulse control disorders, or attribute it to addictive personality.
Sexual Arousal Disorders
Not so long ago women who had problems with arousal were called frigid, while men in such circumstances were labeled as impotent. Nowadays more sensitive and clinical terms are used in the medical community, although the outdated labels are still widely used colloquially. A number of things may cause conditions such as insufficient lubrication in women and erectile dysfunction in men. For obvious reasons, sexual arousal problems can overlap with sexual desire problems, and both together and separately can produce an aversion to sexual contact.
The most common sexual arousal problem for men is erectile dysfunction, a partial or total inability to reach or sustain an erection that occurs with some frequency and regularity. It is important to note that most men experience an episode of erectile dysfunction at some point in their lives, an isolated incident is not a clinical problem. For women the lack of physical arousal frequently manifests as insufficient vaginal lubrication (which may or may not correspond to the presence of sexual desire). Biomedical causes of erectile dysfunction vary, but the two most common ones are damage to the nervi erigentes (which is responsible for erections, and which may be affected by colo-rectal and prostatic surgeries), and diabetes, which results in a decreased blood flow to the penis. However, erectile dysfunction may not always have physical causes.
It is estimated that 10 to 20% of erectile dysfunction cases are psychological in nature. Psychological causes for erectile dysfunction may include depression, stress, anxiety, low self-esteem, and apathy. Depression is a comprehensive issue that may affect all human systems, including the capacity for sexual arousal. Stress causes of erectile dysfunction may have nothing to do with sexuality or the relationship itself—stress about work or money can nevertheless contribute to arousal problems.
Anxiety can have a self-perpetuating effect on erectile dysfunction; if a man experiences it once, he may become overly anxious that the problem will occur again. This “performance anxiety” can ironically cause further instances of erectile dysfunction. Low self-esteem, either due to prior instances of erectile dysfunction, or unrelated issues, can also contribute. Finally, sexual apathy may be an effect of the natural aging process, but may also be caused by medication, including some medication for the psychological conditions reviewed above.
Historically, sexual arousal disorders in women have been somewhat difficult to diagnose and treat partially because of cultural ideas and taboos around female sexuality, and the fact that subjective and objective arousal in women do not always easily correspond to each other. Some forms of sexual arousal disorder in women is classified as “subjective,” and other forms as “genital”–these terms refer to experiences and symptoms surrounding the disorder, rather than the clinical validity of it. The “subjective” disorder means that a woman experiences absent or diminished feelings of excitement and pleasure from sexual stimulation, while physical sexual responses, such as vaginal lubrication, still occur.
Genital Sexual Arousal Disorder
Genital sexual arousal disorder refers to absent or diminished genital sexual arousal. Symptoms may include minimal or absent vaginal lubrication or vulval swelling from sexual stimulation, and decreased sensations from touching and caressing the genitals. The causes for these problems include autonomic nerve damage and estrogen deficiency; women also may have greater difficulty becoming aroused with age, and their genital sensations may be impeded by vuvlar atrophy that is associated with menopause. In general, women with this disorder may experience sexual desire, and can be aroused by sexual stimulation, but have a weak genital response. However, many women experience a combination of these two forms.
On the other end of the spectrum for women is Persistent Sexual Arousal Disorder, which describes unwanted spontaneous genital arousal, without accompanying sexual interest or desire. The arousal in these cases is not relieved by orgasms, and can linger for up to several days.
Orgasm disorders (also known as anorgasmia) in men and women describe a delay or absence of orgasm following sexual excitement. Orgasm disorders can have biophysical, pharmacological, or psychological roots. They are a common side effects of SSRI psychoactive drugs.
Each case of sexual dysfunction can combine various physical and psychological factors, and has to be assessed, diagnosed, and treated individually. However, some common treatments exist. Some general guidelines for both men and women experiencing sexual disorders include limiting alcohol intake, quitting smoking, seeking help for emotional and psychological issues, and improved communication with sexual partner(s). In addition to lifestyle changes, and regular or sex therapy, the following options are available for men with Erectile Dysfunction:
Impotence drugs fall into several different categories. There are Erectile Dysfunction Drugs, the most famous of which is Viagra. Other FDA-approved drugs include Cialis and Levitra. All three work by increasing the flow of blood into the penis, so that with sexual stimulation the man is able to achieve an erection.
These drugs are counter-indicated for people who take alpha-blockers for prostate or blood pressure problems, and people who take nitroglycerin for chest pains, or experience chest pains during sex. Additionally, people who experience problems with blood pressure, or who have suffered an aneurism, a heart attack, or heart arrhythmia should consult their doctor about other options. Side effects from these drugs may include headache, heartburn, flushing, congestion, and vision changes. Cost for these drugs varies, but they are commonly covered by most insurance providers.
In addition to the oral drugs described above, Erectile Dysfunction can also be treated with aprostadil injections (available as Caverject, Prostin VR, and Edex) and penile suppositories (available as MUSE). This medicine causes blood vessels to expand, increasing blood flow within the entire body, including the penis; this helps a man achieve erection.
There are a number of counter-indicationsss, including allergies to aprostadil, a history of priapism, Peyronie’s disease, and any conditions that cause thickened or slowed blood flow, including sickle cell anemia, leukemia, and thrombocythemia. Side effects for this medicine are usually localized, and include mild pain in case the medicine is administered by injection, painful erection, and bruising at the site of injection. For people who can take this medicine safely this is an effective option; costs for it vary depending on provider rates and insurance reimbursements.
Beyond drugs that aid the blood flow, there is hormone therapy, which can raise testosterone levels, and thus aid both libido and erections. Testosterone can be administrated through intramuscular injections every several weeks, a patch worn on the body or the scrotum, a gel, or oral tablets. This is not an appropriate therapy for men with prostate or breast cancer. Side effects can include acne, fluid retention, increased urination, changes in breast and testicle size, and aggravated sleep apnea.
Beyond pharmaceutical options, men can treat Erectile Dysfunction with an Erectile Dysfunction Vacuum, more commonly known as “the penis pump.” It is a device that works well for many men, and consists of a cylinder with a pump that attaches to the end of the penis. A constriction ring is placed on the cylinder at the other end. Between the cylinder and the pump a vacuum is created, which helps the penis to become erect; then the constriction ring aids in maintaining the achieved erection. Many favor this solution as it is non-pharmaceutical and non-invasive; however, it is counter-indicated for people with blood conditions. Side effects may include bruising on the penis shaft, and a decreased force of ejaculation. There are several brands of EDVs (both hand-operated and battery-powered) on the market, ranging in cost from approximately $300 to $500. Most insurances cover at least a part of the cost, if a diagnosis of Erectile Dysfunction is on record.
Penile implants (or prostheses) are a good option for men whose Erectile Dysfunction is unlikely to be resolved naturally or through other courses of treatment. The implants come in two versions: malleable and inflatable; the former causes the penis to always be semi-erect, while the latter allows the man to have an erection whenever he wants, and is virtually undetectable. As any surgery, this one carries possible risks with it, including uncontrolled bleeding after the surgery, infection, and scar tissue. Additionally, the impants may break down, and require removal. There is also risk of erosion, which involves the breakdown of the tissue surrounding the prosthesis. This also requires removal.
Finally, vascular reconstructive surgery is a last clinical resort to improve the blood flow to the penis; however, this procedure is difficult, expensive, and not always effective. As a result, it is very rare.
Beyond the medical and pharmaceutical courses of treatment, there are many options for natural erection enhancement. There are many advertisements of herbal so-called “miracle” pills that offer quick fixes to erectile problems, but there are also legitimate natural aides. One such remedy is L-arginine, which is an amino acid that aids the bodily processes of vessel dilation and increased blood flow. It can be taken as an oral supplement (sometimes referred to as “natural Viagra”), but is also found in meat, fish, and poultry. Gingkooo and Ashwagandha (also known as Indian Ginseng) both help stimulate blood flow to the penis, while zink supplements can help men who suffer from a zink deficiency, shown to contribute to Erectile Dysfunction.
For women who have already implemented the lifestyle changes and therapeutic options, or who have sexual dysfunction clearly linked to hormonal imbalances, there is a range of available medical treatments.
The most common treatment is localized estrogen therapy, where estrogen is delivered through a vaginal ring, oral tablet, or cream. Estrogen can enhance vaginal elasticity, increase blood flow to the vagina, aid lubrication, and help brain chemistry responsible for the sexual response.
However, estrogen has risks that include blood clotting (generally connected to oral birth control, but present, to a lower degree, with all forms of Estrogen therapy), uterine cancer (and breast cancer in women who use it for more than 5 years), and gallstone formation. Side effects may include water retention, nausea, breast tenderness, mood swings, headaches, and nausea. Estrogen therapy is conventional and widely practiced; as such it is usually well-covered by health insurance providers. Less practiced and more controversial is Androgen therapy, which includes regulation of testosterone. It has been found to be helpful for some women with very low testosterone levels, although some studies challenge those findings.
Beyond hormone therapy, some medications like Tibolone (not approved by the FDA for use in the United States) may be prescribed off-label to women as ways to enhance sexual arousal. Studies have shown that Viagra may be beneficial for some women who suffer from SSRI-caused sexual dysfunction.
Folk and Herbal Remedies
Both L-Arginine and Gingko also work as natural supplements to aid women with sexual dysfunction. Additionally, a herb called damiana has a long history among indigenous peoples of Central America as an aphrodisiac and for women. Certain flower essences and Reiki are also alternative solutions to aid this issue.
Non-Western and Complimentary Medicine Perspectives on Sexual Disorders
Non-Western and alternative systems of medicine consider sexual arousal issues in the context of the entire body, and treat it accordingly.
Homeopathy seeks to stimulate the body’s defense mechanisms and processes so as to prevent or treat illness. Some typical homeopathic remedies for sexual dysfunctionnn include Angus Castus, Caladium, Selenium metallicum, Lycopodium, and Staphysagria. Homeopathy does not distinguish between strictly physical and mental causes; however, each of these tinctures is correlated with a specific cluster of symptoms.
So, Selenium metallicum is prescribed when the desire is there, but sexual ability is diminished, while Staphysagria is supposed to help with “performance anxiety.” Acupuncture and Traditional Chinese Medicine have centuries-old practices for treating various forms of sexual dysfunction. Studies have shown that acupuncture can help with problems concerning specific organs; additionally, acupuncture is used by many to treat hormonal imbalances.
For people undertaking this course of treatment it is important to understand that the Chinese perspective on sexuality is strongly rooted in traditional folk beliefs and cultural traditions, including the Daoist notions about sexuality and twin energies of the yin and the yang. These beliefs include the virtue of delayed and minimized ejaculations for men, while experiencing the sensations of an orgasm—something that might be classified as a problem in Western medicine! Finally, Chiropractic interventions for sexual dysfunction can help by restoring normal nerve function and communication, which allows body functions involved in sexual response to work optimally and naturally.