Sexual dysfunction

Whether we consider sex to be an important part of our lives or not, if dysfunction becomes part of our sexual world, it can have profound and destructive effects for many of us. Sexual dysfunction can affect both men and women and women at any age although the likelihood of us being affected increases with age.

We can define sexual dysfunction as a disruption of one or more of the phases of the sexual response cycle. The phases are as follows:-

Excitement
Plateau
Orgasm
Resolution

Although we are aware that the incidence of sexual dysfunction is relatively common, there are many people who find it a difficult subject to discuss but on the whole, sexual dysfunction is largely treatable and your doctor will very likely be able to offer help.

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Sexual Dysfunction in men

Erectile Dysfunction

There are a number of conditions which can contribute to sexual dysfunction in men. The most well known is erectile dysfunction whereby the individual is unable to achieve or maintain an erection long enough to allow sexual intercourse to take place.

There are many causes and contributory causes of ED which include:-

Narrowing of the blood vessels which may be associated with high blood pressure (hypertension)
Hypertension itself may be a cause
High cholesterol levels
Diabetes
Hormonal issues
Surgery
Injury
Anxiety
Depression
Relationship issues
Stress
Drug taking, both prescription and recreational

The physical underlying conditions can be treated and so subsequently will help alleviate the ED. In addition, there is another class of drugs known as PDE inhibitors which cause an increase of blood flow to the penis which when accompanied by arousal will enable an erection to occur; this class of drugs includes Viagra and Cialis.

In the case of the psychological issues, drugs may be used, antidepressants for instance but alongside this we may consider counselling and other lifestyle changes such as meditation, taking regular exercise and changing to a healthier, more nutritious lifestyle.

Premature ejaculation

This condition occurs when ejaculation occurs in the male either before penetration can occur or very shortly after penetration

There are a variety of possible causes:-

Prostate problems
Thyroid problems
Depression
Stress
Relationship problems
Anxiety about sexual performance
Use of recreational drugs
Strict upbringing in relation to sexual activity
History of sexual abuse
Biological issues, for instance, having a very sensitive penis

We can address some of these issues with a direct investigation into prostate and thyroid issues and antidepressants and therapy for the psychological issues but there are some specific drug therapies that we can consider:-

Dapoxetine

This is an SSRI drug that has been licenced in the UK specifically for treating premature ejaculation. It can be taken as required, 1 - 3 hours before sex but only once a day

Phosphodiesterase-5 inhibitors

This is the group of PDE inhibitors mentioned in the treatment for erectile dysfunction and they can also be used in the treatment of PE

Sexual dysfunction in women

Reduced libido (sex drive)

Loss of libido can be attributed to a range of things and it may surface at particular times of life. For instance, during pregnancy, after childbirth and in times of stress. However, there are a number of physical and psychological factors which may contribute to this issue:-

Depression
Tiredness
Relationship issues
Diabetes
Thyroid issues
Alcohol abuse
Some prescription medications such as SSRI antidepressants
Drop in testosterone levels which may occur if the ovaries or adrenal glands are not functioning correctly

Orgasm Issues

Vaginismus

This is also known as dyspareunia and actually refers to pain in the vagina experienced during sex. The muscles in the vagina actually go into spasm making sexual intercourse painful or even impossible. It may be associated with a woman’s belief that intercourse is ‘wrong’ or even past sexual trauma or vaginal injury. In addition, the skin condition called Lichen Sclerosis can cause reduced elasticity and thinning of the skin which in turn can mean that intercourse can result in skin ‘tears’.

Treatment can involve counselling, using vaginal dilators and treating any skin conditions that may be involved.

Sex after menopause

During menopause we experience drops in levels of oestrogen which in turn can lead to vaginal dryness.

The treatment for this is to use lubricating cream or ointment

Female Ggenital mutilation

FGM is the deliberate cutting, changing or injuring the female genital region. Obviously this is likely to lead to reduced sexual desire and a lack of pleasurable sensation in addition to experiencing difficult and painful sex.

If this is a problem, do not hesitate to seek medical attention from your GP.

Conclusion

More can be done to help with sexual dysfunction than many people may realise from sex therapy and lifestyle changes to drug intervention. To seek advice, contact your GP