Sexual Health and Sexual Dysfunction

Sexual health is a state of complete physical and mental well-being concerning sexual maturity and sex organs. Thus, besides healthy sexual organs, a correct attitude regarding sexual practices and sound mental health is equally important. Thus, sexual dysfunction is a vague term, which includes a multitude of reasons: physical, social, and psychological, among others. Thus, it is a multi-factorial disorder with varying genetic susceptibility and environmental triggers upon a person’s sexual health.

While occasional disturbances and lack of adequate satisfaction are fairly common, the problem arises when the stress is prolonged. Often it causes long-term distress, which progresses to dysfunction and sexual disorder. It is thus, important to ask for professional help when the dysfunction leads to distress, which affects one’s daily life.

Often, sexual disorders are a manifestation of a physical or mental illness. For example, premature ejaculation, bedwetting is common in persons suffering from depression and other mood disorders. Consequently, the first-line drugs for such conditions are tricyclic anti-depressants or TCAs. Thus, it is important that secondary causes, if present, must be identified and treated to relieve sexual dysfunction associated distress.

Some of the other risk factors and warning signs associated with the first manifestation of sexual disorder are as follows:

Post-chemotherapy for perineal cancers (cervical, vaginal, bladder, rectal), women experience sexual side effects such as a reduction in sexual drive, vaginal dryness, and, as a result, painful coitus, which reinforces negative emotions associated with sex.

In men with pre-existing heart disease, a chronic inability to maintain an erection of the penis during sex (erectile dysfunction) may be the first sign. The corporal vessels of the penis, having a smaller lumen, are more vulnerable to damage by lipids, hypertension, and atherosclerosis than the other vessels. Thus, before the cardiac manifestations become apparent, erectile dysfunction may be the first presenting signs of impending heart disease.

The stigma associated with sexual health and its disorders is immense. A significant percentage of the population suffers from some of the other kinds of sexual distress. Thus, it is important to shun the taboo and ask for professional help, to prevent consequences and early diagnosis of disorders when they are amenable to treatment.

Read more:

• Sexual Health: Physical, Mental and Social well-being
• Sexually Transmitted Diseases: Risks and Prevention

Sexual Dysfunction: Classification of Sexual Disorders

1.Arousal Disorders:

In arousal disorder, there is a lack of physical, emotional, or mental response to sexual stimulation.
As mentioned above, in men, the most common sexual dysfunction is erectile dysfunction, which increases with increasing age. According to the Male Aging Study, nearly half of the men reported experiencing erectile dysfunction between the 4th and 7th decade of life.

On the other hand, women may experience vaginal dryness, lack of stimulation and sensation, or no swelling of the clitoris during sexual activity. (Clitoris in females is homologous to the penis in males and is highly vascular. During sexual activity, the blood flow to both the organs increases, resulting in intumescence or swelling.

Such difficulties may lead to decreased sex or, in extreme cases, a total inability to have sex.
The converse of it is termed as ‘Persistent Genital Arousal Disorder.’ In males, it manifests as priapism, or an erect penis all the time, even in the absence of genital stimulation. In females, it results in orgasms throughout the day. Both of them can be reasons for significant distress.

2.Desire Disorders

Desire disorders mainly stem from emotional and hormonal issues. Depression, stress, anxiety affect the desire for sex in both genders. In general, women achieve menopause (stoppage of menstrual cycles) by the age of 45-50 years. It leads to decreased sex hormones, estrogen, and progesterone, thus affecting sexual desire.

Similarly, with increasing age, the amount of testosterone decreases, leading to impotence and low libido. The symptoms might include anhedonia (lack of pleasure in daily activities), lack of sexual desire, or erotic thoughts.

The most common sexual dysfunction disorder in women is low libido. Nearly one-quarter of women experience low libido in premenopausal age, the incidence of which nearly doubles after attainment of menopause. As discussed above, it may be associated with painful stimulation or vaginal dryness, which makes the act of sex undesirable and results in a decreased desire.

‘Hypoactive Sexual Desire Disorder’ is another term used to describe distress, causing emotions such as low libido, lack of sexual desires, and inability to satisfy the other partner. However, according to the latest guidelines, it has been clubbed with arousal disorders into one category: Female Sexual Interest Arousal Disorder, as many females experience both the symptoms of low libido and arousal disorders, albeit at different times. However, the classification remains controversial as it groups arousal and desire disorders into one.

The counterpart in men for lack of interest in sex is diagnosed as Male Hypoactive Sexual Desire Disorder.

3.Orgasmic Disorders

Orgasmic disorders cause significant distress, once in the act of coitus.

For women, of concern is Anorgasmia (seen in around 5% of women), which refers to difficulty in or a lack of orgasm and the passage of vaginal lubricating fluid. The specific concerns may vary: From not experiencing one to delayed orgasm.

For men, orgasm ends in ejaculation and the release of seminal fluid. The specific concerns in men include:

Premature ejaculation: It is a subjective term and refers to ejaculation within a few minutes of arousal, and sooner than what the opposite partner desires.

Retrograde Ejaculation: The semen, instead of coming out of the urethra (The urethra is the common passage for urine and semen in men), through reverse peristalsis enters the bladder. It results in inadequate and ineffective ejaculation, which can be a cause of infertility.

Delayed Ejaculation: It is the opposite of premature ejaculation. Long after arousal and erection

Delayed ejaculation is characterized by difficulty reaching orgasm.

4.Painful Sex

It is also referred to as dyspareunia and is more commonly experienced by women as compared to men. Sex, as a natural physiological mechanism, is supposed to give pleasure to both partners. Painful sex resulting from multiple factors is again a cause for sexual dysfunction.

In women, vaginismus is one of the common causes of painful sex, leading to involuntary squeeze or spasm of the pelvic floor’s supporting muscles. As a result, penile insertion or any tampon insertion is painful.

In men, Peyronie’s disease, in which the erections are bent, causes sexual discomfort, and may also lead to erectile dysfunction and other ejaculation disorders.

Causes of Sexual Dysfunction:

A large number of sexual disorders are due to widely different causes. Communication barriers, mistrust in the relationship, adultery, excessive consumption of pornographic material are some of the non-physical causes of sexual dysfunction complaints. The broad categories include:

Physical Health Problems: 

The following problems may predispose the person to develop sexual dysfunction disorders.

Cardiovascular disorders: Hypertension, Hyperlipidemia, and Hypercholestorelmia.

Endocrine disorders: Diabetes Mellitus, Hypothyroidism, Liver failure and Obesity

Urinary-Renal disorders: Kidney failure, Urinary tract infections, Benign prostatic hyperplasia, Vaginismus, and Peyronie’s disease.

Genital System Disorders: Pelvic wall weakness and prolapse of vagina/bladder/rectum, Uterine fibroids, and endometriosis

Neurological Disorders: Organic and inorganic brain diseases, epilepsy, spinal cord injuries, sleep disturbances

Cancer and cancer chemotherapy, chemoradiation.

Psychological Health Problems:

Depression, performance anxiety, stress, body dysmorphism, post-traumatic disorders, low self-worth, and unrealistic expectations due to the use of tamponade, pornographic material.

Substance use Problems:

They include therapeutic drugs such as antidepressants and anti-hypertensives.

They also include alcoholism, smoking (most common), and illicit drug use such as cocaine, cannabis, methamphetamines, mephedrone.

Diagnosing Sexual Dysfunction Disorders:

Generally, they are first noticed or experienced by the person himself or his/her partner. Considering the stigma attached, the majority of the people hesitate to have a consultation.

A sex-expert or other professionals such as Obstetric-Gynecologist, urologist, or a sex-therapist helps the treating physician come to a diagnosis, address the underlying physical and mental causes, and accordingly, initiate therapy.

A full-body checkup and tests (to rule out infertility), along with a detailed history and physical examination is the key to diagnosis. It may also point towards localizing a particular system as a cause of illness or some particular medication, contributing to the dysfunction.

Sexual Dysfunction: Treatment and Therapy

The treatment options and the goal of therapy depend upon the cause of sexual dysfunction.

For example, in men with Erectile Dysfunction, phosphodiesterase inhibitors like Sildenafil (by the trade name Viagra) increase blood flow to the penis and provide symptomatic relief tumescence during the act of intercourse. However, they do not address the root cause of the problem, such as an underlying cardiovascular or endocrine problem.

Also, lifestyle changes (like switching over to plant-based diets, less saturated fatty acids, and more antioxidant-rich fruits and vegetables) along with exercise (kegel exercises in men and women, 30 minutes of moderate exercise a day) helps improve mild ED and is also a protective factor for the development of ED.

Women with HSDD have two FDI approved drugs: Fibanserin and Bremelanotide to treat the condition. However, as mentioned earlier, the causes of sexual dysfunction are multifactorial, and hence drug therapy should be complemented with other forms of treatment options, such as counseling and behavioral training.

Some examples include Penile pumps and injections for helping with erection—laser therapy for regaining vaginal elasticity and improving lubrication, thereby reducing pain.

Hormone therapy is also used in the form of hormone replacement therapy. For example, in women, it includes estrogen and progesterone replacement after menopause, and in men, testosterone replacement for those who have a senile decrease in levels of the hormone. 

In conclusion, some Do’s and Don’ts include:

Do’s:

• Stress relaxation techniques like yoga, meditation, breathing exercises.
• Ensuring a healthy diet and adequate sleep and rest.
• Exercising daily and being fit.
• Spending quality time with friends and family.

Don’ts:

• Having a sedentary lifestyle
• Stressing out on things which are beyond one’s control
• Do not avoid sexual activity or suppress urges, as it improves with practice.
• Do not delay treatment so that the condition can be treated earliest, and complications do not develop.