Sexual Dysfunction

Sexual dysfunction is a topic that many people are hesitant to discuss. It occurs more commonly in the 40-65 year old age range. Fortunately, most cases of sexual dysfunction are treatable, so it is important that people share their concerns with their partners and their health care professionals.

Hormonal rebalancing, health management, counseling, education, and improved communication between partners can significantly improve quality of life issues for many people dealing with the issue of sexual dysfunction. We work to individualize these plans for each person seeking our help.

Definition: a problem occurring during any phase of the sexual response cycle (see below) that causes distress and prevents the individual or couple from experiencing satisfaction

Sexual Response Cycle

1) Excitement (including desire & arousal)
2) Plateau
3) Orgasm
4) Resolution

Types of Sexual Dysfunction

• Desire/Libido Disorders – absent, decreased (or increased) desire for sexual activity
• Arousal Disorders – inability to become physically aroused or excited during sexual activity, lack of lubrication in women and lack of or lessened erection in men
• Orgasmic/Ejaculatory Disorders – delayed, premature, or absent climax
• Pain Disorders – significant discomfort associated with sexual activity that limits or stops activity

The History of Sexual Dysfunction

• early 1980s was first recognition that sexual dysfunction was not just psychological but had physical causes
• 1998 Viagra first introduced to market for erectile dysfunction in men
• 1999 JAMA published study documenting that 43% of women and 31% of men experience distress related to sexual function at some point in their lifetime

Causes of Sexual Dysfunction

• hormonal imbalance
• medication side effects
• chronic medical conditions (including diabetes, heart and blood vessel disease, nerve disorders, liver and kidney disease)
• alcohol use/abuse
• illicit drug use/abuse
• vaginal infections
• depression/anxiety
• history of or current abuse
• unhappy relationship
• everyday life stresses
• boredom with partner or sexual routine
• demanding job
• worry and responsibility of children
• cancer treatments (breast, prostate)

How do you diagnose sexual dysfunction?

Often a person recognizes there is a problem with their or their partner’s enjoyment of a sexual relationship. The person may approach their health care provider who will take a detailed history and perform an appropriate physical exam. Tests may be ordered to evaluate hormonal and medical problems that could be contributory. Evaluation of the person’s attitudes regarding sex will help the provider better understand the underlying cause of the problem and make recommendations for appropriate treatment.

What are possible treatments for sexual dysfunction?

• Medications – If a medication is the cause of the dysfunction, then changing that medication or its dose may help if appropriate. If hormonal issues are present, then supplementing or rebalancing hormones may be beneficial. Some men may benefit from drugs that increase blood flow to the penis.
• Mechanical Aids – Men with erectile dysfunction may be helped by certain devices or may need surgical referral. Women with vaginal narrowing may be aided by medical dilators.
• Physical Therapy – Pelvic floor physical therapy can be beneficial for both men and women who have experienced sexual dysfunction.
• Sex Therapy
• Behavioral Treatments
• Psychotherapy
• Education
• Communication

Female Sexual Dysfunction

• Associated with hormonal contraceptive use
• Related to pregnancy- during, immediately after, while breastfeeding
• During perimenopause- drop in testosterone noticed
• After menopause- vaginal tissues dry and sensitive