Ask the Docs

Sexual Dysfunction in Men and Women

By Vanessa Vizcaino, M.D.

            What better way to introduce this topic than to add it to the February issue for Valentine’s Day? Sexual dysfunction or sexual problems are defined as difficulty during any stage (desire, arousal, orgasm, and resolution) of the sexual act, which prevents the individual or couple from enjoying sexual activity.  I know there are many questions about libido, orgasms, and sexual function in general, because both my male and female patients of all adult ages ask me on a daily basis. People are often embarrassed to ask questions regarding sex for obvious reasons. I am here to tell you all not to be embarrassed! Sexuality and sex is a major part of adult life, and even as we age, it is important to address the issues that come up.

          In a JAMA article from 1999 in a survey of men and women aged 18 – 59 years, about 43 percent of women and 31 percent of men reported some sexual problem. I suspect the numbers haven’t changed much. I found a list on Discovery Health with the following little-known facts (mostly about women):

1. About 10 percent of women have never had an orgasm.
2. Painful intercourse has been experienced by almost two out of three women at some time in their lives.
3. It is common for breast-feeding women to have inadequate vaginal lubrication.
4. About 15 percent of postmenopausal women experience a decrease in their sexual desire.
5. The success rate for women’s orgasmic dysfunction treatment by sex therapists tends to range from 65 percent to 85 percent.
6. About 22 percent of women experience low sexual desire (compared to 5 percent of men).
7. Some 21 percent of men experience premature ejaculation.
8. A woman’s level of androgen (a hormone that develops and maintains masculine characteristics) typically falls 50 percent during and after menopause (but it’s unclear whether the drop translates into decreased sex drive in a large percentage of women).

As far as men are concerned, many think the “little blue pill” can fix anything that occurs in this department. This is of course a myth, and any man that has had this problem can attest to this fact. This is mostly because sexual problems can come from physical or psychological issues, and sometimes both. Many chronic illnesses and the medications used to treat them can cause sexual dysfunction at any stage. Sometimes, despite having no physical problems, men simply have a hard time. Emotional factors affecting sex include both interpersonal problems and psychological problems within the individual. Interpersonal problems include marital or relationship problems, or lack of trust and open communication between partners. Personal psychological problems include depression, sexual fears or guilt, or past sexual trauma. These of course can affect women as well, and often contribute to more of the problem with young women than any other physical issue.

Women are often more emotional and we have a hard time separating the sexual act from the emotional component of the relationship. Let’s face it, how often has a couple been at odds over an issue or fight? And even though the man is willing and able to overlook that in order to get sex, the woman just can’t bring herself to get intimate. As with everything, there are exceptions to this, but from clinical experience I can tell you this is often a source of discord in many relationships. I like to refer my patients to counselors or therapists to work on their emotional barriers and issues in order to experience a better sex life. Simple, open, accurate, and supportive education about sex and sexual behaviors or responses may be all that is required in many cases. Some couples may benefit from joint counseling to address interpersonal issues and communication styles. Psychotherapy may be required to address anxieties, fears, inhibitions, or poor body image.

Physical issues also contribute to sexual dysfunction. Some of these include:

·         Injuries to the back (typically the lumbar and sacral spine)

·         An enlarged prostate gland

·         Disease (diabetic neuropathy, multiple sclerosis, tumors, and, rarely, tertiary syphilis)

·         Drugs, such as alcohol, nicotine, narcotics, stimulants, antihypertensives (medicines that lower blood pressure), antihistamines, and some psychotherapeutic drugs (used to treat psychological problems such as depression)

·         Endocrine disorders (thyroid, pituitary, or adrenal gland problems)

·         Failure of various organs (such as the heart and lungs)

·         Hormonal deficiencies (low testosterone, estrogen, or androgens)

·         Nerve damage (as in spinal cord injuries)

·         Problems with blood supply

·         Some birth defects

Treatment exists for sexual dysfunction no matter the cause. Depending on the cause, some issues are easier to fix than others. For people with nerve damage and severe psychological trauma, treatments are not always effective. Listed below are some common treatments:

– Medical causes that are reversible or treatable are usually managed medically or surgically. Physical therapy and mechanical aides may prove helpful for some people experiencing sexual dysfunction due to physical illnesses or disabilities.

-Sildenafil (Viagra) or one of the other drug variations may be helpful for men who have difficulty attaining and keeping an erection. The medication increases blood flow to the penis. Men who take nitrates for coronary heart disease should not take these drugs.

-Mechanical aids and penile implants are an option for men who cannot attain an erection and find the above medications are not helpful.

-Women with vaginal dryness may be helped with lubricating gels, hormone creams, and in cases of premenopausal or menopausal women, with hormone replacement therapy. In some cases, women with androgen deficiency can be helped by taking testosterone. Kegel exercises may also increase blood flow to the vulvar/vaginal tissues, as well as strengthen the muscles involved in orgasm.

-Behavioral treatments involve many different techniques to treat problems associated with orgasm and sexual arousal disorders. Self-stimulation and the Masters and Johnson treatment strategies are among the many behavioral therapies used. ( http://masters-johnson-method.com)

I hope you all find this helpful and I encourage anyone with these issues to seek help. I believe sex is a crucial part of adult life and it is an integral part of romantic relationships. Make time for it, be open to new techniques and ideas and more importantly, ENJOY IT!

Have a wonderful, fun and exciting Valentine’s Day!

Vanessa Vizcaino, MD

If you would like further information, please call us at Family Medical and Wellness Center (561) 721-1953.