Sexual dysfunctions are most common in the early adult years, with the majority of people seeking care for such conditions during their late 20s through 30s. The incidence increases again in the perimenopause and postmenopause years in women, and in the geriatric population, typically with gradual onset of symptoms that are associated most commonly with medical causes of sexual dysfunction.
Sexual dysfunction is more common in people who abuse alcohol and drugs. It is also more likely in people suffering from diabetes and degenerative neurological disorders. Ongoing psychological problems, difficulty maintaining relationships, or chronic disharmony with the current sexual partner may also interfere with sexual function.
Open, informative, and accurate communication regarding sexual issues and body image between parents and their children may prevent children from developing anxiety or guilt about sex, and may help them develop healthy sexual relationships.
Review all medications, both prescription and over-the-counter, for possible side effects that relate to sexual dysfunction. Avoiding drug and alcohol abuse will also help prevent sexual dysfunction.
Couples who are open and honest about their sexual preferences and feelings are more likely to avoid some sexual dysfunction. One partner should, ideally, be able to communicate desires and preferences to the other partner.
People who are victims of sexual trauma, such as sexual abuse or rape at any age, are urged to seek psychiatric advice. Individual counseling with an expert in trauma may prove beneficial in allowing sexual abuse victims to overcome sexual difficulties and enjoy voluntary sexual experiences with a chosen partner.
•Men or women:
•Inability to feel aroused
•Lack of interest in sex (loss of libido)
•Pain with intercourse (much less common in men than women)
•Delay or absence of ejaculation, despite adequate stimulation
•Inability to control timing of ejaculation
•Inability to get an erection
•Inability to keep an erection adequately for intercourse
•Burning pain on the vulva or in the vagina with contact to those areas
•Inability to reach orgasm
•Inability to relax vaginal muscles enough to allow intercourse
•Inadequate vaginal lubrication before and during intercourse
•Low libido due to physical/hormonal problems, psychological problems, or relationship problems
SIGNS AND TESTS
The health care provider will investigate any physical problems and conduct tests based on the particular type of sexual dysfunction you’re experiencing. In any case, a complete medical history should be taken and physical examination should be done to:
•Highlight possible fears, anxieties, or guilt specific to sexual behaviors or performance
•Identify predisposing illness or conditions
•Uncover any history of prior sexual trauma
A physical examination of both the partners should include the whole body and not be limited to the reproductive system.
Treatment depends on the cause of the sexual dysfunction. 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, conditions, or disabilities.
For men who have difficulty attaining an erection, the medication sildenafil (Viagra), which increases blood flow to the penis, may be very helpful, though it must be taken 1 to 4 hours before intercourse.
Men who take nitrates for coronary heart disease should not take sildenafil. Mechanical aids and penile implants are also an option for men who cannot attain an erection and find sildenafil isn’t 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.
Vulvodynia can be treated with testosterone cream, with use of biofeedback and with low doses of some antidepressants which also treat nerve pain. Surgery has not been successful.
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.
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.
PROGNOSIS AND OUTCOME
The prognosis (probable outcome) depends on the form of sexual dysfunction. In general, the probable outcome is good for physical dysfunctions resulting from treatable or reversible conditions. It should be noted, however, that many organic causes do not respond to medical or surgical treatments. Prolonged physical dysfunction can also create sexual dysfunction.
In functional sexual problems resulting from either relationship problems or psychological factors, the prognosis may be good for temporary or mild dysfunction associated with temporary stress or lack of accurate information. However, those cases associated with chronically-poor relationships or deep-seated psychiatric problems typically do not have positive outcomes.
Some forms of sexual dysfunction may cause infertility.
Persistent sexual dysfunction may cause depression in some individuals. The importance of the disorder to the individual (and couple, when applicable) needs to be determined. Decreased sexual function is important only if it is a cause of concern for the couple. Sexual dysfunction that is not addressed adequately may lead to conflicts or potential breakups.