Sexual Dysfunction; Causes, Symptoms, Diagnosis, Treatment

Sexual dysfunction
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Sexual dysfunction (or sexual malfunction or sexual disorder) is difficulty experienced by an individual or a couple during any stage of normal sexual activity, including physical pleasure, desire, preference, arousal or orgasm. According to the DSM-5, sexual dysfunction requires a person to feel extreme distress and interpersonal strain for a minimum of 6 months (excluding substance or medication-induced sexual dysfunction). Sexual dysfunctions can have a profound impact on an individual’s perceived quality of sexual life. The term sexual disorder may not only refer to physical sexual dysfunction, but to paraphilias as well; this is sometimes termed disorder of sexual preference.

Sexual function is an essential component of life, both in species propagation as well as the quality of life. Sexual dysfunction can lead to reduced quality of life and potentially procreative advancement. Male sexual dysfunction, especially erectile dysfunction, has been extensively studied and effective therapies are available for men with this disorder. However, female sexual dysfunction (FSD) is more complicated and significantly less is understood in comparison to male sexual dysfunction. Therefore, the present review focuses on therapies available or in development as well as challenges faced by investigators in the study of FSD. Other recent reviews articles may be useful for understanding additional aspects of FSD [].

Types of Sexual Dysfunction

The spectrum of sexual dysfunction encompasses:

  • Decreased sexual desire—persistent or recurrent deficiency or absence of desire for sexual activity giving rise to marked distress and interpersonal difficulty;
  • Sexual aversion disorder—persistent or recurrent aversion and avoidance of all genital sexual contact leading to marked distress and interpersonal difficulty;
  • Difficulty in erection—recurrent or persistent, partial or complete failure to attain or maintain an erection until the completion of the sex act;
  • Difficulty in achieving orgasm—persistent or recurrent delay in or absence of orgasm, following a normal sexual excitement phase;
  • Premature ejaculation—persistent or recurrent ejaculation with minimal sexual stimulation, before, on or shortly after penetration and before the person wishes it, which causes marked distress.[]

Sexual dysfunction generally is classified into four categories

  • Desire disorders —lack of sexual desire or interest in sex
  • Arousal disorders —inability to become physically aroused or excited during sexual activity
  • Orgasm disorders —delay or absence of orgasm (climax)
  • Pain disorders — pain during intercourse

List of disorders of Sexual Dysfunction

DSM

The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders lists the following sexual dysfunctions:

  • Hypoactive sexual desire disorder (see also asexuality, which is not classified as a disorder)
  • Sexual aversion disorder (avoidance of or lack of desire for sexual intercourse)
  • Female sexual arousal disorder (failure of normal lubricating arousal response)
  • Male erectile disorder
  • Female orgasmic disorder
  • Male orgasmic disorder
  • Premature ejaculation
  • Dyspareunia
  • Vaginismus

Additional DSM sexual disorders that are not sexual dysfunctions include:

  • Paraphilias
  • PTSD due to genital mutilation or childhood sexual abuse

Other sexual problems of Sexual Dysfunction 

  • Sexual dissatisfaction (non-specific)
  • Lack of sexual desire
  • Anorgasmia
  • Impotence
  • Sexually transmitted diseases
  • Delay or absence of ejaculation, despite adequate stimulation
  • Inability to control the timing of ejaculation
  • Inability to relax vaginal muscles enough to allow intercourse
  • Inadequate vaginal lubrication preceding and during intercourse
  • Burning pain on the vulva or in the vagina with contact to those areas
  • Unhappiness or confusion related to sexual orientation
  • Transsexual and transgender people may have sexual problems before or after surgery.
  • Persistent sexual arousal syndrome
  • Sexual addiction
  • Hypersexuality
  • All forms of Female genital cutting
  • Post-orgasmic diseases, such as Dhat syndrome, post-coital tristesse (PCT), postorgasmic illness syndrome (POIS), and sexual headache.

Causes Sexual Dysfunction

Physical causes — Many physical and/or medical conditions can cause problems with sexual function. These conditions include diabetes, heart, and vascular (blood vessel) disease, neurological disorders, hormonal imbalances, chronic diseases such as kidney or liver failure, and alcoholism and drug abuse. Physical causes refer to health conditions that contribute to sexual problems or the inability to achieve satisfaction. Some of the most common physical causes for sexual disorders include:

  • Neurological disorders like multiple sclerosis
  • Fatigue, frequent headaches or chronic pain
  • Urinary or bowel difficulties
  • Surgery, especially in the pelvic area
  • Diseases like arthritis, diabetes or high blood pressure
  • Use of certain medication or recreational drugs
  • Injuries

Psychological causes — These include work-related stress and anxiety, concern about sexual performance, marital or relationship problems, depression, feelings of guilt, concerns about body image, and the effects of past sexual trauma.

  • Heart disease
  • Clogged blood vessels (atherosclerosis)
  • High cholesterol
  • High blood pressure
  • Diabetes
  • Obesity
  • Metabolic syndrome — a condition involving increased blood pressure, high insulin levels, body fat around the waist and high cholesterol
  • Parkinson’s disease
  • Multiple sclerosis
  • Certain prescription medications
  • Tobacco use
  • Peyronie’s disease — development of scar tissue inside the penis
  • Alcoholism and other forms of substance abuse
  • Sleep disorders
  • Treatments for prostate cancer or enlarged prostate
  • Surgeries or injuries that affect the pelvic area or spinal cord
  • Depression, anxiety or other mental health conditions
  • Stress
  • Relationship problems due to stress, poor communication or other concerns
  • Sexual trauma or abuse in the past
  • Anxiety disorder and attacks
  • Poor self-image and lack of confidence

Medications

  • Certain medications can cause changes in the level of experienced sexual desire through “non-specific effects on general well-being, energy level, and mood”. Declining levels of sexual desire have been linked to the use of anti-hypertension medication and many psychiatric medications; such as antipsychotic medications, tricyclic anti-depressants, monoamine-oxidase (MAO) inhibitors, and sedative drugs.
  • However, the most severe decreases in sexual desire relating to psychiatric medication occur due to the use of selective serotonin reuptake inhibitors (SSRIs). In women specifically, the use of anticoagulants, cardiovascular medications, medications to control cholesterol, and medications for hypertension contributed to low levels of desire.

Hormone

  • Sexual desire is said to be influenced by androgens in men and by androgens and estrogens in women. Many studies associate the sex hormone, testosterone with sexual desire. Testosterone is mainly synthesized in the testes in men and in the ovaries in women. Another hormone thought to influence sexual desire is oxytocin.
  • Exogenous administration of moderate amounts of oxytocin has been found to stimulate females to desire and seek out sexual activity. In women, oxytocin levels are at their highest during sexual activity. In males, the frequency of ejaculations affects the libido. If the gap between ejaculations extends toward a week, there will be a stronger desire for sexual activity.

Interventions

There are a few medical interventions that can be done on individuals who feel sexually bored, experience performance anxiety, or are unable to orgasm. For everyday life, a 2013 fact sheet by the Association for Reproductive Health Professionals recommends:

  • Erotic literature
  • Recalling instances when feeling sexy and sexual (The patient is instructed to recall her physical appearance, the setting, the smells in the air, the music she was hearing, and the foods she was eating at that time and use these as ‘cues’ for feeling sexual now)

Social and Religious Views of Sexual Dysfunction

  • The views on sexual desire and on how sexual desire should be expressed vary significantly between different societies and religions. Various ideologies range from sexual repression to hedonism. Lawson various forms sexual activity, such as homosexual acts and sex outside marriage vary by countries. Some cultures seek to restrict sexual acts to marriage.
  • In some societies, there is a double standard regarding the male and female expression of sexual desire. Female genital mutilation is practiced in some regions of the world in an attempt to prevent women to act on their sexual desire and engage in “illicit” sex.

Symptoms of Sexual Dysfunction

  • The total absence of sexual desire or a low sex drive
  • An inability to get aroused or maintain arousal for the duration of sexual activity
  • Recurrent ejaculation with minimal sexual stimulation
  • Inadequate lubrication in spite of sexual excitement
  • Not achieving an orgasm, after going through the normal excitement phase
  • Pain while having intercourse
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Sexual dysfunction
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Vaginal Dryness

  • Why It’s Happening Vaginal dryness can result from hormonal changes that occur during breastfeeding or menopause. In fact, a study of 1,000 postmenopausal women published in January 2010 in the journal Menopause found that half of the postmenopausal women experience vaginal dryness.

Low Desire

  • Why It’s Happening As hormones decline in the years leading up to menopause, your libido can go south, too. But low desire isn’t just a problem for older women: Half of females ages 30 to 50 have also suffered from a lack of lust, according to a national survey of 1,000 women. Low libido can result from a number of issues, including medical problems like diabetes and low blood pressure, and psychological issues like depression or simply being unhappy in your relationship. Certain medications, like antidepressants, can also be libido killers, as can hormonal contraceptives, according to a study published in June 2010 in The Journal of Sexual Medicine.
  • What You Can Do – There’s no one-stop solution to boost libido, so talk to your doctor, who can help you get to the root of the problem. If the issue is emotional or psychological, they may recommend seeing a therapist. “A traditional or sexual therapist can help couples evolve from having the same old conversation patterns, life habits, and sexual habits to having a sexual relationship that’s fulfilling, invigorating, and romantic,” says Worley.

Painful Sex

Sexual dysfunction
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  • Why It’s Happening As many as 30 percents of women report pain during sex, Pain can be caused by vaginal dryness, or it may be an indication of a medical problem, like ovarian cysts or endometriosis, according to The American Congress of Obstetricians and Gynecologists. Painful sex can also be related to vaginismus, a condition in which the vagina tightens involuntarily when penetrated.
  • What You Can Do – Talk to your healthcare provider to rule out medical issues like ovarian cysts, endometriosis, or vaginismus. If those aren’t the problem, your doctor may recommend pelvic floor physical therapy, medication, or surgery to treat the cause of pain, says Worley. “It’s important to understand that the first treatment doesn’t always work, and sometimes multiple attempts at treatment are needed before you find success,” he says.

Arousal Problems

  • Why It’s Happening The inability to become aroused may be due to a number of reasons, such as anxiety or inadequate stimulation (aka, you need more foreplay). If you experience dryness or pain during sex, it can also be harder to become turned on. Hormonal changes due to menopause or a partner’s sexual issues (like erectile dysfunction or premature ejaculation) can also make it more difficult to get in the mood.
  • What You Can Do – Work with your healthcare provider to ID the underlying reason you can’t become aroused, recommends Worly. He or she can help connect you with the right form of treatment to correct the problem, whether that’s seeking out sexual therapy, a medication (like hormones), or treatment for your partner’s problem, he says.

Trouble Reaching Orgasm

  • Why It’s Happening – About 5 percent of perimenopausal women experience orgasm problems,” says Worly. Aside from hormone changes, an inability to reach orgasm may also be due to anxiety, insufficient foreplay, certain medications, and chronic diseases.
  • What You Can Do – Just like other forms of sexual dysfunction, it’s key to talk to your doctor to address the underlying problem before trying to treat it. In the meantime, try being more mindful while you’re getting it on by paying attention to the sensations as they happen.  suggests that being mindful during sex can make it easier to achieve orgasm. It may also be useful to add a vibrator to your sexual repertoire, says Worley. “Vibrators are now sold at most pharmacies, both in the store and online, so it’s possible to buy them discreetly from the comfort of your home,” he notes.

Diagnosis of Sexual Dysfunction

  • Physical exam This might include careful examination of your penis and testicles and checking your nerves for sensation.
  • Blood tests – A sample of your blood might be sent to a lab to check for signs of heart disease, diabetes, low testosterone levels, and other health conditions.
  • Urine tests (urinalysis) Like blood tests, urine tests are used to look for signs of diabetes and other underlying health conditions.
  • Ultrasound – This test is usually performed by a specialist in an office. It involves using a wand-like device (transducer) held over the blood vessels that supply the penis. It creates a video image to let your doctor see if you have blood flow problems. This test is sometimes done in combination with an injection of medications into the penis to stimulate blood flow and produce an erection.
  • Psychological exam Your doctor might ask questions to screen for depression and other possible psychological causes of erectile dysfunction.

Treatment of Sexual Dysfunction

Most types of sexual dysfunction can be corrected by treating the underlying physical or psychological problems. Other treatment strategies include:

  • Medication — When a medication is the cause of the dysfunction, a change in the medication may help. Men and women with hormone deficiencies may benefit from hormone shots, pills, or creams. For men, drugs, including sildenafil, tadalafil, vardenafil, and avanafil may help improve sexual function by increasing blood flow to the penis.
  • PDE5 Inhibitors – Increasing blood delivery to the genitals with the development of the first marked PDE5 inhibitor, sildenafil revolutionized the treatment of erectile dysfunction in men. The physiological mechanism responsible for relaxation of smooth muscle of cavernous tissue (both male and female) is initiated with the release of nitric oxide (NO) from adjacent nerve endings and/or endothelial cells upon mental and sensory stimuli via spinal reflex [].
  • Prostaglandins – Prostaglandins (PG) are found in virtually all tissues and organs. They are autocrine and paracrine lipid molecules, which are quickly metabolized, and participate in a variety of physiological events, including blood flow regulation. Specifically, the PG isoform PGE1 (signaling through its EP2 receptor) causes smooth muscle relaxation in the vaginal, uterine, as well as penile smooth muscle []. PGE1/EP2 activation leads to increases in cAMP resulting in activation of protein kinase A, which causes smooth muscle relaxation. Prostaglandins have been used in male sexual dysfunction, especially erectile dysfunction (administered through penile injection), for some time and have displayed positive outcomes for certain women with genital sexual arousal disorder, most likely through increasing vaginal secretion and arterial smooth muscle relaxation [].
  • Nitric Oxide Donor and Combination Therapy – It is well established that the production of NO is essential in vascular relaxation to numerous stimuli. PDE5 inhibitors augment NO-initiated dilation by propagating the downstream mediator, cGMP, through the activation of guanylate cyclase. Thus, activation of the NO-NO synthase (NOS) system is a potential site for pharmacological intervention. Pacher et al., demonstrated the topical application of a NO donor, DS1, a linear polyethyleneimine-nitric oxide/nucleophile adduct, increased vaginal blood flow in anesthetized rats [].
  • Vasoactive Intestinal Peptide – Vasoactive intestinal peptide (VIP) is a polypeptide hormone containing 28 amino acid residues and is produced in many areas of the human body. VIP has potent vasorelexant effects and has been suggested to contribute to vaginal blood flow control []. Like many peptidic therapies, oral administration of VIP is complicated by low bioavailability and high rate of clearance. Therefore, an alternative approach using an inhibitor of neutral endopeptidase (NEP), the primary enzyme responsible for the degradation of VIP, has been in development under the assumption that inhibition of NEP will lead to more VIP in the circulation, which can increase clitoral and vaginal blood flow when sexually stimulated [].
  • Testosterone – The use of testosterone to treat FSD has delivered mixed results. A primary concern in testosterone therapy is the long-term side effects including: hirsutism, acne and masculinization []. Given the results following the Woman’s Health Initiative, replacement therapy with estrogen and progestin revealed elevation in coronary heart disease, stroke and thrombosis formation [], a certain amount of caution must be taken in the treatment of FSD with hormones.
  • Estrogen – Estrogen plays a vital role in the regulation of female sexual function. Alterations in estradiol levels can result in vaginal wall smooth muscle atrophy and increased vaginal canal acidity, ultimately leading to discomfort and stress []. The findings from the Woman’s Health Initiative raised concerns on estrogen replacement therapy, however, the benefits of estrogen in normal function are well accepted. Estrogen plays a vital role in the regulation of female sexual function. Alterations in estradiol levels can result in vaginal wall smooth muscle atrophy and increased vaginal canal acidity, ultimately leading to discomfort and stress [].
  • Centrally Mediated Stimulation – The sexual response for men and women is distinct. Regarding treatment of male ED, PDE5 inhibitors have proven to be very successful, whereas in FSD similar achievements have not been made. Treating FSD through central acting mediators has recently received more attention. This area of investigation has gained momentum by recent publication demonstrating that several hypothalamic nuclei are activated in rodent sexual response []. Therefore, central regulation/activation of the female sexual response could mark an alternative approach for treating FSD.
  • Nitric Oxide Donor and Combination Therapy – It is well established that the production of NO is essential in vascular relaxation to numerous stimuli. PDE5 inhibitors augment NO-initiated dilation by propagating the downstream mediator, cGMP, through the activation of guanylate cyclase. Thus, activation of the NO-NO synthase (NOS) system is a potential site for pharmacological intervention. Pacher et al., demonstrated the topical application of a NO donor, DS1, a linear polyethylenimine-nitric oxide/nucleophile adduct, increased vaginal blood flow in anesthetized rats [].
  • Centrally Mediated Stimulation – The sexual response for men and women is distinct. Regarding treatment of male ED, PDE5 inhibitors have proven to be very successful, whereas in FSD similar achievements have not been made. Treating FSD through central acting mediators has recently received more attention. This area of investigation has gained momentum by recent publication demonstrating that several hypothalamic nuclei are activated in rodent sexual response []. Therefore, central regulation/activation of the female sexual response could mark an alternative approach for treating FSD.
  • Vasoactive Intestinal Peptide – Vasoactive intestinal peptide (VIP) is a polypeptide hormone containing 28 amino acid residues and is produced in many areas of the human body. VIP has potent vasorelexant effects and has been suggested to contribute to vaginal blood flow control []. Like many peptidic therapies, oral administration of VIP is complicated by low bioavailability and high rate of clearance. Therefore, an alternative approach using an inhibitor of neutral endopeptidase (NEP), the primary enzyme responsible for the degradation of VIP, has been in development under the assumption that inhibition of NEP will lead to more VIP in the circulation, which can increase clitoral and vaginal blood flow when sexually stimulated [].
  • Mechanical aids — Aids such as vacuum devices and penile implants may help men with erectile dysfunction (the inability to achieve or maintain an erection). A vacuum device (Eros) is also approved for use in women, but can be costly. Dilators may help women who experience narrowing of the vagina.
  • Sex therapy — Sex therapists can be very helpful to couples experiencing a sexual problem that cannot be addressed by their primary clinician. Therapists are often good marital counselors, as well. For the couple who wants to begin enjoying their sexual relationship, it is well worth the time and effort to work with a trained professional.
  • Behavioral treatments — These involve various techniques, including insights into harmful behaviors in the relationship, or techniques such as self-stimulation for treatment of problems with arousal and/or orgasm.
  • Psychotherapy — Therapy with a trained counselor can help a person address sexual trauma from the past, feelings of anxiety, fear, or guilt, and poor body image, all of which may have an impact on current sexual function.
  • Education and communication — Education about sex and sexual behaviors and responses may help an individual overcome his or her anxieties about sexual function. Open dialogue with your partner about your needs and concerns also helps to overcome many barriers to a healthy sex life.
  • Providing education – Education about human anatomy, sexual function, and the normal changes associated with aging, as well as sexual behaviors and appropriate responses, may help a woman overcome her anxieties about sexual function and performance.
  • Enhancing stimulation – This may include the use of erotic materials (videos or books), masturbation, and changes in sexual routines.
  • Providing distraction techniques – Erotic or non-erotic fantasies; exercises with intercourse; music, videos, or television can be used to increase relaxation and eliminate anxiety.
  • Encouraging non-coital behaviors – Non-coital behaviors (a physically stimulating activity that does not include intercourse), such as sensual massage, can be used to promote comfort and increase communication between partners.
  • Minimizing pain Using sexual positions that allow the woman to control the depth of penetration may help relieve some pain. Vaginal lubricants can help reduce pain caused by friction, and a warm bath before intercourse can help increase relaxation.
  • Alprostadil self-injection With this method, you use a fine needle to inject alprostadil (Caverject Impulse, Edex) into the base or side of your penis. In some cases, medications generally used for other conditions are used for penile injections on their own or in combination. Examples include papaverine, alprostadil and phentolamine. Often these combination medications are known as bimix (if two medications are included) or trimix (if three are included).
  • Alprostadil urethral suppository –  Alprostadil intraurethral (Muse) therapy involves placing a tiny alprostadil suppository inside your penis in the penile urethra. You use a special applicator to insert the suppository into your penile urethra. The erection usually starts within 10 minutes and, when effective, lasts between 30 and 60 minutes. Side effects can include pain, minor bleeding in the urethra and formation of fibrous tissue inside your penis.
  • Penile implants – This treatment involves surgically placing devices into both sides of the penis. These implants consist of either inflatable or malleable (bendable) rods. Inflatable devices allow you to control when and how long you have an erection. The malleable rods keep your penis firm but bendable.
  • Exercise – Recent studies have found that exercise, especially moderate to vigorous aerobic activity, can improve erectile dysfunction. However, benefits might be less in some men, including those with established heart disease or other significant medical conditions.
  • Psychological counseling – If your erectile dysfunction is caused by stress, anxiety or depression — or the condition is creating stress and relationship tension — your doctor might suggest that you, or you and your partner, visit a psychologist or counselor.
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Testosterone replacement – Some men have erectile dysfunction that might be complicated by low levels of the hormone testosterone. In this case, testosterone replacement therapy might be recommended as the first step or given in combination with other therapies that are flollowing..

  • Androgen therapy
  • Estrogen therapy
  • Phosphodiesterase inhibitors
  • Testosterone replacement therapy
  • Tibolone

Potential and Current Therapeutic Options Available for the Treatment of Female Sexual Dysfunction

General Target Product Brand, Company Mechanism of Action
Peripheral Vaginal/Clitoral Blood flow
  • PDE5 inhibitors
Sildenafil
Tadalafil
Vardenafil
(Viagra®, Pfizer)
(Cialis®, Lilly)
(Levitra®, Bayer)
An external file that holds a picture, illustration, etc. Object name is nihms256271ig1.jpg cGMP availability; mediates vascular smooth muscle (VSM) relaxation
  • Prostaglandin
Alprostadil (Femprox®, NexMed)
(Alista®, Vivus)
Binds to EP2 receptor;
An external file that holds a picture, illustration, etc. Object name is nihms256271ig1.jpg cAMP and mediates VSM relaxation
  • Nitric oxide
L-arginine-
yohimbine
L-arginine
(NMI-870®, NitroMed)
(ArginMax®, The Daily Wellness Co.)
An external file that holds a picture, illustration, etc. Object name is nihms256271ig1.jpg NO production; augments
cGMP availability; mediates VSM relaxation
  • VIP
Candoxatril (Candoxatrilat®, Pfizer) Inhibits degradation of VIP;
An external file that holds a picture, illustration, etc. Object name is nihms256271ig1.jpg VSM relaxation
Hormonal
  • Estrogen
Estradiol (Vagifem®, Upjohn)
(Premarin®, Wyeth)
Improves vaginal dryness and irritation
  • Testosterone
Testosterone
Testosterone
Testosterone
(Intrensa®, Watson)
(Tostrelle®, Cellegy)
(Androsorb®, Novavax)
An external file that holds a picture, illustration, etc. Object name is nihms256271ig1.jpg sexual activity, libido and pleasure
  • Synthetic
Tibolone (Livial®, Organon) Improves vaginal dryness and overall sexual function
CNS
  • Dopaminergic agonist
Apomorphine
Bupropion
(Uprima®, Tap)
(Wellbutrin XL®, GlaxoSmithKline)
Binds to D receptors; increases sexual responsiveness
  • Synthetic α-melanocortin- stimulating hormone
Bremelanotide (PT-141®, Palatin) Binds to MC4 receptors; contributes to VSM relaxation

The specific management involves the following stages

  • Helping the woman develop more positive attitudes towards her genitals – After fully describing the female sexual anatomy, the therapist needs to encourage the woman to examine herself with a hand mirror on several occasions. Extremely negative attitudes (especially concerning the appearance of the genitals, or the desirability of examining them) may become apparent during this stage, possibly leading to failure to carry out the homework. Some women find it easier to examine themselves in the presence of the partners; others may only get started if the therapist helps them do this first in the clinic. If this is necessary a medically qualified female therapist is to be involved.
  • Pelvic muscle exercises – These are intended to help the woman gain some control over the muscles surrounding the entrance to the vagina. If she is unsure whether or not she can contract her vaginal muscles she may be asked to try to stop the flow of urine when she next goes to the toilet. The woman can later check that she is using the correct muscles by placing her finger at the entrance to her vagina where she needs to be able to feel the muscle contractions. Subsequently, she is advised to practice firmly contracting these muscles for an agreed number of times (e.g. 10) several times a day.
  • Vaginal penetration – Once the woman has become comfortable with the external genital anatomy she is advised to explore the inside of her vagina with her fingers. This is partly to encourage familiarity and partly to initiate vaginal penetration. Negative attitudes may also become apparent at this stage (e.g. concerning the texture of the vagina, its cleanliness, fear of causing damage, and whether it is ‘right’ to do this sort of thing). The rationale for any of these objections is to be explored. At a later stage, the woman might try using two fingers and moving them around. Once she is comfortable inserting a finger herself, her partner needs to begin to do this under her guidance during their homework sessions. A lotion (e.g. K-Y or baby lotion) can make this easier. Graded vaginal dilators can be used. However, clinical experience has shown that the use of fingers is just as effective.
  • Vaginal containment – When vaginal containment is attempted the pelvic muscle exercises and the lotion are used to assist in relaxing the vaginal muscles and making penetration easier. This is often a difficult stage and the therapist, therefore, needs to encourage the woman to gain confidence from all the progress made so far. Persisting concerns about possible pain may need to be explored, including how the woman might ensure that she retains control during this stage.
  • Movements during containment – Once containment is well established the couple is asked to introduce movement during containment, with preferable women starting the movements first. With this, the general programme of sex therapy is completed and now the treatment needs to include superimposition of treatment for specific sexual dysfunctions.
  • Steps in the management of vaginismus – Treatment is to be individualized for each woman and/or partner, whenever possible with their input. The psychological issue, as well as interpersonal issues,s need to be addressed first. The sex education needs to focus on clarifying normal sexuality and reducing negative attitude for sex. Besides the use of general relaxation exercises, the relaxation procedure needs to focus on teaching the women to relax muscles around the inner thigh and pelvic area. The specific behavioural management is to be followed.

Other oral erectogenic agents

  • Trazodone – One of the earliest drugs used in erectile dysfunction was trazodone. Trazodone and its active metabolite have an antagonistic effect on 5HT2C receptors and may also have adrenoceptor antagonistic action. Available data suggest that trazodone is more efficacious than placebo in mixed and psychogenic erectile dysfunction.
  • Yohimbine – It is a α2-adrenergic blocker. Before introduction of sildenafil, yohimbine was the most widely used oral medication for management of erectile dysfunction. Available evidence suggests that it is more efficacious than placebo.
  • Apomorphine  Apomorphine is a dopamine agonist (D1 & D2 receptors) and its sublingual form (Apo-SL) is a new central initiator of erection and has been found to be effective in various types of erectile dysfunction.. Recent studies show that sublingual apomorphine has a safe cardiovascular profile and thus making it a new treatment option for patients with concomitant disease including cardiovascular disease and diabetes mellitus.
  • Phentolamine – Oral phentolamine mesylate, is a competitive inhibitor of α- adrenergic receptor. It also has the advantage of lack of interaction with nitrates and hence has been suggested as an alternative to the treatment of erectile dysfunction in patients with the cardiac illness.
  • L-arginine L-arginine is the precursor of Nitric Oxide (NO) and has been shown to improve erections in 40% of patients.
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Remedies for Sexual 

Some of the most commonly recommended home remedies for improving sexual disorders include:

  • A mixture of milk (250 ml) , to which drumstick flowers (10 to 15 grams) have been added
  • A combination of pistachios, dried dates, quince seeds and almonds, which have all been blended together.
  • Eating 100 grams of dried dates on a regular basis
  • Herbs, such as kava-kava, ginko biloba, chives, diffusa, arginine, lepidium meyenii and damiana
  • Natural therapies, like full body massages and hot baths.
  • Aromatherapy using essential oils like clary sage, rose, jasmine and lavendar
  • Chewing on a few pieces of garlic or increasing the amount of garlic consumed through meals

In case the sexual disorder is a result of a medical condition, then it may be necessary to first address that. Medical treatment may also be used in case home remedies do not prove to be very effective. Some of the medication or therapies suggested for curing sexual disorders in men and women include:

Diet for Sexual Disorders

Given below are some of the food items that should be included in a diet for better sexual health:

  • Alfalfa sprouts
  • Avocado
  • Garlic
  • Ginger
  • Nuts
  • Olive oil
  • Onions
  • Salmon

Similarly, there are certain foods that may aggravate sexual disorders and therefore should be strictly avoided by individuals who do have problems or are undergoing treatment. Some of the foods that should be consumed in limited quantities or preferably not at all include:

  • Red meat
  • Caffeinated beverages like tea, coffee and aerated drinks
  • Alcohol
  • Sweets and sugary items
  • Starchy food, such as processed or packaged items

There are some alternate health care practitioners who refer to Vitamin E as the sex vitamin as it helps in the production of sex hormones. They believe it improves sexual attraction, desire and moods. Hence, increasing the intake of these vitamins can reduce sexual disorders considerably.

References

Sexual dysfunction

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