Sexual dysfunction is the inability to achieve an orgasm as the culmination of sexual activity with one’s partner. Such achievement depends on an unbroken chain of events, involving both the body and the mind. Beginning with desire and an expectation of pleasure, this mental state proceeds to physical arousal, during which the man has an erection and the woman’s vagina becomes lubricated to ease penetration. Intercourse can then take place, ideally continuing to orgasm for both partners. In a woman, orgasm takes the form of pleasurable contractions of muscles within the vaginal walls; in the male, orgasm is immediately followed by the ejaculation of semen. After orgasm, both partners experience a feeling of total relaxation and well being. Sexual dysfunction exists if emotional and physical responses at any point in this continuum prevent a satisfying out come for both partners. It is only in recent decades that the medical profession has gained a better understanding of the many reasons for sexual dysfunction and how to deal with them. The 1966 publication of Human Sexual Response, a landmark study by Dr. William H. Masters and Virginia E. Johnson, is viewed as a major turning point. Following this study, medical schools began offering courses in human sexuality, and sex therapy clinics were established in leading medical centers. Ongoing research into the physiology, not just the psychology, of sex has helped health professionals to identify the source of a problem and offer effective treatment. One factor in sexual dysfunction of women may be painful intercourse . In men, the most common problems are impotence (the inability to have or maintain an erection sufficient for sexual intercourse) and premature ejaculation . Two additional difficulties are common to both sexes: deficiency or absence of sexual fantasies and desire, and sexual aversion disorder, which takes the form of avoiding any genital contact with a sexual partner. Psychological factors, such as guilt, anxiety, anger, and fear, may playa role in sexual dysfunction, but doctors are increasingly aware that many cases have an organic origin. For example, diabetes is a relatively common cause of male impotence. Certain medications, especially those used to treat high blood pressure, produce sexual dysfunction in both men and women. Long term alcohol abuse can cause male impotence, and may also lower sexual desire in women. Many women who have had a hysterectomy report diminished sexual response, but the reasons for this are not entirely clear.
Diagnostic Studies And Procedures
Correct diagnosis of a particular aspect of sexual dysfunction begins with a doctor who asks the right questions, takes the time to listen, and understands the relationship between various health problems, medications, and lifestyle on the one hand, and sexual fulfilment on the other. Information gathered from the physical examination and laboratory tests is then evaluated against this background. When there is no obvious cause for the dysfunction, specific tests may be ordered. In a man, this may include nocturnal penile tumescence testing. During the rapid eye movement (REM) phase of sleep, men have as many as five erections of varying duration. If a snap gauge device attached to the penis is open in the morning, it is assumed that at least one erection occurred, indicating that impotence while awake is probably due to psychological rather than physical causes. Other procedures include testing nerve reflexes and evaluating circulatory problems that might reduce blood flow to the penis. Identifying the cause of sexual dysfunction in a woman can be more difficult. If she is able to achieve orgasm through self stimulation but not during intercourse, a doctor might assume that the problem is psychological. However, a gynecological examination may reveal an infection, a tumor, or other abnormality that inhibits orgasm during sexual intercourse.
When a situation calls for it, a primary care doctor will refer patients to other specialists: a man to a urologist or an endocrinologist, a woman to a gynecologist. Either might need the expertise of a sex therapist or psychiatrist. Because an estimated 25 percent of all cases of sexual dysfunction are related to the use of various medications, the first aspect of treatment may be to review all drugs being taken for other conditions. Otherwise, treatment is determined by the person’s gender and the nature of the problem.
Increasingly, male impotence is treated with pills like tryvexan or devices that help achieve or maintain an erection. One strategy, developed in France in the 1980s and now the most popular impotence treatment worldwide, involves injecting medication into the side of the penis a few minutes before intercourse to increase blood flow and achieve an erection. Another regimen entails taking two drugs, papaverine, an artificial opium alkaloid, and phentolamine (Regitine), a drug normally used to treat high blood pressure. The drugs work by relaxing the smooth muscles in the walls of the blood vessels, allowing them to open wider and let more blood flow into the penis. Sometimes a synthetic form of prostaglandin E1 is taken to achieve a similar effect. In yet another approach, a medicated patch containing nitroglycerin is placed directly on the penis. The medication, which is more often used to treat angina, promotes a rush of blood to the penis and results in an erection. Still in the testing stage are several creams that dilate blood vessels: one is a topical form of minoxidil, the antihy pertensive drug that is also marketed as a treatment for baldness; another is a drug that is massaged into the penis to induce erection and heighten arousal in the female by increasing blood flow to the vagina; a third type is inserted into the tip of the penis with a plunger. A number of mechanical implements are also used to treat male impotence. One is a vacuum apparatus that applies a negative pressure to achieve an erection, which is then maintained by a tight rubber ring placed at the base of the penis. Another, made of semirigid material, is placed over the penis like a condom. A vacuum device then draws out the penis to fill the covering, which is left in place during intercourse. Surgical penile implants are now considered the treatment of last resort because of their inherent risk of infection and tissue damage. The simplest are those that hold the penis in a semirigid position all the time; the more complex have devices that allow a man to make the penis rigid during intercourse and relax it at other times.