Sex problems review (2)

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

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 exercisesmay 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.

COMPLICATIONS

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.

References

Eyler AE, Biggs WS. Medical human sexuality in family medicine practice. In: Rakel RE.Textbook of Family Medicine. 7th ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 55.

Lentz GM. Emotional aspects of gynecology: sexual dysfunction, eating disorders, substance abuse, depression, grief, loss. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM eds.Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007: chap 9.

Lue TF, Broderick GA. Evaluation and nonsurgical management of erectile dysfunction and premature ejaculation. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Sauders Elsevier; 2007: chap 22.