What is sexual dysfunction?
The term “sexual dysfunction” describes a set of conditions that affect your sex life. Among other problems, sexual dysfunction can reduce your desire for sex, or your ability to become sexually aroused. It may prevent you from achieving an orgasm, cause premature ejaculation, or it may cause pain during intercourse. Sexual dysfunction gets in the way of a pleasurable sex life, which can affect your mood, relationships, and overall well-being.
Sexual dysfunction can be caused by physical or emotional factors, or a combination of both.
Which diseases most commonly cause sexual dysfunction?
Certain medical conditions or diseases are associated with an increased risk of sexual dysfunction. The most common are:
- Cardiovascular disease, including hypertension (high blood pressure) and peripheral vascular disease (a circulation disorder that affects blood vessels away from the heart).
- Prostate cancer.
How does cardiovascular disease affect sexual function?
Many cardiovascular diseases, especially hypertension and peripheral vascular disease, damage small blood vessels that supply blood to the areas of the body away from the heart. The changes in these blood vessels reduce the blood flow to these areas, which include the genitals.
Poor blood flow to the penis or vagina affects a person's ability to become aroused and have sexual intercourse. Some studies suggest that 30 to 50% of cases of erectile dysfunction (the inability to get or keep an erection suitable for intercourse) are the result of blood vessel disease.
For those with cardiovascular disease, the following factors may also play a role in sexual dysfunction:
- Fatigue, shortness of breath, chest pain and muscle weakness.
- A general feeling of weakness and disability.
- The fear that sexual activity may trigger a severe cardiac event, such as a heart attack.
- Sexual side effects of medications used to treat cardiovascular disease—particularly hypertension (high blood pressure)—that include loss of desire, erectile dysfunction and problems with ejaculation.
Even if you have cardiovascular disease, you may be able to resume sexual activity and be treated for sexual dysfunction if needed. It is important, however, to follow your doctor’s recommendations and cardiovascular disease treatment plan.
Lifestyle changes also can help improve your blood flow and reduce the risk of sexual dysfunction. Risk can be reduced if you:
- Quit smoking.
- Reduce alcohol intake.
- Eat a healthy diet.
- Get regular exercise.
- Be physically active.
How does diabetes affect sexual function?
Diabetes also can affect the blood vessels, leading to ED. In addition, a condition called diabetic neuropathy—which involves damage to the nerves—may cause orgasm without ejaculation.
In men, diabetes can lead to a hardening and narrowing of the blood vessels that supply the erectile tissue of the penis. This can cause problems in getting an erection, and the penis may be less firm while erect.
In women, diabetes can lead to hardening of the blood vessels of the vaginal wall. Decreased blood flow can affect vaginal lubrication, causing the vagina to be too dry for comfortable intercourse. This condition also seems to put women at greater risk for recurring yeast infections.
For people with diabetes, the first step in treating sexual dysfunction is to control their blood glucose levels. When the diabetes is well-controlled, there is a decreased risk for many complications, including sex-related problems.
Treatments for erectile dysfunction that are used for men with diabetes include:
- Sildenafil citrate (Viagra®).
- Vardenafil (Levitra®).
- Tadalafil (Cialis®).
- Avanafil (Stendra®).
- Intracavernous injection therapy.
- Mechanical devices (vacuum devices, penile implants, etc.).
For women with vaginal dryness, a water-soluble lubricant (such as Astro-Glide® or K-Y® Jelly) may help.
How does prostate cancer affect sexual function?
Although prostate cancer is not a cause of erectile dysfunction, treatments for the disease can cause erectile dysfunction. All current treatments for prostate cancer may cause erectile dysfunction, although the onset of dysfunction can vary, depending on the treatment.
Current methods of treating prostate cancer include:
- Surgery with radical prostatectomy (removal of the entire prostate gland): Erectile dysfunction can begin immediately following a radical prostatectomy, whether the nerve-sparing or non-nerve-sparing technique is used. The nerves are those that control erections and are very close to the prostate. If the nerve-sparing technique is used, recovery from erectile dysfunction may occur within the first year following the procedure. Recovery of erectile function after a non-nerve-sparing technique is possible, but unlikely. Following radical prostatectomy most men can reach orgasm, but because the prostate and seminal vesicles have been removed, ejaculation does not occur.
- Radiation therapy by external beam or brachytherapy (seed implant): The onset of erectile dysfunction following radiation therapy is gradual and usually begins about six months following radiation therapy.
- Hormone therapy (to decrease androgens, as in testosterone): When hormone therapy is used, erectile dysfunction may occur around two to four weeks following the start of the therapy. It is usually accompanied by a decreased libido (desire for sex).
Treatment options to help patients regain erectile function after prostate cancer treatment include:
- Sildenafil (Viagra®) or other oral agents.
- Intracavernous injection therapy (injection of medication into the penis).
- Vacuum constriction devices.
- Intraurethral therapy (medication taken as a suppository placed in the urinary tube).
- Penile prostheses (implanted devices).
How does depression affect sexual function?
The brain is the body's most sensitive “sex organ.” Sexual desire starts in the brain and works its way down. Chemicals called neurotransmitters help brain cells (neurons) communicate to stimulate blood flow to the sex organs.
In a person with depression, these chemicals are out of balance. As a result, sexual desire is low or non-existent. In addition, low levels of certain neurotransmitters can dull the feelings of pleasure.
The strain that a depressive illness can place on a patient's relationship can further interfere with sexual functioning and pleasure. For both men and women, being unable to start, participate in or enjoy sex can lead to a crippling loss of self-confidence. This can undermine recovery from the depression.
Ironically, some medicines used to treat depression—particularly a group of medicines called selective serotonin reuptake inhibitors (SSRI)—can further affect sexual functioning. An estimated 33% of people taking antidepressants experience decreased desire and difficulty in achieving orgasm. Some antidepressants also may cause problems with erections in men. As the dosage of antidepressants increases, so do the sexual side effects.
Your doctor can help you manage the sexual side effects associated with many antidepressant medicines without compromising treatment. Methods include taking brief drug “holidays” and switching to a drug that has less effect on sexuality. Some antidepressants, such as bupropion (Wellbutrin®), vilazodone (Viibryd®), and mirtazapine (Remeron®), are shown to cause fewer sexual side effects. Be sure to talk with your doctor before discontinuing or taking a break from your medications.
In order to better cope with the effects of depression, as well as the sexual side effects of treatment, patients must be open and honest with their doctors and their partners. Most patients choose to continue treatment once they realize that their sexual problems may be caused by these medicines and can be overcome. They do not reflect a problem with themselves or their relationships.
How does menopause affect sexual function?
The loss of estrogen following menopause can lead to changes in a woman's sexual functioning. Lower levels of estrogen can result in a significant decrease in blood supply to the vagina.
Like diabetes, this decreased blood flow can affect vaginal lubrication, causing the vagina to be too dry for comfortable intercourse. Menopausal women may notice that they are not as easily aroused, and may be less sensitive to touching and stroking—which can result in decreased interest in sex.
The emotional changes that often accompany menopause can also add to a woman's loss of interest in sex and/or ability to become aroused. For women with vaginal dryness, a water-soluble lubricant (such as Astro-Glide® or K-Y Jelly®) may help.
Hormone replacement therapy may improve certain conditions, such as loss of vaginal lubrication and genital sensation that can create problems with sexual function. However, hormone replacement therapy poses certain risks, including uterine bleeding and an increased risk of breast cancer. For that reason, the use of hormone replacement therapy must be evaluated on an individual basis.
Some post-menopausal women, though, report an increase in sexual satisfaction. This may be due to decreased anxiety associated with a fear of pregnancy. In addition, post-menopausal woman often have fewer child-rearing responsibilities, allowing them to relax and enjoy intimacy with their partners.