Definition
Sexual arousal disorder is an aberration during any stage of the sexual response cycle (desire, arousal, orgasm, and resolution) that prevents the experience of satisfaction through sexual activity. A person with this disorder may be interested in sexual intercourse but has difficulty becoming stimulated enough to go through with it.
Sexual arousal disorders were previously known as frigidity in women and impotence in men, though these have now been replaced with less judgmental terms. Impotence is now known as erectile dysfunction, and frigidity is now described as any of several specific problems with desire, arousal, or anxiety.
For both men and women, these conditions may appear as an aversion to, and avoidance of, sexual contact with a partner. In men, there may be partial or complete failure to attain or maintain an erection, or a lack of sexual excitement and pleasure in sexual activity. In women, there may be an inability to lubricate enough to complete the sex act.
Considerations
Occasional impotence occurs in approximately 50 percent of American adult men, and chronic impotence affects about 1 in 8 American men, with the chances increasing as a person ages. Between 2 and 30 million men in the United States are affected by impotence problems, according to recent estimates. About 52 percent of men between 40 and 70-years-old have some degree of erectile dysfunction (ED).
Impotence can be classified as primary or secondary. A man with primary impotence has never had an erection sufficient for intercourse. Secondary impotence involves loss of erectile function after a period of normal function. This tends to occur gradually, except in cases caused by injury or sudden illness.
Treatment of secondary impotence is usually more successful than that of primary impotence because the patient has some history of normal penile function in the past.
There are several components required for an erection:
* A responsive emotional state of mind
* A normally functioning pituitary
* Adequate testosterone
* Adequate penile blood supply
Premature ejaculation (when orgasm comes on too quickly) is different from impotence, and a couple should seek counseling for this problem.
Male infertility is quite different from impotence. A man who is unable to maintain an erection may be perfectly capable of siring a child. An infertile male may be able to have intercourse normally, but he may be unable to father a child.
Symptoms
In Men or Women:
* Lack of interest or desire in sex
* Inability to feel aroused
* Pain with intercourse (much less common in men than women)
* Infertility
In Men:
* Inability to achieve an erection
* Inability to maintain an adequate erection for intercourse
* Delay or absence of ejaculation despite adequate stimulation
* Inability to control timing of ejaculation
In Women:
* Inability to relax vaginal muscles enough to allow intercourse
* Inadequate vaginal lubrication before and during intercourse
* Inability to attain female orgasm
Causes
Sexual dysfunction can exist throughout a person's life or may develop after an individual has previously experienced normal sexual responses. The difficulty may develop gradually over time, or may occur suddenly and present itself either as total or partial dysfunction in one or more stages of the sexual response cycle. The cause may be physical, psychological, or both.
Emotional factors include both interpersonal problems (marital/relationship troubles, lack of trust between partners) and an individual's psychological problems (depression, sexual fears or guilt, past sexual trauma, and so on).
Physical factors include drugs (alcohol, nicotine, narcotics, stimulants, antihypertensives, antihistamines, or most psychotherapeutic drugs); complications related to back, prostate, or vascular surgeries; failure of various organ systems (such as the circulatory and respiratory systems); endocrine disorders (thyroid, pituitary, or adrenal gland problems); neurological problems caused by trauma (such as spinal cord injuries) or disease (such as diabetic neuropathy, multiple sclerosis, tumors, and, rarely, tertiary syphilis); hormonal deficiencies (low testosterone or androgens); and some fetal development abnormalities.
Sexual dysfunction disorders are generally classified into four categories: sexual desire disorders, sexual arousal disorders, orgasm disorders, and sexual pain disorders.
Sexual desire disorders (decreased libido) may result from a decrease in normal androgen or testosterone hormone production. Other causes may be aging, fatigue, medications, pregnancy, or psychiatric conditions such as depression and anxiety.
Common causes of impotence
* Medication use (especially antihypertensives)
* Smoking
* High blood pressure
* Hormonal deficiency caused by disease (diabetes) or injury
* Liver disease, usually caused by alcoholism
* Circulation problems (arteriosclerosis, anemia, or vascular surgery)
* Neurological problems (injury, trauma, disease)
* Urological procedures (prostatectomy, orchiectomy, radiation therapy)
* Penile implants (or prostheses) that are not functioning properly
* Depression, anxiety, fatigue, boredom, stress, fear of failure
* Mood altering drugs, alcohol, medications
* Deep-seated psychological problems
Orgasm disorders, which can affect both sexes, are a persistent delay or absence of orgasm following sexual excitement. Sexual pain disorders affect many more women than men and are known as dyspareunia (painful intercourse) and vaginismus (an involuntary spasm of the musculature of the vagina that interferes with intercourse). Dyspareunia may be caused by insufficient lubrication in the female, which may result from breastfeeding, irritation from contraceptive creams and foams, aging, or by fear and anxiety. Vaginismus may be caused by a sexual trauma such as rape or incest.
Sexual dysfunctions are more common in the early adult years, with the majority of patients seeking care for such conditions during their late twenties into their thirties. The issues increase again in the geriatric population, typically with a gradual onset of symptoms associated most commonly with organic causes of sexual dysfunction.
Increased risk is often linked to a history of diabetes, degenerative neurological disorders, chronic psychological problems, alcohol use, drug abuse, difficulty maintaining relationships, or chronic disharmony with the current sexual partner.
Prevention
Honest 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 carrying those emotional responses into their adulthood.
Review all medications (prescription and over-the-counter) for possible side effects regarding sexual dysfunction. Avoiding drug and alcohol abuse may help prevent sexual dysfunction.
Couples engaging in adequate communication may be able to avoid some problems within their relationship that could potentially create some forms of sexual dysfunction.
People who are victims of sexual trauma should receive comprehensive treatment, including individual counseling and group therapy. This may prove beneficial in allowing them to fully enjoy voluntary sexual experiences with a partner of their choice.
Treatment
Specific physical findings and testing procedures depend on the form of sexual dysfunction examined. A complete history and physical exam should be done to identify predisposing illness or conditions; highlight possible fears, or guilt specific to sexual performance; and bring out any history of prior sexual trauma. A physical examination of both the partners should not be limited to the reproductive system.
Treatment measures should be specific to the cause of the sexual dysfunction. Organic causes that are reversible or treatable are usually managed medically or surgically. Physical therapy and mechanical aides may help some people with physical illnesses, conditions, or disabilities. Viagra (sildenafil) often improves both organic and psychological sexual dysfunction in males by increasing blood flow to the penis. Men on nitrates for coronary heart disease should refrain from taking sildenafil, as it may cause dangerous drug interactions. Mechanical aids and penile implants are sometimes used. Men with androgen deficiency sometimes benefit from testosterone shots. Women with androgen deficiency can tolerate smaller doses of testosterone orally or topically with a cream.
Self-stimulation and the Masters and Johnson treatment strategies are just two of many behavioral therapies used to treat problems associated with orgasm and sexual arousal disorders.
Some couples may require joint counseling to address interpersonal issues and communication styles. Psychotherapy may be required to address anxieties, fears, inhibitions, or poor body image. In general, the prognosis is good for physical (organically caused) dysfunctions resulting from treatable or reversible conditions. However, many organic causes do not respond to medical or surgical treatments. In functional sexual problems resulting from either relationship issues or psychological factors, the prognosis may be good for temporary or mild dysfunction associated with situational stressors or lack of accurate information. However, those cases associated with chronically poor-functioning relationships or deep-seated psychiatric problems usually do not have positive outcomes. Some forms of sexual dysfunction may cause infertility.
For impotence caused by fear of infection, use safe sex practices and consider abstinence. Talk to your health care provider if impotence is related to fear of recurring heart problems—sexual intercourse is usually safe.
If the problem is persistent or if there are other associated and unexplained symptoms, call your health care provider.
Persistent sexual dysfunction may cause depression. Sexual dysfunction that is not addressed adequately may lead to conflicts or potential breakups for couples.
Sources:
* Journal of Men's Health and Gender
* Journal of the American College of Cardiology
* National Institutes of Health - National Library of Medicine
