Sexual dysfunction (or sexual malfunction or sexual disorder ) is a difficulty experienced by an individual or partner during each stage of normal sexual activity, including physical pleasure, desire, preference, passion or orgasm. According to DSM-5, sexual dysfunction requires a person to feel extreme pressure and interpersonal tension for at least 6 months (excluding substance or drug-induced sexual dysfunction). Sexual dysfunction can have a major impact on the quality of a person's perceived sexual life. The term sexual disorder may not only refer to physical sexual dysfunction, but also paraphilias; this is sometimes called sexual preference interference .
Comprehensive sexual history and general health and other sexual issues (if any) are important. Assessing anxiety, guilt, stress, and performance concerns is an integral part of optimal management of sexual dysfunction. Many sexual dysfunctions are defined based on the cycle of human sexual response, proposed by William H. Masters and Virginia E. Johnson, and then modified by Helen Singer Kaplan.
Video Sexual dysfunction
Category
Disorders of sexual dysfunction can be classified into four categories: sexual desire disorders, arousal disorders, orgasm disorders and pain disorders.
Sexual Impairment
Disorders of sexual desire or decreased libido are characterized by lack or absence for some periods of sexual desire or libido for sexual activity or sexual fantasies. This condition ranges from lack of sexual desire in general to the lack of sexual desire for couples today. This condition may have started after a period of normal sexual function or the person may always have no/low sexual desire.
The causes vary widely, but include a possible reduction in normal estrogen production in women or testosterone in both men and women. Other causes are aging, fatigue, pregnancy, drugs (such as SSRIs) or psychiatric conditions, such as depression and anxiety. While a number of causes of low sexual desire are often cited, only a few have ever been the object of empirical research.
Sexual arousal disorder
Previous sexual arousal disorders are known to be frigidity in women and impotence in men, although these have now been replaced by less judgmental terms. Impotence is now known as erectile dysfunction, and frigidity has been replaced by a number of terms that describe specific problems that can be broken down into four categories as described by the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorder: lack of desire, lack of passion , pain during intercourse, and lack of orgasm.
For men and women, this condition can manifest themselves as aversion, and avoidance, sexual contact with a partner. In men, there may be partial or total failure to achieve or maintain an erection, or lack of sexual arousal and pleasure in sexual activity.
There may be physiological origin for this disorder, such as decreased blood flow or lack of vaginal lubrication. Chronic illness can also contribute, as well as the nature of the relationship between the pairs.
In addition, the condition of Post-Orgasmic Syndrome (POIS) can cause symptoms when aroused, including adrenergic type presentation; Rapid breathing, paresthesias, palpitations, headache, aphasia, nausea, itchy eyes, fever, muscle aches/weakness and fatigue.
From the onset of arousal, symptoms can last up to a week in patients.
The etiology of this condition is unknown, but it is believed to be a pathology of either the immune system or the autonomic nervous system. It is defined as a rare disease by NIH but its prevalence is unknown. It is not considered psychiatric, but may appear as anxiety related to coital activity and thus can be misdiagnosed as such. There is no known cure or treatment.
Erectile dysfunction
Erectile dysfunction or impotence is a sexual dysfunction characterized by an inability to develop or maintain penile erection. There are various underlying causes, such as damage to nervi erigentes that prevent or delay erections, or diabetes and cardiovascular disease, which only reduces blood flow to the tissues in the penis, many of which are medically reversible.
The cause of erectile dysfunction can be psychological or physical. Psychological erectile dysfunction can often be helped by almost anything that the patient believes; there is a very strong placebo effect. Physical damage is much more severe. One of the physical causes of ED is sustained or severe damage that occurs in nervi erigentes. This nerve is of course in addition to the prostate arising from the sacral plexus and can be damaged in the prostate and colorectal surgery.
Illness is also a common cause of erectile dysfunction; especially in men. Diseases such as cardiovascular disease, multiple sclerosis, renal failure, vascular disease and spinal cord injury are the source of erectile dysfunction.
Due to its embarrassing nature and shame felt by the sufferer, the subject is taboo for a long time, and is the subject of many urban legends. Traditional medicine has long been advocated, with some being widely advertised since the 1930s. The introduction of perhaps the first pharmacologically effective drug for impotence, sildenafil (the trade name Viagra), in the 1990s caused a wave of public attention, fueled in part by the greed of news about it and heavy advertising.
It is estimated that about 30 million men in the United States and 152 million men worldwide suffer from Erectile Dysfunction. However, social stigma, low health literacy and social taboos lead to reporting that makes accurate prevalence rates difficult to determine.
The Latin term impotentia coeundi describes the inability to insert the penis into the vagina. Now largely replaced by more precise terms.
Premature ejaculation
Premature ejaculation is when ejaculation occurs before the couple reaches an orgasm, or mutually satisfying periods have elapsed during sexual intercourse. There is no length of time for sexual intercourse to last, but generally, premature ejaculation is thought to occur when ejaculation occurs in less than 2 minutes of penile insertion time. For diagnosis, the patient should have a chronic history of premature ejaculation, poor ejaculatory control, and problems should cause displeasure and make the patient, partner, or both feel depressed.
Historically associated with psychological causes, new theories suggest that premature ejaculation may have an underlying neurobiological cause that can cause rapid ejaculation.
Orgasmic disorder
Orgasm disorders, especially Anorgasmia, present as a delay or absence of persistent orgasms after a normal phase of sexual arousal in at least 75 percent of sexual intercourse. This disorder can have physical, psychological, or pharmacological origins. SSRI antidepressants are a common cause of pharmaceuticals, because they can delay orgasm or completely eliminate them. The common physiologic agent of anorgasmia is menopause, in which one in three women report problems acquiring orgasm during sexual stimulation after menopause.
Further to this there are so-called post-orgasmic disorders, which would better categorize the condition: 'Post-orgasm disease syndrome' (see post-orgasmic disorder section).
Sexual pain disorder
Sexual pain disorder affects women almost exclusively and is also known as dyspareunia (painful intercourse) or vaginismus (spasm of the vaginal wall muscles that interfere with sexual intercourse).
Dyspareunia can be caused by inadequate lubrication (vaginal dryness) in women. Poor lubrication can result from lack of stimulation or stimulation, or from hormonal changes caused by menopause, pregnancy, or breastfeeding. Irritation from creams and contraceptive foams can also cause drought, such as fear and anxiety about sex.
It is unclear what causes vaginismus, but it is suspected that past sexual traumas (such as rape or abuse) can play a role. Another female sexual pain disorder is called vulvodynia or vulvar vestibulitis. In this condition, women experience a burning sensation during sex that seems to be related to skin problems in the vulva and vaginal areas. The cause is unknown.
Post-orgasmic disease
Post-orgasm disease causes symptoms immediately after orgasm or ejaculation. Post-coital tristesse (PCT) is a feeling of melancholy and anxiety after a sexual relationship lasting up to two hours. Sexual headaches occur in the skull and neck during sexual activity, including masturbation, arousal or orgasm.
In men, postorgasmic disease syndrome (POIS) causes severe muscle pain throughout the body and other symptoms soon after ejaculation. The symptoms last up to one week. Some doctors speculate that the frequency of POIS "in the population may be greater than that reported in the academic literature", and that many POIS sufferers are undiagnosed.
Symptomology of POIS can be present as an adrenergic-type presentation; Rapid breathing, paresthesias, palpitations, headache, aphasia, nausea, itchy eyes, fever, muscle aches/weakness and fatigue.
From the beginning of orgasm, symptoms can last up to a week in patients.
The etiology of this condition is unknown, but it is believed to be a pathology of either the immune system or the autonomic nervous system. It is defined as a rare disease by NIH but its prevalence is unknown. It is not considered psychiatric, but may appear as anxiety related to coital activity and thus can be misdiagnosed as such. There is no known cure or treatment.
Dhat Syndrome is another condition that occurs in men. It is a culture-bound syndrome that causes anxiety and dysphoric mood after sex but is different from mood and low concentration (acute aphasia) seen in Post-Orgasm disease syndrome *
Pelvic Floor Dysfunction
Pelvic floor dysfunction can be a cause of sexual dysfunction in women and men, and can be treated with physical therapy.
Unusual sexual disturbances in men
Erectile dysfunction of vascular disease is usually seen only in elderly individuals with atherosclerosis. Vascular disease is common in individuals who have diabetes, peripheral vascular disease, hypertension and those who smoke. Every time the blood flow to the penis is disturbed, erectile dysfunction is the end result.
Hormone deficiency is a cause of relatively rare erectile dysfunction. In individuals with testicular failure such as Klinefelter's syndrome, or those who have undergone radiation therapy, chemotherapy or childhood exposure to the mumps virus, the testes may fail and produce no testosterone. Other hormonal causes of erectile failure include brain tumors, hyperthyroidism, hypothyroidism or adrenal gland disorders.
Penile structural abnormalities such as Peyronie's disease can make sexual intercourse difficult. The disease is characterized by a thick fibrous band on the penis that leads to a visibly defective penis.
Drugs are also the cause of erectile dysfunction. Individuals who use drugs to lower blood pressure or use antipsychotics, antidepressants, sedatives, narcotics, antacids or alcohol can have problems with sexual function and loss of libido.
Priapism is a painful erection that lasts for several hours and occurs in the absence of sexual stimulation. This condition develops when blood is trapped in the penis and can not flow out. If the condition is not treated promptly, it can cause severe scarring and loss of permanent erectile function. This disorder occurs in men and young children. Individuals with sickle cell disease and those who abuse certain drugs can often develop this disorder.
Maps Sexual dysfunction
Cause
There are many factors that can cause a person to experience sexual dysfunction. This may be caused by an emotional or physical cause. Emotional factors include interpersonal or psychological problems, which can be the result of depression, sexual fears or guilt, past sexual traumas, and sexual disorders, among others.
Sexual dysfunction is very common among people who have an anxiety disorder. Ordinary anxiety can obviously cause erectile dysfunction in men without psychiatric problems, but disorders diagnosed clinically such as panic disorder commonly lead to avoidance of sexual intercourse and premature ejaculation. Pain during intercourse is often an anxiety disorder comorbidity among women.
Physical factors that can cause sexual dysfunction include the use of drugs, such as alcohol, nicotine, narcotics, stimulants, antihypertensives, antihistamines, and some psychotherapy drugs. For women, virtually all physiological changes that affect the reproductive system - premenstrual syndrome, pregnancy, and the postpartum period, menopause - can have adverse effects on libido. Back injury can also affect sexual activity, as well as problems with enlarged prostate gland, problems with blood supply, or nerve damage (such as in sexual dysfunction after spinal cord injury). Diseases such as diabetic neuropathy, multiple sclerosis, tumors, and, rarely, tertiary syphilis can also affect activity, such as failure of various organ systems (such as heart and lung), endocrine disorders (thyroid, pituitary, or adrenal gland). problems), hormone deficiency (low testosterone, other androgens, or estrogens) and some birth defects.
Pelvic floor dysfunction is also a physical cause and the cause of many sexual dysfunctions.
In the context of heterosexual relationships, one of the main reasons for decreased sexual activity among these couples is male partners who experience erectile dysfunction. This can be very sad for a male partner, causing a bad body image, and it can also be a major source of low desire for these men. In an aging woman, it is natural that the vagina narrows and stops developing. If a woman does not participate in regular sexual activity (in particular, activities involving vaginal penetration) with her partner, if she decides to have penetrative sex, she will not be able to accommodate the penis immediately without risk of pain or injury. This can turn into a vicious cycle, often causing female sexual dysfunction.
According to Emily Wentzell, American culture has an anti-aging sentiment that has caused sexual dysfunction to become "a disease that requires care" rather than seeing it as a natural part of the aging process. Not all cultures seek treatment; for example, the male population living in Mexico often receives erectile dysfunction as a normal part of their adult sexuality
Female sexual dysfunction
Several theories have looked at female sexual dysfunction, from a medical to a psychological perspective. Three theories of social psychology include: the theory of self-perception, hypothesis overjustification, and hypothesis of inadequate justification:
- Self-perception theory: people make attributions about their attitudes, feelings, and behaviors by relying on their observations of external behavior and the circumstances in which the behavior occurs
- The hypothesis of overjustification: when an external gift is given to someone to perform an intrinsically rewarding activity, one's intrinsic interest will be reduced
- Justification is not enough: based on the classical cognitive dissonance theory (inconsistencies between two cognitions or between cognition and behavior will create discomfort), this theory states that people will change one cognition or behavior to restore consistency and reduce the difficulty
The importance of how a woman perceives her behavior should not be underestimated. Many women regard sex as a task as opposed to a pleasant experience, and they tend to consider themselves inadequately sexually, which in turn does not motivate them to engage in sexual activity. Several factors affect women's perception of their sexual life. These may include: race, gender, ethnicity, educational background, socioeconomic status, sexual orientation, financial, cultural and religious resources. Cultural differences also exist in how women view menopause and its impact on health, self-image, and sexuality. A study has found that African American women are the most optimistic about menopausal life; Caucasian women are the most anxious Asian women, most obstructed about their symptoms, and Hispanic women are the most resilient.
About one-third of women experience sexual dysfunction, which can cause women to lose confidence in their sexual lives. Because these women have sexual problems, their sexual lives with their partners become a burden without pleasure, and finally, they actually lose interest in sexual activity. Some women find it difficult to be mentally awakened; However, some have physical problems. Several factors can affect female dysfunction, such as situations where women do not trust their sex partners. The environment in which sex takes place is very important, because being in a very public or very private place can make some women feel uncomfortable. Inability to concentrate on sexual activity due to poor mood or workload can also cause a woman's sexual dysfunction. Other factors include physical discomfort or difficulty in achieving arousal, which can be caused by aging or changes in body condition.
Menopause
The female sexual response system is complex and even today, not fully understood. The most common of female sexual dysfunctions that have been associated with menopause include lack of desire and libido; this is mostly related to hormonal physiology. In particular, it is a decrease in serum estrogen that causes changes in sexual function. Androgen depletion can also play a role, but the current is less clear. The hormonal changes that occur during a menopausal transition have been suggested to influence women's sexual responses through several mechanisms, some more conclusive than others.
Aging in women
Whether aging directly affects the sexual function of women during menopause is another area of ​​controversy. However, many studies, including a critical review of Hayes and Dennerstein, have shown that aging has a strong impact on sexual functioning and dysfunction in women, particularly in the areas of desire, sexual attraction, and frequency of orgasm. In addition, Dennerstien and colleagues found that the main predictor of sexual response during menopause was prior sexual function. This means that it is important to understand how physiological changes in men and women can affect their sexual desire. Despite the negative-looking effects that menopause can have on sexuality and sexual function, sexual trust and well-being can increase with age and menopausal status. Furthermore, the impact that relationship status on quality of life can have is often underestimated.
Testosterone, together with its dihydrotestosterone metabolites, is essential for normal sexual function in both men and women. Dihydrotestosterone is the most common androgen in men and women. Testosterone levels in women at age 60, on average, about half of them before women are 40. Although this decline occurs gradually for most women, those who have undergone bilateral oophorectomy have suddenly decreased testosterone levels; this is because the ovaries produce 40% of the testosterone in the body.
Sexual desire has been linked to three separate components: encouragement, conviction and values, and motivation. Especially in postmenopausal women, it fades and is no longer the first step in a woman's sexual response (if it ever happens).
List of interruptions
DSM
The fourth issue of Diagnostic and Statistical Manual of Mental Disorders includes the following sexual dysfunction:
- Hypoactive sexual desire disorder (see also asexuality, which is not classified as a nuisance)
- Sexual aversion disorder (avoidance or lack of desire for intercourse)
- Female sexual arousal disorder (failure of normal lubricant response)
- Male erectile disorder
- Female orgasmic disorder (see Anorgasmia)
- Male orgasmic disorder (see Anorgasmia)
- Premature ejaculation
- Dyspareunia
- Vaginismus
Additional sexual DSM disorders that do not sexual dysfunction include:
- Paraphilias
- PTSD due to genital mutilation or childhood sexual abuse
Other sexual issues
- Sexual dissatisfaction (not specific)
- Lack of sexual desire
- Anorgasmia
- Impotence
- Sexually transmitted diseases
- The delay or absence of ejaculation, despite sufficient stimulation
- Inability to control ejaculation time
- Inability to relax the vaginal muscles sufficiently to allow the relationship
- Inadequate vaginal lubrication and during sexual intercourse
- Pain that burns on the vulva or in the vagina with contact to the area
- 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
- Hiperseksualitas
- All Female genital cutting forms
- Post-orgasmic disease, such as Dhat syndrome, post-coital syndrome (PCT), postorgasmic disease syndrome (POIS), and sexual headaches.
Treatment
Men
Several decades ago the medical community believed that most cases of sexual dysfunction were related to psychological problems. While this may be true for some men, most cases have now been identified to have physical causes or correlations. If sexual dysfunction is thought to have a psychological component or cause, psychotherapy may be helpful. Situational anxiety arises from previous bad incidents or lack of experience. This anxiety often leads to the development of fear of sexual activity and avoidance. In return avoiding leads to an increasing cycle of anxiety and penis desensitization. In some cases, erectile dysfunction may be due to marital disharmony. A wedding counseling session is recommended in this situation.
Lifestyle changes such as smoking cessation, drug or alcohol abuse can also help in some types of erectile dysfunction. Some oral medications such as Viagra, Cialis and Levitra have been available to help people with erectile dysfunction and have become first-line therapy. These medications provide an easy, safe, and effective treatment solution for about 60% of men. In the rest, drugs may not work because of a false diagnosis or a chronic history.
Another type of drug that is effective in about 85% of men is called intracavernous pharmacotherapy and involves injecting vasodilator drugs directly into the penis to stimulate an erection. This method has an increased risk of priapism when used in conjunction with other treatments, and localized pain.
When conservative therapy fails, unsatisfactory treatment options, or contraindications for use, insertion of penile prosthesis, or implant penis, may be selected by the patient. Technological advances have made the insertion of penile prosthesis a safe choice for the treatment of erectile dysfunction that provides the highest patient and partner satisfaction rates of all available ED treatment options.
Pelvic floor physical therapy has proven to be a valid treatment for men with sexual problems and pelvic pain.
Female
No drugs are approved to address women's sexual disorders, although some are being investigated for their effectiveness. The vacuum device is the only approved medical device for arousal and orgasm disorders. It is designed to increase blood flow to the clitoris and external genitalia. Women who experience pain with intercourse are often prescribed pain relievers or desensitization agents. Others are prescribed lubricant and/or hormone therapy. Many patients with female sexual dysfunction are often also referred to counselors or therapists for psychosocial counseling.
Menopause
Estrogens are responsible for the maintenance of collagen, elastic fibers, and urogenital tract vessels, all of which are essential in maintaining vaginal structure and functional integrity; they are also important for maintaining pH and vaginal moisture levels, both of which help keep the tissue lubricated and protected. Prolonged estrogen deficiency causes atrophy, fibrosis, and reduced blood flow to the urogenital tract, leading to menopausal symptoms such as vaginal dryness and pain associated with sexual activity and/or sexual intercourse. It has consistently shown that women with lower sexual function have lower levels of estradiol.
Androgen therapy for hypoactive sexual desire disorder (HSDD) has little benefit but its safety is unknown. It was not approved as a treatment in the United States. If used more commonly among women who have oophorectomy or who are in a postmenopausal state. However, like most treatments, this is also controversial. One study found that after a 24-week trial, women taking androgens had higher sexual desire scores than the placebo group. As with all pharmacological drugs, there are side effects in using androgens, which include hirutism, acne, ploycythaemia, elevated high-density lipoproteins, cardiovascular risk, and endometrial hyperplasia are likely in women without hysterectomy. Alternative treatments include topical estrogen cream and gel can be applied to the vulva or vaginal area to treat dryness and vaginal atrophy.
Clinical studies
In modern times, the original clinical study of sexual problems was usually no later than 1970 when Masters and Johnson's Human Sexual Inadecacy was published. It was the result of more than a decade of work in Reproductive Biological Reproduction Research in St. Louis, which involved 790 cases. The work grew from earlier Masters and Johnson's Human Sexual Response (1966).
Before Masters and Johnson's clinical approach to sexual problems came largely from Freud's thinking. It was held with psychopathology and was approached with certain pessimism about the possibility of help or improvement. Sexual problems are just symptoms of a deeper disease and a diagnostic approach derived from psychopathologists. There is little difference between difficulty in function and variation or between deviations and problems. Although work by psychotherapists such as Balint's rough sexual difficulties is divided into frigidity or impotence, the term too quickly gains negative connotations in popular culture.
The Achievement of the Human Sexual Inability is to move the mind from psychopathology to learning, only if the problem does not respond to educative treatment of psychopathological problems being considered. Also the treatment is directed at the couple, whereas before the couple will be seen individually. Masters and Johnson see that sex is a joint act. They believe that sexual communication is a major problem for sexual problems rather than individual-specific problems. They also propose joint therapy, a pair of therapists that are suitable for clients, on the grounds that a male therapist can not fully understand women's difficulties.
The Masters and Johnson basic care program is a two-week intensive program to develop efficient sexual communication. Couples based and the therapist leads the program starting with the discussion and then feel the focus between couples to develop a shared experience. From experience, specific difficulties can be determined and approached with specific therapy. In a number of cases men only (41) Masters and Johnson have developed the use of female substitutes, an approach they immediately leave on the ethical, legal and other issues it sets forth.
In defining various sexual problems, Masters and Johnson define the boundary between dysfunction and irregularities. Dysfunction is transient and is experienced by most people, dysfunction is limited to primary or secondary impotence of men, premature ejaculation, ejaculation of incompetence; female primary orgasm dysfunction and situational orgasm dysfunction; pain during intercourse (dyspareunia) and vaginismus. According to Masters and Johnson, sexual arousal and climax are the normal physiological processes of each functionally intact adult, but although autonomous it can be inhibited. The treatment program for Master and Johnson dysfunction was 81.1%.
Although the work of the Masters and Johnson fields in the US is rapidly flooded with an enthusiastic rather than systematic approach, it blurs the space between 'enrichment' and therapy. Although it has been argued that the impact of the work is such that it is impossible to repeat such a clean experiment.
See also
References
External links
- The International Society for Sexual Medicine NIH
- site on sexual issues
Source of the article : Wikipedia
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