Sexual Dysfunction and Disease
Sexual functioning is important to a person’s quality of life. Problems
with sexual function can have a negative effect on mood, interpersonal
relationships and overall well-being.
The term "sexual dysfunction" describes a number of conditions that
harm a person's ability to have an enjoyable sex life. Sexual dysfunction
includes problems that affect a person’s desire for sex, ability to become
sexually aroused and ability to reach orgasm, as well as problems resulting in
pain during intercourse.
Sexual dysfunction can be caused by physical and emotional factors, or a
combination of both. Certain medical conditions are associated with an increased
risk of sexual dysfunction. Most common of these conditions 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, involve changes to the small blood vessels that supply areas of the
body away from the heart, such as the legs, feet and genitals. Poor blood flow
to the penis or vagina can impact a person’s ability to become aroused and
engage in sexual intercourse. Some studies suggest that 30 percent to 50 percent
of cases of erectile dysfunction (the inability to achieve or maintain an
erection suitable for intercourse) are the result of blood vessel disease.
Further, any medical condition that causes a general feeling of weakness and
disability has the potential to decrease sexual desire and performance. For
example, the fatigue, shortness of breath, chest pain and muscle weakness that
may accompany cardiovascular disease also may be responsible for problems with
sexual function. The fear that sexual activity may trigger a severe cardiac
event, such as a heart attack, also may be a factor in decreasing sexual
function in people with cardiovascular disease. In addition, some medications
used to treat cardiovascular disease, particular hypertension, can have negative
sexual side effects, including loss of desire, erectile dysfunction and problems
In many cases, individuals with cardiovascular disease can resume sexual
activity and be treated for sexual dysfunction, when appropriate, if they follow
their doctors’ recommendations and cardiovascular disease treatment plan.
Certain lifestyle changes—such as quitting smoking, reducing alcohol intake,
eating a healthy diet, and engaging in regular exercise and physical activity—also
can help improve blood flow and reduce the risk of sexual dysfunction.
How does diabetes affect sexual function?
Diabetes also can affect the blood vessels. In addition, a condition called
diabetic neuropathy—which involves damage to the nerves—may contribute to
problems with sexual function.
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 achieving
an erection. In addition, the penis may be less firm during an erection. 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 woman 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.
There are other treatments for sexual dysfunction that may be used for people
with diabetes. These include the use of medication, specifically sildenafil
citrate (Viagra™), varderafil (Levitra™), or tadalafil (Cialis™) to treat erectile
dysfunction, mechanical devices (vacuum devices, penile implants, etc.) and counseling.
For women with vaginal dryness, a water-soluble lubricant (such as Astro-Glide or K-Y Jelly) may be helpful.
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 can be associated with erectile dysfunction, although the onset
of dysfunction can vary, depending on the treatment.
The 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 they 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.
- 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
approximately two to four weeks following the initiation of the therapy and
usually is accompanied by a decreased libido (desire for sex).
The treatment options for erectile dysfunction for patients who have received
treatment for prostate cancer include sildenafil (Viagra), intracavernous
injection therapy (injection of medication into the penis), vacuum constriction
devices, intraurethral therapy (medication taken as a suppository placed in the
urinary tube) and 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
In a person with depression, a clinical mood disorder, 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 initiate, participate in or enjoy sex can lead to a crippling
loss of self-confidence, which—in turn—can undermine recovery from the
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 percent 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, the sexual side effects increase, as well.
There are ways to help manage the sexual side effects associated with many
antidepressant medicines, without compromising treatment. These include taking
brief drug "holidays" and switching to a drug that has less effect on
sexuality. Keep in mind that no medication should be discontinued or stopped
briefly without discussing it with your doctor. Some newer medicines—such as
amineptine, Wellbutrin, Remeron and Serzone—are shown to cause fewer or no
sexual side effects.
In order to better cope with the debilitating 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 the sexual problems they are experiencing are associated
with the medicines and are reversible, and do not reflect a problem with
themselves or their relationships.
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. As with 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. Further, the emotional changes that often
accompany menopause can 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 be helpful.
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.
It should be noted that some post-menopausal women 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.
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