Sexual Dysfunction

Clinic

• Sexual dysfunction is difficulty in physical pleasure, desire, preference, arousal or orgasm
• WHO defines it as a person's inability to participate in a sexual relationship as they would wish.
• According to DSM-5 Sexual dysfunction is feeling of extreme distress and interpersonal strain at least for six months

Four Types

(1) Sexual desire disorders

Lack of sexual desire, libido for sexual activity, or sexual fantasies for some time.

(2) Sexual arousal disorders

Sexual arousal disorders were previously known as frigidity in women and and impotence in men, though these have now been replaced:

• Frigidity has been replaced with a number of terms describing specific problems that can be broken down into four categories
  1. Lack of desire
  2. Lack of arousal
  3. Dyspareunia, Vaginismus, Vulvodynia
  4. Anorgasmia

Cause

• Causation is unknown; however, it may be either immune system or autonomic nervous systems.
• It is not thought to be psychiatric in nature, but psychologically triggered.

(3) Orgasm disorders

• Anorgasmia: It is classified as persistent delays or absence of orgasm following a normal sexual excitement phase in at least 75% of sexual encounters.
• A common physiological cause of anorgasmia is menopause.

Subtypes

• Premature ejaculation: When ejaculation occurs before the partner achieves orgasm, or a mutually satisfactory length of time has passed during intercourse. There is no correct length of time for intercourse to last, but generally, premature ejaculation is thought to occur when ejaculation occurs in under two minutes from the time of the insertion of the penis. For a diagnosis, the patient must have a chronic history of premature ejaculation, poor ejaculatory control, and the problem must cause feelings of dissatisfaction as well as distress for the patient, the partner, or both. It has psychological causes, but newer theories suggest underlying neurobiological causes.

• Post-orgasmic disorders (Symptoms shortly after orgasm or ejaculation)
  • Post-coital tristesse (PCT):
    • Feeling of melancholy and anxiety after sexual intercourse that lasts for up to two hours.
    • Headaches occur in the skull and neck during sexual activity, including masturbation, arousal or orgasm.
  • Dhat syndrome: It is a culture-bound syndrome which causes anxious and dysphoric mood after sex in men.
  • Postorgasmic illness syndrome (POIS) may cause symptoms when aroused, including adrenergic-type presentation:
    • Rapid breathing
    • Paresthesia
    • Palpitations
    • Headaches
    • Aphasia
    • Nausea
    • Itchy eyes
    • Fever/ Myalgia / Weakness / Fatigue

(4) Sexual pain disorders

• Dyspareunia, vaginismus and vulvodynia in women
• Peyronie's disease and Priapism in men.

Dyspareunia

• It may be caused by vaginal dryness.
• Poor lubrication may result from insufficient excitement and stimulation, or from hormonal changes caused by menopause, pregnancy, or breastfeeding.
• Irritation from contraceptive creams and foams can also cause dryness, as can fear and anxiety about sex.

Vaginismus

• It is unclear exactly what causes vaginismus, but past sexual trauma (such as rape or abuse) may play a role.

Vulvodynia

• It is a female sexual pain disorder that women experience burning pain during sex, which seems to be related to problems with the skin in the vulvar and vaginal areas.
• Its cause is unknown.
• Vulvar vestibulitis is a special form, when pain is localized to the Vulval vestibule.

Peyronie's disease

• It can make sexual intercourse difficult and/or painful. The disease is characterized by thick fibrous bands in the penis that lead to excessive curvature during erection.
• Its incidence estimated at 0.4–3%
• Most common in men 40–70
• It has no certain cause, risk factors include genetics, minor trauma, chronic systemic vascular diseases, smoking, and alcohol.

Priapism

• It is a painful erection that occurs for several hours and occurs in the absence of sexual stimulation.
• This condition develops when blood is trapped in the penis and is unable to drain. If the condition is not promptly treated, it can lead to severe scarring and permanent loss of erectile function. The disorder is most common in young men and children.
• Individuals with sickle-cell disease and those who use certain medications can often develop this disorder.

Pelvic floor dysfunction

Pelvic floor dysfunction can be an underlying cause of sexual dysfunction in both women and men, and is treatable by pelvic floor physical therapy

Miasms

• Male, Impotence: FFI, HIV, HSV-1, HSV-2, HTLV-1, LBB
• Male, Weakness, Bulbo cavernous reflex: HSV-1, HSV-2
• Male, periapism: RBS
• Male, Ejaculation spontaneous: RBS
• Female, Vulvar vestibulitis (painful tender): HPV
• Female salpingitis: HSV-1, HSV-2