woman sitting on bed beside a man feeling upset

Sexual Dysfunctions : Aetiology

Sexual Dysfunction refers to a person’s inability to participate in a sexual relationship as he or she would wish. Diagnosis of sexual dysfunction is made when the symptoms persist for at least 6 months, experienced on almost all (75-100%) of sexual encounters & cause clinically significant distress in the individual.

Epidemiology

Transient sexual difficulties are very common. But more persistent problems & distress are much less.

In One study, 51.2% of women & 41.6% of men experienced one or more sexual problems during one year. But distress was reported by only 10.9% of women & 9.9% of men.

55.8% women & 35.1% men of those who reported lack of interest in sex said that the problem lasted for 6 months or more.

Age:

In Men:

  • Loss of sexual desire & erectile dysfunction increases with age.
  • Premature Ejaculation is more commonly reported at younger age.

In Women:

  • Association between age & sexual problems is more complex. Whereas the level of sexual interest typically decreases with age, older women are less likely to regard this as a problem.

Aetiology

The aetiological factor can be considered using ‘three – window approach.’

(I) The First Window- the current situation:

  • Relationship Problems- resentment & insecurity within a relationship.
  • Poor communication between partners about their sexual feelings & needs.
  • Misunderstandings & lack of information.
  • Unsuitable circumstances & lack of privacy.
  • Concerns about pregnancy or sexually transmitted infections.
  • Low self-esteem & Poor Body image.

(II) The Second Window- Vulnerability of the individual:

1. Negative Attitude:

Negative attitudes stemming from childhood that Sex is Bad or Immoral are likely to interfere with an individual’s ability to enjoy sexual relationship.

2. Need to Maintain Self Control:

Excessive need to maintain self control, especially in the presence of another person, interfere with normal sexual functioning.

3. Earlier Experience of Sexual abuse or Trauma:

Earlier experience of sexual Abuse or Trauma may lead to sexual problems later in life.

4. Propensity to Sexual Inhibition:

A satisfactory sexual response is based upon the balance of sexual excitation and sexual inhibition. Sexual inhibition can be due to fear of performance failure or fear of performance consequences (e.g. sexually transmitted diseases, being seen by others during sexual encounters, having an undesired pregnancy).

There is a strong association between high propensity to sexual inhibition & eractile problems but not with premature ejaculation.

A. Mental Health & Sexuality:

1. Depression:
  • Loss of Libido
  • Erectile Dysfunction
2. Hypomania:
  • Increased Libido
3. Anxiety Disorders:
  • Higher rates of sexual dysfunctions are seen.
  • Premature Ejaculation is common in patients with Social Anxiety Disorder.
4. Schizophrenia:
  • Impact on sexuality is complex.
  • Sexual thoughts & behaviours are common.

B. Physical Health & Sexuality:

Poor physical health is associated with decreased sexual activity & reduced sexual satisfaction.

Various Mechanisms which can lead to Sexual problems:

1. Damage to Neural Control of genital response:
  • Peripheral Neuropathy
  • Disease of Spinal Cord: For example, Multiple Sclerosis
  • Injury or Surgery causing Nerve Damage: Spinal cord injury, Prostectomy, Hystrectomy.
  • Brain Abnormalities: Epilepsy & Cerebral Tumour.
2. Impairment of Vascular supply of genitalia.
3. Alterations of Endocrine Mechanisms:
  • Low Testosterone Levels: Decreased Libido & Eractile Dysfunction in males.
  • Low Oestrogen Levels: Impaired Vaginal Lubrication in females.
  • Hyperprolactinemia: Decesed Libido in both male and female & Eractile dysfunction in males.
  • Diabetes Mellitus: Erectile Dysfunction, Decreased Libido & impairment in genital response.

C. Side effects of Medications:

1. Antidepressants:
  • Decreased Libido
  • Inhibition of orgasm & ejaculation
  • Delayed Ejaculation
2. Antipsychotics:
  • Erectile Dysfunction
  • Delayed Ejaculation
  • Orgasmic dysfunction in women
3. Antihypertensive:

Beta Blockers (Propanolol), Centrally acting Hypertensive (Guanethidine) & Alpha 2 agonists (clonidine) can lead to Erectile dysfunction, Delayed ejaculation in men & Orgasmic Dysfunction in women.

Reference:

3 thoughts on “Sexual Dysfunctions : Aetiology”

  1. I must admit this has begun in my relationship, and it’s an odd feeling. Always read about it, and never could fathom not having interest in sex. But, had a major infidelity issue with my wife, and I guess the “trauma” of it has completely dissolved any and all interest in sex, for weeks at a time.

    I could only wonder if this is what losing a limb is like. Not every imagining life without an arm, until it’s dead and gone. I’m only guessing though.

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