Sexual Dysfunction
Wed, 2007-07-11 13:07 - Kerry
from: health.msn.com
Sexual Dysfunction: Is Age the Culprit?
by Dr. Rob for MSN Health & Fitness
Q. Is it true that all men experience some age-related dysfunction in the bedroom? I'm in my late 30s and I'm already noticing a difference. Not total failure, but less stamina, less drive. I feel way too young for this to be happening.
A. When we are younger, life in general seems less complicated. But as we add years, we tend to have more emotional and physical stresses to deal with. As a result, pleasures we once took for granted may not happen with the frequency or spontaneity that they used to. This is certainly no truer than when we are talking about erectile dysfunction (ED, impotence), a condition that affects most men to varying degrees at some point in their lives.
Is it a true "failure to launch"?
Erectile dysfunction can vary in severity; some guys cannot get an erection at all, while others have an inconsistent ability to achieve or maintain an erection. But no matter how it presents, ED inhibits a man's sexual satisfaction and often his partner's. Although ED tends to be more common as men get older, it is not an inevitable consequence of aging.
ED is most likely an underreported and under-diagnosed condition because many men do not discuss this issue with their physicians. We do know that by age 45 most men have experienced a temporary form of ED at one time or another. For these men, erectile dysfunction tends to go away and life returns to normal. But for the millions of American males (5 percent of men over 40 and 15 percent of men over 70) who experience chronic ED or impotence, the condition has the potential to cause emotional turmoil and destroy intimate relationships.
Contributing factors leading to ED
Although you mentioned you were in your late 30s, you did not say whether you had any health or emotional issues that could be behind your "dysfunction in the bedroom." This information is important because the majority of cases of ED are due to medical (health issue), social (substance abuse) or emotional factors.
Some of the more common medical and social concerns contributing to ED include:
- Diabetes (especially if it is not properly controlled)
- Cardiovascular disease (atherosclerosis, uncontrolled high blood pressure)
- Possible side effect from medications (beta blockers, antihistamines, certain antidepressants, and others
- Nerve or spinal cord damage
- Obesity
- Lack of physical fitness
- Fatigue
- Complications from smoking (one pack per day smokers are 40 percent more likely to have ED compared to nonsmokers)
- Substance abuse (marijuana, heroin, cocaine and alcohol); too much alcohol can cause a "shrinkage of the testicles," leading to decreased production of the male hormone testosterone (in England they call this cause of ED "brewer's droop")
Common emotional contributors to ED include:
- Depression
- Guilt (possibly due to infidelity)
- Problems with the relationship
- Anxiety and worry (performance concerns)
- Mental stress or exhaustion
Rediscovering your mojo
Please don't suffer in silence or withdraw from your partner. This can only result in misunderstandings and hurt feelings. Instead, visit your health care professional. Be honest about the concerns and issues weighing heavily on your mind. In many cases your physician will ask you specific questions and do a thorough exam, checking for an enlarged prostate or prostate cancer. There are also several tests that may be run to check sugar, PSA, kidney function, hormone levels, bad (LDL) cholesterol (elevated levels may indicate atherosclerosis, a build-up of fatty deposits in the arteries which can decrease blood flow to the affected area, in this case, the penis) and urine. You may also be asked to take a psychosocial examination that helps to identify any psychological factors that could be exacerbating ED.
Since erectile dysfunction can be caused by a variety of reasons, the treatment must be individualized for you. It may consist of simple strategies (exercising, quitting tobacco, alcohol or adjusting medications), using physician-prescribed erection-inducing drugs or devices, counseling in one form or another (psychotherapy, relationship counseling), or a combination of approaches. But no matter what, please don't give up or feel your sexual life is over. In most cases, common-sense measures may help to improve as well as enhance both your and your partner's sexual pleasure.
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Sexual Dysfunction in Women
http://health.yahoo.com/ency/healthwise/uh1854/uh1855
What is sexual dysfunction in women?
Sexual dysfunction is a decrease in or lack of sexual satisfaction. Sexual dysfunction in women is very common. It affects up to 40% of women, most commonly young women, and tends to decrease with age. 1
The four major types of sexual dysfunction in women are:
What are some causes of sexual dysfunction in women?
The causes of sexual dysfunction in women are often interrelated.
What are the symptoms of sexual dysfunction in women?
Symptoms of sexual dysfunction include:
How is sexual dysfunction in women diagnosed?
Women often recognize a sexual problem by noting an absence or change in their level of sexual desire or satisfaction. Your health professional will take a complete medical history and perform a physical examination, and then work with you to determine the cause of your concerns.
How is sexual dysfunction in women treated?
Many cases of sexual dysfunction are treatable, once the underlying cause is identified. Treatment may include treating existing medical conditions, education, and communication counseling. Because your sexual experience involves physical, emotional, and psychological factors, successful treatment requires a high level of comfort between the health professional and you, and possibly your partner.
Frequently Asked Questions
Learning about sexual dysfunction in women:
Being diagnosed:
Getting treatment:
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Kirtly Jones, MD - Obstetrics and Gynecology
Does one pill fix both problems at once?
from: womenshealth.about.com
Depression Drug Helps Women With Low Sex Drive
By Tracee Cornforth
Low sex drive affects at least one out of five women in the United States. A study presented at this year's American Psychiatric Association meeting found that bupropion hydrochloride sustained-release tablets may be an effective treatment for some women who suffer from hypoactive sexual desire disorder (HSDD). There is currently no approved drug treatment for low sex drive in women.
Researchers found that almost one-third of the women in the study responded with increases in the number of episodes of sexual arousal, sexual fantasy, and interest in engaging in sexual activity. Women included in the study were aged 23 to 65 and had experienced HSDD for an average of six years. Participants saw improvement as early as two weeks after beginning treatment.
Taylor Segraves, M.D., Ph.D., lead investigator and professor of psychiatry at Case Western Reserve University School of Medicine said, "The results of this study are encouraging. One aspect that demonstrated a substantial improvement was that by the end of the treatment phase nearly 40 percent reported being satisfied with their sexual desire, whereas 100 percent were dissatisfied before starting treatment."
Although a person diagnosed with HSDD can still function sexually, the disorder is characterized by a combination of factors including persistently diminished or absent sexual fantasies or desire for sexual activity. Low sex drive is a condition that can cause both emotional distress and problems in intimate relationships, according to Dr. Segraves.
Bupropion hydrochloride SR enhances the presence of neurotransmitters, norepinephrine and dopamine, in the brain and is not associated with the sexual side effects often experienced by patients using selective serotonin reuptake inhibitors (SSRIs) anti-depressants such as Prozac, Paxil, and Zoloft.
Is bupropion hydrochloride SR the answer for your low sex drive?
It may be, but even Dr. Segraves agrees that more research is needed on the use of this drug as a treatment for HSDD. The drug is currently approved for the treatment of depression and is marketed as Wellbutrin SR by Glaxo Wellcome Inc.
Created: December 4, 2003
"I'm Not in the Mood"
Hypoactive Sexual Desire Disorder
Hypoactive sexual desire disorder (HSDD) is the most common form of female sexual dissatisfaction (FSD) and occurs when there is a persistent lack of desire or absence of sexual fantasies. In other words, you're rarely in the mood; you neither initiate sex nor seek stimulation.
Lack of desire often occurs as a result of relationship conflicts, say Drs. Jennifer and Laura Berman, two of the nation's top experts on sexual health for women.
"Communications problems, anger, a lack of trust, a lack of connection and a lack of intimacy can all adversely affect a woman's sexual response and interest," they write in their book: For Women Only: A Revolutionary Guide to Overcoming Sexual Dysfunction and Reclaiming Your Sex Life.
If this sounds like you, counseling and therapy with your partner is probably your No. 1 treatment option to overcome HSDD, the sisters say.
Medical Causes of HSDD
Obviously, lifestyle factors also influence the desire for sex. A single working mom who is overwhelmed by family needs may feel too exhausted to relax, kick back and fantasize about sex — let alone engage in it! However, sometimes a medical condition is the underlying cause of low libido, including:
Medication Use: Many commonly prescribed drugs, such as antihypertensives, antidepressants and birth control pills, interfere with sex drive, arousal and orgasm by affecting the balance of sexual hormones and the transmission of chemical messengers. For instance, antidepressants known as selective serotonin reuptake inhibitors combat depression by increasing the production of serotonin in the brain. Unfortunately, serotonin dampens sexual desire.
Menopause: The onset of menopause, either surgical or natural, is characterized by a gradual decline of the hormones estrogen, progesterone and testosterone. Reduced testosterone levels, in particular, say the Bermans, can lead to a "sudden or gradual" decline in libido. Ironically, the conventional hormone replacement regime of estrogen and progesterone given to relieve menopausal symptoms can make matters worse, because estrogen increases a protein (called steroid hormone-binding globulin) in the blood that binds to testosterone, causing it to become less available to the body.
Depression: A common symptom of depression is diminished sex drive, which, in turn, can exacerbate depression. Studies indicate that 12 percent of all women will experience clinical depression at some point in their lives. As mentioned, one of the side effects of the popular antidepressants Prozac, Paxil and Zoloft is loss of libido. Dysthymia is a lower-grade form of depression that is not easily diagnosed because you can function with it, note the Bermans. A woman with dysthymia may feel isolated and overwhelmed and withdraw from sex and social activities.
Overcoming Libido Loss
If you're suffering from loss of libido and think there is a medical basis for your problem, here are some solutions to consider:
Talk to your doctor about testosterone, especially if you have had your ovaries removed, are taking estrogen or under severe stress. Get your testosterone level evaluated and if it is below 20 nanograms per deciliter, consider starting testosterone therapy. "To us, testosterone is so central to a woman's sexual function, that no lover and no amount of sexual stimulation can make up for its absence," write the Bermans, who report enormous success in treating low-libido patients with supplemental testosterone. Testosterone to treat FSD has not been approved by the FDA, notes Dr. Jennifer Berman, so you'll need to find a physician open to prescribing it to treat lack of sexual desire. If you are already on hormone replacement therapy for menopausal symptoms, ask your doctor to add testosterone to your regimen.
Switch to medications known to have less effect on sexual function or lower dosages. The antidepressants Prozac, Zoloft and Paxil, of which women are major consumers, cause loss of libido in as many as 60 percent of patients. "We generally switch to one that has less of a sexual side effect," like Celexa, Wellbutrin, BuSpar, Serzone or Effexor, says Jennifer.
Viagra, the little blue pill may help jump-start your sex life as long as "you have the desire to engage in sex and have been stimulated enough for it to take effect," say the Bermans. It's especially helpful if your lack of desire is related to hysterectomy or menopause. Physicians aren't exactly sure how Viagra helps rekindle lust — the Bermans are investigating how it works in their clinic — but they know it helps women achieve arousal, which is the phase that comes after desire, by increasing blood flow to the vagina, clitoris and labia.
More: Medications That Cause Low Sexual Desire
Next: Preventing Low Sexual Desire
Last updated:10/05
More sex-ed
14 Embarrassing Sex Questions – Answered!
Unless they’ve been surgically altered, most women’s breasts are not perfectly matched. That’s because breasts are made of mammary gland tissue and fat, and there are naturally different amounts in each, explains Dr. Glenn Updike, assistant professor of obstetrics and gynecology at Magee Women’s Hospital in Pittsburgh.
All women have some difference in their breasts; for some, the difference is more pronounced. Usually, this is only a cosmetic, and sometimes comfort, issue. (If it’s embarrassing or impacting your sex life, surgical remedies are available.) However, while different-sized breasts are common, if one breast suddenly becomes much larger than the other it could indicate an infection or tumor, so have your gynecologist evaluate it immediately.
When you climax, the muscles around your genitals – including the sphincter muscle – relax, and when they do, it’s not unusual for a little gas to escape, says Dr. Millicent Comrie, MPH, founder and medical director of the Long Island College Center for Women’s Health in Brooklyn. But even before orgasm, because the penis rubs against the anus through the vaginal wall, the in-and-out motion may trigger gas, Comrie says. If it’s a frequent problem and really embarrassing to you, she suggests taking an over-the-counter anti-gas medication that contains simethicone before having sex.
3. If I had a dream about having sex with another woman, does that mean I’m gay or bisexual?
Not necessarily, says Michele Sugg, a certified sex therapist in Branford, Connecticut, and member of the American Association of Sexuality Educators, Counselors, and Therapists. It could mean you’re attracted to women (or a particular woman), but it could also mean you’re missing the closeness that friendships with women brings. “Sometimes women symbolize nurturance, love and closeness,” Sugg explains. “If you’re in a relationship with a guy and you’re not getting enough closeness, a dream like this might symbolize that you need more of that.”
It’s important to remember that an erotic dream doesn’t define your sexual identity. “Even if it means you feel sexually attracted to another woman, you don’t need to pigeonhole yourself,” Sugg says. “A lot of studies find that women’s sexuality is more fluid. Maybe at times you’ll be attracted to women and at times you won’t be. There’s a scale rather than being gay, straight or bi.”
Cold sores don’t seem to carry the same stigma as genital herpes. But the fact is, strains of the same herpes simplex virus cause cold sores on the lips (and other areas of the face, chest, even the fingers), as well as the blisters around the genitals.
Herpes simplex virus 1 (HSV-1) usually occurs above the waist (generally through kissing or sharing eating utensils), while herpes simplex virus 2 (HSV-2) usually occurs below the waist (generally through sexual contact). But the reality is that you can get either virus in either area through oral-genital contact. “People aren’t as embarrassed to say ‘I get cold sores’, but fewer people are apt to bring up that they have genital herpes, although both of them could be in either place,” Updike says. Genital HSV-1 actually appears to be on the rise among adolescents, according to Comrie, “because they’re having oral sex instead of intercourse.” While both HSV1 and HSV2 are treatable, neither are curable.
Health experts say the popular belief that cold sores are benign stems from social perception – not medical reality. Actually, the virus strain that causes cold sores can, in some cases, also cause serious eye and brain infections. It’s estimated that 50%-80% of American adults have oral herpes, while 20% have genital herpes.
5. Can certain exercises really lead to better sex?
Absolutely. For starters, a good cardiovascular routine helps build energy and stamina. In addition, strength training and stretching can help you build muscles and improve your flexibility so you can get into – and maintain – various positions during sex.
To locate your PC muscles, try stopping the flow of urine when you pee. Hold the squeeze for five seconds, then release. Doing 50 to 150 Kegel squeezes a day will help keep those muscles in good sex shape. (Avoid doing Kegels regularly while urinating; it can lead to urinary tract and bladder infections.) “It builds the vaginal muscle up so you can really tighten around your partner,” Comrie says.
6. Is cybersex really cheating?
Those who take a Clintonian view of sex may not consider a volley of provocative emails to be cheating, given that the participants are only exchanging thoughts or fantasies, not bodily fluids. But ask yourself if you’d want your partner to read your exchange and if he’d be hurt, angry or resentful if he did. “If your partner wouldn’t feel comfortable with what you’re doing, you’re probably out of bounds in terms of your relationship agreement,” Sugg says. If the answer is yes, try to figure out what you’re looking for online that’s missing from your relationship. Maybe you’re bored with your sex life. Or your husband sees you as the mother of his children, while you still feel like a sex kitten. Or you want to try something extraordinary like role play or light bondage or even going to a sex party.
Rather than act out online, consider talking about it with your partner and expanding your sex life together. “When people can talk about their needs, there’s less It’s not cheating because it’s virtual,” Sugg says. Besides, real sex beats virtual sex any day.
If you push a baby out through your vagina, you can expect some stretching. “After delivery, the vaginal opening is anywhere from one to four centimeters bigger than it was before,” says Dr. Bruce Rosenzweig, director of urogynecology at Rush University Medical Center in Chicago. Whether your private parts snap back to pre-delivery size after your recovery depends on how big your baby was, how long you pushed, how well your OB repaired any tears, and whether you’re diligent about doing your postpartum Kegel exercises. “If you do those Kegel exercises to strengthen the vaginal muscles, the outcome is better,” Comrie says. If you had an episiotomy and your OB was meticulous about sewing it up, she adds, “you could be better than before.”
That said, after multiple deliveries, your vagina may still feel a bit roomier, and you may want more tightening than you’ll get from marathon Kegel sessions. If so, ask your gynecologist about vaginal reconstruction (aka perineoplasty or vaginoplasty), which can help lift and tighten the sagging muscles at the vagina’s opening and deeper inside.
8. I’ve never had an orgasm during intercourse. Is something wrong with me?
“If you can’t have orgasms with intercourse, you’re normal,” assures Stephanie Buehler, Psy.D., director of the Buehler Institute for sex therapy in Irvine, California. “Sometimes women get upset because their partners say “My last lover could have orgasms, so there must be something wrong with you.”
Now, assuming you don’t kick him to the curb for being an insensitive cad, you’re well within your rights to point out that about 70% of women don’t orgasm during intercourse without direct clitoral stimulation. You can also clue him in to the fact that it’s perfectly OK for one of you to lend a hand. “Touching your clitoris during sex really ups the chances that you’ll have an orgasm,” says Carol Queen, Ph.D., staff sexologist for the online sex toy boutique Good Vibrations (GoodVibes.com).
9. Where’s my G spot?
That’s the million-dollar sex question. Some researchers don’t believe in the G spot; others staunchly defend its existence but disagree about its exact location. One school of sex researchers maintains that the G spot is the glandular tissue around the urethra (found behind your pubic bone, about two inches inside your vagina). Others believe it’s really farther back, in a triangular area on the back of the bladder wall – called the trigone or T Zone – where three nerves come together. It’s probably some combination of these. But if your partner’s plucking the right strings, so to speak, does it matter which instrument he’s playing?
10. Can anal sex give me hemorrhoids?
Not as long as you’re relaxed and enjoying it, assures Ellen Barnard, MSSW, a sex educator/counselor and co-founder of A Woman’s Touch in Madison, Wisconsin (a-womans-touch.com). Hemorrhoids (painful swollen veins in the anal area) can result from excess pressure around your anus – say, when you’re really straining to go to the bathroom. But when you use a good lubricant and the penetration feels comfortable, not forced, there’s no risk of “backdoor sex” causing hemorrhoids.
In fact, some sex researchers believe tush play may actually prevent hemorrhoids. “It improves the strength and flexibility of the skin and muscles so that the anus is better able to respond to pressure, rather than bulging and producing hemorrhoids,” Barnard says.
Beyond the extensive airbrushing magazine photos undergo, the hard truth is that even if you started with a nice, tight package, child birthing changes everything. Once you push a couple of 8- to 10-pound babies through the birth canal, things down there are gonna look more like Mary Poppins’ carpet bag than a cute little change purse.
Indeed, according Rosenzweig, some women’s vaginas sag so much that they complain of discomfort while walking.
Age is, not surprisingly, another culprit. You don’t expect to look like the pouty-lipped young things in Clearasil ads when you’re 45, right? Well, just as the lips around your mouth can thin with age, so can the lips in your southern hemisphere. “Women lose fat in that area, the elasticity and tone of the tissue decreases and the inner vaginal lips droop,” explains Dr. Dolores Kent, a Beverly Hills ob/gyn and cosmetic surgeon.
But in the same way women can opt for Restalyne or collagen to fill and plump, those who want to recapture the vaginas of their youth can have labiaplasty (trimming up the inner lips) and/or perineoplasty (tightening the vaginal opening). Although some women “have their vaginas done” because vaginal changes cause medical problems or make sex uncomfortable, Kent says that 85% of the women who come to her for such procedures are worried about aesthetics. “They’ve seen the men’s magazines and feel their vulvas aren’t pretty,” she says.
Sure, but you’re probably worrying needlessly, says Dr. Mary Jane Minkin, clinical director of obstetrics and gynecology at Yale University School of Medicine in New Haven, Connecticut. “Most of the women who come in saying I smell really bad smell fine,” she says. Still, if you’re concerned, see your gyn because strong odor (and discharge) is a sign of a bacterial infection. If there’s no infection and you’re still worried about your scent, avoiding spicy or pungent foods may help, Rosenzweig says.
Minkin often recommends an over-the-counter product called Rephresh that rebalances the vagina’s pH and makes you more fragrant. Don’t use douches or feminine sprays. Not only are they irritating, they can alter the vagina’s natural flora, which increases your risk of getting an infection and can mask an existing one.
13. Do I have a greater risk for infection if my genitals are pierced?
“It’s probably not a great idea to have foreign objects around your genitalia because areas that are prone to moisture and intimate contact are very attractive to bacteria,” Rosenzweig says. “But if you have great hygiene and a normal immune system, a genital piercing isn’t going to increase your risk for yeast infections or bacterial vaginosis.”
Still, some people always have a little redness or irritation around pierced areas, even when they’re in ho-hum spots like ears, noses or navels. So, if your piercing seems perpetually inflamed, take it out.
If you’ve had sex, you’ve probably bumped into human papilloma virus (HPV) – about 80% of sexually active people have been exposed to at least one of the 30 known strains of HPV. However, in the vast majority of cases – 90% – the infection clears up on its own. Odds are, you won’t even realize you had it. The thing to keep in mind is that while most HPV viruses come and go without notice, about 10 strains can increase your risk of developing cervical cancer.
The best way to protect yourself is with routine Pap tests, which look for changes in the cervix that could eventually become cancer. “We don’t know why some women develop cervical cancer and others don’t,” says Dr. Thomas Herzog, director of the division of gynecologic oncology at Columbia University in New York City. “But there are millions of women with HPV and just over 11,000 cases of cervical cancer in the U.S. each year, so if you’re screened regularly, it’s very unlikely you’ll develop cervical cancer. And if you did it would be caught extremely early and likely completely cured.”
Most women over 30 who’ve had three consecutive normal Paps are now advised to be screened only every two to three years. If you’re under 26, consider getting the new HPV vaccine, Gardasil, which protects against the four main strains of HPV responsible for about 70% of cervical cancers.
Test Your Sexual Health IQ
So, you know about birds, bees and that Tab A goes into Slot B. But there's so much more to know about getting it on, especially when it comes to your sexual health. Find out what you may have missed in Sex Ed class with this sexual health quiz.