Sexual Dysfunction - Research Paper Example

 Sexual Dysfunction Abstract Sexual dysfunction can affect both men and women. However, not all patients of sexual dysfunctions seek medical interventions. Sexual therapy on the other hand involves a systematic strategy which includes treatment of unsatisfactory sexual experiences due to sexual dysfunctions. Most of the patients of sexual dysfunctions tend to be less happy as compared to those with satisfactory sexual encounters. Sexual dysfunctions could be attributed to previous sexual abuse, high expectations of sex, sexual transmitted infections, over load of responsibilities. Primarily, sexual dysfunction in a marriage could lead to infidelity and divorce. This paper discusses, the sexual issue giving broad information on the symptoms, causes and treatments of the same. Sexual satisfaction contributes to higher quality of life. Therefore sexual therapy needs to incorporate verbal, physical, emotional and spiritual intimacy. The approaches discussed in this paper help couples to restore health sexual communication which in turn reduces anxiety and eliminates negative experiences. Subsequently, this therapy contributes to increased pleasure and facilitates a natural physiological reaction. a. Description of the problem Sex influences many aspects of life of individual. However, individuals from all races, gender and age may encounter sexual problems. These problems include, low libido, lack of intimacy, premature ejaculation, low sexual drive (LSD) among others. Both women and men may encounter lower sexual drive with age. This can be related to the decrease of estrogen and testosterone respectively. In this paper, we will focus more on low libido and low sexual desire in both women and men. Low sexual desires often arise due to low libido (Gehart, 2012). Libido, a term which arises from the Latin language means desire. Libido has further been described as the urge for, drive to or interest in sexual satisfaction through sexual activity or objects. It refers to a phenomenon of species typical complex construct that leads to the generation of responsiveness to erotic stimuli. This stimuli may include sexual cues, response to sexual arousal and spontaneous sex related fantasies and thoughts. These stimuli can be gravely influenced by cultural and social factors (Balon, 2011). Different hormones in both males and females can be attributed to sex stimuli in the same. Physiological activities contribute to the sexual desires in different settings. Biologically, the neurochemical and endocrine hormones both contribute to the relational and motivational components of sexual desire. These components may act as enhancers or inhibitors of sexual desire. The female and male sexual cycle relies on the amygdala through meditation of estrogen or androgen. Estrogen/androgen works in conjunction with Nitric Oxide (NO) to regulate nervous and physiological functions during sexual activity for a particular individual. In this aspect, NO acts as the locally acting hormone as well as the neurotransmitter (Balon, 2011). b. Current statistics on the topic area  Research into female sexual dysfunction (FSD) seems to be inadequate. This could be attributed to the lack of a standard definition of FSD. The currently existing studies which have been published were conducted among volunteers in a clinic. Earlier studies by Spector and Carey in 1998 indicate that prevalence of most sexual dysfunctions would be higher in clinical samples as compared to the community samples. For instance, a study conducted in the clinics on inhibited female orgasm ranged from eighteen to seventy six percent. On the other hand, the prevalence in community samples ranged between five to twenty percent. In addition, the former indicated a prevalence of sixty-two percent in women seeking sex therapy arousal treatment for arousal disorder. Community samples alternatively indicated a prevalence of eleven percent (Janssen, 2007). Erectile dysfunction being one of the sexual problems affects about thirty million men in United States of America. This high prevalence occurs across the world as well with more than tens of thousands of new cases being made every year. It is predicted that the population suffering from erectile dysfunction could increase from one hundred and fifty-two million statistics of 1995 to three hundred and twenty-two million in 2025. This could be attributed to the increasing life expectancy and high incidence of erectile dysfunction in the aging population. Primarily erectile dysfunction is prevalent in older people, as well as those who suffer from hormonal derangement, vascular insufficiency, medical comorbidities and interruption of neuronal pathways (Janssen, 2007). A cross sectional study conducted on male patients visiting an andrology clinic in Egypt helps to determine prevalence and incidence of sexual problems. One thousand and five hundred men were taken into account. The results indicated high prevalence of erectile dysfunction risk factors. The results indicated ninety-two point six percent of patients had erectile dysfunction. Fifty point eight percent had premature ejaculation while as seven point six percent had low sexual desire. Additionally, psychogenic causes of erectile dysfunction among the samples were attributed to twenty percent while as organic causes contributed to eighty percent of the cases. Ten percent of this cases could be regarded as mild, forty percent as moderate while as severe erectile dysfunction occurred as fifty percent. A significant association between increasing severity and increasing values the cavernous veins of (EDV) end-diastolic velocity was observed. Also, a decrease in peak systolic velocity (PSV), penile rigidity and resistive index (RI) contributed to an increase in severity of erectile dysfunction (McAnulty, 2006). c. Symptoms and causes of the problem. Previous studies indicate a close inverse relationship between sexual distress and sexual satisfaction and happiness. Low sexual desire also contributes to unhappiness, decreased physical satisfaction as well as emotional satisfaction. In addition, low sexual desire relates with some cases of anxiety and marital difficulties. In a study conducted on women with low sexual desire, it was observed that those in romantic relationships experienced more sexual distress among those in romantic relationships as compared to those not in romantic relationships. The Sexual Advice Association notes that sexual problems affects more than fifty percent of women globally. Additionally, sexual problems increase with age among the women (McAnulty, 2006). Low sexual desire among women occurs as a complicated topic and may not be easily categorized or defined. This is due to the myriad of aspects to consider in its etiology. Symptoms of low sexual desire could be due to physical, relational as well as emotional causes or a combination of all the factors. Regarding the physical factors, low sexual disorder could be associated with hormonal fluctuations caused by menopause, pregnancy, birth control methods and breastfeeding. In addition, low sexual disorder could be caused by diabetes mellitus, hypothyroidism and sexually transmitted diseases (Mulcahy, 2006). Regarding the psychological factors, low sexual disorder arises due to the loss of a loved one as well as the loss of a job. In addition, negative body image, depression, relationship distress, substance abuse, infidelity, negative dogmas about sex add up to the psychological factors causing LSD.A study conducted in 2006 on two thousand, six hundred and thirty-two women aimed at identifying the most experienced sexual concerns. Most women noted “being too busy to have sex” and “being too tired to have sex” as the most common concerns. The research further identified fatigue, stress and life pressures as most frequent factors causing low sexual desire. Another study conducted in 2008 indicated that women with overload of roles experienced problems with job satisfaction, psychological health, leisure satisfaction and low sexual desire. Additionally, dysfunction includes loss of arousal, pain during sex, inability to orgasm and loss of desire. In order to identify the particular causative factors, both psychological and physical factors need to be considered. Also, the relationship between a woman and her partner needs to be assessed (Miller, 2009). Professionals across various fields in sexual medicine and psychological health lack a common ground to define and address low sexual desire. Characteristically, long debates revolve around diagnoses involving low sexual desire or Hypoactive Sexual Desire Disorder. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis of HSDD needs to meet three criteria. First, the individual needs to report lack of sexual thoughts and fantasies as well as the desire to engage in sexual activities. Secondly, the individual needs to be report a distress arising as a result of low sexual desire. Thirdly, the low sexual desire needs to satisfactorily prove to not be associated with substance abuse or medical procedures (Loe, 2004). e. Treatment of the problem Partly due to the multifaceted and complex etiology of sexual disorders, many researchers advocate for integrative treatment. The magazine called Weeks features treatment review as well as recommendations for Hypoactive Sexual Desire Disorder following a study conducted in 2008. The study advocates for assessment and treatment of the disorder according to the interactional, individual and intergenerational factors. The individual realm primarily captures the biological, psychological and cognitive factors. The biological factors occur as the primary contributors which lead to low sexual disorder. The psychological factors include depression, anxiety as well low levels of self-esteem. The cognitive factors include individual beliefs in sex, current sexual preferences and current sexual behaviors. This individual realm often ends up with the patients being referred to a physician (Zahran, Abdeldaeim, Fouda & Elgebaly, 2012). With regard to interactional issues, the study recommends examining for couple dynamics, power struggles, communication patterns, ways of sexual relations and relationship discords. The study recommends that intergenerational factors need to be investigated. These intergenerational factors include cultural and familial beliefs about sex. These beliefs may be influenced by the contemporary dynamics. However, this approach lack empirical proof of credibility. Nevertheless, the approach provides a good example for how professionals in this field need to identify and conceptualize the complex etiologies of sexual desire disorders (Loe, 2004). Biological Approaches to Treatment Generally, the United States leads in a cultural trend towards medicalization of sexual dysfunctions. This trend seemingly brings an increased cultural visibility of sexual health problems and patient confidence and comfort in seeking treatment for both male and female sexual dysfunctions. However, this also brings about its own disadvantages. Researchers argue that sexual dysfunctions may not be treated successfully using medical treatments. This failure could be attributed to the individual psychological factors which significantly worsen the problem (Chavez & Indiana State University, 2006). Since the discovery of medical therapy for sexual dysfunctions, cultural and professional attention seems to drift more towards the treatment of male sexual problems and less towards female sexual dysfunctions. The trend discussed above acts as the perfect illustration for this. Those who receive PDE5 inhibitors such as Viagra and Cialis among the male patients have fallen off the therapy. Such treatments fail to maintain the initial gains for its users who eventually discontinue the treatment due to basic partner relationships dynamics and failed expectations. This therefore illustrates the issues associated with the medical aspects and risks of focusing on the same for treatment of sexual dysfunctions. Other criticism on medicalization of sexual disorders arise from feminist professionals and researchers within the realm of sex therapy (Janssen, 2007). This view of biological approaches on female sexual dysfunction tends to pathologize normal sexual functioning. In this aspect, normal sexual functioning involves sexual arousal, sexual desire among other sexual functioning. Critics further speculate that these approaches may be inspired by the financial aspects of a possible success of the same. When medical interventions are applied for factual normative changes among females, adverse effects may be experienced. Additionally, the patients experience unnecessary anxiety following their previous sexual experiences. Therefore, part of the treatment needs to include information on basic sexual functioning of the human body. Also, the treatment needs to provide interventions and techniques which promote better functioning as desired. Some treatments offer all these concerns especially for FSD (Miller, 2009). Primarily, medicines used to alleviate symptoms of low sexual disorder target two hormones. These include the testosterone and estrogen and are both associated with sexual desire among women. Testosterone acts as the primary hormone for significant sexual desire. Estrogen on the other hand helps to ensure lubrication of the vagina which further leads to elasticity. Use of testosterone patches considerably boosts sexual desire for women. However, this may cause an increase in breast cancer risk after only one year of administration (McAnulty, 2006). Although most physicians prescribe the patch as “off label” for sexual disfunctioning among women, the U.S. Food and Drug Administration raises speculations over the health risks associated with the same. “Off label” medications and prescriptions constitute the medications used for alternative purposes besides the officially approved purpose. Some physicians believe that testosterone patches may be used to treat sexual dysfunctions among women besides the officially approved purpose of the patch. The USFDA voted against the testosterone patch as a treatment for low sexual desire over the safety concerns for women’s health. The underlying long term problems with using testosterone patch may not be known quite well (Mulcahy, 2006). Alternatively, estrogen replacement therapy (ERT) may be used in post-menopausal women to heighten their sexual desire. However, similarly to the testosterone patch, the estrogen replacement therapy may be linked to numerous dangerous side effects. It is believed that ERT causes blood clots and stroke. Other effects include other gall bladder disease, breast cancer and heart diseases. However, a low dose is often used to treat osteoporosis in women. Recently, a drug called Flibanserin was discovered in Germany. Originally, Flibanserin was used as an antidepressant and was later discovered to possess capabilities of boosting sexual desire. Flibanserin may be used in the general public although the U.S. Food and Drug Administration denied its approval requests in the United States. Furthermore, long term effects of the drug remain unclear (Zaslau, 2011). Psychological Approaches. This section discusses the psychological treatments for low sexual disorder and hypoactive sexual desire disorder. Therefore, we may review the criteria established by the American Psychological Association for evaluating treatment effectiveness. The American Psychological Association’s Task Force on Promotion and Dissemination of Psychological Procedures (1998) conducted a research to investigate psychological treatments for HSDD and LSD and compiled a list of acceptable therapies. These therapies can be grouped into two categories of well-established therapies and probably efficacious therapies (Balon, 2011). According to American Psychological Association (1998), therapies labeled as efficacious treatments are those which meet the established criteria. The treatment needs two experiments which prove the treatment as significantly superior according to statistics given to a control group. Secondly, one or many studies which meet a criteria for well-established treatments. The only exception involves a demonstration of insignificant effects by at least two investigators. These criteria established by the American Psychological Association (1998) allows for evaluation of treatments specifically intended for sexual dysfunction such as Hypoactive Sexual Desire Disorder (Balon, 2011). f. Biblical perspectives on the problem It would be wrong for any Christian to imagine they would become more than Christ without facing adversity. For what reason would the New Testament remind us of the need to keep up the fight towards sanctification? “Consider it pure joy, my brothers and sisters, whenever you face trials of many kinds, because you know that the testing of your faith produces perseverance. Let perseverance finish its work so that you may be mature and complete, not lacking anything.” (James 1:2-4 NIV). This shows that marriage needs to be a manifestation of God’s ability to strengthen integrity (Janssen, 2007). Following numerous studies conducted before, various recommendations have arisen regarding how best to treat low sexual drive among women. A study conducted by Mintz et.al 2010 examined the efficiency of a particular book entitled “A Tired Woman’s Guide to Passionate Sex”. The book serves as self-help for the patients which aims at improving sexual desire, arousal and other factors concerning sexual health. The study involved forty - five women who responded to advertisements near a University in Midwestern United States. These age of the participants ranged between twenty-nine and fifty-seven years old. Additionally, they were experiencing low sexual drive in their heterosexual marriages. The group of women in the intervention group received a copy of “A Tired Woman’s Guide to Passionate Sex” immediately. The group of women in the control group on the hand were notified that they would receive their copy in six weeks (Wincze & Carey 2001). The book, “A Tired Woman’s Guide to Passionate Sex” has two hundred and thirty-seven pages with three chapters. These foundational chapters include the story of the author, causative factors of low sexual desire and emotional and physical benefits of sex. The self-help book further has five chapters on cognitive-behavioral and psycho-educational treatment approaches. The third foundational chapter which discuses about benefits of sex asks the readers to engage in a special activity described therein. This activity aims at increasing the motivation of an individual to participate in accepting their own motivations towards building individual sexual drive (Wincze & Carey 2001). The activity occurs as a six step treatment based on theoretical and clinical literature as well as research. The treatments include the Bit of Spice and the Five T’s. The first of the five T’s which features Thoughts encourages one to consider cognitive restructuring with regard to sexual motivation and desire. The topic further gives guidelines on practices of mindfulness applicable during sexual activities. The second topic, Talk, gives skills on sexual communication and how to blend it in with general communication. Thirdly, the topic on Time illuminates on the strategies for time management as well as goal setting. The topic further gives opinions regarding couple moments and self-care. The forth step on Touch, discusses the activities best suitable non goal directed and affectionate touching. The topic further gives information on sexual responses of women. The step on Spice, mainly involves various suggestions which enliven the sexual life of the readers. Finally, the step on Trysts discusses on applicable suggestions for creating ample time for sexual activities. The topic further demystifies myths on spontaneous sex (Wincze & Carey 2001). g. Homework assignments Bibliotherapy could be used to reach large populations within a relatively low budget. More people would rather invest in self-help therapies than seek medical intervention for sexual dysfunctions. Roughly two thousand self-help books are introduced every year into the market. Often, individuals with sexual dysfunctions caused by psychological disorders do not seek medical advice. These psychologically include anxiety and stress. The World Health Organization (WHO) noted that nearly eighty-five percent of Americans with diagnosable substance abuse disorders and mental health do not seek treatment (McVary, 2011). These statistics tend to coincide with epidemiologic study on prevalence of sexual dysfunctions. A study conducted previously indicates that only twenty percent of women with sexual dysfunctions sought medical interventions. In another study, twenty five percent of the women for a sample of 10,429 women with symptoms of sexual dysfunctions sort medical advice. Seventy five percent of the sample on the other hand relied on the media as a source of information. With respect to this, bibliotherapy seems to be the best approach to delivering relevant knowledge to the public at low costs (McVary, 2011). In 2000, the women above fifty years of age accounted for forty-two million of the population. With the prevalence of sexual dysfunction discussed above, at least sixteen million of the same population would be experiencing low desire. Furthermore, four million individuals would be distressed over their sexual dysfunction. Previous research indicated that African American women registered lowest prevalence of low sexual desire and HSDD. Present researches evaluate menopausal, socio-demographic and possible hormonal aspects which lead to HSDD and low desire (McVary, 2011). h. Additional information (optional) The physiological integrity of the male sexual functioning depends on the muscular and nervous tissues of the corpora cavernosa of the organ. Additionally, sexual functioning relies on psychic and endocrine factors from the center of the brain. An erection primarily occurs due to the production of Nitric Oxide in specific nerves within the corpora cavernosa. Testosterone functions as the primary male hormone which is produced within the testes. This hormone regulates numerous and complex physiologic operations such as the basic mechanisms responsible for penile tumescence and libido. Adequate levels of testosterone significantly influences on male libido. Often, sexual intercourse tends to be more likely during the female ovulation. This could be attributed to the implied cues from the women or the pheromones which are menstrual cycle dependent (Gehart, 2012). References Top of Form Bottom of Form Balon, R. (2011). Sexual dysfunction: Beyond the brain-body connection. Basel: Karger. Chavez, C. P., & Indiana State University. (2006). The role of sexual attitudes in sexual dysfunction for a clinic-referred sample of women veteran sexual trauma victims. Gehart, D. R. (2012). Mindfulness and acceptance in couple and family therapy. New York: Springer. Janssen, E. (2007). The psychophysiology of sex. Bloomington: Indiana University Press. Loe, M. (2004). The rise of Viagra: How the little blue pill changed sex in America. New York: New York University Press. McAnulty, R. D. (2006). Sex and sexuality: 2. Westport, CT [u.a.: Greenwood Press. McVary, K. T. (2011). Contemporary treatment of erectile dysfunction: A clinical guide. New York: Humana. Miller, C. A. (2009). Nursing for wellness in older adults. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Mulcahy, J. J. (2006). Male sexual function: A guide to clinical management. Totowa, N.J: Humana Press. Wincze, J. P., & Carey, M. P. (2001). Sexual dysfunction: A guide for assessment and treatment. New York: Guilford Press. Zahran, A. R. M., Abdeldaeim, H. M., Fouda, K., & Elgebaly, O. F. (2012). Congenital penile curvature presenting as unconsummated marriage. Repair by 16-dot plication with subjectively reported patient and partner satisfaction. Arab Journal of Urology, 10(4), 429-433. Zaslau, S. (2011). Dx/Rx: Sexual dysfunction in men and women. Sudbury, Mass: Jones & Bartlett Learning. Read More