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Sexual Dysfunction

Sexual dysfunctions cover a wide variety of disorders, including male impotence, premature ejaculation in males, spasms of the vagina, pain with sexual intercourse, and problems with sexual desire (libido) and response. Men over age 65 are at increased risk for impotence. Impotence, however, is not a normal part of aging. The causes of sexual disorders vary, and include psychological causes and some medical conditions, such as illness or injury.

Signs and Symptoms

bulletPremature or abnormal ejaculation in men
bulletInability to achieve or maintain an erection (impotency)
bulletPain during intercourse
bulletLack or loss of sexual desire
bulletDifficulty achieving orgasm
bulletInadequate vaginal lubrication in women

 

What Causes It?

 

bulletAge 65 and over in men
bulletDepression or anxiety
bulletStressful life events
bulletCertain medical conditions

 

What to Expect at Your Provider's Office

Your health care provider will do a physical examination. He or she may ask about your ethnic, cultural, religious, and social background, which can influence your sexual desires, expectations, and attitudes. Blood tests can help distinguish between psychological and physical causes for sexual dysfunctions. Other tests for men may include penile tumescence measurements, which are done while you are sleeping to determine whether an impotence problem is psychological or physical.

Treatment Options

Treatment Plan

Various drugs are available for impotence and vaginal discomfort. Psychotherapy, sex therapy, or behavioral therapy can be helpful for many sexual disorders. Surgery on the veins of the penis is performed in severe cases. This treatment is still considered experimental. An implant in the penis may help for severe impotence that does not respond to other treatment.

Drug Therapies

Prescription

 

bulletSildenafil citrate (Viagra)—increases natural response to sexual stimulation; serious side effects in some men
bulletAntidepressants—for sexual dysfunction related to panic states and depression
bulletTestosterone—for some types of impotence
bulletVasodilators—for some types of impotence; administered by injection

 

Over the Counter

 

bulletDibucaine (1%) or lidocaine (1%)—ointment to relieve external vaginal irritation
bulletLubricants to relieve vaginal dryness (for example, K-Y Jelly)

 

Complementary and Alternative Therapies

Sexual dysfunction secondary to decreased circulation, hormonal imbalance, depression, or anxiety may be reduced with alternative therapies.

Nutrition

 

bulletVitamin C (1,000 mg three times per day) supports vascular integrity.
bulletVitamin E (400 IU per day), B6 (50 to 100 mg per day), and zinc (30 mg per day) to support hormone production.
bulletMagnesium (200 mg twice a day) supports hormone production.
bulletB-complex (50 to 100 mg per day) helps reduce stress.

 

Herbs

Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots.

For sexual dysfunction related to poor circulation:

 

bulletGinkgo (Ginkgo biloba, 50 to 100 mg per day) increases peripheral circulation and may improve sexual function.
bulletHawthorn (Crataegus oxyacantha), rosemary (Rosemarinus officinalis), ginger root (Zingiber officinalis), and prickly ash bark (Xanthoxylum clava-herculis) are circulatory stimulants. Use singly or in combination, 3 cups of tea per day or 20 to 30 drops tincture three times per day.
bulletYohimbe bark (Pausinystalia yohimbe) can be used for sexual dysfunction, under the supervision of your provider.

 

For sexual dysfunction secondary to hormonal imbalance:

 

bulletChaste tree (Vitex agnus-cactus) helps normalize pituitary function but must be taken long-term (12 to 18 months) for effectiveness.
bulletSaw palmetto (Serenoa repens) may help hormone balance.
bulletDamiana (Turnera diffusa) may support testosterone levels. It also tones the central nervous system and may help relieve anxiety.
bulletMilk thistle (Silybum marianum), dandelion root (Taraxacum officinale), and vervain (Verbena hastata) support the liver and may help restore hormone ratios. Use equal parts in a tea (1 cup before meals), or tincture (15 to 20 drops before meals).

 

For sexual dysfunction associated with depression or anxiety:

St. John's wort (Hypericum perforatum), kava kava (Piper methysticum), skullcap (Scutellaria laterifolia), lemon balm (Melissa officinalis), passionflower (Passiflora incarnata), and gotu kola (Centella asiatica). Combine equal parts in a tea (1 cup twice a day) or tincture (20 to 30 drops twice a day). May take six weeks for results.

Homeopathy

Homeopathy may be useful as a supportive therapy.

Physical Medicine

Contrast sitz baths promote circulation. You will need two basins that you can comfortably sit in. Sit in hot water for three minutes, then in cold water for one minute. Repeat this three times to complete one set. Do one to two sets per day three to four days per week.

Massage

Therapeutic massage can reduce the effects of stress.

Following Up

Most sexual dysfunctions are long-term and require professional care.

Special Considerations

Certain drugs and herbs used for treating these psychological or physical disorders may have serious side effects. Marital counseling and other forms of interpersonal therapy are also important.

Supporting Research

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.

Blumenthal M, ed. The Complete German Commission E Monographs. Boston, Mass: Integrative Medicine Communications; 1998:383.

Conn RB, Borer WZ, Snyder JW. Current Diagnosis (No. 9). Philadelphia, Pa: WB Saunders; 1996:9.

Hoffman D. The New Holistic Herbal. New York, NY: Barnes & Noble Books; 1995:195.

Murray MT. The Healing Power of Herbs: The Enlightened Person's Guide to the Wonders of Medicinal Plants. Rocklin, Calif: Prima Publishing; 1995:127, 149–150.

Scalzo R. Naturopathic Handbook of Herbal Formulas. Durango, Colo: 2nd ed. Kivaki Press; 1994:66.

Tierney LM, McPhee SJ, Papadakis, MA, eds. Current Medical Diagnosis & Treatment 1999. Stamford, Conn: Appleton & Lange; 1999.