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Sexual dysfunction

Introduction:

Sexual dysfunction -- having a problem with sexual desire or response -- covers a wide variety of problems. In men, they include erectile dysfunction (ED) and premature or delayed ejaculation in men, and in women, spasms of the vagina and pain with sexual intercourse. For both sexes, they can include other problems with sexual desire (libido) and response.

Men over age 65 are at higher risk for ED, although ED is not a normal part of aging. Among women with sexual dysfunction, 43% say decreased sexual desire is their No. 1 complaint. The problem may be psychological, physical, or a combination of both.



Signs and Symptoms:
  • Premature or delayed ejaculation in men
  • Erectile dysfunction -- not being able to get or keep an erection
  • Pain during sex
  • Lack or loss of sexual desire
  • Lower urinary tract symptoms
  • Difficulty having an orgasm
  • Vaginal dryness


What Causes It?:

Sexual dysfunction can be temporary or long-lasting. Causes vary and may include:

  • Being age 65 and over in men
  • Taking some prescription medications, including some antidepressants
  • Hormonal imbalances
  • Drug abuse
  • Depression, anxiety, or other psychological issues
  • Stressful life events
  • Some medical conditions, such as diabetes and coronary heart disease


What to Expect at Your Provider's Office:

Your health care provider will do a physical examination. Many times, lab tests and a physical exam may not show a cause. Your doctor may ask about your ethnic, cultural, religious, and social background, which can influence your sexual desires, expectations, and attitudes. Your doctor may test your hormone levels, particularly levels of testosterone, which affects sex drive in both men and women.



Treatment Options:

If depression is causing sexual dysfunction, antidepressants may help. Although some antidepressants may cause low libido, others may not. It may take some time for you and your doctor to find the right antidepressant for you.

Erectile dysfunction -- Sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) can treat erectile dysfunction but may have potentially serious side effects in some men. Vasodilators (drugs that dilate blood vessels, improving blood flow) may be injected into the penis. Vacuum devices may also be used. Vascular surgery or an implant in the penis may help if the problem does not get better with other treatment.

Problems related to menopause -- When estrogen drops after menopause, women may have vaginal dryness and other changes that may make sex painful for some. Women who have painful intercourse after menopause may want to ask their doctor about estrogen therapy, as a vaginal ring or cream. Over-the-counter products are available as creams or gels for women who have vaginal dryness. Your doctor may also consider a testosterone patch or cream, although using testosterone for sexual dysfunction is controversial.

A variety of psychological, behavioral, and interpersonal therapies may also help with many sexual disorders. For example, combination therapy, including both sex therapy and medications, may work best for premature ejaculation.

Complementary and Alternative Therapies

Sexual dysfunction caused by decreased circulation, hormonal imbalance, depression, or anxiety may be helped by alternative therapies. Be sure to work with an experienced provider of alternative therapies and tell all of your doctors about the herbs, supplements, and medications you are taking. Many have side effects and can interact with each other. Unless noted, treatments are for both men and women.

Nutrition and Supplements

  • Vitamin C may help both men and women, as it increases blood flow. One study suggests vitamin C may increase libido in women.
  • Essential fatty acids, found in evening primrose oil, fish oil, and borage oil, help improve blood flow. Essential fatty acids may increase the risk of bleeding, especially if also take blood-thinners such as warfarin (Coumadin), clopidogrel (Plavix) or aspirin.
  • Dehydroepiandrosterone (DHEA), a hormone made by the body's adrenal glands, has been studied for both men and women. DHEA levels get lower as women grow older. Some studies show DHEA may help restore libido in older women, but doesn't help younger women. And some studies suggest DHEA may help some men with ED, although it doesn't seem to help those with diabetes or neurological problems. DHEA is sold as a supplement, but it is a powerful hormone that can change into other hormones such as estrogen and testosterone once in the body. Do not use DHEA without your doctor's supervision.
  • L-arginine may help men with ED, according to one study. A lower dose didn't seem to work by itself. But another study suggested that adding pycnogenol to a lower dose of arginine might help ED. The study was preliminary, so more research is needed. People with high blood pressure, kidney or liver disease, or who take blood-thinners or diabetes medications should not take arginine. L-arginine may make herpes worse. It may interact with medications used to treat ED, such as sildenafil (Viagra), and with nitrates used to treat heart disease. People with autoimmune diseases should not take pycnogenol.
  • Propionyl-L-carnitine added to Viagra seemed to improve erections more than Viagra alone in men with diabetes and ED, according to one study. But more research is needed. Propionyl-L-carnitine can increase the risk of bleeding, especially if you also take blood-thinners such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin. Propionyl may make an underactive thyroid (hypothyroidism) worse and may raise the risk of seizures in people with a history of seizures.

Herbs

Herbs are a way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

Chaste tree (Vitex agnus castus) helps your body produce hormones normally but must be taken long term (12 - 18 months) to work.

For men:

  • Ginkgo (Ginkgo biloba) increases circulation and may improve sexual function, although one study found no effect. Ginkgo may increase the effects of certain blood-thinning medications (anticoagulants), so ask your doctor before taking ginkgo.
  • Korean red ginseng (Panax ginseng) helped men with ED improve sexual function, according to one double-blind study. People in the study took 2 weeks off after 8 weeks of treatment. Ginseng is a stimulant and may not be right for people with insomnia, autoimmune diseases, schizophrenia, heart disease, bleeding disorders, and hormone-sensitive cancers such as breast or prostate cancer. Ginseng interacts with a number of medications, including blood thinners and insulin. Ask your doctor before taking it.
  • Maca (Lepidium meyenii) may boost sexual desire in men, according to one study. Maca has been grown as a vegetable in Peru for thousands of years. However, more study is needed to see if it works for low libido and whether it is safe.
  • Saw palmetto (Serenoa repens) and Pygeum africanum may help if your sexual problems are caused by prostate disease. Saw palmetto can interact with certain medications, including blood-thinners, so do not take it without your doctor's supervision.
  • Yohimbe (Pausinystalia yohimbe) contains some yohimbine hydrochloride, a chemical found in a prescription drug used to treat erectile dysfunction. However, the levels vary. Do not take yohimbe without the supervision of your health care provider. High doses are dangerous, and yohimbe interacts with several drugs and isn't safe for people with certain medical conditions.

For women:

  • Arginine, ginseng, ginkgo, and damaina (Turnera diffusa), plus certain vitamins and minerals, in a formulation called Argin-Max, showed effectiveness in one study. People with high blood pressure, kidney or liver disease, or who take blood-thinners or diabetes medications should not take arginine. Ginseng is a stimulant and may not be right for people with insomnia, autoimmune diseases, schizophrenia, heart disease, bleeding disorders, and hormone-sensitive cancers such as breast or prostate cancer.  Ginseng interacts with a number of medications, including blood-thinners and insulin. Ask your doctor before taking ginseng or arginine.
  • Korean red ginseng (Panax ginseng) improved sexual arousal in menopausal women, according to one study. Ginseng is a stimulant and may not be right for people with insomnia, autoimmune diseases, schizophrenia, heart disease, bleeding disorders, and hormone-sensitive cancers such as breast or prostate cancer. Ginseng interacts with a number of medications, including blood thinners and insulin. Ask your doctor before taking it.
  • Yohimbe combined with arginine may increase arousal. As is true for men, you should not take yohimbe without the supervision of your health care provider.

Acupuncture and Traditional Chinese Medicine

Acupuncture and Traditional Chinese Medicine (TCM) have been used for centuries to treat sexual dysfunction. Studies show that acupuncture may help specific organs, and many people use acupuncture and TCM to address hormonal imbalances.

Yoga and Meditation

Yoga and meditation can reduce the effects of stress and relieve anxiety about sexual dysfunction.

Massage

Therapeutic massage can reduce stress.



Following Up:

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



Special Considerations:

Some drugs and herbs used for treating sexual dysfunction may have serious side effects. Marital counseling and other forms of therapy are also important.



Supporting Research:

Adimoelja A. Phytochemicals and the breakthrough of traditional herbs in the management of sexual dysfunctions. Int J Androl. 2000;23 Suppl 2:82-4.

Aung HH, Dey L, Rand V, Yuan CS. Alternative therapies for male and female sexual dysfunction. Am J Chin Med. 2004;32(2):161-73.

Clayton A, Ramamurthy S. The impact of physical illness on sexual dysfunction. Adv. Psychosom Med. 2008;29:70-88.

Frank JE, Mistretta P, Will J. Diagnosis and treatment of female sexual dysfunction. Am Fam Physician. 2008;77(5):635-42.

Gentile V, Vicini P, Prigiotti G, et al. Preliminary observations on the use of propionyl-L-carnitine in combination with sildenafil in patients with erectile dysfunction and diabetes. Curr Med Res Opin. 2004;20:1377-84.

Gonzales GF, Cordova A, Vega K, et al. Effect of Lepidium meyenii (MACA) on sexual desire and its absent relationship with serum testosterone levels in adult healthy men. Andrologia. 2002;34:367-72.

Hong B, Ji YH, Hong JH, et al. A double-blind crossover study evaluating the efficacy of Korean red ginseng in patients with erectile dysfunction: a preliminary report. J Urol. 2002;168:2070-3.

Ito TY, Polan ML, Whipple B, Trant AS. The enhancement of female sexual function with ArginMax, a nutritional supplement, among women differing in menopausal status. J Sex Marital Ther. 2006 Oct-Dec;32(5):369-78.

Ito TY, Trant AS, Polan ML. A double-blind placebo-controlled study of Argin-Max, a nutritional supplement for the enhancement of female sexual function. J Sex Martial Ther. 2001;27:541-9.

Jang DJ, Lee MS, Shin BC, Lee YC, Ernst E. Red ginseng for treating erectile dysfunction: a systematic review. Br J Clin Pharmacol. 2008 Oct;66(4):444-50. Review.

Ledda A, Belcaro G, Cesarone MR, Dugall M, Schönlau F. Investigation of a complex plant extract for mild to moderate erectile dysfunction in a randomized, double-blind, placebo-controlled, parallel-arm study. BJU Int. 2010 Feb 22. [Epub ahead of print]

Mattar CN, Chong YS, Su LL, Agarwal AA, Wong P, Choolani M. Care of women in menopause: sexual function, dysfunction and therapeutic modalities. Ann Acad Med Singapore. 2008;37(3):215-19.

McKay D. Nutrients and botanicals for erectile dysfunction: examining the evidence. Alt Med Rev. 2004;9(1):4-16.

Meston, CM, Worcel M. The effects of yohimbine plus L-arginine glutamate on sexual arousal in postmenopausal women with sexual arousal disorder. Arch Sex Behav. 2002;31:323-32.

Oh KJ, Chae MJ, Lee HS, Hong HD, Park K. Effects of Korean red ginseng on sexual arousal in menopausal women: placebo-controlled, double-blind crossover clinical study. J Sex Med. 2010 Apr;7(4 Pt 1):1469-77.

Perelman MA. A new combination treatment for premature ejaculation: a sex therapist's perspective. J Sex Med. 2006;3(6):1004-12.

Seagraves R, Woodard T. Female hypoactive sexual desire disorder: History and current status. J Sex Med. 2006;3(3):408-18.

Shamloul R. Natural aphrodisiacs. J Sex Med. 2010 Jan;7(1 Pt 1):39-49.

Sivalingam S, Hashim H, Schwaibold H. An overview of the diagnosis and treatment of erectile dysfunction. Drugs. 2006;66(18):2339-55.

Stanislavov R, Nikolova V. Treatment of erectile dysfunction with pycnogenol and L-arginine. J Sex Marital Ther. 2003;29:207-13.

Wheatly D. Triple-blind, placebo-controlled trial of Ginkgo biloba in sexual dysfunction due to antidepressant drugs. Hum Psychopharmacol. 2004 Dec;19(8):545-8.

Wilt T, Ishani A, Mac Donald R, et al. Pygeum africanum for benign prostatic hyperplasia. Cochrane Database Syst Rev 2002;CD001044.




Review Date: 4/16/2012
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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