Volume 2 Issues 9, September, 2021
Sex has remained a matter of both stigma and mystery among many even today. Consequently it is also one of the less investigated topics. Even among medical graduates, emphasis on imparting & evaluation of their knowledge in sexual problems is inadequate. When such is the case, public is preoccupied with myths and misconceptions about sex. This long standing negative attitude is probably the cause of growing incidence of psychogenic sexual disorders. Interpersonal relationship problems, past sexual trauma, stress associated with job, death and divorce, primary psychiatric disorders like depression are the other common causes of sexual dysfunction.
Studies indicate about 30% of men and 40% of women are suffering from it. Low sexual desire, sexual aversion, impaired sexual arousal, orgasmic dysfunction, vaginismus and dyspareunia are the types of sexual dysfunction recognized in women. In men it includes low sexual desire, sexual aversion, erectile dysfunction, premature ejaculation and retarded ejaculation.
The treatment of sexual dysfunction was revolutionized in 1970s with the contribution of Masters and Johnson. The ‘Dual Sex Therapy’, essentially cognitive and behavioural, recognizes that the dysfunction is in the couple as a unit and not in the individual. It is done in three stages of ‘non‐genital stimulation’, ‘genital stimulation’ and ‘penile‐vaginal intercourse’ where the couple actively participates. Several interpersonal issues are rectified at each stage as the therapy progresses. It involves 12‐15 sessions. Now, modified versions of sex therapy to address individually and in group formats are available.
The drug therapy is not curative but significantly reduces the magnitude of the problem. Apo‐morphine, a centrally acting D1/D2 agonist is the only drug useful in desire disorders in both males and females. Trazodone, alprostadil, phentolamine, nitric oxide enhancers are all useful in male erectile disorders. The most popular ones are the nitric oxide enhancers like sildenafil, vardenafil and tadalafil. However they cannot be used daily and are contraindicated in Ischemic heart disease. Penile prosthesis and vaccum pump are the other options for erectile dysfunction. Premature ejaculation is treated by using adverse effect of delaying the ejaculation by SSRIs like fluoxetine and paroxetine. ‘Depoxetine’ is the newer drug currently popular for this. Antianxiety drugs like buspirone and benzodiazepines are also useful for premature ejaculation. Preliminary studies indicate that amantadine, bupropion and buspirone are useful in delayed ejaculation. The treatment options by use of medications for female arousal disorder are discouraging .Hormone therapy (testosterone, estrogen) has been found to be useful to an extent in disorders of arousal and orgasmic phases.
Clinician should make it a point to raise this sexual issue during examination, as the patient may not disclose because of the stigma. A tactful psychoeducation & learning the necessary skills may reduce much of the burden of sexual dysfunction.
Mysore Medical College, Mysore.
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