Mens Sexual Dysfunction-What Constitutes A Problem?
by Mack M
Sexual dysfunctions are not all or nothing phenomena but occur on a continuum both in terms of frequency and severity. With our current knowledge, any cut off is inevitably arbitrary It is rarely possible to identify cases with a purely organic or purely psychogenic aetiology. Indeed, with our growing knowledge of psychoneuropharmacology and endocrinology, the distinction between organic and psychogenic becomes increasingly blurred.
Comorbidity of sexual dysfunctions is common. For example, nearly half of men with low sexual desire have another sexual dysfunction, and 20% of men with erectile dysfunction have low sexual desire.
In addition to the intrapersonal complexity of sexual problems, the patient's partner and their relationship probably have a more profound effect on sexual health than on any other aspect of health. In up to a third of patients with sexual problems, the partner also has a sexual dysfunction. The interactions between various aspects of sexual problems experienced by a couple are complex, often circular, and rarely reveal simple causal or consequential relationships.
Abnormalities of sexual desire, and indeed sexual desire itself, are difficult to define. The factors considered by clinicians and patients when gauging desire include sexual fantasies, arousal, thoughts, and activity. Given the confusion over the meaning of the concept, it is not surprising that views differ over the term that best describes it. Sexual fantasies, the desire for sexual activity, and distress about the level of desire in a patient and his partner all contribute to the construct of inhibited sexual desire. It is more commonly reported in women than in men in the general population and in clinic populations. Differences in sexual desire often lead to considerable distress for a couple and can be a source of major conflict in the relationship.
Inhibited sexual desire is often associated with other sexual dysfunctions in the patient or partner. The lifetime prevalence of depression and anxiety disorders is increased. There is a strong association with emotional distance and conflict within a relationship, although it is impossible to determine whether this is cause or consequence from the studies available. Indeed, it is probably meaningless to attempt to do so from population studies given the great individual variability and the very gradual, transactional nature of change in these aspects of relationships.
Characteristic cognitive features have been identified in many cases--for example, the belief that desire does not gradually develop during a sexual encounter but must either be present at the start or does not occur at all, and the belief that subtle feelings such as warmth or tenderness are not sexual and that sexual arousal cannot take place without intense, overtly erotic feelings.
Sexual desire in men can be inhibited by a wide range of physical factors. This can be due to the general effects of illness such as a severe bout of flu or chronic renal failure or to specific effects such as those seen in alcoholism, liver disease, testosterone deficiency, and prolactin secreting pituitary tumours (which may occur in as many as 10% of men presenting with inhibited sexual desire). It is also often a side effect of drugs such as antihypertensives, antidepressants and antipsychotics, anticonvulsants, and cytotoxic agents.
Most studies of outcome indicate that response to psychological intervention for inhibited sexual desire is very poor.
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