Introduction:

Sexual dysfunctions cover a wide variety of problems, including erectile dysfunction (ED) and premature or delayed ejaculation in men, spasms of the vagina, pain with sexual intercourse, and 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. Decreased sexual desire is the most common complaint among women, affecting up to 43% of women. 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 achieve or maintain 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 of sexual disorders vary and may include:

• Age 65 and over in men
• Some prescription medications, including some antidepressants
• Hormonal imbalances
• Drug abuse
• Depression, anxiety, or other psychological issues
• Stressful life events
• Certain 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 libido (sex drive) in both men and women.

Treatment Options:

If sexual dysfunction is caused by depression, antidepressants may help.

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 respond to other treatment.

Problems related to menopause -- When estrogen drops after menopause, women may experience vaginal dryness and other changes that may make sex painful for some. Women who experience 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 experience vaginal dryness. Your doctor may also consider a testosterone patch or cream, although there is controversy about using testosterone for sexual dysfunction.

A variety of psychological, behavioral, and interpersonal therapies are also available for many sexual disorders. For example, combination therapy, including both sex therapy and sexual pharmaceuticals, is often the best treatment approach for premature ejaculation.

Complementary and Alternative Therapies

Sexual dysfunction caused by decreased circulation, hormonal imbalance, depression, or anxiety may be helped by alternative therapies. Unless noted, treatments are for both men and women.

Nutrition and Supplements

• Vitamin C (250 - 500 mg one to two times per day) may be helpful for both men and women, as it increases blood flow. One study suggests vitamin C may increase libido in women.
• Vitamin E (400 IU per day), B6 (50 - 100 mg per day), and zinc (30 mg per day) to support hormone production.
• Essential fatty acids (1,000 mg three times per day), found in evening primrose oil, fish oil, and borage oil, help improve blood flow. Essential fatty acids may increase the effects of certain medications, so ask your doctor before taking them.
• B-complex (50 - 100 mg per day) helps reduce stress.
• For women: levels of dehydroepiandrosterone (DHEA, 50 mg per day), a hormone produced by the body's adrenal glands, get lower as women grow older. Some studies show DHEA may help restore libido in older women, but has no effect on younger women. DHEA is a powerful hormone that can convert into other hormones such as estrogen and testosterone once in the body. Do not use DHEA without a doctor's supervision.

Herbs

Herbs are generally a safe 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) for effectiveness.

For men:

• Ginkgo (Ginkgo biloba, 50 - 100 mg per day) 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.
• Saw palmetto (Serenoa repens, 160 mg two times per day) and Pygeum africanum (100 mg two times a day between meals) may help if your sexual problems are caused by prostate disease. Saw palmetto can interact with certain medications, 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 affects numerous 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. Arginine can affect blood pressure, blood sugar, and circulation so check with 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.

Physical Medicine

Contrast sitz baths promote circulation. You will need two basins that you can comfortably sit in. Sit in hot water for 3 minutes, then in cold water for 1 minute. Repeat three times to complete one set. Do one to two sets per day 3 - 4 days per week. Do not use this technique if you have prostate cancer or other malignancies.

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 routinely use acupuncture and TCM to address hormonal imbalances.

Yoga and Meditation

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

Massage

Therapeutic massage can reduce the effects of stress.

Following Up:

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

Special Considerations:

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