Introduction:

Sexual dysfunctions cover a wide variety of disorders, including impotence and premature or delayed 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, although impotence is not a normal part of aging. Decreased sexual desire is the most common complaint among women, affecting up to 43% of women.

Signs and Symptoms:

• Premature or delayed ejaculation in men
• Inability to achieve or maintain an erection (impotency)
• Pain during intercourse
• Lack or loss of sexual desire
• Lower urinary tract symptoms
• Difficulty achieving orgasm
• Inadequate vaginal lubrication in women

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. They 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. These tests are done during sleep to determine whether an impotence problem is psychological or physical.

Treatment Options:

If sexual dysfunction is caused by depression, antidepressants may help. Viagra (sildenafil) can treat erectile dysfunction but does have potentially serious side effects in some men and should not be taken if you have heart disease. Cialis (Tadalafil) and Levitra (Vardenafil) work in similar fashion, but also have side effects.

Vasodilators administered by injection are sometimes used for erectile dysfunction.

Estrogen may be recommended to women who experience pain during intercourse. Over-the-counter products are available as creams or gels for women whose bodies produce inadequate lubrication. Some women may also receive a prescription for testosterone therapy, especially if they are postmenopausal.

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.

Penile injections, suppositories, and 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.

Complementary and Alternative Therapies

Sexual dysfunction caused by decreased circulation, hormonal imbalance, depression, or anxiety may be reduced with 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.
• Magnesium (200 mg twice a day) supports hormone production.
• B-complex (50 - 100 mg per day) helps reduce stress.
• For women: dehydroepiandrosterone (DHEA, 50 mg per day), a hormone produced by the body's adrenal gland, diminishes 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 normalize pituitary function and hormone production but must be taken long term (12 - 18 months) for effectiveness.

For men:

• Ginkgo (Ginkgo biloba, 50 - 100 mg per day) increases peripheral circulation and may improve sexual function, although one recent study found no effect. Ginkgo may increase the effects of certain blood-thinning medications.
• Saw palmetto (Serenoa repens, 160 mg two times per day) and Pygeum africanum (100 mg two times a day between meals) can be helpful if the problem results from prostate disease.
• Panax ginseng or Asian ginseng (100 - 250 mg two times per day), in rotation with Siberian ginseng (Eleutherococcus senticosus, 100 - 300 mg two times per day), may help boost testosterone levels.

Do not take the above herbs if you take blood-thinning medication.

You should take yohimbe (Pausinystalia yohimbe) only under the guidance of your health care provider. Do not self-treat because high doses are dangerous, and yohimbe interacts with several drugs and affects numerous medical conditions.

For women:

• Arginine, ginseng, gingko, and damaina (Turnera diffusa), plus certain vitamins and minerals, in a formulation called Argin-Max, showed effectiveness in one study.
• Yohimbe combined with arginine may increase arousal.

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.

Acupuncture and Traditional Chinese Medicine

Acupuncture and Traditional Chinese Medicine (TCM) have been used for centuries to treat sexual dysfunction. Studies show direct impact of various acupuncture points on sexual 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:

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.