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Sexual dysfunction

• Signs and Symptoms
• What Causes It?
• What to Expect at Your Provider's Office
• Treatment Options
• Following Up
• Special Considerations
• Supporting Research

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. The causes of sexual disorders vary and include psychological problems and some medical conditions, such as illness or injury. Sexual dysfunction can be temporary or long-lasting.

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
• Difficulty achieving orgasm
• Inadequate vaginal lubrication in women

What Causes It?

• Age 65 and over in men
• Some prescription medications, including some antidepressants
• Hormonal imbalances
• Drug abuse
• Depression or anxiety
• Stressful life events
• Certain medical conditions

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, which are done while you are sleeping 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. Over-the-counter products are available as creams or gels for women whose bodies produce inadequate lubrication.

A variety of psychological, behavioral, and interpersonal therapies are also available for many sexual disorders.

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.
• Magnesium (200 mg twice a day) supports hormone production.
• B-complex (50 - 100 mg per day) helps reduce stress.
• For women: DHEA (dehydroepiandrosterone, 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 get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should 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 to 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.
• 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.

Yohimbe ( Pausinystalia yohimbe ) should only be taken 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:

• A combination of 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. See the above cautions on yohimbe, and do not take without medical supervision.

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 this 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 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 traditional Chinese medicine 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.

Supporting Research

Baulieu EE, Thomas G, Legrain S, et al. Dehydroepiandrosterone (DHEA), DHEA sulfate, and aging: Contribution of the DHEAge Study to a sociobiomedical issue. Proc Natl Acad Sci . 2000;97;4279-4284.

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass: Integrative Medicine Communications; 1998:383.

Conn RB, Borer WZ, Snyder JW. Current Diagnosis (No. 9). Philadelphia, Pa: WB Saunders, Co; 1996:9.

Ernst E, Pittler MH. Yohimbine for erectile dysfunction: a systematic review and meta-analysis of randomized clinical trials. J Urol 1998;159:433-6.

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.

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.

Murray MT. The Healing Power of Herbs: The Enlightened Person's Guide to the Wonders of Medicinal Plants. Rocklin, Calif: Prima Publishing; 1995:127, 149-150.

Scalzo R. Naturopathic Handbook of Herbal Formulas. 2nd ed. Durango, Colo: Kivaki Press; 1994:66.

Tierney LM Jr, McPhee SJ, Papadakis MA, eds. Current Medical Diagnosis & Treatment 1999. Stamford, Conn: Appleton & Lange; 1999.

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: 9/1/2006
• Reviewed By: Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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