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What Is Sexual Dysfunction?

Both women and men can experience difficulty in achieving satisfying sexual intercourse. Sexual dysfunction refers to disturbance in any component of the sexual response cycle. The deficiency may be in one or more phases of the response cycle; i.e. some may have issue with sexual desire (libido), others with inability to be aroused, while still others are not able to achieve orgasm. The common problems affecting males include erectile and ejaculatory dysfunctions. In women, failure to consummate or to allow vaginal penetration, and painful intercourse are important concerns. For those of you who do not enjoy or have difficulty in enjoying sexual activity, the primary hurdle is the psychological inertia. Most would give up sexual fulfilment, rather than to seek help from trained medical doctor, psychiatrist and sexual therapist. We recognise the embarrassment you will have to overcome to broach on sensitive information of yourself. Loss of sexual interest, reduced quality of sexual arousal during intercourse and vaginal dryness and pain during intercourse are very prevalent as women reach the mid-forties and beyond. Most men seek help when they found difficulty in achieving adequate erection or when early ejaculation deprives the couple of sexual satisfaction. Loss of sexual interest in young men, though uncommon, challenges the therapist. There are many couples who complain of non-consummation, and came forth when childbearing or marital disharmony become urgent.

Causes Of Sexual Dysfunction

We cannot ignore that most sexual dysfunction has an underlying psychological component; you may be having ongoing anxiety, you may be depressed, you may be having excessive stress at work or you may be having interpersonal problem. Very often, a history of sexual abuse at an earlier age, or mal-adjustment to a previous sexual relationship may taint your current perception of sexual enjoyment. Nevertheless, in many, the sexual dysfunction is related to chronic medical diseases, long term use of certain medications, hormonal changes and modifiable lifestyle habits. To distil the exact cause of sexual dysfunction is often not possible, as the mind and body interact intimately before the distress expresses itself as a symptom.

Treatment For Sexual Dysfunction

Treatment generally begins with the first detail clarification of the presenting complaint. By drawing out the necessary information in a non-threatening environment, the process itself is therapeutic. We identify at the outset the various disease conditions that may contribute to sexual functioning and aim to get them under control. It may be necessary to refer to the attending physicians for their input. Women with vaginal dryness may find relief with topical gels and hormone containing creams. HRT is useful for post-menopausal women. There are drugs on trial in treating women with poor arousal response as well as poor dry. In men who come with erectile dysfunction, the use of sildenafil, vardenafil or tadalafil are very helpful when they are prescribed for short term and long term use. When you do not respond to these drugs, we will move on to other management options like intra-penile injections and vacuum devices. Premature ejaculation is treated with topical cream and certain centrally-acting drugs. When the libido is problematic, assessment of the hormonal profile may suggest the use of androgen replacement therapy. Above all these measures, we cannot under-estimate the premier role of couple therapy and counselling. To prevent sexual dysfunction, simply “stay healthy and live happy”. We need to avoid succumbing to hypertension, diabetes, obesity, high cholesterol and stiffened blood vessels; and if we already have them, it is important to keep them controlled and not progress rapidly. The drugs that we take should not be those that affect our sexual performance. It is helpful not to drink alcohol in excess, to stop smoking and to quit the use of recreational drugs. Regular exercises to stay physically fit, and learning to manage stress at work and at home are important. Obviously, the way we relate to our sexual partner emotionally, the way we communicate with each other and how we resolve conflicts together will affect us in both triggering and maintaining our sexual difficulties.

Low Sex Drive - Is It A Problem?

There is a small amount of male hormones circulating in your system, and they are produced mainly from the ovaries and adrenal glands. Similar to estrogen level, androgen level also decline with age. Though the normal androgen range of 2-4nmol/L is small when compared to the normal male range, supplementing with testosterone significantly improves the drive and energy. Replacing testosterone alone usually is not as effective as combined with estrogen replacement, because your sexual response relies on vascular support that is derived from estrogen. Other reasons of reduced libido include chronic illnesses like diabetes, use of some medications that are necessary in managing high blood pressure, depression and others. Work stress and family disruptions can surreptitiously reduce sexual motivation. Depression and other maladaptive neurotic tendencies can likewise interfere with libido. Low sex drive can be restored. The main hurdle is your acknowledgement and your motivation to right the situation. There is no “magic bullet”, even when it is obviously a lack of hormones, replacement of them do not reverse the condition instantly. Treatment usually involves the cooperating partner. Much time has to be spent in pin-pointing the correct diagnosis. By the time you seek medical attention, the depth of the problem extends to many layers of non-attended problems. We often need to approach the situation from behavioral, psychological, attitudinal and medical fronts. You may be required to attend several sessions of interview, filling up questionnaires to assess your condition and sampling of blood to assess level of hormones; besides the normal physical examination and ultrasound scanning to exclude possible organic diseases. Deep seated psychological issue has to be confronted and work through. At times, psychiatric input may be necessary and joint management may be organized. When hormonal replacement is decided, the appropriate formula and dosing will be administered. Whatever the eventual outcome of the management journey, to take the first step will certainly yield positive results because it will bring about better understanding.

Hyposexual Disorder in Woman

Many of you suffer from it, but majority basically ignore it or deny its relevance. Absent libido or sex drive among women is more common than you hear of. The prevalence of this “under the wrap” condition really depends on the socio-cultural attributes that you are residing in. Neuro-physiologically, sex drive is an instinctual motivation that is directly influenced by mental activity and hormones, which are dependent on age and health issues that are on-going. The hormones that play a central role in libido are estrogens and the androgens (testosterone). In the adult woman, many parts of the body are under the direct influence of estrogens, which give the characteristic female physique and psyche. Estrogen is produce by the ovary in a cyclical manner from puberty to the menopause. As the number and quality of eggs in the ovary decline with age, the level of estrogen falls in tandem. Besides affecting the mental receptivity towards sexual activity, estrogen is important in improving blood flow to the vulva, clitoris and vagina. Low level of estrogen gradually gives rise to failure of sexual arousal and response. There are different stages of a woman’s life when her estrogen level dips. Of these, the immediate months after delivering a baby may have long term impact on a woman’s sexuality, which often occur without you realizing. The monthly menstrual fluctuation of hormonal levels may sometimes affect your receptivity of sexual ideas as well. Absent or low estrogen causes the female sex organs to reduce in size and its ability to respond. Child bearing and childbirth, the integrity of the pelvic floor structure is altered, the nerve and muscle activity is reduced and the blood flow is also reduced. The accompanying discomfort with sexual activity worsens the loss of libido. There is also the physical and mental exhaustion from looking after the newborn with or without a career to mind.


38 Irrawaddy Road #05-21/22
Mt Elizabeth Novena Specialist Centre
Singapore 329563
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502 Bishan St 11 #01-356
Singapore 570502
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Singapore 820681 (LRT Stn)
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