health

1. Definition.
2. What Are Pathophysiological Sexual Disorders?
3. Male pathophysiological sexual dysfunction.
4. Female pathophysiological sexual dysfunction.
5. How Common Is Pathophysiologic Sexual Dysfunction?
6. How Do People Know They Have Pathophysiologic Sexual Dysfunction?
7. How Do Doctors Diagnose Pathophysiologic Sexual Disorders ?
   
8. Treatment.
9. Complications.

SEXUAL DISORDER SEXUAL DISORDER SEXUAL DISORDER SEXUAL DISORDER
SEXUAL DISORDER SEXUAL DISORDER SEXUAL DISORDER SEXUAL DISORDER
SEXUAL DISORDER SEXUAL DISORDER SEXUAL DISORDER SEXUAL DISORDER
SEXUAL DISORDER SEXUAL DISORDER SEXUAL DISORDER SEXUAL DISORDER
SEXUAL DISORDER SEXUAL DISORDER SEXUAL DISORDER SEXUAL DISORDER
SEXUAL DISORDER SEXUAL DISORDER SEXUAL DISORDER SEXUAL DISORDER
SEXUAL DISORDER SEXUAL DISORDER SEXUAL DISORDER SEXUAL DISORDER

The term “sexual disorders” refers to any problem with sexual performance or
the function of sexual organs. Many of these problems have psychological or
psychosomatic origins. Those with a physical or medical origin represent only
a small percentage of all cases, but a substantial number. These cases occur
more often than previously thought, probably due to underreporting.

Pathophysiological (physiological disruption of normal function) sexual
disorder includes any sexual disorder that results from physical problems.
The disorder can be as serious as structural deformities in the male or
female sex organs. Further classification involves whether the disorder is
congenital (existing from birth) or if it was acquired (shaped by a traumatic
incident). Pathophysiological sexual disorders have similar symptoms to
sexual dysfunction except the causes are different: Sexual dysfunction is
often brought on by psychological or psychophysical (the influence of
psychological factors on physical function) influences. Only 10 percent of
sexual disorders are truly pathophysiological with a clear physical or medical
origin. They include intersex (discrepancies between external genitals
and internal sex organs) conditions, male pathophysiological sexual dysfunction,
and female pathophysiological sexual dysfunction.

The most commonest sexual disorder in males is erectile dysfunction of the penis.
This conditionis most often caused by psychological problems or stress. However,
there are several physical causes of the disorder, most of which are associated
with aging. Although erectile dysfunction can happen to men of all
ages for physical or medical reasons, about one-half of men over age 65
and three-fourths of men over age 80 report erectile dysfunction.
Three main causes are: problems with the blood flow, problems with the nerves
in the penile area, and problems with hormones.
The blood flow problems are of two types: not enough blood flows
into the penis or the blood in the penis flows out too quickly. To sustain
an erection, blood needs to engorge the penis. If the incoming blood vessels
are too constricted, then not enough blood can flow into the penis to
enlarge and stiffen the penis. However, if the outgoing blood vessels are
not constricted enough, then blood cannot stay in the penis long enough
to maintain an erection. These problems are caused by abnormalities in
the blood vessels caused by previous surgery, diabetes*, blood clots*, or
arteriosclerosis (hardening of the arteries).
Nerve damage in the penile area can interfere with the neurological
communication that stimulates an erection in the penis. The nerve
damage might be with the nerves sending the message from the brain
to stimulate the functions that result in an erection. Alternatively, the
damage may be in the nerves sending sensation to the brain diminishing
the effects of sexual stimulation. This problem can be caused by spinal
cord injuries from infection, external impact, or structural change. Other
causes of penile nerve damage include diabetes, previous surgery, and
nerve system irregularities.
Problems with hormones are related to failure of the testes to produce
testosterone. The two hormones important for a balance leading to normal
sexual functioning are testosterone and gonadotropin. Testosterone
is responsible for all male sexual characteristics. Gonadotropin is produced
by the pituitary* gland to stimulate production of testosterone.
The presence of above average gonadotropin indicates that the testes are
not producing enough testosterone. Too little testosterone and too much
gonadotropin can lead to erectile dysfunction.

Dysparunia
is the condition in which sexual intercourse is painful for women. As
the pain is greater than any pleasure derived from sexual intercourse, a
woman experiencing dysparunia is likely to avoid sexual relationships.
The causes of this condition are varied, but they can be grouped according
to whether the pain is felt during or after intercourse.
If the pain is felt during intercourse, it may be caused by infection to the
vulva*, the vagina*, or the Bartholin glands*. Other causes include the aftereffects
of surgery from childbirth and congenital irregularities in the hymen
(the membrane that covers the opening to the vagina) or the vaginal walls.
If the pain is felt after intercourse, its cause may be an infection of
the cervix*, uterus, or fallopian tubes*. Most often these are the results of
pelvic inflammatory disease caused by the sexually transmitted bacteria,
chlamydia and gonorrhea. Other causes can be a pelvic tumor or internal
scar tissue that forms after surgery or an infection.
Many women suffer pelvic pain and infertility due to endometriosis,
a condition in which tissue cells similar to the ones lining the uterus
are found outside the uterus in the abdominal cavity or in other organs.
When these cells line the ovaries or the fallopian tubes they can interfere
with the normal functioning of these organs leading to infertility.
Endometriosis can also be the cause of other sexual disorders.
Vaginismus, the involuntary contractions of vaginal muscles, is a
symptom associated with many sexual dysfunctions. When this symptom
occurs, the sexual act is interrupted as penetration becomes difficult or
painful for the woman. It can be caused by current infections or by previous
painful vaginal experience such as surgery or difficult childbirth. It is
a natural reaction to anticipated pain of intercourse.
Vaginitis and vaginal atrophy are conditions resulting in irritation in
the vagina. Vaginitis is usually the result of an infection. Vaginal atrophy
is usually caused by the lack of lubrication associated with age.
Consistent irritation in the vulva area is referred to as vulvodynia.
This condition occurs without warning and continues without relief. It
is usually caused by damage to the nerves in that area. It usually occurs
with (or is instigated by) a number of other conditions, including yeast
infection, skin disorders, and diabetes. Vulvodynia can only be diagnosed
by ruling out any other disorder as the cause.
Sexual arousal disorder is the condition in which a woman cannot be
fully aroused to have sexual relations. It is often found to be caused by
psychological conditions, such as fear of intimacy or loathing the current
sex partner. However, there are several physical conditions that can lead
to lack of sexual arousal. These include vaginitis, endometriosis, diabetes,
or aging. If a woman knows that she has no psychological reason to reject
sexual relations, she should have a health exam to determine if any medical
problem could be the cause of her sexual arousal disorder

Most estimates of sexual dysfunction report that 43 percent of women
and 31 percent of men experience some form of sexual dysfunction.
However, less than 10 percent involve a physical cause. A survey of gynecologists
found that when the doctor asked the patient about sexual
problems, 12 percent reported a problem, presumably of a gynecological
origin. Diabetes contributes to sexual dysfunction: 50 percent of men and
35 percent of women with Type 2 diabetes report trouble with sexual relations.
One-half to two-thirds of patients with heart disease also experience
sexual disorders. The occurrence of any intersex condition, regardless of
how mild or severe, is estimated at 1 percent of all births.

Many people live with a below average sexual drive and live relatively
happy lives despite that fact. As many of the conditions of sexual disorders
are not life-threatening, these people can lead normal lives without treatment.
However, when individuals participating in a sexual relationship
or anticipating a sexual relationship cannot function as they want, then
treatment may be required. Similarly, some people are comfortable in an
intersex state and content to remain the way they were born. However, if
it is interfering with adapting to life, these individuals may seek medical
advice and consider or undergo a gender reassignment operation.
If adults with diabetes or heart disease experience a decrease in sexual
desire, they may have a sexual disorder related to the medical condition.
Adolescents who do not develop sexually at the same rate as their peers
may suspect a sexual disorder and seek medical advice and examination.

The diagnosis of any sexual disorder begins with taking a medical history
and performing a physical exam. The common causes of sexual disorders
are tested, such as diabetes, heart disease, or gland disorders. Blood and
urine tests are used to analyze the presence of hormones and to determine
the chromosomal gender. Any irregularities in hormonal or chromosomal
balance would indicate a disorder. The effort would be made to identify
and treat any underlying medical conditions. Many times the sexual disorder
disappears when treatment for the underlying condition is effective.
Hormonal imbalances indicate the need for diagnosis and treatment of
any disorders in the glands producing the hormone.
The beginning of the search for a diagnosis is a complete
history and a physical exam. A hormonal imbalance in men would be recognized
by feminine characteristics such as a high-pitched voice, and legs
and arms might be unusually large for the patient’s age. Other symptoms
include physical size below average for age in muscles and sexual organs.
For women, a hormonal imbalance would be recognized by a large clitoris
resembling a penis and a missing or malformed vagina.
For someone suspected of having an intersex condition because the
sexual organs are not clearly male or female, a series of tests should be conducted.
Blood tests would reveal the chromosomal gender. Sexual organs
that are not in the genital area, such as testes that have not descended,
can be detected by x-rays or ultrasound* imaging of the pelvic area.
Amniocentesis, which is the analysis of fluids drawn from the uterus of a
pregnant woman, can indicate developmental abnormalities of the fetus
and the irregular presence of sex hormones.

DIAGNOSIS

The diagnosis for sexual dysfunction in men and women begins with
a medical history and a physical exam for general physical health. Any
problems with blood flow can be identified through testing the blood
pressure in the legs. Any problems with the nerves in the penile area can
be detected through rectal exams, which would indicate if the nerves
in that area are healthy and fully functional. Problems with hormonal
imbalance can be indicated through blood tests. The nature of female
sexual disorders needs to be diagnosed by focusing on the specific cause.
Endometriosis is identified through a series of tests. An ultrasound of the
area can present visual evidence of the effects of endometriosis. A blood
test analyzes the presence of a blood protein common in women with
endometriosis. For men and women the doctor should do blood tests for
specific diseases associated with sexual dysfunction.

Treatment focuses on resolving the specific complaint of
patients with pathophysiological sexual disorder. Two well-known treatments
are hormonal replacement therapy and sex reassignment surgery.
Hormone replacement therapy involves prescribing synthetic hormones
to imitate the effects of the normal hormonal levels. For men the synthetic
hormone replaces testosterone; for women, the synthetic hormone
replaces estrogen. For men and women, this treatment is fairly effective,
but not without complications. Testosterone replacement in men is associated
with liver disorders. Estrogen replacement in women contributes
to higher risks of breast cancer.
Through much of the 20th century, doctors recommended sex reassignment
operations at an early age, based on the assumption that young children
can adapt to the reassigned sex and experience little trauma and discontinuity
in development. Advocates also felt that early reassignment increased the
effectiveness of parent/child bonding as the parents would know to treat the
child as a member of the reassigned sex. The child would grow up knowing
to accept the gender role of the reassigned sex. For this to be effective, the
parents had to be strong in their decision from the start and had to continue
with that decision through consistent behavior for the rest of the child’s life.
Arguing for the contrary point of view is the case of David Reimer.
David lived a traumatic childhood, partly because he thought he was a
girl but did not feel like a girl. Once David found out that he was born
male, he changed his life to live as a man, but he was unhappy and died
early as a suicide. The Reimer case led to more criticism of early surgical
sex reassignment for ambiguous genitalia and other physiological conditions
of intersex. Critics point out that structural changes made surgically
do not affect genetic composition.
Many serious studies of sex reassignment have found that most of the
affected people do not adjust well. As much as possible, these individuals
should be recognized by their chromosomal gender. If the chromosomal
gender is clearly identified, minor operations may be done to reduce genital
abnormalities. Also, if the sexual disorder is influenced by hormonal
deficiencies, the doctor may recommend hormone treatments. If gender
clarification surgery is necessary later in life, it should be at a time when
affected individuals can have a voice in the decision making.

Pathophysiological problems need a medical response.
However, no matter what the cause, there are always psychological implications.
The usual brain-to-body communication is interrupted throughthe physical disorder. The need to reestablish the connection may requirepsychotherapy.
However, whereas most sexual disorders have a psychologicalcomponent, without identifying and treating the physical cause,psychotherapy alone would not be effective.