Fertility

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By NUH Women’s Centre

 

What is Sexual Dysfunction
Sexual dysfunction in men/women refers to disturbance in any component of the physiological sexual response cycle. Changes may be seen in desire, arousal, performance (particularly in men) and/or organism response. The common problems affecting males include erectile and ejaculating dysfunctions. In women, pain disorders such as vaginismus (involuntary muscle spasm of the vaginal wall preventing intercourse) and dyspareunia (painful intercourse) are significant concerns.

 

Symptoms of Sexual Dysfunction
Males:

  • Loss of libido / interest
  • Reduced arousal
  • Inability to attain an erection
  • Inability to maintain erection sufficient for intercourse
  • Delayed or absent ejaculation

Females:

  • Loss of libido / interest
  • Reduced arousal
  • Inadequate vaginal lubrication and dryness
  • Painful intercourse
  • Delayed or absent orgasm

In both: non-consummation; fertility concerns; marital disharmony; relationship issues

 

What causes Sexual Dysfunction?
Psychological
Anxiety, stress, interpersonal problems, fears, depression, early history of sexual abuse

 

Physical / organic

  • Vascular / neurological / metabolic problems - high blood pressure, high cholesterol, diabetes, atherosclerosis, obesity, aging related changes
  • Hormonal disturbances: menopause, andropause
  • Penile injuries, deformities (such as Peyronie's)
  • Prostatic, lower urinary tract problems
  • Prescription drugs, alcohol, smoking, substance abuse
  • Allergic reaction to soaps, creams, douches (in women)

How is Sexual Dysfunction treated
Treatment depends on the type of sexual dysfunction. Organic precipitating factors need to be appropriately treated.

 

For erectile dysfunction in men, the currently available drugs containing active compounds such as sildenafil, vardenafil or tadalafil are useful; these drugs act by increasing the blood flow to the penis through important cellular pathways. Other management options include intra-penile injections and vacuum devices.

 

For premature ejaculation - the common type of ejaculatory dysfunction (30%), topical anesthetic creams and certain centrally-acting drugs are useful.

 

Testosterone is helpful in improving desire and libido - both in men and women.

 

Women with vaginal dryness may find relief with topical gels and hormone containing creams. HRT is useful for post-menopausal women.

 

Couple therapy and counselling are other important management options.

 

Prevention

  • Identify and treat the predisposing conditions
  • Prevention and active management of hypertension, diabetes, obesity, hyperlipidemia and atherosclerosis
  • Choosing prescription drugs without sexual side effects
  • Avoiding alcohol, smoking and recreational drugs
  • Improving physical fitness
  • Lifestyle changes and stress management
  • Open communication, resolving conflicts and relationship issues

For more information, you may contact the Women's Clinic at
(65) 6772 2255 / 2277, or email us at Womens_Clinic@nuhs.edu.sg.

 

This featured article is contributed by the NUH Women’s Centre, National University Hospital. Please visit www.nuhgynae.com.sg to read more

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