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from fundamentalist
religious movements which forbid women to discuss matters of
the groin to scientific experts who have always claimed “it’s
all in your head”.
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“I’m not in the
mood”
“After the surgery,
it just doesn’t feel the same”
“I can’t get turned
on like I used to”
“It hurts when I
have sex sometimes” |
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Female sexuality has only until recently been placed on the
shelf of medical and scientific priorities for understanding
and development. What greater behavior and aspect of human
nature could be more important than sexuality? Though women
have made incredible strides in political and professional
fields alongside their male counterparts in the recent past,
an understanding of the complex mechanisms governing their
sexuality has largely remained behind.
Until now.
The advent and revolution of
understanding female sexuality can be attributed in
large part to what Viagra has done for male sexuality:
a clinical and scientific study and understanding of
sexual response.
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Though later to the party than their male counterparts, female
sexual medicine is now undergoing a renaissance due largely to
recent advances in clinical and basic science research in both
conventional as well as alternative medicine. Our increased
focus on health maintenance and wellness are placing diet,
stress management, and psychosexual health as critical factors
to maintaining health as medication and surgery. The
information age that we live in will no doubt pummel us with
information on diet, drugs, and exercise, but also tips on
enhancing our sexual health as well.
WHAT IS A SEXUAL DISORDER?
It is estimated that up
to 40 million women in America suffer from some form of sexual
complaint, either in the form of decreased libido, arousal
disorder, or orgasmic dysfunction. (Or any combination of the
above).
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The most common
complaints that bring a patient to the office include:
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Lack of desire, or decreased libido
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Inability to sustain arousal, such as genital lubrication
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Unable to reach orgasm after sufficient stimulation and
arousal
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Pain during intercourse
Because the range of
these symptoms are highly variable within the individual, a
set of definitions for classifying and studying these
complaints are as follows:
Hypoactive Sexual Desire Disorder
According to the Sexual
Function Health Council of the America Foundation for Urologic
Disease, hypoactive sexual desire disorder is defined as a
lack of desire that causes concern and distress for the woman.
Up to 35-60% of complaints fall within this category. Loss of
desire and decreased libido are common presentations that a
patient will bring up either during a sexual health
consultation, or even a routine health checkup.
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What are the causes of Sexual Dysfunction?
To say that the causes
are complex would be an understatement. There is sufficient
evidence that complex emotional, medical and hormonal factors
may be responsible.
Emotional Causes:
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Depression is often cited as the most frequent cause of
decreased interest in daily activities, with sexual desire
topping the list.
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Chronic stress triggers the fight or flight cascade, and the
resulting mental and physical changes will shut off the
desire for intimacy.
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Relationship issues leading to anger or resentment can
frequently cause communication and intimacy problems.
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Histories of sexual assault or sexual abuse are examples of
post-traumatic stress disorders that can lead to problems
with sexual desire.
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Medical:
Drugs that cause diminished libido:
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Antidepressants—SSRIs (Prozac-like) and Tricyclics (Elavil)
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Antihypertensive—Calcium Channel blockers, Beta
blockers
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Anti-ulcer—Tagemet, Pepcid
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Sedative—Valium like drugs
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Anti-psychotic agents—Haldol and other schizophrenic
agents
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Cholesterol lowering—Statins (Lipitor, Zocor)
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Oral Contraceptives
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And of course—TOBACCO AND ALCOHOL!!
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Hormonal:
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Testosterone, the hormone traditionally associated with male
virility, is also considered the primary hormone in women
for sexual desire. Though at an infant stage, preliminary
studies show that giving testosterone in postmenopausal
women can increase libido. The identical results have been
shown in women who are surgically menopausal via removal of
their uterus and ovaries.
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Endocrine disorders, particularly with the adrenal glands
that secrete the corticosteroids that form estrogen and
testosterone, can also give rise to the hormone problems
discussed above. Breastfeeding women are often observed to
have diminished sexual interest and desire, most likely
because the prolactin they produce shuts down the estrogen
pathway. NEXT
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