RISK FACTORS FOR FEMALE SEXUAL DYSFUNCTION
ANDROGEN INSUFFICIENCY
Circulating androgens are found in much higher concentrations than estrogens, and are involved in a variety of biochemical and physiological functions. Androgen insufficiency syndrome, characterized by low libido, decreased arousal, orgasm, motivation, lack of well being, fatigue, adequate estrogen level, and low androgen levels, is thought to be responsible for up to 30-50% of the cases of sexual dysfunction in women.
Numerous studies have described and clarified the effect of androgens in male sexuality. It is only recently, however, that studies have been performed to illustrate the equally important action of androgens on the sexual functioning of women. In women androgens act on a variety of organs ranging from the mammary gland to the uterus, oviducts, and vagina. Not only are androgens essential for reproductive development in women, but they are also vital to the production of estrogens, and for the maintenance of sexual libido. Androgens have a three-fold action on female sexual function. They (1) increase libido by providing the fuel for a woman’s psychosexual stimulation, (2) increase sensitivity and blood flow to the external genitalia, and (3) increase the intensity of sexual gratification.
Although androgens have been extensively studied, their role in sexual functioning is poorly understood. Recent investigations have implicated androgens as modulators of sexual desire, arousal, and orgasm in women. Thus, the lack of androgens have been implicated in mediating the symptoms of female sexual dysfunction. At the onset of menopause there is a dramatic decrease in circulating estrogen levels. However, recent studies show that androgen levels drop before menopause, following an age-related decline from peak levels. This unexplained, gradual decrease in androgens results in symptoms such as impaired sexual function, decreased well being, fatigue, and loss of bone mass, low libido and lack of desire for intimacy. Many women have been conditioned to believe that these symptoms are the result of aging, however these symptoms of female sexual dysfunction seem to have a physiologic basis: low androgen levels. Until recently, symptoms of androgen insufficiency were treated with psychoactive drugs and other therapeutic agents. Recent studies show that these symptoms can be quickly identified and treated with androgen supplementation.
DEPRESSION
Although circulatory and hormonal issues are important factors in sexual health, emotional issues also play a large role in the quality of sexual functioning. Specifically, depression often contributes to sexual problems and can intensify a dysfunction caused by medical issues.
Depression has long been shown to negatively affect sexual performance. It can reduce sexual drive and blunt sexual interest. Depression can reduce energy levels and make it more difficult to achieve optimal physical and sexual functioning. Becoming sexually aroused is difficult if the individual is feeling depressed. Fully enjoying sex may be impossible under these conditions.
Further complicating the effects of depression is the fact that many of the newer anti-depressants also have profound side effects that can negatively impact sexual abilities. Commonly used anti-depressants such as Prozac, Zoloft, Paxil and others can influence sexual abilities in a number of ways. This family of medications, known also as SSRI’s, can reduce sexual interest, decrease the ability to achieve erections, reduce vaginal lubrication, prohibit male ejaculation and diminish the capacity for orgasm in both men and women.
When fatigue and depression are present, a number of considerations may be worthwhile. Although it may limit spontaneity, enjoy sexual activities when you are well rested and refreshed. Many doctors, in fact, believe that sexual activities in the morning can be more satisfying. Nighttime oxygenation of the genitals and nocturnal erections often mean better sexual functioning earlier in the day. Later in the day, try a short nap before making love. If making love in the evening, try having sex before eating a heavy meal or before drinking alcohol. Maximize the effects of Viagra by taking it on an empty stomach when well rested.
Be realistic about your abilities and communicate these to your partner. Even for men, it’s OK not to be in the mood for sex or to realize that you are too tired at the present time. If you are not in the mood for sex don’t try to fake it. Be sensitive, honest and clear about your needs and desires. Communicating these to your partner can reduce performance anxiety and lessen the chance that your sexual encounter will end in disappointment and frustration.
In summary, sexual dysfunction and depression go hand and hand. There is no reason to feel shame or embarrassment if you find yourself depressed. Such feelings are commonplace in today’s society. Untreated, depression however, can be self-defeating and potentially dangerous. Typically, counseling and medications either alone or in combination with one another are the most common and effective treatments of depression. These treatments can significantly improve appetite and sleep, restore energy and ultimately renew sexual interest.
ORAL/PATCH CONTRACEPTIVE USE
TREATMENT FOR INFERTILITY/ENDOMETRIOSIS/PAINFUL MENSTRUATION
CHILDBIRTH
ANTI-DEPRESANTS
BREAST CANCER SURVIVOR
POST-HYSTERECTOMY
PERI- OR POST-MENOPAUSE
CORONARY ARTERY DISEASE
DIABETES
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