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Sexual dysfunction 

Sexual dysfunction

Sexual dysfunction

Ian Eardley

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date: 28 April 2017

Male sexual dysfunction

Erectile dysfunction—the inability to attain or maintain an erection satisfactory for sexual intercourse. It affects about 50% of men over the age of 40 years and can be caused by neurological, vascular, endocrine, and psychiatric diseases, and by drugs, with psychogenic and organic risk factors coexisting in most men. Specific remedies can cure erectile dysfunction in a few patients: the mainstay of treatment in most will be oral therapy using a phosphodiesterase type 5 inhibitor.

Penile deformity—usually due to Peyronie’s disease: there is no licensed medical therapy and treatment is by surgical correction of any debilitating deformity.

Prolonged erection (priapism)—this is a medical emergency, requiring urgent therapy to prevent loss of erectile function. Most cases are caused by reduced venous drainage of the corpus cavernosum, most commonly due to intracavernosal injections, sickle cell disease, other hyperviscosity syndromes, or the use of some psychotropic drugs. Treatment initially involves aspiration via a wide bore cannula of enough blood to produce detumescence.

Premature ejaculation—a common but poorly understood condition that has no licensed medical therapies and is best treated with psychosexual therapy.

Female sexual dysfunction

Hypoactive sexual desire—may affect up to one-third of women under the age of 50 years: its aetiology is commonly multifactorial, including complex interaction with relationship issues, and the motivation for and success of treatment is low.

Sexual arousal disorders—affect up to one-quarter of women and may be caused by psychological or physical factors: treatment is directed towards the predominant aetiological issues.

Anorgasmia—reported by up to 37% of women in association with many psychological and cultural influences: therapy is primarily psychosexual, particularly when the problem is lifelong.

Dyspareunia—reported by up to 15% of sexually active women and can be caused by organic, psychological, or couple-related factors. Vaginismus affects less than 1%, with vulvar vestibulitis the most common cause: treatment is often unsatisfactory.

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