Female and Male Sexual Dysfunction
... that interfere with penetration, and noncoital sexual pain as genital pain following stimulation during foreplay. The Types of MSD Extensive research has been written about erectile dysfunction (ED). ED is the inability to attain or to maintain an erection until completion of the sexual activity (Heiman, 2003). Heiman (2003) writes that ED is a common complaint and that its prevalence increases with age. On the other hand, the lack of an orgasm or male orgasmic disorder is uncommon for 8.3% of men reporting this as a problem in one study (Heiman, 2003). The most common type of MSD is premature ejaculation which is defined as the “persistent or recurrent ejaculation with minimal sexual stimulation before, on or shortly after penetration and before the person wishes it” (Heiman, 2003, p. 76). The statistics in this paragraph does not represent the male gay community. In gay men, inhibited sexual excitement is the most frequent type of MSD (Bhugra & Wrigth, 1995). The second most frequent MSD is inhibited male orgasm followed by inhibited sexual excitement and premature ejaculation (Bhugra & Wrigth, 1995). In a study consisting of 500 single gay men, 50% had arousal phase disorder; however, in an in-depth study of 22 gay male couples, 45% complained of ED (Bhugra & Wrigth, 1995). The statistics implies that there is a high prevalence rate of ED in gay men. The causes of FSD and MSD The prevalence of MSD and FSD that actually meet the DSMIV criteria is “lower and less well established by large scale population-based studies” (Heiman, 1999, p. 1). Additionally, the “epidemiological, etiological, and health associations to sexual dysfunction have only begun to be explored” (Heiman, 1999, p. 1). For these reasons, causes of FSD and MSD are speculative and yet specific to the select populations studied. Nonetheless, the (NHSLS) and the Massachusetts Male Aging Study (MMAS) purports that FSD and MSD are highly related to physiological and psychological (Heiman, 2003). These factors have been consistently identified as causes of FSD and MSD in both non-gay women and men and gay women and men. Unlike men, women sexual problems decrease with age as long as they do not concern lubrication or vaginal dryness (Heiman, 2002). FSD that due to menopause increases with age because menopause is responsible for reduced sexual function (Greendale, Lee, & Arriola, 1999). Heiman (2002) also reports that decreased household income is associated with FSD. Additionally, health problems such as urinary tract infection are associated with sexual arousal disorder and so is adult-child sexual contact or male sexual force (Heiman, 2002). The latter is also associated with hypoactive desire disorder (Heiman, 2002). There is a relationship between social status variables and pain disorder according to Heiman (2002). Unfortunately, clinical research and basic science is lacking to obtain better information on the physiological and psychological factors that influence FSD (Goldstein, 2000). On the other hand, research shows that age is a significant factor in ED because ED increases with age (Heiman, 2002). Additionally, Heiman (2002) and Carson (2002) agree that MSD indicators of ED are cardiovascular disease, diabetes, disease-related medications, cigarette smoking, depression, and anger. Heiman (2002) also contends that urinary track infections, social status, being sexually touched before puberty, and sexually forcing a woman to have sex are associated with ED. Premature ejaculation on the other hand is reported to be associated with liberal sexual attitudes and same-sex sexual activity (Heiman, 2002). The latter is also associated with low sexual desire disorder (Heiman, 2002). Lastly, MSD is more associated with health problems than anything else (Heiman, 2002). Although MSD is the same for gay men and non gay men some of the causes of it can differ (Bhugra & Wright, 1995). Research shows that gay men experience MSD due to anxiety from their sexual orientation (Bell, 1999). For gay men, MSD can be reached once their ‘manhood’ is lost or questioned (Bhugra & Wright, 995). Bhugra & Wright (2003) states that within the male community, manhood has to be won and thus pressure exists especially when one questions his sexual identity. The assumption is that it is not won if it is still being questioned. Bhugra & Wright (1995) also contend that when a gay man is trying to come to terms with his sexual identity, his masculinity is conditional; therefore, causing anxiety. Anxiety can cause MSD. Heiman (2002) contends that MSD is associated with same sex sexual activity and just as with women, higher education is associated with less dysfunction (Heiman, 2002). FSD and MSD Treatment Options One of the first defenses against FSD and MSD is education (Heiman, 2002). Education on lifestyle issues that effect FSD and MSD such as smoking, alcohol consumption, reduction in fat and cholesterol, exercise, improvement and compliance with cardiovascular and diabetic medications, stress reduction, depression treatment, can prevent or reduce FSD and MSD (Heiman, 2002). Education using the media so far is responsible for informing the public about FSD and MSD informing the world about treatment (Carson, 2002). Sildenafil also known as Viagra has shown to be the effective pharmocologic treatment for MSD and in some instances FSD (Carson, 2002). Viagra prescriptions increased 438% (Carson, 2002). Education is not only good for the public but also for physicians. In a study, 71 percent of patients reported that physicians would not recognize ED as a medical condition and 68% of the patients reported that they did not inform their physician about their sexual problems due to not wanting to embarrass them (Carson, 2002). Nonetheless, education has proven to be an effective treatment method women and men should know how to get help for their sexual dysfunctions. To diagnose FSD, Goldstein (2000) writes that a history, physical examination, psychologic interview, and laboratory testing is conducted. In terms of treating FSD, Heiman (2002) contends that there is no effective pharmacological agent for hypoactive sexual desire disorder women. This is the contention although research shows that testosterone can be an effective treatment for this type of problem (Heiman, 2002). To further support this notion, Goldstein (2000) contends that estrogen and/or androgen replacement hormonal therapy may be useful in treating all FSD. Moreover, estrogen applications can relieve vaginal dryness, burning during intercourse, improved clitoral sensitivity, increases in libido, and decreased pain. Women can also use vaginal lubricants, vaginal dilators, and pelvic floor rehabilitation (Goldstein, 2000). Charters (1998) reports that a hormone therapy combination of testosterone and estrogen is effective in maintaining sexual arousal. Sexual arousal disorder in females can also be treated with Viagra but it is unclear whether or not Viagra is good for specific subgroups because in studies, there was no significant difference between women sexual response to Viagra when compared to a placebo (Heiman, 2002). Heiman (2002) believes that pharmacological agents should be compared to and combined with psychological treatments because of the lack of genital focus of women in treating female sexual arousal disorder. The most effective approach for women to have an orgasm thus far is through masturbation (Heiman, 2002). In addition to the aforementioned treatment options, Fourcroy (2003, p. 1445) writes there are six major pharmaceutical therapeutic paths being pursued for treatment of FSD to include “dopaminergic agonists and related substances, melanocortin-stimulating hormones, adrenoceptors antagonists, ni...