SEXUAL DYSFUNCTION

• Sexual dysfunction


  Difficulty experienced by individual or couple during any stage of normal sexual activity, including physical pleasure, desire, preference, arousal, or orgasm
• Sexual desire disorders


  Lack or absence, for some period of time, of sexual desire or libido for sexual activity
• Sexual arousal disorders


  Previously known as frigidity in women and impotence in men, though these have now been replaced with less judgmental terms
• Erectile dysfunction (ED)


  Sexual dysfunction characterized by the inability to develop or maintain an erection of the penis
• Premature ejaculation


  Ejaculation occurs before the partner achieves orgasm (<2 minutes from the time of the insertion of the penis), or a mutually satisfactory length of time has passed during intercourse
• Orgasm disorders


  Persistent delays or absence of orgasm following a normal sexual excitement phase in sexual encounters
• Sexual pain disorders


  • Dyspareunia (painful intercourse)
  • Vaginismus (an involuntary spasm of the vaginal wall muscles)
  • Vulvodynia or Vulvar Vestibulitis (burning pain during sexual intercourse)
• Post-orgasmic diseases


  • Post-Coital Tristesse (feeling of melancholy and anxiety after sexual intercourse)
  • Sexual Headaches
  • Post-orgasmic Illness Syndrome (severe muscle pain throughout the body and other symptoms immediately following ejaculation)
  • Dhat Syndrome (anxious and dysphoric mood after sex)
• Pelvic floor dysfunction


  The underlying cause of sexual dysfunction in both women and men, treatable by physical therapy
• Amy Newman is a 37-year-old woman attending a subfertility clinic. She has been married for 5 years and has two boys, 3 and 5 years old. She and her husband, Ross (40 years), had planned on having three children. Because they were married when they were both 32, they planned on having them close together. Amy has not been using a contraceptive for a year and a half and is concerned because she is apparently unable to conceive a third child.
• Infertility


  Inability to conceive & maintain a pregnancy after 12 months (6 months for woman older than 35 years old age) of unprotected sexual intercourse
• Primary infertility


  Infertility in a couple who have never had a child
• Secondary infertility


  The failure to conceive following a previous pregnancy
• Five categories of male causative factors for infertility

  • Endocrine
  • Spermatogenesis
  • Sperm antibodies
  • Sperm transport
  • Disorders of intercourse
• Endocrine causes of male infertility


  • Pituitary diseases
  • Pituitary tumors
  • Hypothalamic
• Effects of infertility


  • Personal suffering
  • Partners become more anxious to conceive, increasing sexual dysfunction
  • Marital discord often develops, especially when under pressure to make medical decisions
  • Women trying to conceive often have depression rates similar to women who have CVD or CA
  • Emotional stress and marital difficulties are greater in couples where infertility lies with the man
• In many cultures, the inability to conceive bears a stigma
• In closed social groups, a degree of rejection (or a sense of being rejected by the couple) may cause considerable anxiety and disappointment
• Causes of infertility


  • One third - are related to female factors alone
  • One third - to male factors alone
  • One third - to a combination of male and female factors
• Categories of male causative factors

  • Endocrine
  • Spermatogenesis
  • Sperm antibodies
  • Sperm transport
  • Disorders of intercourse
• Endocrine factors


  • Pituitary diseases
  • Pituitary tumors
  • Hypothalamic diseases
  • Low levels of luteinizing hormone (LH)
  • Low Follicle-Stimulating Hormone (FSH)
  • Low testosterone can decrease sperm production
• Spermatogenesis


  • The process in which mature functional sperm are formed
  • Several factors that can affect the development of mature sperm - also referred to as gonadotoxins
• Gonadotoxins


  • Drugs (e.g., chemotherapeutics, calcium channel blockers, heroin, alcohol, and nicotine)
  • Infections (e.g., prostatitis, sexually transmitted illnesses, and contracting mumps after puberty)
  • Systemic illness
  • Heat exposure: Prolonged heat exposure of testicles (e.g., use of hot tubs, wearing tight underwear, frequent bicycle riding)
  • Pesticides
  • Radiation to the pelvic region
• Sperm antibodies


  • An immunological reaction against the sperm that causes a decrease in sperm motility (movement of sperm)
  • Common after vasectomy reversal or testicular trauma
  • Antisperm Antibody (ASA) has been considered as an infertility cause in around 10–30% of infertile couples
  • In both men and women, ASA production is directed against surface antigens on sperm, which can interfere with sperm motility and transport through the female reproductive tract, inhibiting capacitation and acrosome reaction, impaired fertilization, influence on the implantation process, and impaired growth and development of the embryo
• Sperm transport factor


  Related to anatomy that might be missing or blocked, thus interfering with the transportation of sperm
• Causes of sperm transport factor

  • Vasectomy
  • Prostatectomy
  • Inguinal hernia
  • Congenital absence of the vas deferens
• Disorders of intercourse

  • Erectile dysfunction
  • Ejaculatory dysfunctions
  • Anatomical abnormalities
  • Psychosocial factors
• Categories of female causative factors

  • Ovulatory dysfunction
  • Tubal & pelvic pathology
  • Cervical mucus factor
• Ovulatory dysfunction


  • Includes anovulation or inconsistent ovulation
  • Affect 15%–25% of couples experiencing infertility and have a very high success rate with appropriate treatment
• Tubal and pelvic pathology


  • Damage to the fallopian tubes - related to previous (PID) pelvic inflammatory disease or endometriosis
  • Uterine fibroids - benign growths of the muscular wall of the uterus, which can cause a narrowing of the uterine cavity & interfere with embryonic & fetal development, causing a spontaneous abortion
• Cervical mucus factors


  • Cervical surgeries such as cryotherapy a medical intervention used to treat cervical dysplasia
  • Infection
• Risk Factors for Women Infertility

  • Autoimmune disorders
  • Diabetes
  • Eating disorders or poor nutrition
  • Excessive alcohol drinking
  • Excessive exercising
  • Obesity
  • Older age
  • Sexually transmitted infections
• Risk Factors for Men Infertility

  • Environmental pollutants
  • Heavy use of alcohol, marijuana, or cocaine
  • Impotence
  • Older age
  • Sexually Transmitted Infections
  • Smoking
• Gynecologist


  Provided the initial screening for the female partner; (history, physical examination, and pelvic examination)
• Urologist


  Provided the initial screening for the male partner that includes history and physical exam
• The couple may be referred to a reproductive specialist after this initial screening
• Common Diagnostic Tests


  • Screening for sexually transmitted illnesses (STIs)
  • Laboratory test to assess hormonal levels (TSH, FSH, LH, and testosterone)
  • Semen analysis
  • Assessing for ovulatory dysfunction
  • Endometrial biopsy
  • Laparoscopy
  • Hysterosalpingogram
• Semen analysis


  • Male partner abstains for 2–3 days before providing a masturbated sample of semen
  • Specimens are collected at the site of testing or brought to the site within an hour of collection
  • Semen analysis includes volume, sperm concentration, motility, morphology, WBC, immunobead, & mixed agglutination reaction test
  • Several semen analyses may be required because sperm production normally fluctuates
• Basal body temperature (BBT)


  • A female takes her temperature each morning before rising using a basal thermometer & records her daily temperature
  • Ovulation occurred if there is a rise in the temperature by 0.4°F for 3 consecutive days
• Detecting LH surge


  A rapid increase in LH 36 hours before ovulation that is referred to as the LH surge, can be tested with urine or serum