Psychopharmacology: Sexual Dysfunctions

The list of causes or differential diagnoses of sexual dysfunction is quite extensive, but Gabbard’s doesn’t go into much detail on this topic. For this week’s discussion, research potential causes and differential diagnoses of sexual dysfunction and provide a thorough listing of your findings. This will likely include factors in categories like medical, psychiatric, psychosocial, pharmacotherapy, among other categories. Also discuss psychiatric medications that are implicated in sexual dysfunction, those that can improve sexual dysfunction, as well as non-psychiatric medications that are used to treat sexual dysfunction.

Answer

Sexual Dysfunction.

Sex is an integral part of human life, and sexual satisfaction usually leads to a good quality of life, while the reverse is true. The neurological, vascular, and endocrine systems coordinate sexual function because it is a complex bio-psycho-social process. Physical, biological, social, and emotional factors all play together in the sexual act. Notably, the sexual cycle, including excitement, plateau, orgasm, and resolution, must be attained for sexual satisfaction.

Sexual dysfunction, therefore, is any problem that occurs during any phase of the sexual cycle that prevents the couple from getting satisfactory sexual activity. Disorders of sexual dysfunction can be grouped as desire, orgasmic, arousal, and pain disorders. Desire disorders are characterized by the failure of urge or interest to engage in sexual activity (Avasthi et al., 2017). Besides, in arousal disorders, the genitals fail to respond to the urge. Orgasmic disorders are where one fails to reach a climax or reaches climax more quickly than the other partner. Finally, pain disorders are associated with discomfort during sexual activity. Moreover, erectile dysfunction is the most common form of sexual dysfunction in men, while arousal disorders, orgasmic disorder, and vaginal dryness due to inadequate lubrication are the common forms of sexual dysfunction in women.

Causes of Sexual Dysfunction

The causes of sexual dysfunction can be medical, psychiatric, psychosocial, and pharmacological. Diabetes mellitus, hypertension, obesity, dyslipidemia, cardiovascular diseases are some of the medical causes of sexual dysfunction. These conditions either interfere with the nerve or blood supply to the genital organs leading to their dysfunction. Among the psychiatric conditions that cause sexual dysfunction include depression, anxiety, eating disorders, and borderline personality disorders. These conditions promote impairment of the interpersonal relationships necessary for satisfactory engagement in sexual activity.

Besides, marital or relationship problems, feelings of guilt, concerns about one’s body image, stress and anxiety related to one’s work, substance abuse, and the effects of past sexual trauma like rape are some of the psychosocial causes of sexual dysfunction (Sathyanarayana Rao et al., 2018). These factors will interfere with the desire, arousal, and even orgasm leading to sexual dysfunction. Antihypertensive drugs like thiazides and spironolactone, alcohol, amphetamines, barbiturates, methadone, tricyclic antidepressants such as amitryptiline, first-generation antipsychotics, and selective serotonin reuptake inhibitors (SSRIs) antidepressants are some of the drugs implicated in sexual dysfunction. Alcohol, for example, decreases sexual desires by increasing the production of inhibins. These drugs can also cause delayed orgasm and ejaculation.

Differential Diagnosis of Sexual Dysfunction

According to McMahon (2019), the differential diagnoses include loss of libido, hypogonadism, depression, and psychological conditions.

Management of Sexual Dysfunction

As much as some psychiatric drugs are implicated in sexual dysfunction, some drugs can be used as substitutes and help improve sexual function. Second-generation antipsychotics, bupropion, mirtazapine, reboxetine, and nefazodone are some of them. Non- psychiatric medications can also be used to manage sexual dysfunction. In men, phosphodiesterase -5 inhibitors such as tadalafil, sildenafil, avanafil, and vardenafil, vasoactive intracavernosal injections with papaverine, vasoactive intestinal peptide, forskolin and alprostadil, intraurethral therapy with alprostadil and transdermal therapy with testosterone and nitroglycerine can be used (Avasthi et al., 2017). These drugs promote improved blood flow to the penis treating erectile dysfunction. Estrogen therapy can be used in women. Besides, non-pharmacological methods, including psychosocial education and physical activity, are applicable in managing sexual dysfunction.

Conclusion

Sexual dysfunction is a prevalent condition in the population, yet it is less frequently discussed due to stigma. The causes are multifactorial ranging from medical, psychiatric, psychosocial to pharmacological. The four types of sexual dysfunction include desire, arousal, orgasmic, and pain disorders. A multimodal approach should be adopted in the management of the condition where both pharmacological and non-pharmacological methods are applied.

References

Avasthi, A., Grover, S., & Sathyanarayana Rao, T. S. (2017). Clinical practice guidelines for the management of sexual dysfunction. Indian Journal of Psychiatry59(Suppl 1), S91–S115. https://doi.org/10.4103/0019-5545.196977

McMahon, C. G. (2019). Current diagnosis and management of erectile dysfunction. The Medical Journal of Australia210(10), 469–476. https://doi.org/10.5694/mja2.50167

Sathyanarayana Rao, T. S., Maheshwari, S., George, M., Chandran, S., Manohar, S., & Rao, S. S. (2018). Psychosocial interventions for sexual dysfunction in addictive disorders. Indian Journal of Psychiatry60(Suppl 4), S506–S509. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_37_18

Sooriyamoorthy, T., & Leslie, S. W. (2022). Erectile Dysfunction. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK562253/

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