Introduction to Sexual Dysfunctions
Sexual dysfunctions refer to difficulties occurring during any stage of a sexual response cycle, which prevent the individual or a couple from enjoying the sexual activity and may cause clinically significant distress. A normal sexual response cycle usually includes excitement, plateau, orgasm, and resolution, any abnormalities of which can lead to sexual dysfunctions. Sexual dysfunctions are mainly divided into four categories: sexual desire disorders, arousal disorders, orgasm disorders, and pain disorders; and 10 subtypes have been described in the latest American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
Sexual dysfunctions can happen at all ages in men and women although the risks increase with aging. Both physical and psychological factors can cause sexual dysfunctions. Physical causes mainly result from various conditions, such as diabetes, heart disease, hormonal imbalance, chronic kidney disease, and alcoholism or drug abuse. Psychological factors or emotional factors are easily overlooked, including stress and anxiety, sexual trauma, depression, and other psychological problems.
Sexual Dysfunction: A Kind of Psychiatric Disorder
Sexual dysfunctions are much more prevalent among patients with psychiatric disorders, a kind of behavioral or mental pattern characterized by abnormalities in thoughts, cognition, emotion, and behaviors. It has been indicated that not only psychiatric psychopathology but also pharmacotherapy all contributed to sexual dysfunctions.
A normal sexual function requires the involvement of both peripheral autonomic and central nervous systems, and is mediated and influenced by a variety of endocrine factors, neurotransmitters, and neuropeptides. Neurotransmitters, such as dopamine, serotonin, epinephrine, norepinephrine, monoamine, and acetylcholine are potential targets associated with psychiatric psychopathology and treatment, which also have been demonstrated with sexual activities. Dopamine, a major neurotransmitter as well as a hormone in the central system, plays an essential role in mental functions, which also is a critical regulator in sexual motivation, copulation, genital reflexes, and erectile function. Anti-psychiatric drugs, such as thioridazine for the treatment of schizophrenia, cause deterioration in erectile and orgasmic function. And dopamine receptor agonists are widely used to arouse sexual behavior and for the treatment of erectile dysfunctions. Mental illness, especially depression and anxiety, is another commonly neglected pathogenic factors for sexual dysfunctions, and antidepressants selective serotonin reuptake inhibitors (SSRIs) can facilitate and aggravate the sexual dysfunction.
Current Treatment of Sexual Dysfunctions
Management of sexual dysfunction is individualized based on the cause of the disease, considering both physical and psychological factors. Lifestyle improvement is helpful for patients with smoke, drugs, or alcohol abuse. Hypoglycemic drugs and drugs that improve heart function are suitable for patients suffering from sexual dysfunction caused by diabetes and heart disease. For those sexual dysfunction patients who are caused by psychiatric disorders and anti-psychiatric treatment, psychological counseling, psychotherapies, and further medication is needed. Anti-psychiatric drugs, such as dopaminergic agonists, 5-HT2 antagonists, nitric oxide enhancers, and some second-generation antipsychotics also can be used to improve sexual function.
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