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RECOGNIZE WHAT IS SEXUAL DISFUNCTION
Wed, 29 Jun 2022
Sexual dysfunction is the inability of an individual / person to carry out intercourse as expected, due to the failure of the physiological responses needed for effective sexual interaction or the inability to control or experience orgasm. Sexual dysfunction can be found in men and women, in husband and wife it can also be in both husband and wife together as a cause and effect.
According to the Guidelines for Classification and Diagnosis of Mental Disorders edition III, sexual dysfunction is divided into several groups, namely:
1. Lack or Loss of Sexual Appetite
Loss of sexual desire is a major problem and is not secondary to other sexual difficulties, such as erectile failure or dysareunia. Reduced sexual desire does not get rid of sexual pleasure or arousal, but causes a reduction in early sexual activity.
This disorder includes hypoactive sexual desire disorder, which is characterized by a deficiency or absence of sexual fantasies and desire for sexual activity. Hypoactive sexual desire disorder is more common than sexual aversion disorder, and is more common in women than men.
2. Rejection and Lack of Sexual Pleasure
Refusal when having sex is accompanied by negative feelings, which cause feelings of fear and anxiety so that sexual activity is avoided. While the lack of sexual pleasure, even though sexual intercourse is running normally, orgasm can still be achieved but it does not bring pleasure.
Usually more common in women than men.
3. Failure of genital response
In men, the main problem is erectile dysfunction, such as difficulty getting or maintaining an erection adequate for satisfactory intercourse. When erections occur normally in certain situations, such as during masturbation or at bedtime, the cause is usually psychogenic. In women, the main problem is vaginal dryness or failure to lubricate. The cause can be psychogenic or pathological or estrogen deficiency.
Erectile dysfunction is the inability of a man to get an erection and/or maintain an erection until the end of coitus. This disorder used to be called impotence. A man with lifelong erectile dysfunction is never able to get an erection sufficient for insertion into the vagina. In male erectile disorders that are acquired, a man has managed to penetrate the vagina at one time in his sexual life, but is unable to do so later in life. In situational erectile dysfunction, a man is able to have sexual intercourse in certain situations, but cannot do so in others.
Basically, erectile dysfunction is divided into 2 (two) factors, namely psychological and organic.
1. Psychological factors are usually motivated by factors of saturation, irritation, disappointment, loss of attraction to a partner, sexual trauma to the fear of failure triggered by a lack of self-confidence. The majority of sufferers of erectile dysfunction are caused by psychological factors, namely men of productive age.
2. Organic factors: erectile dysfunction is usually associated with diseases such as diabetes, hypertension, hypercholesterolemia, post-prostate surgery and narrowing of blood vessels. Age factors can also affect where the older the age the greater the risk of erectile dysfunction. The tendency of sufferers of erectile dysfunction caused by organic factors, namely men over the age of fifty years. As for the causes of erectile dysfunction in men, among others: blood vessel disorders, neurological disorders, drugs (such as psychotropic drugs, antidepressants (lithium), sedatives, and hormones), disorders of the penis, psychological problems that affect sexual arousal.
4. Orgasmic dysfunction
Namely orgasm that occurs very slowly or does not occur at all. It is more common in women. There are many things that can be the cause of a woman unable to reach orgasm, both organically and psychologically, including:
• Have experienced sexual violence or rape;
• tedious sexual activity;
• Taking drugs such as fluoxetine, paroxetine, or sertraline;
• Hormonal disease, menopause, or chronic disease that affects sexual desire;
• Diseases affecting the pelvic nerves eg multiple sclerosis, diabetic neuropathy and spinal cord injuries;
• Excessive fatigue and stress;
• Negative attitudes toward sex, usually from childhood or adolescence;
• Embarrassed to talk with partner about the type of stimulation or style that gives maximum pleasure;
• Disputes with your partner or lack of emotional attachment to them.
5. Premature ejaculation
Premature ejaculation is the release of semen (semen, sperm) at the time of orgasm. A clearer definition is the removal of sperm that is too early or too fast, takes place when the penis penetrates the vagina or ejaculates a few seconds after penetration. So, premature ejaculation is an event that releases sperm too quickly at the time of intromissi, and the man is unable to resist the urge to ejaculate in the vagina for a few seconds. This can happen before, during, or immediately after penetration, but before the man wants it. In general, premature ejaculation is caused by insecurity and lack of confidence.
Premature ejaculation is another form of impotence that is less severe. Another cause that is negative in cultural conditioning is the result of the man being too hasty and the first experience of hasty sex, for example coitus with prostitutes or coitus carried out by stealing opportunities accompanied by fear. Often premature ejaculation is associated with anxiety and guilt. Psychological causes such as guilt in the field of sex, perfectionism, unrealistic expectations in sex, hypersensitivity in interpersonal relationships and parent-child conflicts.
6. Vaginismus
Vaginismus is the contraction of the muscles of the outer third of the vagina which causes the vaginal canal to close, making it difficult for penile intromission or pain to occur.
In another very extraordinary event, the vaginal contractions were so intense, that the penis was pinched and 'trapped' so that it could not come out of the vagina. There is what is called the penis captivus. Events of vaginismus can occur spontaneously without realizing it, can be reflective when the penis penetrates, or during penile emotion (the testicles secrete semen) or occurs during a gynecological examination.
Because psychological and physical factors (mind and body) play an important role, the current therapy recommendations include pelvic muscle physiotherapy, medical drugs, psychotherapy, cognitive therapy about sexuality or a combination of the four therapies. Pelvic muscle physiotherapy alone can achieve healing in about 80 percent of cases. In a number of refractory cases (difficult to cure), injections of botox muscle relaxant solution (botulinum toxin) have shown effectiveness.
7. Dyspareunia
The term dyspareunia was once used in England only to refer to painful intercourse with organic causes. Dyspareunia means persistent or recurrent genital pain, related to sexual intercourse (the insertion of the penis into the vagina) or attempts to insert an object into the vagina (either partially or completely), which is self-complicated or causes discomfort. Other meanings of dyspareunia are the sensation of pain when the vagina is being or has been completely entered, the experience of pain during intercourse (sexual intercourse) and/or non-sexual pain with vaginal penetration, or genital pain experienced before, during, or after intercourse.
About 4% of 4100 married women experience dyspareunia, and 73% of them have a primary physical cause. In Indonesia, the number of dyspareunia is not known for certain considering socio-cultural barriers, some people are still taboo about discussing sex problems/problems, many women are reluctant to talk openly with their partners, especially to see a doctor. This is the biggest obstacle to case management.
8. Excessive sex drive
Men and women may occasionally complain of excessive sexual urges (hypersex) which is a problem in itself and usually occurs in late adolescence or young adulthood. If the condition is secondary to an affective disorder (F30-F39) or if it occurs at the onset of dementia (F00-F03). Included in this group are nymphomania and satyriasis.
9. YTT sexual dysfunction, not caused by organic disorders or diseases
This category includes sexual dysfunction that cannot be classified into the categories described above. Examples include people who experience the physiological components of sexual arousal and orgasm but report no erotic or even anesthetic sensations (orgasmic anhedonia). Women with conditions resembling premature ejaculation in men are also classified here.
Women who experience orgasm and desire multiple orgasms, but do not experience them can also be classified here. In addition, disorders of excessive dysfunction, rather than inhibition, such as masturbation or compulsive coitus (sex addiction), or those who experience genital pain when masturbating can be classified here. Other unspecified disorders are found in people who have more sexual fantasies that they feel are false or dysphoric, but the range of common sexual fantasies is very wide.
Diagnosis and treatment of sexual dysfunction requires the collaboration of several experts, such as urologists, obstetricians, endocrinologists, andrologists, neurologists, psychiatrists, and sexual therapists, in order to get the right diagnosis and treatment options. Sexual dysfunction treatment aims to address the main problem that causes sexual dysfunction. Therefore, the treatment of sexual dysfunction will be tailored to each cause. These treatments include:
Consumption of drugs with the approval of a doctor because it can cause interference with the work of the heart organ.
Psychological therapy is carried out by a psychologist or psychiatrist to help someone overcome psychological disorders that cause sexual dysfunction. An example is therapy to overcome anxiety, fear, or feelings of guilt that have an impact on the sufferer's sexual function.
In addition, the doctor or psychologist will provide an understanding of sex and sexual behavior to the patient. An understanding of sexual relations needs to be possessed by sufferers so that anxiety about their sexual abilities can be resolved.
Therapy sessions can also be done together with partners to find out about each other's needs and anxieties so that they can overcome obstacles in sexual activity.
For women with low estrogen levels, estrogen replacement therapy can be given to help vaginal elasticity by increasing blood flow and lubrication in the vagina. This therapy can be given in the form of a vaginal ring, cream, or tablet. As for men with low testosterone levels, doctors can give testosterone hormone therapy to increase testosterone levels in the body.
To treat sexual dysfunction due to a disease is to treat the underlying disease. For example, people with diabetes will be given metformin or insulin to control blood sugar levels.
To overcome sexual dysfunction, it is also necessary to apply a healthy lifestyle, such as exercising regularly and quitting smoking or drinking alcohol. This activity can help improve the quality of sexual activity.
Some assistive devices, such as pumps (vacuum) and vibrators, can help a woman or a man deal with sexual problems. Penile implant surgery is also sometimes considered to help men overcome erectile dysfunction.
To prevent the emergence of sexual dysfunction, you can change your behavior and lifestyle to be healthier, namely by quitting smoking and drinking alcohol, maintaining an ideal body weight, managing stress and anxiety well, undergoing rehabilitation to overcome drug abuse. Sexual dysfunction is also a part of the aging process, so it is sometimes difficult to avoid.
Author: dr. Fida Alawiyah (Medical Consultant Doctor PRAMITA Clinical Laboratory Jl. Sultan Abdurrahman No. 9A Pontianak)
According to the Guidelines for Classification and Diagnosis of Mental Disorders edition III, sexual dysfunction is divided into several groups, namely:
1. Lack or Loss of Sexual Appetite
Loss of sexual desire is a major problem and is not secondary to other sexual difficulties, such as erectile failure or dysareunia. Reduced sexual desire does not get rid of sexual pleasure or arousal, but causes a reduction in early sexual activity.
This disorder includes hypoactive sexual desire disorder, which is characterized by a deficiency or absence of sexual fantasies and desire for sexual activity. Hypoactive sexual desire disorder is more common than sexual aversion disorder, and is more common in women than men.
2. Rejection and Lack of Sexual Pleasure
Refusal when having sex is accompanied by negative feelings, which cause feelings of fear and anxiety so that sexual activity is avoided. While the lack of sexual pleasure, even though sexual intercourse is running normally, orgasm can still be achieved but it does not bring pleasure.
Usually more common in women than men.
3. Failure of genital response
In men, the main problem is erectile dysfunction, such as difficulty getting or maintaining an erection adequate for satisfactory intercourse. When erections occur normally in certain situations, such as during masturbation or at bedtime, the cause is usually psychogenic. In women, the main problem is vaginal dryness or failure to lubricate. The cause can be psychogenic or pathological or estrogen deficiency.
Erectile dysfunction is the inability of a man to get an erection and/or maintain an erection until the end of coitus. This disorder used to be called impotence. A man with lifelong erectile dysfunction is never able to get an erection sufficient for insertion into the vagina. In male erectile disorders that are acquired, a man has managed to penetrate the vagina at one time in his sexual life, but is unable to do so later in life. In situational erectile dysfunction, a man is able to have sexual intercourse in certain situations, but cannot do so in others.
Basically, erectile dysfunction is divided into 2 (two) factors, namely psychological and organic.
1. Psychological factors are usually motivated by factors of saturation, irritation, disappointment, loss of attraction to a partner, sexual trauma to the fear of failure triggered by a lack of self-confidence. The majority of sufferers of erectile dysfunction are caused by psychological factors, namely men of productive age.
2. Organic factors: erectile dysfunction is usually associated with diseases such as diabetes, hypertension, hypercholesterolemia, post-prostate surgery and narrowing of blood vessels. Age factors can also affect where the older the age the greater the risk of erectile dysfunction. The tendency of sufferers of erectile dysfunction caused by organic factors, namely men over the age of fifty years. As for the causes of erectile dysfunction in men, among others: blood vessel disorders, neurological disorders, drugs (such as psychotropic drugs, antidepressants (lithium), sedatives, and hormones), disorders of the penis, psychological problems that affect sexual arousal.
4. Orgasmic dysfunction
Namely orgasm that occurs very slowly or does not occur at all. It is more common in women. There are many things that can be the cause of a woman unable to reach orgasm, both organically and psychologically, including:
• Have experienced sexual violence or rape;
• tedious sexual activity;
• Taking drugs such as fluoxetine, paroxetine, or sertraline;
• Hormonal disease, menopause, or chronic disease that affects sexual desire;
• Diseases affecting the pelvic nerves eg multiple sclerosis, diabetic neuropathy and spinal cord injuries;
• Excessive fatigue and stress;
• Negative attitudes toward sex, usually from childhood or adolescence;
• Embarrassed to talk with partner about the type of stimulation or style that gives maximum pleasure;
• Disputes with your partner or lack of emotional attachment to them.
5. Premature ejaculation
Premature ejaculation is the release of semen (semen, sperm) at the time of orgasm. A clearer definition is the removal of sperm that is too early or too fast, takes place when the penis penetrates the vagina or ejaculates a few seconds after penetration. So, premature ejaculation is an event that releases sperm too quickly at the time of intromissi, and the man is unable to resist the urge to ejaculate in the vagina for a few seconds. This can happen before, during, or immediately after penetration, but before the man wants it. In general, premature ejaculation is caused by insecurity and lack of confidence.
Premature ejaculation is another form of impotence that is less severe. Another cause that is negative in cultural conditioning is the result of the man being too hasty and the first experience of hasty sex, for example coitus with prostitutes or coitus carried out by stealing opportunities accompanied by fear. Often premature ejaculation is associated with anxiety and guilt. Psychological causes such as guilt in the field of sex, perfectionism, unrealistic expectations in sex, hypersensitivity in interpersonal relationships and parent-child conflicts.
6. Vaginismus
Vaginismus is the contraction of the muscles of the outer third of the vagina which causes the vaginal canal to close, making it difficult for penile intromission or pain to occur.
In another very extraordinary event, the vaginal contractions were so intense, that the penis was pinched and 'trapped' so that it could not come out of the vagina. There is what is called the penis captivus. Events of vaginismus can occur spontaneously without realizing it, can be reflective when the penis penetrates, or during penile emotion (the testicles secrete semen) or occurs during a gynecological examination.
Because psychological and physical factors (mind and body) play an important role, the current therapy recommendations include pelvic muscle physiotherapy, medical drugs, psychotherapy, cognitive therapy about sexuality or a combination of the four therapies. Pelvic muscle physiotherapy alone can achieve healing in about 80 percent of cases. In a number of refractory cases (difficult to cure), injections of botox muscle relaxant solution (botulinum toxin) have shown effectiveness.
7. Dyspareunia
The term dyspareunia was once used in England only to refer to painful intercourse with organic causes. Dyspareunia means persistent or recurrent genital pain, related to sexual intercourse (the insertion of the penis into the vagina) or attempts to insert an object into the vagina (either partially or completely), which is self-complicated or causes discomfort. Other meanings of dyspareunia are the sensation of pain when the vagina is being or has been completely entered, the experience of pain during intercourse (sexual intercourse) and/or non-sexual pain with vaginal penetration, or genital pain experienced before, during, or after intercourse.
About 4% of 4100 married women experience dyspareunia, and 73% of them have a primary physical cause. In Indonesia, the number of dyspareunia is not known for certain considering socio-cultural barriers, some people are still taboo about discussing sex problems/problems, many women are reluctant to talk openly with their partners, especially to see a doctor. This is the biggest obstacle to case management.
8. Excessive sex drive
Men and women may occasionally complain of excessive sexual urges (hypersex) which is a problem in itself and usually occurs in late adolescence or young adulthood. If the condition is secondary to an affective disorder (F30-F39) or if it occurs at the onset of dementia (F00-F03). Included in this group are nymphomania and satyriasis.
9. YTT sexual dysfunction, not caused by organic disorders or diseases
This category includes sexual dysfunction that cannot be classified into the categories described above. Examples include people who experience the physiological components of sexual arousal and orgasm but report no erotic or even anesthetic sensations (orgasmic anhedonia). Women with conditions resembling premature ejaculation in men are also classified here.
Women who experience orgasm and desire multiple orgasms, but do not experience them can also be classified here. In addition, disorders of excessive dysfunction, rather than inhibition, such as masturbation or compulsive coitus (sex addiction), or those who experience genital pain when masturbating can be classified here. Other unspecified disorders are found in people who have more sexual fantasies that they feel are false or dysphoric, but the range of common sexual fantasies is very wide.
Diagnosis and treatment of sexual dysfunction requires the collaboration of several experts, such as urologists, obstetricians, endocrinologists, andrologists, neurologists, psychiatrists, and sexual therapists, in order to get the right diagnosis and treatment options. Sexual dysfunction treatment aims to address the main problem that causes sexual dysfunction. Therefore, the treatment of sexual dysfunction will be tailored to each cause. These treatments include:
- Drug consumption
Consumption of drugs with the approval of a doctor because it can cause interference with the work of the heart organ.
- Psychotherapy
Psychological therapy is carried out by a psychologist or psychiatrist to help someone overcome psychological disorders that cause sexual dysfunction. An example is therapy to overcome anxiety, fear, or feelings of guilt that have an impact on the sufferer's sexual function.
In addition, the doctor or psychologist will provide an understanding of sex and sexual behavior to the patient. An understanding of sexual relations needs to be possessed by sufferers so that anxiety about their sexual abilities can be resolved.
Therapy sessions can also be done together with partners to find out about each other's needs and anxieties so that they can overcome obstacles in sexual activity.
- Treatment for hormonal disorders
For women with low estrogen levels, estrogen replacement therapy can be given to help vaginal elasticity by increasing blood flow and lubrication in the vagina. This therapy can be given in the form of a vaginal ring, cream, or tablet. As for men with low testosterone levels, doctors can give testosterone hormone therapy to increase testosterone levels in the body.
- Treatment for physical problems
To treat sexual dysfunction due to a disease is to treat the underlying disease. For example, people with diabetes will be given metformin or insulin to control blood sugar levels.
- Lifestyle changes
To overcome sexual dysfunction, it is also necessary to apply a healthy lifestyle, such as exercising regularly and quitting smoking or drinking alcohol. This activity can help improve the quality of sexual activity.
Some assistive devices, such as pumps (vacuum) and vibrators, can help a woman or a man deal with sexual problems. Penile implant surgery is also sometimes considered to help men overcome erectile dysfunction.
To prevent the emergence of sexual dysfunction, you can change your behavior and lifestyle to be healthier, namely by quitting smoking and drinking alcohol, maintaining an ideal body weight, managing stress and anxiety well, undergoing rehabilitation to overcome drug abuse. Sexual dysfunction is also a part of the aging process, so it is sometimes difficult to avoid.
Author: dr. Fida Alawiyah (Medical Consultant Doctor PRAMITA Clinical Laboratory Jl. Sultan Abdurrahman No. 9A Pontianak)
