Sexual dysfunction has many faces: libido is greatly reduced, pain during sexual intercourse occurs, orgasm cannot be properly experienced. In addition, erectile dysfunction or premature ejaculation are often at play. But in the search to find the triggers, researchers often find multiple interfering factors.
It may perhaps be metabolic diseases, as the working group of Stacy Tessler Lindau, University of Chicago, found out on the basis of a study of 2000 diabetic patients between 57 and 85 years of age. The respondents often indicated having problems with orgasm, particularly where men and erections are involved. Nevertheless, only one in five diabetic females and one in two male diabetic patients confided in a doctor – the issue still seems to be afflicted with a certain taboo. All the more reaso for researchers and medical practitioners to pursue it, say the authors of the paper.
Obesity in particular leads to decreased sexual activity, says a French study. A research group led by Nathalie Bajos, with this topic in mind, interviewed 12 000 adults. While actually not so surprising, the researchers nevertheless came to a remarkable additional finding: Obese people practise contraception, on average, less conscientiously and – amazing! – significantly more unwanted pregnancies and abortions arise with this. However many a drug may also be responsible for a slump in bed.
A desire-blocker straight from the pack
The previously largest German study on this issue pursued the question of how prevalent sexual dysfunction is among young women. Doctors at the Eberhard-Karls-University Tuebingen interviewed, together with colleagues from Heidelberg and Basel, about 1,000 female medical students using a questionnaire revolving around a Female Sexual Function Index. The result: About 34 percent had risk factors for sexual dysfunction – hormonal contraceptives in particular led to a marked decrease in libido in comparison to other contraceptive methods. Also, employment and family issues, or rather the stress associated with them, proved to be harmful to love-life.
Rid of depression, away with libido
But the “pill” is not the only lust killer: psychotropic-type drugs such as those known as selective serotonin-reuptake inhibitors (SSRIs) have this property, as much with women as with men. Symptoms are primarily significantly decreased libido, difficulty in experiencing a satisfying orgasm, erection problems or feelings of dryness in the vagina. When approving the respective medication, little notice is given to the fact that, as experts’ estimates indicate, perhaps up to 60 percent of all patients suffer from these disorders. Even after stopping use of the drugs, the effect often persists for months or years. Given the still rather inaccurate body of data, psychiatrists are now calling for larger studies. At the very least the effects can in animal modelling now be demonstrate scientifically. In it, scientists examined the influence of the commonly prescribed SSRIs fluoxetine on rats. Even after stopping the administrations, their sexual dysfunction did not disappear. Rather, functional changes were verified in areas of the brain stem, in the so-called raphe nuclei.
Any man can …
Something else which can however also possibly be hiding behind erectile dysfunction is respiratory arrest which occurs during sleep. In one study, researchers in Regensburg and Munich studied 400 patients. The distinct correlation: Whoever suffers from sleep apnea also has, in 70 percent of cases, erectile dysfunction. The more severe the hypoxia was, the more pronounced appeared also to be the sexual affliction. In the same age comparison group without nocturnal breathing interruptions, only 35 percent had the same dysfunction. Researchers at the University of Regensburg attribute this to endothelial and hormonal processes, triggered by too little oxygen.
Erectile dysfunction is today no longer just mere destiny: Since the introduction of phosphodiesterase-5 inhibitors, multiple studies show that over 80 percent of all those afflicted can be treated. Drug companies have, after the success of these agents, been working on better galenics: Vardenafil is now also available as a soluble tablet – the result of findings from an acceptability study. Therefore, according to the developers, spontaneous sexuality is again possible. In contrast to the classical formulations, patients participating in double-blind randomised studies POTENT I and POTENT II – nomen est omen – value discrete intake of it without water as well as the rapid onset of effect. Apart from that, the action profile is the same as familiar old tablets.
Nevertheless good ol’ money is the central focus here too: While medical practitioners in Germany can restore their accounts for all services rendered on behalf of insured persons for the diagnosis of erectile dysfunction itself, the patients themselves have to pay for the actual drugs. New companies are soon to conquer the market – next year a generic sildenafil will be available. For one small group this helps little: statistically speaking, treatment with PDE-5 inhibitors or vasoactive drugs such as alprostadil fails for about five percent of patients with erectile dysfunction. There remains thereafter only one way to get a handle on the matter: andrologists have now developed flexible or hydraulic penile implants, in order to help out here.
Too quick to the finish line
There are other problems with “him”: If the time until ejaculation is under two minutes, andrologists categorise it as premature ejaculation (Ejaculatio praecox). Men remain silent about it with embarrassing concern, and therefore practitioners should, in the course of screening, address the problem in a concrete manner, urge specialists. One can actually do something about it: The short-acting serotonin-reuptake inhibitor dapoxetine increases the time until release to three and a half minutes, where without medication it only amounted to a minute. A recently published review article attests to the substance’s quite good properties.
It does not always have to be a pill
If an absence of libido is nonetheless the underlying reason for the disturbed sexual dysfunction, drugs help very little. And so Andrea Bradford and Cindy Meston, of the University of Texas in Austin, USA, attach precious little value to aphrodisiacs – with good grounds of evidence: They gave 50 patients who suffered from a lack of sexual arousal a placebo. Under the sham treatment, sexual satisfaction improved in about one third – a figure which, via discussion therapy, was able to be increased further. The authors see the key relevant interferences in psychological factors such as stress, peer pressure or feelings of shame in relation to the partner. Therefore the proposition of discussions should take first place, even ahead of drug administration, they postulate.