Materiały źródłowe

• #1 The pathophysiology of hypoactive sexual desire disorder in women – PubMed

  https://pubmed.ncbi.nlm.nih.gov/20434725/

  Hypoactive sexual desire disorder (HSDD) is defined as a deficiency or absence of sexual fantasies and desire for sexual activity that causes marked distress or interpersonal difficulty. […] A number of potential causative and contributory factors to low sexual desire have been identified, reflecting the interplay among hormonal, neurobiological, and psychosocial factors. […] One theory is that sexual desire is controlled in the brain by a balance between inhibitory and excitatory factors. In general, dopamine, estrogen, progesterone, and testosterone play an excitatory role in sexual desire, whereas serotonin, prolactin, and opioids play an inhibitory role. It is hypothesized that decreased sexual desire may be due to a reduced level of excitatory activity, an increased level of inhibitory activity, or both. […] A greater understanding of the complex pathophysiology of HSDD would improve the identification and management of women for whom low sexual desire is a concern.

• #2 An Overview of Hypoactive Sexual Desire Disorder: Physiology, Assessment, Diagnosis, and Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8673442/

  HSDD is characterized by a deficiency of sexual thoughts, feelings or receptiveness to sexual stimulation that has been present for at least 6 months, causes personal distress, and is not due to another medical condition. […] While a definitive physiology of HSDD is still unknown, multiple hormones and neurotransmitters likely participate in a Dual-Control Model to balance excitation and inhibition of sexual desire. […] A theme throughout this section is that while there are many potential physiological players in female sexual desire, a definitive pathophysiology of HSDD has yet to be discovered. […] HSDD can result if there is dysfunction of excitatory or inhibitory signals by preventing adequate excitation or promoting excessive inhibition. […] Neuroimaging studies support deficient excitation in the brains of women with HSDD: there is decreased activity in brain regions responsible for sexual desire with increased activity in brain regions responsible for self-focus and moral judgement. […] The physiology of sexual desire consists of interactions between multiple hormones and neurotransmitters. HSDD is likely due to an overall decrease in sexual excitation signals, an increase in sexual inhibition signals, or some combination of the two.

• #3 Hypoactive sexual desire disorder – Wikipedia

  https://en.wikipedia.org/wiki/Hypoactive_sexual_desire_disorder

  Low sexual desire alone is not equivalent to HSDD because of the requirement in HSDD that the low sexual desire causes marked distress and interpersonal difficulty and because of the requirement that the low desire is not better accounted for by another disorder in the DSM or by a general medical problem. It is therefore difficult to say exactly what causes HSDD. It is easier to describe, instead, some of the causes of low sexual desire. […] In the case of acquired/generalized low sexual desire, possible causes include various medical/health problems, psychiatric problems, low levels of testosterone or high levels of prolactin. One theory suggests that sexual desire is controlled by a balance between inhibitory and excitatory factors. This is thought to be expressed via neurotransmitters in selective brain areas. A decrease in sexual desire may therefore be due to an imbalance between neurotransmitters with excitatory activity like dopamine and norepinephrine and neurotransmitters with inhibitory activity, like serotonin.

• #3 Hypoactive sexual desire disorder – Wikipedia

  https://en.wikipedia.org/wiki/Hypoactive_sexual_desire_disorder

  Some factors are believed to be possible causes of HSDD in women. As with men, various medical problems, psychiatric problems (such as mood disorders), or increased amounts of prolactin can cause HSDD. Other hormones are believed to be involved as well. Additionally, factors such as relationship problems or stress are believed to be possible causes of reduced sexual desire in women.

• #4 Circuits of Sexual Desire in Hypoactive Sexual Desire Disorder

  https://www.psychiatrist.com/jcp/circuits-sexual-desire-hypoactive-sexual-desire-disorder/

  Dysfunction of reward pathways is hypothetically linked to numerous conditions, from depression to substance abuse and, more recently, to sexual dysfunction, including hypoactive sexual desire disorder (HSDD). […] HSDD may result from hypofunctional excitation, hyperfunctional inhibition, or some combination of the two, due to dysregulation of neurotransmitters in reward circuits. […] Low sexual desire in HSDD is theoretically due to hypoactivity of mesolimbic dopaminergic neurons. […] Just this situation is now the widely hypothesized mechanism of disease action in HSDD, namely overactive 5-HT causing underactive DA. […] HSDD is currently conceptualized to be a disorder of reward circuitry, caused by either hypofunctional excitation or hyperfunctional inhibition or both.

• #5 Loss of Libido: Causes and Treatment | Doctor

  https://patient.info/doctor/loss-of-libido

  Libido is conscious or unconscious sexual desire. Loss of libido is a sexual dysfunction relating to loss of sexual desire or sexual drive and is also termed hypoactive sexual desire disorder (HSDD). HSDD is characterised by: […] Falling levels of hormones may impair libido. This can occur in the climacteric or with the treatment of prostate cancer. […] The suggestion that the cause of impaired libido is a deficiency of hormones is usually overly simplistic. It is likely that there is an interplay between hormonal, neurobiological and psychosocial factors. In general, dopamine, oestrogen, progesterone and testosterone play an excitatory role in sexual desire, whereas serotonin and prolactin have an inhibitory effect. […] A Cochrane review did not find evidence to support the use of either tibolone or selective oestrogen receptor modulators (eg, raloxifene) in the treatment of low libido in perimenopausal or postmenopausal women. […] Another Cochrane review found that dehydroepiandrosterone may slightly improve sexual function in perimenopausal and postmenopausal women but are associated with significant androgenic effects.

• #6 Low Libido / Low Sex Drive: Causes, Diagnosis & Treatments (NY/NJ/CT)

  https://www.mazemenshealth.com/sexual-health/low-libido/

  Increased prolactin can have a very negative effect on libido. […] It is crucial that all men (and women) with low libidos have not only their testosterone levels checked but also their prolactin levels. […] There is also reasonable evidence that increasing DHEA-S levels can improve libido in premenopausal women. […] The thyroid may be overactive and make too much of the thyroid hormones, which is called hyperthyroidism. […] Too little of the thyroid hormones (hypothyroidism), slows down the metabolism and can cause any or all of these symptoms: Decreased Libido. […] Brain chemistry is, of course, quite complicated. However, in terms of sexual function and libido, it is most critical to understand two of the most important ones: serotonin and dopamine. […] Increased serotonin levels often decreases libido.

• #6 Low Libido / Low Sex Drive: Causes, Diagnosis & Treatments (NY/NJ/CT)

  https://www.mazemenshealth.com/sexual-health/low-libido/

  Low libido is patient defined and is usually described as a lowered interest, or no interest, in sexual activity of any kind. […] Low libido is a complex diagnosis based on medical tests, anecdotal evidence and the experience of the patient. […] The causes of low libido are varied. Low libido may be caused by one main factor or by a combination of several factors. […] Testosterone levels have a significant and central role in libido for both men and women. In fact, most men with a low testosterone level will suffer from a low libido. […] For unknown reasons, probably relating to brain chemistry, it may take a man nine months of good testosterone levels on TRT, to notice a significant change in libido. […] Fortunately, the vast majority of men will have a significant improvement in their libido with testosterone replacement therapy, even if there are other psychological or relationship issues present.

• #6 Low Libido / Low Sex Drive: Causes, Diagnosis & Treatments (NY/NJ/CT)

  https://www.mazemenshealth.com/sexual-health/low-libido/

  Depression itself can, of course, have a negative effect on libido. […] Increased dopamine levels in the brain correlate to an increased libido. […] Depression also has a significantly negative effect on libido. […] Many men will regain their interest in sex, once they are able to perform in the manner they would like. […] Psychological and relationship issues can have a devastating effect on a man’s interest in sex. […] It is important to remember that it may be a symptom of an underlying medical issue, and not just in your head. […] Fortunately, for the majority of the men we see, the underlying causes of low libido can be diagnosed and successfully addressed.

• #7 How Stress Affects Your Libido

  https://continentalhospitals.com/blog/how-stress-affects-your-libido/

  Stress is a common part of daily life, but it can take a significant toll on your body and mind. […] Among the many physical and emotional effects of stress, one that is often overlooked is its impact on libido or sexual desire. […] Stress is a natural response to challenging or threatening situations. […] One of the ways stress can manifest is through a decrease in libido. […] Stress triggers the release of hormones such as cortisol and adrenaline, which are designed to help the body cope with immediate stressors. […] Elevated cortisol levels can disrupt the balance of other hormones in the body, including sex hormones like estrogen and testosterone. This disruption can result in a decrease in sexual desire and arousal. […] Chronic stress is often linked to anxiety, depression, and other mental health disorders, all of which can negatively affect libido.

• #7 How Stress Affects Your Libido

  https://continentalhospitals.com/blog/how-stress-affects-your-libido/

  Stress can also affect the body in ways that can reduce sexual desire. […] Stress-related symptoms such as fatigue, headaches, digestive issues, and muscle tension can make it harder to focus on intimacy or feel physically comfortable during sexual activity. […] Stress does not only affect an individual’s libido but can also strain relationships. […] The emotional and physical distance created by stress can make it difficult for couples to connect, leading to a decline in sexual desire and satisfaction. […] Stress is a natural part of life, but when it becomes chronic, it can negatively affect your libido and overall sexual health. […] The hormonal, mental, physical, and relational impacts of stress can significantly reduce your desire for intimacy and affect your emotional well-being.

• #8 Sexual health and serotonin 4 receptor brain binding in unmedicated patients with depression—a NeuroPharm study | Translational Psychiatry

  https://www.nature.com/articles/s41398-023-02551-x

  Sexual dysfunction is prominent in Major Depressive Disorder (MDD) and affects women with depression more than men. […] Patients with MDD relative to healthy controls have lower brain levels of the serotonin 4 receptor (5-HT4R), which is expressed with high density in the striatum, i.e. a key hub of the reward system. […] Reduced sexual desire is putatively related to disturbed reward processing and may index anhedonia in MDD. […] Here, we aim to illuminate plausible underlying neurobiology of sexual dysfunction in unmedicated patients with MDD. […] We find evidence for a positive association between sexual desire and striatal 5-HT4R availability in women with depression. […] Interestingly, this raises the question if direct 5-HT4R agonism can target reduced sexual desire or anhedonia in MDD.

• #9 Sexual health and serotonin 4 receptor brain binding in unmedicated patients with depression—a NeuroPharm study | Translational Psychiatry

  https://www.nature.com/articles/s41398-023-02551-x

  Sexual dysfunction (e.g., low sexual desire, arousal difficulties and anorgasmia) is a prominent feature of major depressive disorder (MDD) reaching a prevalence as high as 75%. […] Indeed, 42% of male and 50% of female patients with untreated MDD experienced a decreased sexual drive. […] Sexual dysfunction more often affects women with depression compared to men. […] Interestingly, a review from 2018 concluded that the greatest risk factor for sexual dysfunction in women is depression itself and that a particularly strong link between depression and low sexual desire is evident. […] Reduced sexual desire might reflect overall perceived anhedonia (i.e., lack of interest in what is usually pleasurable), which is a core symptom of MDD. […] Anhedonia is putatively linked to disturbances in reward circuit brain functioning.

• #9 Sexual health and serotonin 4 receptor brain binding in unmedicated patients with depression—a NeuroPharm study | Translational Psychiatry

  https://www.nature.com/articles/s41398-023-02551-x

  We hypothesise that sexual function, in particular sexual desire in women, is positively associated with striatal 5-HT4R binding. […] We found a positive association between baseline scores of the CSFQ-14 dimension sexual desire/interest and baseline striatal 5-HT4R binding in women. […] The observed difference in 5-HT4R binding within women with sexual dysfunction and normal sexual function in addition to the coupling between low 5-HT4R binding and poorer sexual desire supports the hypothesis of low 5-HT4R agonism capacity in depression. […] We speculate that our findings may reflect that sexual desire is partly dependent on 5-HT4R agonism capacity in the reward brain circuitat least in womenand thus may be an interesting molecular brain marker or an antidepressant target to investigate in future studies.

• #10 Low Libido (Low Sex Drive) Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/15216-low-libido-low-sex-drive

  Other causes of low libido include: Side effects from some medications. Antidepressants, antipsychotic medications, chemotherapy drugs and blood pressure medications can decrease your sex drive. […] For men, a drop in sex drive can happen for several reasons, including: Low testosterone: This sex hormone controls many aspects of libido. Levels can drop with age or due to a medical condition. […] The right treatment depends on what’s causing your low sex drive. Several treatment options are available. […] Types of treatment for low libido include: Education and communication. Learning more about how sex and desire work can help reduce anxiety. […] Hormone therapy for menopause. If menopause is lowering your sex drive, hormone therapy (HT) may help. […] Hormone therapy for low testosterone. For men with low testosterone, treatment may include testosterone replacement.

• #10 Low Libido (Low Sex Drive) Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/15216-low-libido-low-sex-drive

  Low libido (low sex drive) means you don’t feel as interested in sex as you used to. You might want it less often, or your desire might not feel as strong. The change can be temporary or last longer. […] Many things can lower your libido including your physical and mental health, aging, relationships and stress levels. […] Some health conditions that may affect your sex drive include: Cancer, Chronic kidney disease, Chronic pain, Diabetes, Headaches, Heart disease, High blood pressure, High levels of the hormone prolactin, Rheumatoid arthritis, Underactive thyroid. […] Mental health and life stress can also lower your desire for sex. These issues might include: Problems with your relationship, like a lack of trust or closeness, Stress from work, family or daily life, Depression, low self-esteem, feelings of hopelessness or physical fatigue, Anxiety, which raises stress hormones that can lower sex drive, Past sexual trauma, like abuse or assault.

• #10 Low Libido (Low Sex Drive) Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/15216-low-libido-low-sex-drive

  Talking with a therapist can help you work through thoughts, emotions or conditions like anxiety or depression that may affect your desire. […] A therapist can help you and your partner improve communication, solve problems and rebuild intimacy. […] Sex therapists specialize in helping people with sexual concerns, including low desire. They can offer support, education and practical advice.

• #11 EAU Guidelines on Sexual and Reproductive Health – Uroweb

  https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/low-sexual-desire-and-male-hypoactive-sexual-desire-disorder

  Testosterone seems to be essential for a mans sexual desire; however, sexual desire does not directly relate to the circulating level of testosterone, especially in older men. The biological and psychological components that take place in the pathophysiology of LSD are shown in Table 7.1. In addition to these factors, there is some speculation about the role of thyroid and oxytocin hormones. […] In an international survey aimed at estimating the prevalence and correlates of sexual problems in 13,882 women and 13,618 men from 29 countries (Global Study of Sexual Attitudes and Behaviours), risk factors for male LSD were age 60-69 and 70-80 years, poor overall health, vascular diseases, being a current smoker, belief that ageing reduces sex, divorce in the past 3 years, financial problems in the last 3 years, major depression, being worried about the future of a relationship and less than one sexual relation in a week. In a recent study that determined the factors associated with LSD in a large sample of middle-aged German men, PE, ED, and lower urinary tract symptoms were associated with LSD. In contrast, men having more than two children, higher frequency of solo masturbation, perceived importance of sexuality, and higher sexual self-esteem were less likely to have LSD.

• #11 EAU Guidelines on Sexual and Reproductive Health – Uroweb

  https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/low-sexual-desire-and-male-hypoactive-sexual-desire-disorder

  Low sexual desire secondary to low testosterone levels can be treated with different formulations of testosterone. The favourable effect of testosterone therapy on sexual motivation and the presence of sexual thoughts was shown in a meta-analysis. The aim of treatment should be to reach the physiological range of testosterone. Hyperprolactinaemia can also cause LSD and one of the most relevant aetiological factors is prolactin-secreting pituitary adenomas. These adenomas can be easily diagnosed with MRI of the pituitary gland and can be treated with dopamine agonist agents. The other accompanying endocrine disorders, such as hypothyroidism, hyperthyroidism and diabetes, should be treated accordingly. Pharmacotherapy can also be used to treat major depression; however, it should be remembered that antidepressants may negatively affect sexual functioning; therefore, antidepressant compounds with less effect on sexual function should be chosen. Psychotherapy can increase the efficacy of pharmacotherapy, especially for patients whose LSD is due to depression.

• #11 EAU Guidelines on Sexual and Reproductive Health – Uroweb

  https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/low-sexual-desire-and-male-hypoactive-sexual-desire-disorder

  Several aetiological factors are considered to contribute to the pathophysiology of LSD. Levine proposed three components of sexual desire as drive (biological), motivation (psychological) and wish (cultural). However, it is believed that both in the surveys and clinical practice those three components are usually found interwoven. […] The endorsement of negative thoughts during sexual intercourse (i.e., concerns about erection, lack of erotic thoughts, and restrictive attitudes toward sexuality) predicts LSD in men. Furthermore, feeling shame during sexual intercourse, because of negative sexual thoughts (e.g., concern about achieving an erection), characterises men with LSD as opposed to women with the same condition. Psychopathological symptoms stemming from a crisis context negatively impacted male sexual desire, as well. In addition, dyadic male sexual desire was best accounted for by sexual satisfaction. It is worth noting that, despite LSD being less common in men than in women, it is the most frequent complaint in couples therapy. Therefore, the role of relationship factors must be addressed. In addition, anxiety proneness has been associated with LSD in men and is expected to shift mens attention from erotic cues to worrying thoughts, thereby decreasing sexual desire. Finally, it is worth noting that current approaches focus on sexual desire discrepancies between partners; the focus on discrepancies rather than on the partner who presents low desire not only reduces stigma, but also provides new opportunities for managing desire in the relationship context.

• #11 EAU Guidelines on Sexual and Reproductive Health – Uroweb

  https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/low-sexual-desire-and-male-hypoactive-sexual-desire-disorder

  Treatment of LSD should be tailored according to the underlying aetiology. Data on efficacy of psychological interventions for LSD are scarce. Accordingly, recommendations must be interpreted with caution. Psychological interventions with a focus on cognitive and behavioural strategies may be beneficial for LSD in men. Mindfulness treatments may be a strong candidate, as well. Since both members of a couple may experience age-related changes concurrently and interdependently, it could be helpful to address the sexual health needs of the ageing couple (including LSD) as a whole rather than treating the individual patient. Indeed, psychologists are putting more emphasis on the concept of sexual desire discrepancy. Sexual desire discrepancy is often found in couples or partners, and mirror a natural part of life and partners dynamics. Clinical approaches based on this lens are less stigmatising as they consider the normal variations in sexual desire that occur throughout the lifespan. This intervention option targets couples distressed by sexual desire discrepancies rather than a single individual targeted as the one presenting low sexual desire.

• #12 Testosterone Boosters: How to Boost Testosterone Naturally Over 50

  https://www.webmd.com/healthy-aging/the-best-testosterone-boosters-for-men-over-50

  Testosterone is the major sex hormone in men. It affects bodily functions including: […] Symptoms of low testosterone include: […] Low libido […] Testosterone declines with age, but it is a slow decline. Testosterone decreases 1% to 2% per year. More than 33% of men over 45 may have lower than normal testosterone levels. […] Testosterone therapy also has a risk for some serious side effects, including: […] Stress causes your levels of cortisol to rise. Cortisol is a hormone that works against your testosterone. When it rises, testosterone falls. […] Women and people assigned female at birth also produce testosterone. It’s important for your sex drive, bone and muscle health, energy, and mood. […] The American College of Obstetricians and Gynecologists supports testosterone therapy for treating sexual dysfunction after menopause, but the FDA hasn’t approved it.

• #13 What Is Libido and What Makes It High or Low?

  https://www.verywellhealth.com/what-is-libido-5084040

  „Libido” is the term used to describe sexual appetite or sex drive. Factors like your emotional state, hormone levels, and physical health can all affect your libido. Age-related changes in sex drive can also occur. […] A high or low libido is only considered a problem if it interferes with a persons sexual function or quality of life. […] The causes of low libido can be broadly described as psychological (relating to the mind), physiological (relating to the body), pharmaceutical (drug-related), or pathological (related to disease). […] Hormonal shifts are a common cause of low libido. People of all sexes can experience low libido in response to decreases in the sex hormones estrogen, progesterone, and, in particular, testosterone. […] Very low testosterone defined as below 300 nanograms per deciliter of blood is called hypogonadism. It is a relatively common condition given that testosterone levels start to decline after age 30 years.

• #14 Female sexual dysfunction – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/female-sexual-dysfunction/symptoms-causes/syc-20372549

  Low sexual desire. This most common of female sexual dysfunctions involves a lack of interest in sex and not wanting to have sex. […] Lower estrogen levels after menopause may lead to changes in your genital tissues and how you respond to sex. Lower estrogen leads to less blood flow to the pelvis. This can cause you to have less feeling in your genitals and to need more time to become aroused and reach orgasm. […] Sexual desire also lessens when hormone levels drop.

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• #16 Sexual Dysfunction in Women: A Practical Approach | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0815/p281.html

  Sexual dysfunction in women is a common and often distressing problem that has a negative impact on quality of life and medication compliance. […] The etiology of female sexual dysfunction is multifactorial, encompassing biological, psychological, relational, and sociocultural factors. Biological factors may impact sexual function in a variety of ways. Some chronic illnesses, such as vascular disease, diabetes mellitus, neurologic disease, and malignancy, can directly or indirectly impact sexual function. Aging itself is associated with decreased sexual responsiveness, sexual activity, and libido. […] Hormonal changes occurring in midlife may impact a woman’s sexual function. Menopause is marked by a decline in ovarian hormone levels, which occurs gradually in natural menopause but may be sudden if menopause occurs because of surgery, radiation, or chemotherapy. Decreased vaginal lubrication and dyspareunia are associated with low estradiol levels; however, the association between low sexual desire and lower estradiol levels has been inconsistent.

• #16 Sexual Dysfunction in Women: A Practical Approach | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0815/p281.html

  Serotonin-enhancing medications have an inhibitory effect on sexual function. Sexual dysfunction induced by selective serotonin reuptake inhibitor use is common, with an incidence between 30% and 70%, and may include difficulty with sexual desire, arousal, and orgasm. […] The most common psychological factors impacting female sexual function are depression, anxiety, distraction, negative body image, sexual abuse, and emotional neglect. […] Group cognitive behavior therapy may be effective for low sexual desire. […] Mindfulness-based interventions have been shown to effectively treat several types of female sexual dysfunction, including low sexual desire and arousal, and acquired anorgasmia. […] Directed masturbation training is the treatment of choice for lifelong anorgasmia. […] Sexual health concerns are common in natural or surgically induced menopause, particularly sexual pain related to genitourinary syndrome of menopause. […] Randomized controlled trials involving naturally or surgically menopausal women with low sexual desire or arousal have shown improvements in sexual function with transdermal testosterone therapy (with or without concomitant estrogen therapy).

• #17 Loss of libido | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/sexual-and-reproductive/loss-of-libido/

  Loss of libido (sex drive) is a common problem affecting up to 1 in 5 men and even more women at some point in their life. […] However, an unexpected loss of libido especially when it lasts for a long time or keeps returning can also indicate an underlying personal, medical or lifestyle problem, which can be upsetting to both partners in a relationship. […] Relationship problems are among the most common causes of loss of libido. […] Depression is very different from simply feeling unhappy, miserable or fed up for a short while. […] Many people lose some interest in sex as they get older, mainly as a result of falling levels of sex hormones, age-related health problems, or the side effects of medication. […] Less commonly, low libido may be caused by an underactive thyroid. […] A hormonal problem called hyperprolactinaemia can also have a negative effect on your sex drive.

• #17 Loss of libido | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/sexual-and-reproductive/loss-of-libido/

  Long-term (chronic) medical conditions such as cardiovascular disease, diabetes and obesity can also have a negative effect on your libido. […] Certain medications can sometimes reduce libido, such as medications for high blood pressure, including diuretics, medications for depression, including SSRI antidepressants, and medications commonly used to treat psychosis.

• #18 Sexual Dysfunction Following Injury: Time for Enlightenment and Understanding | BrainLine

  https://www.brainline.org/article/sexual-dysfunction-following-injury-time-enlightenment-and-understanding

  Hypoactive sexual desire disorder is experienced by both men and women; however, they may not be hampered by any dysfunction once they are involved in the sex act. Conversely, hypoactive desire may be used to mask another sexual dysfunction. Lack of desire may be expressed by decreased frequency of coitus, perception of the partner as unattractive, or overt complaints of lack of desire. In some cases there are biochemical correlates associated with hypoactive desire. A recent study found markedly decreased levels of serum testosterone in men complaining of this dysfunction when they were compared with normal controls in a sleep-laboratory situation. Also, a central dopamine blockage is known to decrease desire. […] The course and prognosis of secondary sexual dysfunctions vary widely, depending on the etiology.

• #18 Sexual Dysfunction Following Injury: Time for Enlightenment and Understanding | BrainLine

  https://www.brainline.org/article/sexual-dysfunction-following-injury-time-enlightenment-and-understanding

  Sexual disorder attracted little attention in epileptic patients until relatively recently. Several reports, however, now stress the frequency of sexual disturbance in patients with temporal lobe epilepsy. Hyposexuality has emerged as the commonest abnormality, with perversions of sexual interest and outlet occurring in a much smaller number.

• #18 Sexual Dysfunction Following Injury: Time for Enlightenment and Understanding | BrainLine

  https://www.brainline.org/article/sexual-dysfunction-following-injury-time-enlightenment-and-understanding

  In our clinical work we find that hyposexuality, meaning loss of libido, is most often due to a depressive illness. Certain chemical agents – notably antihypertensive, anticonvulsant, serotoninergic antidepressant and neuroleptic drugs – may cause a loss of libido. A variety of cerebral diseases may also have this effect. […] The difference aspects of sexual function may be affected separately. Loss of libido may depend upon both psychic and somatic factors. It may be complete, as in old age or in medical and endocrine diseases, or it may occur only in certain circumstances or in relation to a certain situation or individual. […] Lack of desire can also be the result of chronic stress, anxiety, or depression. […] The presence of desire depends on several factors: biological drive, adequate self-esteem, previous good experiences with sex, the availability of an appropriate partner, and a good relationship in nonsexual areas with one’s partner. Damage to any of those factors may result in diminished desire.

• #19 Thyroid and libido: Connection, treatments, and more

  https://www.medicalnewstoday.com/articles/thyroid-and-libido

  The thyroid makes hormones that influence various organs and systems within the body, including the systems responsible for a persons sex drive, or libido. […] Reduced libido can arise as a result of an underactive thyroid (hypothyroidism) as well as an overactive thyroid (hyperthyroidism). […] This, in turn, can cause changes to sexual desire, as well as impairments in sexual function. These changes can affect both females and males. […] The 2019 review notes that prolonged primary hypothyroidism can lead to a condition known as hyperprolactinemia, in which the brains pituitary gland overproduces the hormone prolactin. […] Researchers associate increased levels with a lack of sexual desire in both sexes. […] Hypothyroidism can also cause a reduction in the thyroid hormones T3 and T4. This can lead to symptoms that may negatively impact libido and sexual functioning in both males and females.

• #20 Thyroid and libido: Connection, treatments, and more

  https://www.medicalnewstoday.com/articles/thyroid-and-libido

  Hypothyroidism can disrupt the regulation of the HPG axis, leading to a reduction in levels of certain sex hormones, including testosterone, sex hormone-binding globulin (SHBG), and dehydroepiandrosterone (DHEA). […] Besides a decrease in libido, males with hypothyroidism may experience the following forms of sexual dysfunction: erectile dysfunction (ED) and ejaculatory dysfunction, such as premature ejaculation and delayed ejaculation. […] In males, hyperthyroidism may increase levels of the hormone SHBG, which can lead to increased levels of estrogen and reduced levels of circulating testosterone. […] Researchers have identified a possible link between hypothyroidism and the following forms of sexual dysfunction in females: reduced libido, vaginal dryness, and pain during sex. […] Both hypothyroidism and hyperthyroidism can affect sex drive, or libido, in both males and females. […] Treating the underlying condition can help restore a persons libido.

• #21 Drug-induced sexual dysfunction in men and women – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/drug-induced-sexual-dysfunction-in-men-and-women.html

  Many medical conditions and their treatments contribute to sexual dysfunction. […] Understanding the potential for drug-induced sexual problems and their negative impact on adherence to treatment will enable the clinician to tailor treatments for the patient and his or her partner. […] Sexual function consists of the phases of sexual desire, arousal and orgasm. […] Low desire, lack of swelling and lubrication in women, erectile dysfunction, premature, retrograde or absent ejaculation, anorgasmia and painful sex not only affect the individual, but also impact on their partner. […] Patients attributing their sexual problems to their drugs are less likely to continue the treatment even when necessary for their health. […] Hypertension is associated with sexual dysfunction. […] Antihypertensives may also contribute to the problem and lead to low treatment adherence.

• #22 Drug-induced sexual dysfunction in men and women – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/drug-induced-sexual-dysfunction-in-men-and-women.html

  Sexual dysfunction is more common in women with hypertension (before treatment) compared to normotensive women (42% vs 19%). […] Although the sexual effects of antihypertensives have been poorly studied in women, these drugs may have similar adverse effects on the arousal phase as in men, leading to failure of swelling and lubrication. […] Decreased sexual desire (41% of women) and sexual pleasure (34%) have been reported. […] Many antidepressants cause sexual difficulties. […] Selective serotonin reuptake inhibitors and serotonin noradrenaline reuptake inhibitors inhibit desire, cause erectile dysfunction and decrease vaginal lubrication. […] They also impair orgasm in 571% of patients. […] This adverse effect is used therapeutically to delay premature ejaculation. […] Tricyclic antidepressants inhibit sexual desire and orgasm.

• #22 Drug-induced sexual dysfunction in men and women – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/drug-induced-sexual-dysfunction-in-men-and-women.html

  The majority of antipsychotics cause sexual dysfunction by dopamine receptor blockade. […] This causes hyperprolactinaemia with subsequent suppression of the hypothalamic-pituitary-gonadal axis and hypogonadism in both sexes. […] This decreases sexual desire and impairs arousal and orgasm. […] Antiandrogens such as cyproterone acetate, cimetidine, digoxin and spironolactone block the androgen receptor. […] This reduces sexual desire in both sexes, and affects arousal and orgasm. […] Steroids such as prednisone used for many chronic inflammatory disorders result in low serum testosterone which reduces sexual desire and causes erectile dysfunction. […] Understanding both the impact of a disorder and the effects of its treatment on both the patient and their partner are critical to providing good clinical care.

• #23 Female Sexual Dysfunction | Doctor

  https://patient.info/doctor/female-sexual-dysfunction-pro

  Cardiovascular disease (CVD) is associated with an increased prevalence of FSD. Atherosclerosis affecting the hypogastric/pudendal arterial bed decreases the blood flow to the clitoris and vagina; this is called clitoral vascular insufficiency syndrome. […] Decreased blood flow can result in the loss of corporal smooth muscle in the vagina and clitoris, followed by fibrosis. […] Sexual desire/arousal and orgasm are mediated by central and spinal nerve pathways and involve sympathetic, parasympathetic and somatic nerve activity. […] Neurological conditions can therefore interfere with female sexual function. […] Psychological factors (history of sexual abuse, depression, anxiety, obsessive-compulsive disorders), sociocultural issues (beliefs regarding sexual activity) and interpersonal issues (partner availability, partner function, relationship with partner, communication with partner) affect sexual function in all age groups.

• #24 Sexual dysfunction – Urology – Wayne State University

  https://urology.med.wayne.edu/impotence-sexual

  Hormonal Problems – The hormones play an important part in sexual function. They are responsible for the sex drive (also called libido). Hormonal imbalances such as low testosterone or high prolactin can disrupt the libido. Hormonal imbalances can be diagnosed by a simple blood test, and further testing and treatment is based on the underlying cause of the imbalance. […] Diabetes can interfere with erections in a number of ways, and erectile problems tend to get worse the longer a man has diabetes. Half of all men with diabetes experience some degree of erectile dysfunction. Diabetes may affect the blood flow to the penis. Men with diabetes often experience decreased quality or number of erections. Healthy blood vessels are needed for the engorgement of penile tissue that leads to erection. […] Depression may lead to erectile dysfunction by a loss of sex drive, or by the medications used for treatment. Problems with premature ejaculation and the anxiety associated with it may lead to erectile problems.

• #25 Sex and Diabetes | American Diabetes Association

  https://diabetes.org/health-wellness/sexual-health/sex-diabetes

  Low libido, or sexual desire, is a real problem and one that affects people with diabetes more than those without. […] If your sex drive is stalled, first look to your diabetes management and take steps to lower your blood glucose levels. […] Researchers theorize that inflammation may also dampen desire. […] Sexual desire is a brain-driven event, so if inflammatory molecules cross the blood-brain barrier and circulate in the area where there is sexual desire, then it’s plausible the desire for sex may be affected. […] Another possible culprit: low testosterone, which often affects men and women with diabetes. […] Studies have shown that men with diabetes, especially those who have type 2 or are overweight, or both, have about twice the risk of low testosterone as their peers without the disease, which can affect a man’s passion for sex.

• #26 Sex and Diabetes | American Diabetes Association

  https://diabetes.org/health-wellness/sexual-health/sex-diabetes

  When low testosterone is treated through losing weight and/or testosterone therapy, many men have a renewed desire for sex. […] Some studies suggest that taking testosterone can increase sexual desire in women. […] Not only that, but it’s hard for researchers to determine whether a particular woman’s low libido is a result of diabetes, emotional issues or something else entirely because low libido is common in women regardless of the presence of diabetes. […] Both men and women with diabetes may feel desire but struggle with arousal problems, though the mechanisms behind this sexual dysfunction are better studied and understood in men. […] Poor diabetes management over time can damage the blood vessels and nerves as it does in heart disease and neuropathy (nerve damage) that make arousal possible.

• #27 Low libido causes & treatments – Mayo Clinic Health System

  https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/lets-talk-low-libido

  Physical issues Increased weight, diabetes, high blood pressure, endocrine disorders and high cholesterol can affect the ability to maintain an erection or decrease sex drive. These conditions also can lead to low energy and low self-image which can cause a significant loss of libido. In many cases, this can be corrected through diet, exercise and medical management. […] Pornography This is a big cause for many men. Pornography permeates many committed relationships and can change how men view sexuality. For some, it causes pseudo-low libido, which is when a person is still interested in sex but not in a healthy way. This often leads to unrealistic expectations of body image, confusion about what an intimate encounter is and, in some cases, negative sexual behavior. […] Medications Many medications used for anxiety and depression can lower libido in men and, in some cases, delay orgasm.

• #27 Low libido causes & treatments – Mayo Clinic Health System

  https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/lets-talk-low-libido

  Increased alcohol use can reduce testosterone levels and increase the risk of erectile dysfunction and low libido. […] The issue of low libido in women is even more complex, with causes ranging from past negative and abusive experiences with sex to fatigue and stress. […] Hormone changes Estrogen levels drop during menopause and can greatly affect libido. […] Previous physical or emotional trauma can affect the way people experience sex and lead to low libido. Sexual desire and arousal often are numbed in people who have been physically or sexually abused. […] Treatment plans focus on the many causes of low libido. Sex education and counseling may be recommended, especially to address relationship issues. Medication and hormone therapy options are available to boost libido. […] If you are bothered by low or decreased sex drive, there are changes and treatments that can move you in the right direction.

• #28 Sexual health

  https://www.mayoclinic.org/healthy-lifestyle/sexual-health/expert-answers/loss-of-sex-drive/faq-20058237

  After identifying what’s causing the loss of sex drive, your doctor can suggest treatment options. For example: […] Some medical conditions, such as obstructive sleep apnea, can cause an unusually low testosterone level. Treating the sleep apnea will reverse the low testosterone level and improve sex drive. […] If a reversible cause for low testosterone isn’t found, testosterone replacement therapy might return your testosterone level and sex drive to normal.

• #29 Common Causes of Low Sex Drive in Males

  https://www.healthline.com/health/low-testosterone/conditions-that-cause-low-libido

  Several sleeping disorders and conditions that could affect your sleep are associated with decreased libido, erectile dysfunction, and low testosterone levels. […] Testosterone levels, which are linked to libido, are at their highest during adolescence and gradually decrease as you age. […] If you’re distracted by situations or periods of high pressure, sexual desire may decrease. […] Research suggests that an increase in cortisol, also called the stress hormone, could disrupt hormone levels, lower libido, and increase your risk of erectile dysfunction. […] Low self-esteem could take a toll on your sexual, emotional, and physical well-being. […] Over time, self-esteem issues can result in larger mental health problems, such as depression, anxiety, and drug or alcohol misuse all of which have been linked to low libido.

• #29 Common Causes of Low Sex Drive in Males

  https://www.healthline.com/health/low-testosterone/conditions-that-cause-low-libido

  Too little or too much exercise can also be responsible for low sex drive in males. […] Heavy alcohol drinking, or more than 15 drinks in a week, is associated with a decrease in testosterone. […] In addition to alcohol, the use of some substances and illegal drugs may lower your testosterone levels and affect sexual desire. […] Low libido can lead to a vicious cycle of physical and emotional side effects. […] Some causes for low sex drive in males include low testosterone, stress, low self-esteem, taking certain medications, and heavy alcohol use, among others. […] Several causes may be attributed to low libido, such as taking certain medications, low testosterone levels, and being stressed.

• #30 Libido Boosting Functional Foods | IntechOpen

  https://www.intechopen.com/chapters/84953

  Libido is a sexual desire or drive. Libido is biological desires emotional energy, especially sexual desire. Biopsychosocial variables affect libido. Biologically, sex hormones and nucleus accumbent neurotransmitters (mainly testosterone and dopamine) govern human desire. […] Medical disorders, drugs, lifestyle, relationships, and age might affect libido (e.g., puberty). […] Stress, illness, and pregnancy affect sperm drive. Testosterone, estrogen, progesterone, oxytocin, and norepinephrine act as serotonin. […] Lack of quality sleep, high stress, poor diet, poor physical health, medications and birth control pills, low physical activity, unresolved conflicts, repressed emotions, depression, and anxiety, past sexual abuse, poor self-image and lack of self-confidence, infidelity, and menopause (or other hormonal imbalances like low thyroid) are the main psychological and emotional causes of low sex drive in men and women.

• #30 Libido Boosting Functional Foods | IntechOpen

  https://www.intechopen.com/chapters/84953

  Experts say that hidden hostility or repressed anger towards the partner can cause a lack of sex drive. […] Unfaithfulness can cause a loss of libido. Infidelity may be caused by a lack of libido in some cases, but it’s usually a lack of intimacy. […] Sexual desire may be reduced by psychiatric or social disorders. Insecurity, tension, exhaustion, distraction, and despair are some examples. […] Libido may be affected by hypothyroidism, flutamide, and a partner’s beauty and fitness. […] Anaphrodisiacs reduce libido. Psychostimulants and aphrodisiacs increase libido. It lowers libido. Isotretinoin, SSRIs, antidepressants, antipsychotics, opioids, and beta-blockers cause it. […] Testosterone regulates libido. […] Aging affects Male sex drives peak in their teens, while females peak in their 30s. […] Hormonal problems, like a lack of luteinizing hormone or androgenic hormones, may cause low libido, but these ideas aren’t agreed upon.

• #31 How Medications Impact Libido

  https://www.pharmacytimes.com/view/lossoflibido-0610

  Medications that affect libido often have mechanisms that affect the biologic or hormonal mediators of libido. Prolactin, testosterone, DHEA, and serotonin type 1 (5-HT1), 2 (5-HT2), and 4 (5-HT4) receptors are involved in arousal and sexual function. […] Increased prolactin known as hyperprolactinemia is one of the most commonly cited underlying causes of medication-induced loss of libido. […] Medication-induced libido loss can be divided into 3 main categories: neurologic/psychiatric agents, cardiovascular agents, and miscellaneous agents. […] A commonly reported consequence of depression is loss of libido. […] Unfortunately, the most common class of medications that treat depression, selective serotonin reuptake inhibitors (SSRIs), can cause the same problem. […] Antipsychotics, anticonvulsants, and lithium also contribute to loss of libido.

• #32 Overview of Male Sexual Function and Dysfunction – Genitourinary Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/genitourinary-disorders/male-sexual-function-and-dysfunction/overview-of-male-sexual-function-and-dysfunction

  Libido is the conscious component of sexual function. Decreased libido manifests as a lack of sexual interest in or a decrease in the frequency and intensity of sexual thoughts, whether they arise spontaneously or in response to erotic stimuli. Libido is sensitive to testosterone levels as well as to general nutrition, health, and the effects of medications. […] Common causes of decreased libido include hypogonadism (testosterone deficiency), chronic kidney disease, relationship problems, depression, stress, and diabetes, among others. Testosterone deficiency is very common in older men, with a prevalence of between 40 and 50%. […] Medications that potentially decrease libido include weak androgen receptor antagonists (eg, spironolactone, cimetidine), luteinizing hormone-releasing hormone agonists (eg, leuprolide, goserelin, buserelin), and antagonists (eg, degarelix) used to treat prostate cancer; antiandrogens used to treat prostate cancer (eg, flutamide, bicalutamide); 5-alpha-reductase inhibitors (eg, finasteride, dutasteride) used to treat benign prostatic hyperplasia; some antihypertensives; and virtually all medications that are active in the central nervous system (eg, selective serotonin reuptake inhibitors [SSRIs], tricyclic antidepressants, antipsychotics). […] Loss of libido due to SSRIs or tricyclic antidepressants may be reversible with the addition of bupropion or trazodone.

• #33 6 Medications That Can Affect Your Libido – BuzzRx

  https://www.buzzrx.com/blog/6-medications-that-can-affect-your-libido-2

  Sexual dysfunction is a prevalent problem often not discussed due to embarrassment. Low libido is a type of sexual dysfunction affecting both men and women; this type of sexual dysfunction is generally present with low sexual desire and losing interest in sexual activity. […] Low libido is one of the most common sexual difficulties experienced by men and women. […] Yes, many over-the-counter and prescription medications can decrease libido and affect your sexual life. Medications affect libido in two ways. Some medicines cause physical symptoms that make it harder to have sex. […] Additionally, certain medications can cause a diminished sex drive because they affect the sex hormones. […] Compliance with a blood pressure medication regimen will reduce the risk of heart disease, heart attack, and stroke. Uncontrolled high blood pressure not only affects your heart and blood vessels, but it can also negatively impact the reproductive system, leading to low libido.

• #33 6 Medications That Can Affect Your Libido – BuzzRx

  https://www.buzzrx.com/blog/6-medications-that-can-affect-your-libido-2

  Statins and fibrates are drugs prescribed to people with high cholesterol levels. These medications can lead to reduced libido because they affect cholesterol formation, which can interfere with estrogen levels, and testosterone levels. […] Medications used to treat depression, including tricyclic antidepressants, selective serotonin reuptake inhibitors, (SSRIs) monoamine oxidase inhibitors, and other antidepressants, affect the levels of chemicals in the brain. This can affect the nerve impulses between nerve cells and lead to reduced sexual desire and other areas of sexual function. […] Oral contraceptives and other forms of hormone therapy for birth control, such as the vaginal ring, implant, or intrauterine device, can reduce libido and lead to other sexual problems. […] Several antipsychotic medications such as haloperidol (Haldol), risperidone (Risperdal), and thioridazine (Mellaril) that are used to treat bipolar disorder and other mental health disorders like schizophrenia can reduce the desire for sex. […] Medications such as phenobarbital, phenytoin (Dilantin), and carbamazepine (Tegretol) are prescribed to people with epilepsy and other seizure disorders and can affect sexual health. These medications can lead to low testosterone levels and decreased libido.

• #34 Loss of libido | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/sexual-and-reproductive/loss-of-libido

  Some women have reported a decreased sex drive while using some types of hormonal contraception. […] Long-term (chronic) medical conditions such as cardiovascular disease, diabetes and obesity can also have a negative effect on your libido. […] Certain medications can sometimes reduce libido, such as medications for high blood pressure, including diuretics, medications for depression, including SSRI antidepressants, and medications commonly used to treat psychosis.

• #34 Loss of libido | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/sexual-and-reproductive/loss-of-libido

  Loss of libido (sex drive) is a common problem affecting up to 1 in 5 men and even more women at some point in their life. […] However, an unexpected loss of libido especially when it lasts for a long time or keeps returning can also indicate an underlying personal, medical or lifestyle problem, which can be upsetting to both partners in a relationship. […] Relationship problems are among the most common causes of loss of libido. […] Another thing to consider is whether the problem is a performance issue that makes sex difficult or unfulfilling. […] Depression is very different from simply feeling unhappy, miserable or fed up for a short while. […] Youre probably depressed if youre feeling low or hopeless, or youve lost interest or pleasure in doing things you used to enjoy. […] However, low sex drive can also be a side effect of many antidepressants.

• #34 Loss of libido | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/sexual-and-reproductive/loss-of-libido

  Drinking excess amounts of alcohol can reduce your sex drive, so its a good idea to moderate your intake to no more than three to four units a day if youre a man, and no more than two to three units a day if youre a woman. […] Many people lose some interest in sex as they get older, mainly as a result of falling levels of sex hormones, age-related health problems, or the side effects of medication. […] Older men especially can develop low testosterone levels, which can cause fatigue, depression and a reduced sex drive. […] As women start to approach the menopause, levels of the female hormone oestrogen begin to fall, which can affect libido. […] Less commonly, low libido may be caused by an underactive thyroid. […] A hormonal problem called hyperprolactinaemia can also have a negative effect on your sex drive.

• #35 Can Stress Hurt Your Libido? – Women’s Health Network

  https://www.womenshealthnetwork.com/adrenal-fatigue-and-stress/stress-and-sex-life/

  Yes, stress turns off your sex drive, but we can show you how to switch it back on. […] Under normal conditions, our sex lives are driven by our hormones. Estrogen, progesterone and testosterone naturally raise or lower libido and sexual pleasure depending on our monthly cycles. But when you’re stressed all the time, the adrenal hormone cortisol suppresses sex hormones, which kills your libido. And having low sex drive causes more stress! […] Too much cortisol also decreases testosterone, the main hormone that makes you want to have sex and leads to heightened sexual pleasure. High cortisol even affects DHEA (dehydroepiandrosterone), the mother hormone for estrogen and testosterone. […] Chronic stress also leaves you feeling tapped out, so seek out this blend of herbs in our Adaptisol supplement for energy: Siberian ginseng and rhodiola to relieve fatigue and boost energy, and astragalus root to help fend off the effects of stress. […] When stress blocks libido, make the idea of sex fun again by shopping for bedroom toys and lubrication. […] There are great foods that do double duty by reducing stress and stoking libido.

• #36 The Top Five Causes of a Low Libido – Modern Intimacy

  https://www.modernintimacy.com/top-five-causes-low-libido/

  Low libido is an important aspect of health that often goes undiscussed in medical visits, but it is a topic worthy of attention as our bodies are designed to benefit from this aspect of ourselves beyond that of species survival. […] A lack of sexual desire is one of the most common complaints in the category of sexual dysfunction and can provide valuable insight into health, and for this reason should be addressed more often in medical settings. […] Worry over low testosterone is a common concern voiced by men but it affects women just as much as the main hormonal driver of decreased libido. […] Increased stress and poor sleep are common along with lack of physical activity and inadequate nutrition. […] This occurs because biochemical signaling in our bodies is largely directed by our daily activities and this includes our hormone levels.

• #36 The Top Five Causes of a Low Libido – Modern Intimacy

  https://www.modernintimacy.com/top-five-causes-low-libido/

  Cortisol also affects thyroid function which can influence the amount of testosterone available in the body. […] Poor sleep contributes in the same way as this is the bodys time for restoration and when it is cut short keeps cortisol high and disrupts other hormone-balancing processes, contributing to lower testosterone. […] Hormones are made from the nutrients we ingest and sustaining a healthy, varied diet is essential to a balanced hormone status. […] Unfortunately, many individuals are deficient in these key nutrients, especially in the latter category of vitamins and minerals, due to poor diet and digestive function. […] A side effect of many common prescriptions is loss of libido and/or decrease in sexual activity or performance. […] Birth control interferes with testosterone production while also increasing a protein in the body that binds to it.

• #37 Sexual Dysfunction: Types, Causes, Diagnosis, Treatment

  https://www.verywellhealth.com/sexual-dysfunction-7111756

  Sexual dysfunction is the persistent difficulty engaging in sexual activities. It may involve a physical problem that interferes with a person’s ability to engage in any stage of the normal sexual response, from arousal to climax, and/or a psychological issue that diminishes a person’s sex drive or response to sexual stimulus. Oftentimes, multiple factors are involved. […] Sexual dysfunction often involves multiple factors, some of which perpetuate others. For instance, erectile dysfunction can trigger anxiety, decreasing libido. Similarly, an anxiety disorder can cause erectile dysfunction even if no underlying physical cause exists. […] Chief among the precipitating factors are depression and anxiety, both of which have a cause-and-effect relationship with sexual dysfunction. Depression is known to be independently linked to HSDD and erectile dysfunction. Anxiety is considered a risk factor for erectile dysfunction, premature ejaculation, vaginismus, and vestibulodynia.

• #37 Sexual Dysfunction: Types, Causes, Diagnosis, Treatment

  https://www.verywellhealth.com/sexual-dysfunction-7111756

  A wide range of medical conditions can directly or indirectly affect the physical function of the sexual organs and/or the moods that direct the sexual response. […] In males, hypogonadism (low testosterone) can affect sexual desire, arousal, clarity of thinking, mood, erectile function, and bone density. In females, hormone fluctuations during the menstrual cycle, pregnancy, and menopause can do the same. […] The treatment of HSDD can vary between sexes, given that the underlying causes and features differ. Even so, there are common approaches used for people of any sex, including cognitive behavior therapy (CBT): A form of „talk therapy” that challenges beliefs and alters behaviors that contribute to low sexual desire. […] Testosterone replacement therapy (TRT): Given by injection, patches, pellets, or gels to improve libido and sexual functioning in males. […] Addyi (flibanserin): An oral drug used for the treatment of HSDD in postmenopausal females that works by increasing dopamine (which increases sexual excitement) and lowering serotonin (which decreases sexual excitement).

• #38 Decreased Libido (Low Sex Drive) | PPT

  https://www.slideshare.net/slideshow/decreased-libido-low-sex-drive/131043633

  Hormone Therapy for Post-Menopausal Low Libido HRT- may improve general well being and libido Vaginal estrogen- With/ systemic HRT – can be considered when systemic HRT is contraindicated […] Testosterone Preparations Oral Methyltestosterone, micronized testosterone, DHEA Transdermal Testosterone patches and gels; testosterone ointment or cream (1% or 2%) Injectable or implants Intramuscular testosterone injections, testosterone implants […] Can we use Testosterone? The transdermal testosterone patch is licensed in Europe for the treatment of HSD in surgically menopausal women on concomitant HRT. No pharmacologic therapy is currently approved for the treatment of HSD in premenopausal or naturally postmenopausal women and further research is urgently needed in these populations. […] Lifestyle Changes Reducing stress Exercise, yoga or other relaxation techniques, or support groups Regular „date night- to spend one or two nights away from family responsibilities

• #38 Decreased Libido (Low Sex Drive) | PPT

  https://www.slideshare.net/slideshow/decreased-libido-low-sex-drive/131043633

  Decreased Libido (Low Sex Drive) Hypoactive Sexual Disorder (HSD) F52.4 in ICD-10 Deficiency or absence of sexual fantasy or desire for sexual activity Females are more affected (40%) than males (30%) […] Effects of HSD Chronic stress Anxiety Depression Lack of concentration Insomnia Irritability Relationship conflict Social withdrawal […] Physiological Drugs Pregnancy Antihypertensives (Beta Blockers) Menstruation Antiandrogens Menopause Antiepileptics Lactation Antidepressants Systemic Disease Previous bad experience Diabetes Painful sex Thyroid disorder Erectile/ Ejaculatory disorders Hyperprolactinaemia Sexual assault Hypopituitarism Fear Gonadal Failure Guilty feeling Hypertension Fear of STI/ Pregnancy Fatigue Relationship Problems Depression Interpersonal conflict Renal/ Liver Disease Monotony Infertility Sexual orientation

• #39 Decreased Libido (Low Sex Drive) | PPT

  https://www.slideshare.net/slideshow/decreased-libido-low-sex-drive/131043633

  Pharmacotherapy Fibranserin A centrally acting serotonin receptor agonist/antagonist that results in transient decreases in serotonin and increases in dopamine and norepinephrine in certain regions of the brain Only drug approved by the FDA for female sexual dysfunction common adverse effects- somnolence, dizziness […] DHEA might slightly improve sexual function compared to placebo No evidence that DHEA improved sexual function more than HRT […] Best Aphrodisiac an interesting and interested partner- Masters and Johnson […] Research on sexual function consistently demonstrates- increased libido and pleasure in new relationships. Where there is marriage without love, there will be love without marriage- Benjamin Franklin […] Infertile couples with low libido Testosterone in men- Only as HRT in men with hypogonadism In male with normogonadotropism, can impair spermatogenesis

• #40 Low Libido: 11 Causes for Low Sex Drive in Women | SELF

  https://www.self.com/story/low-sex-drive-in-women-causes

  Many commonly prescribed medications, particularly the selective-serotonin-reuptake-inhibitor (SSRI) class of antidepressants count a reduction in libido among their potential side effects. […] Experiencing negative feelings about your body and your appearance, for any reason, can have a massive impact on how in the mood for sex you are. […] Trauma can have a tremendous impact on someones libido, especially if that trauma is centered around sex, bodies, and/or intimacy. […] If you suspect your birth control may be affecting your sex drive, definitely talk to your doctor if you are able to. […] If you are experiencing low libido and think it may be connected to new or worsening symptoms of a medical condition, talk to your health care provider, who can help you figure out the next best steps.

• #41 Causes and signs of low libido in men | Nuffield Health

  https://www.nuffieldhealth.com/article/causes-and-signs-of-low-libido-in-men

  Alcohol is a depressant that will minimise our interest in sex and ultimately affect a man’s ability to achieve and maintain an erection. […] When it comes to illegal drug use, cannabis can decrease testosterone levels for up to 24 hours, which will in turn reduce our sex drive. […] There are a number of natural causes that can cause our interest in sex to diminish. These include low testosterone levels. […] It’s natural for men to notice a gradual decrease in libido as they age. It’s thought that this is because testosterone levels start to decrease as we get older. […] The older we get, the more likely we are to develop a physical health condition that has the potential to negatively affect our libido.

• #42

  https://link.springer.com/article/10.1007/s00213-024-06643-4

  Sexual desire, also known as libido, is a persistent sexual drive or interest that continues throughout the sexual experience until orgasm or satisfaction is achieved (Kaplan 1979). […] Without desire, individuals may not experience the excitement phase or subsequent stages of the sexual response cycle, as the mental state plays a significant role beyond physical desire and arousal (Basson 2008). […] Cannabis, widely believed to enhance sexual desire, has been found to have a bidirectional effect on sexual functioning. On the one hand, cannabis use has been associated with positive outcomes, such as prolonged intercourse, improved orgasm quality, and increased sexual satisfaction in both men and women; conversely, cannabis use has been linked to negative effects, including erectile dysfunction, sterility, and reduced testosterone levels.

• #43

  https://link.springer.com/article/10.1007/s00213-024-06643-4

  Interestingly, over 70% of participants report increased desire and orgasm intensity. […] Cannabis affects sexual function differently in men and women. […] Research suggests that cannabis may benefit women by assisting with conditions like dyspareunia, vulvodynia, pelvic pain, and other urogenital painful conditions. […] Conversely, in men studies predominantly show that cannabis increases the risk of erectile dysfunction (Lyzwinski 2023). […] The dosage of cannabis consumed significantly affects its impact on sexuality, as varying levels of THC and CBD can influence sexual desire, arousal, and satisfaction (Palamar et al. 2018). […] Despite the challenges surrounding the exploration of cannabis dosage and its impact on sexuality, a few studies have attempted to shed light on this relationship.

• #44

  https://link.springer.com/article/10.1007/s00213-024-06643-4

  Similarly, it was demonstrated that lower doses of cannabis increased sexual pleasure, while higher doses resulted in a reduction in sexual desire and performance among Indian men (Chopra and Jandu 1976). […] This association was further substantiated (Abel 1981) emphasizing the correlation between low doses of cannabis and enhanced sexual activity and very high doses were linked to difficulties in sexual performance (Buffum 1982). […] Overall, the effects of cannabis on human sexuality remain largely elusive and poorly understood.

• #45 Sexual Health Washington DC – Ozempic & Wegovy Influence Sexual Desire and Functioncriminalmotherhousebroken-armfacebook-letter-logotwitterlinkedin-logoyoutubeinstagram

  https://intimmedicine.com/beyond-weight-loss-how-glp-1-agonists-ozempic-wegovy-influence-sexual-desire-and-function/

  GLP-1 agonists have been observed to influence various other behaviors and physiological processes, including sexual desire and function. […] This brain region also influences sexual desire and function, suggesting that GLP-1 agonists might impact these aspects of behavior and physiology as well. […] By decreasing the desire for food and other substances like alcohol, cannabis, opioids, and cigarettes, these medications might also alter sexual desire. […] Weight loss achieved through GLP-1 agonists can lead to hormonal changes that affect sexual function. […] Similarly, weight loss in women can lead to hormonal adjustments that improve sexual satisfaction and desire. […] By promoting weight loss and improving overall metabolic health, GLP-1 agonists may enhance mood and self-esteem, leading to improvements in sexual desire and function.

• #46 Low libido (low sex drive) in men: from diagnosis to treatment | Spire Healthcare

  https://www.spirehealthcare.com/health-hub/specialties/men-s-health/low-libido-low-sex-drive-in-men-from-diagnosis-to-treatment/

  Low libido, also known as low sex drive, refers to a decreased interest in sexual activity. […] Low libido in men can be caused by psychological, lifestyle and medical factors. […] Medical factors include hormonal imbalances, low testosterone levels, diabetes, obesity and cardiovascular disease, as well as the side effects of certain medications. […] All of these factors can cause both low libido and erectile dysfunction. […] Treatment for low libido depends on the cause. If it is due to an underlying health condition, treating this condition will in most cases improve your libido. […] If you have a hormonal imbalance, you may be referred to a doctor specialising in treating hormonal conditions (an endocrinologist). Hormone replacement therapy (HRT) may be recommended. […] Lifestyle changes can also improve your libido, including following a healthy, balanced diet, getting enough sleep and regular exercise, and adopting stress management strategies. […] It is also important to identify and treat any underlying causes that may bring about low libido.

• #47 Family

  https://patents.google.com/patent/US20150231189A1/en

  The invention relates to medicine, namely the pharmaceutical industry, which produces biologically active food supplements to restore sex drive (libido) and improve sexual function in male and is based on natural ingredients. […] Sexual dysfunction including decreased libido, erectile and ejaculation dysfunction, as well as infertility, are widespread medical, psychological, and social problems. […] The main mechanism of its action is to increase the activity of endothelial NO-synthase, recovery of endothelium nitric oxide (NO), increase of cGMP content in smooth muscles and its relaxation that leads to an increase of blood supply to the corpus cavernosum. These effects primarily recover erection. […] L-Arginine is a protein-forming amino acid. It is a source of adequate forming of nitric oxide (NO) by vascular endothelium, which is associated with the dependent relaxation of smooth muscle cells of cavernous tissue determining the hemodynamic changes in the penis during erection and rigidity phase (K. E. Anderson, 2001).

• #48 Family

  https://patents.google.com/patent/US20150231189A1/en

  L-arginine has stimulating effect on the reproductive system: it increases the production of seminal fluid, spermatogenesis; stimulates the potency and sexual activity; can increase the strength and duration of blood supply to the genitals; prolongs the time of sexual intercourse; enhances pleasant sexual sensations; makes orgasms last longer; increases the frequency and intensity of orgasms. It improves mood, activity and endurance. […] The mechanism of action is similar to a phosphodiesterase inhibitor. It increases the production of nitric oxide, improves circulation and muscle power. It is tropic to androgen receptors and acts like testosterone, causing accelerated growth of muscle tissue, increases sex drive and endurance. […] The central mechanism of action of the drug is confirmed by the decrease of prolactin level in blood serum (548 136 to 24.5-467 mU/l, p 0.02) and the expression of anti-stress, psycho-stabilizing effects, as well as increase of libido, sexual activity due to stimulating action of LH on Leydig cells secreting testosterone.

• #49

  https://link.springer.com/article/10.1186/s41110-017-0051-0

  The libido is considered to be a sexual drive in individuals that can be determined and influenced by several factors, such as social, psychological, and hormonal factors. […] It is known that nutritional aspects are important hormone regulators and that sexual dysfunction may, in many cases, be reversed with simple lifestyle changes. […] Herbal medicine has been identified for having an effect upon the hypothalamic-pituitary-testicular axis, thus increasing the libido. This occurs through the increase in the number of several hormone and serum testosterone concentrations, which, in turn, stimulated the dopamine receptor, through mechanisms, such as vasodilation, the generation of nitrous oxide, increased androgen, and gonadotropin. […] Several herbal medicines have been reported as capable of affecting penile erection through different mechanisms.

• #50 FDA approves new treatment for hypoactive sexual desire disorder in premenopausal women | FDA

  https://www.fda.gov/news-events/press-announcements/fda-approves-new-treatment-hypoactive-sexual-desire-disorder-premenopausal-women

  The U.S. Food and Drug Administration today approved Vyleesi (bremelanotide) to treat acquired, generalized hypoactive sexual desire disorder (HSDD) in premenopausal women. […] HSDD is characterized by low sexual desire that causes marked distress or interpersonal difficulty and is not due to a co-existing medical or psychiatric condition, problems within the relationship or the effects of a medication or other drug substance. […] Vyleesi activates melanocortin receptors, but the mechanism by which it improves sexual desire and related distress is unknown. […] In 2016, the FDA published a draft guidance titled Low Sexual Interest Desire and/or Arousal in Women: Developing Drugs for Treatment, to assist companies developing drugs for the treatment of these conditions.

• #51 Vyleesi? Addyi? How women can get help for low sexual desire – UChicago Medicine

  https://www.uchicagomedicine.org/forefront/womens-health-articles/2019/june/vyleesi-addyi-how-women-can-get-help-for-low-sexual-desire

  Certainly, treatments that interfere with sex hormone metabolism like anti-hormone therapies used for breast cancer or infertility or even uterine fibroids can have a very substantial effect on a woman’s libido, as can medicines used to treat mood disorders like depression and anxiety. […] Painful sex, often due in part to vaginal dryness, is a common cause of low libido once the pain is treated, libido often improves. […] Vaginal dryness is commonly due to menopause, tightness in the pelvic floor muscles, too much washing in the genital area, lack of sufficient foreplay or sexual arousal, and dermatologic or other medical conditions. […] Many women (and men) use substances like alcohol and marijuana (or related products) to address libido and related sexual dysfunction problems. […] FDA approval of treatments for female sexual function should avail women of treatments that meet rigorous standards for safety and effectiveness and should protect women from risks associated with unregulated, unsupervised, unproven treatments that could be a waste of their money at best and harmful at worst. […] Neither Addyi nor Vyleesi target this female physiology. Instead, the medications are designed to increase sex drive. Vyleesi activates melanocortin receptors, Addyi targets serotonin receptors, but we still don’t have a full understanding of how these medications affect women’s sexual desire.

• #52 How does Addyi work and is it effective?

  https://www.drugs.com/medical-answers/addyi-work-effective-3573766/

  Addyi (flibanserin) works by balancing the brain chemicals that may lead to lowered sex drive in some women. […] Addyi appears to correct an imbalance of the neurotransmitters (brain chemicals) dopamine and norepinephrine (both responsible for sexual excitement), while decreasing levels of serotonin (which can lower sex drive). As with many drugs, the exact mechanism is not known. […] Studies have shown that in certain premenopausal women with HSDD, treatment with Addyi can increase sexual desire, increase the number of satisfying sexual events and reduce stress caused by low libido (low sex drive or desire). […] Other studies, including a large meta-analysis from Kamrul-Hasan et al, and a post-hoc, pooled analysis of pivotal studies (VIOLET, DAISY, and BEGONIA) from Simon, et al have shown that flibanserin (Addyi) was superior to placebo in increasing the number of sexually satisfying events (SSEs), improving sexual desire scores, and lowering sexual distress in premenopausal women with HSDD.

• #53 Sexual Dysfunction in Women

  https://www.uspharmacist.com/article/sexual-dysfunction-in-women

  Many women will likely experience a sexual problem in their lifetimes. […] The FDA recently approved the first agent for treatment of hypoactive sexual desire disorder (HSDD) in premenopausal women. […] Lack of sexual desire being the most prevalent. […] Declining estrogen and androgen levels associated with aging can significantly contribute to the occurrence of FSD. […] Estrogen withdrawal can have marked effects on the vagina such as atrophy and dryness, which may lead to impaired sexual desire. […] Declining androgen levels are also associated with decreasing sexual desire. […] Other possible biological influences on FSD are medical conditions. […] It is important to note that sexual dysfunction in females can also be drug-induced. […] Flibanserin, described as a multifunctional serotonin agonist antagonist (MSAA), is a serotonin1A receptor agonist and a serotonin2A receptor antagonist.

• #54 Sexual Dysfunction in Women

  https://www.uspharmacist.com/article/sexual-dysfunction-in-women

  The reported mechanism of action is to increase the release of norepinephrine and dopamine and decrease the release of serotonin in the cortex of the brain. […] Testosterone is used off-label in postmenopausal women. […] Evidence from randomized, controlled trials supports the improvement of decreased sexual desire in postmenopausal women using various testosterone formulations. […] Local estrogen therapy (LET), rather than systemic hormone therapy, is generally used to treat specific symptoms of FSD in postmenopausal women who do not have other underlying reproductive conditions such as breast cancer. […] LET may indirectly improve sexual desire and arousal by increasing vaginal lubrication and blood flow. […] Ospemifene mimics the effects of estrogen on vaginal tissue and appears to be as effective as vaginal estrogen for dyspareunia. […] PDE5 inhibitors may be efficacious in women with FSD secondary to the use of SSRIs and may additionally be effective in women diagnosed with sexual interest/arousal disorder. […] There are established and efficacious pharmacotherapeutic options for treating specific aspects of FSD.

• #55 Low Libido (Low Sex Drive)

  https://www.linkedin.com/pulse/low-libido-sex-drive-dr-deepak-sahu-l2fgf

  Hormone replacement therapy with estrogen is often used to address low libido in women, especially during menopause when estrogen levels decline. […] Testosterone replacement therapy may be prescribed to improve libido. […] Bremelanotide is a melanocortin receptor agonist that acts on the central nervous system. It is thought to enhance sexual desire. […] Flibanserin is a serotonin agonist and antagonist that affects serotonin and dopamine levels in the brain. It is believed to modulate neurotransmitters involved in sexual desire. […] Some studies suggest it may have potential benefits for sexual function, though more research is needed.

• #56 Sexual difficulties in the menopause – Australasian Menopause Society

  https://www.menopause.org.au/hp/information-sheets/sexual-difficulties-in-the-menopause

  There is a physiological decline in testosterone with age that is unrelated to natural menopause. […] However, large cross-sectional studies across pre- and post-menopausal women have failed to find a significant correlation between serum testosterone and self-reported sexual function. […] Available testosterone (measured by the free androgen index) does not decline and even rises marginally over the menopausal transition. […] A trial of testosterone therapy may be appropriate for some women whose symptoms do not improve on MHT alone. […] There is evidence for short-term efficacy and safety of physiological doses of testosterone treatment of postmenopausal women with sexual dysfunction due to hypoactive sexual desire disorder.

• #56 Sexual difficulties in the menopause – Australasian Menopause Society

  https://www.menopause.org.au/hp/information-sheets/sexual-difficulties-in-the-menopause

  Low libido refers to diminished desire for sex. When clinically a problem it is referred to as hypoactive sexual desire disorder (HSDD). Low libido is the most common sexual concern reported by women and is often inseparable from diminished capacity to become aroused. […] Hormones are rarely the only factor involved in desire-arousal problems and other factors need to be identified and addressed. […] Studies of sexual function over the menopausal transition have identified that declining sexual function correlates with falling oestradiol and not with testosterone. […] The decline in oestrogen at menopause results in a reduction in vaginal secretions and in vaginal dryness, making intercourse uncomfortable or even painful. […] Systemic, oestrogen-containing MHT can improve sexual function, including libido.

• #57 Overview of Sexual Function and Dysfunction in Women – Women’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/women-s-health-issues/sexual-function-and-dysfunction-in-women/overview-of-sexual-function-and-dysfunction-in-women

  Many factors cause or contribute to the various types of sexual dysfunction. Traditionally, causes are considered physical or psychological. However, the two types of causes cannot be separated. […] Depression and anxiety commonly contribute to sexual dysfunction. […] Various fears of letting go, of being rejected, or of losing control and low self-esteem can contribute to sexual dysfunction. […] After menopause, changes in the vagina and urinary tract (called genitourinary syndrome of menopause) can affect sexual function. […] Selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant, commonly cause problems with sexual function. […] Vaginal dryness or painful sex due to menopause can be treated with vaginal hormone therapy, including low-dose estrogen (as a cream, tablet, or ring) or dehydroepiandrosterone (DHEA, as a suppository).

• #58 Stanford Medicine scientists locate key brain circuit containing the seat of male libido | News Center

  https://med.stanford.edu/news/all-news/2023/08/male-libido-brain.html

  A team of Stanford Medicine researchers have shown in male mice that a particular neuronal circuit is responsible for sexual arousal and for the actions and pleasure that ensue, opening avenues for treatment in men. […] „Weve singled out a circuit in male mammals’ brains that controls sexual recognition, libido, and mating behavior and pleasure,” said Nirao Shah, MBBS, PhD, professor of psychiatry and of neurobiology and the senior author of a study describing the findings, published online Aug. 11 in Cell. […] The study showed that a male mouses determination that a stranger is female activates a brain center in the male that is the seat of libido. […] Along with potential drug applications, the findings could lead to a deeper understanding of the innate differences between male and female mammals and of the forces driving human sexuality.

• #59 Stanford Medicine scientists locate key brain circuit containing the seat of male libido | News Center

  https://med.stanford.edu/news/all-news/2023/08/male-libido-brain.html

  The study’s findings could lead to drugs that serve as libidinal rheostats, capable of tamping down sex circuitry in the brains of men with hyperactive sex drives, or, alternatively, boosting sex drive in men who suffer from a lack of desire. […] „Such drugs would be quite different from today’s phosphodiesterase inhibitors,” which counter erectile dysfunction, Shah said. „Instead of generally enhancing blood flow in small vasculature throughout the body, they would directly amplify or tamp down a specific brain area that controls male sexual desire.”

• #60 Nitric Boost Under Review: The Blue Salt Trick for Men’s

  https://www.globenewswire.com/news-release/2025/04/12/3060400/0/en/Nitric-Boost-Under-Review-The-Blue-Salt-Trick-for-Men-s-Health-Examined.html

  In recent years, a growing number of men across all age groups have silently battled common health concerns such as fatigue, diminished stamina, reduced libido, and circulatory issues. […] Intimacy becomes more about obligation than desire. These are not isolated frustrations they’re symptoms of more profound physiological shifts. […] Studies have shown that by the time many men reach their 40s, nitric oxide levels may be less than half of what they were in their 20s. This gradual depletion can lead to a range of symptoms, including fatigue, muscle weakness, delayed recovery after exercise, diminished libido, and, in many cases, erectile dysfunction. […] Recognizing the central role nitric oxide plays in maintaining male health, researchers and supplement formulators have increasingly focused on natural ways to stimulate its production.

• #61 Overview of sexual dysfunction in females: Management – UpToDate

  https://www.uptodate.com/contents/overview-of-sexual-dysfunction-in-females-management

  Sexual problems are highly prevalent in females. In the United States, approximately 40 percent of females have sexual concerns, and 12 percent report distressing sexual problems. Female sexual dysfunction takes different forms, including lack of sexual desire, impaired arousal, inability to achieve orgasm, pain with sexual activity, or a combination of these issues. Treatment must be tailored to the sexual dysfunction diagnosis or diagnoses and to underlying physical, psychological, and relationship factors. […] Female sexual dysfunction is multifactorial, often with several different etiologies contributing to the problem. Nonetheless, careful evaluation and use of available therapies can improve sexual function for many patients. […] Complete the evaluation and diagnosis — Evaluate the patient for the range of sexual issues and physical, psychological, and relationship factors associated with their concerns before starting treatment. Most patients with sexual concerns have clinical issues that impact more than one aspect of sexual function. The problem may involve more than one phase of the normal sexual response cycle (desire, arousal, orgasm), sexual pain, or a general decrease in sexual satisfaction. As an example, if a patient complains of decreased libido, a full evaluation may also reveal issues with arousal or pain.

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