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Cialis is the new drug
against ED (Erectile Dysfunction). |
Low Sexual DesireLow Desire (Hypoactive Sexual Desire Disorder [HSDD]) Prevalence Among men aged 18-59 in the general population, 14%-17% report a lack of interest in sex. Low sexual desire has been found to be strongly correlated with age. One community-based study found that 26% of men aged 70 and over had HSDD. Gradual decreases in sexual desire are considered a natural consequence of the aging process. Although men's interest in sex declines gradually beyond the fifth decade of life, at least a quarter of men are interested in having regular sexual activity (i.e., more often than monthly) into their eighties. Decreased desire is more likely to cause distress to a patient if there are relatively sudden declines in desire rather than a gradual drop-off. Many older couples will adjust to a decline in sexual desire and genital sexual activity. However, for some individuals and couples, sexual activity remains an important aspect of individual and relationship well-being. Many men, however, are too embarrassed to bring up this topic with their physician even if it is of concern to them. Etiology of Low Desire In most instances, a case of low desire in a man can be traced to one of, or a combination of four possible factors;
Diagnostic Criteria for Low Desire (Hypoactive Sexual Desire Disorder)
The etiology of low desire can be complex and low testosterone may not, in many cases, explain low desire in male patients. For example, many men with low desire have mean total and free testosterone levels that are in the normal range. For the male patient who reports little or no interest in sexual activity, it is important for the clinician to clarify if the problem relates to desire or arousal. For example, a man who says that he has no interest in sex may be referring to the fact that he is having difficulty getting an erection not that he his not interested in being sexual. There are several questions that the clinician can ask the patient to obtain a clearer picture. Patient Questions to Distinguish Between Low Desire and
Erectile Dysfunction Common Medications Associated with Low Desire-Antihypertensive Treating Low Desire The effective treatment of low desire among men is dependent on accurately identifying the etiology of the problem and proceeding with the appropriate course of treatment. For example, providing androgen supplementation to a man with low desire but normal range testosterone will do little to increase his sexual desire. It should also be noted that although a primary factor may be identified, low sexual desire will in many cases be multidimensional. For example, a man's gradually or suddenly declining androgen levels may have initially prompted his flagging desire but the problem was exacerbated by his decreased sense of masculinity, increased tension with his partner caused by his apparent lack of sexual interest, and the emotional stress (e.g., depression) that he subsequently felt. As a result, even if, for example, androgen supplementation was indicated for a man with low desire and below normal testosterone, it is more than likely that he will also require, at a minimum, brief psychosexual counselling. This may involve helping him to:
Adressing Low Desire Associated with Reduced Androgen Low sexual desire associated with low testosterone levels will often be accompanied by other symptoms including erectile dysfunction, fatigue, lethargy, mood swings, loss of motivation, and reduced physical vitality. It should also be noted that these symptoms can be associated not only with decreased testosterone but also with decreases in other hormones such as growth hormone, melatonin, and dehydroepiandrosterone. Laboratory tests to determine testosterone levels should measure bioavailable testosterone, including free and albumin-bound fractions. To reduce expenses, some physicians may wish to measure free testosterone first and them proceed to a test for bioavailable testosterone if the results are not clear. To account for circadian rhythm, assessment should be done between 8 and 11 am. If the testosterone level is below or at the lower limit, the results should be confirmed with a second test of LH and follicle-stimulating hormone. Preliminary studies indicate that androgen supplementation can increase sexual desire among men with low serum testosterone levels. Both physicians and patients must be aware of and consider the potential risks of androgen therapy, especially among older men who are more likely to have coexisting medical conditions. Patients should be carefully screened for any contraindications before androgen therapy is considered. For example, patients with liver or renal disease may be particularly predisposed to the development of gynecomastia . The risks of androgen therapy include: - Water retention (Can lead to hypertension, peripheral
edema, exacerbation of congestive heart failure) Physicians should comprehensively consult the relevant medical literature concerning all possible risks and contraindications of androgen therapy. Addressing Low Desire Associated with Medication Side Effects As noted above, lowered sexual desire is associated with a number of medications. In some cases it may be possible to substitute a different but equivalent medication that has less of an impact on a patient's level of desire. This is particularly the case with antidepressants which are well known to negatively impact on sexual desire and erectile function. Among men taking antidepressants, 38% to 50% report impairments in sexual desire depending on the antidepressant being used. Research suggests that bupropion and nefazodone have fewer sexual side effects than SSRIs. It is important to note that many patients with antidepressant-associated low desire will also have erectile dysfunction and that sildenafil improves erectile function in many of these patients. Addressing Low Desire Associated with Chronic Illness Low desire and other sexual dysfunctions emanating from chronic illness are often associated with both the physiological impact of the illness and psycho-social issues such as poor body image and depression. It is important, therefore, for the physician during the course of assessment to, as much as possible, differentiate between the physiological and psychological factors at play. For example, the illness itself, and medical treatments for it will in many cases have a direct impact on sexual function. Thus, in some cases, medical intervention can help to alleviate the negative impact on desire. Just as importantly, physicians can provide practical advise and brief psycho-sexual counselling. For example, a patient with musculoskeletal disease could be educated about positional changes for sexual intercourse or less demanding pleasuring that will make sexual activity more appealing and feasible or a patient with cancer who's low desire results from chemotherapy and negative body image can benefit from physician initiated discussion of strategies to maintain, restore and adjust sexuality. The range of different chronic illnesses is vast and each can have a specific impact on sexuality and physicians should consult resources appropriate to each illness. Addressing Low Desire Associated with Psychosexual Issues Low desire associated with psychosexual issues can have a complex etiology. Persons who have experienced sexual trauma, abuse, or assault in childhood, adolescence or adulthood can be prone to low desire. Often, low desire is associated with problems in a couple relationship. In both cases, the physician, after an initial assessment, may wish to provide a referral for psychological counselling or sex therapy. With respect to low desire resulting from relationship concerns, it may be helpful for the physician to be aware of the common issues related to low sexual desire that couples may face and to provide brief psychosexual counselling. These issues are listed below. Such counselling can be brief and solution focused, emphasizing current couple behaviours and practical suggestions, many of which can revolve around enhanced couple communication. Issues Related to Low Desire in Couple RelationshipsPartner differences in the desired frequency of sexual
contact. http://www.sexualityandu.ca/professionals/pdfs/Treating_MSD_in_Primary_Care.pdf |
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