General ill-health may lead to loss of libido. This is usually a secondary effect due to lack of well-being and discomfort. Diabetes seems to have an effect on all aspects of sexual function in women but is hard to separate direct effects from ones secondary to concurrent ill-health and distress regarding the disease. Neurological problems such as multiple sclerosis and spinal cord lesions will affect arousal and orgasm, although libido may be normal. Women with cardiovascular disease may fear recurrence of problems such as chest pain or stroke on exertion. Rarely, in conditions such as Addison’s disease, there is a reduction in sex hormones that may lead to loss of desire.
Arthritis and back pain can interfere with movement. Advice regarding use of analgesia together with adoption of different positions for intercourse, often with judicial use of pillows, can be helpful. It is important that doctors appreciate that ill and old people may still have sexual desires and activity. Patients may not want to broach the subject and the doctor may also find it difficult. They may be looking for “permission” from the practitioner to continue with some activity and confirmation that it is normal to still have sexual feelings.
The relationship between depression and loss of desire is complex. Someone may become depressed because of their psychosexual problem, especially if it is putting their relationship in jeopardy. Patients with loss of libido may seem depressed but on closer enquiry it will appear that other aspects of their life are fine. Conversely, depression can cause loss of libido and it is important not to embark on lengthy psychosexual counselling without establishing this. Some of the newer antidepressants, particularly the serotonin reuptake inhibitors, may cause difficulty in achieving arousal and orgasm and may reduce libido in men and women. Women may be prepared to put up with this side effect but become concerned if it is not explained to them that the effect is temporary.
Surgery, particularly disfiguring operations such as mastectomy, may have a severe detrimental effect on a woman’s body image and subsequent sexual function. It may affect her partner and she may feel no longer desired. Women with stoma need special consideration but any surgical scarring can sometimes change the way a woman feels about herself and affect her body image. Doctors must get used to asking about resumption of sexual activity after traumatic illness and life events.
Medical causes of male sexual dysfunction
- Cardiovascular disease
- Neurological disorders
- Prescription drugs
- Prostate disorders and surgery
- Conditions causing low testosterone
- Thyroid disease
- Any major illness
- Major surgery or trauma
- Psychiatric illness
- Drug or alcohol abuse
Medical problems that may lead to sexual problems in men
Although this chapter is primarily about female sexual problems, these cannot be discussed fully without considering male problems. A woman may be the presenting patient whilst the primary problem is with her partner. This may be a covert presentation and it may take the doctor a while to get to the root of the problem.