Sexual dysfunction and impotence

Overview

Sexual dysfunction refers to any condition that prevents an individual from experiencing pleasure during sexual activity. It may involve a lack of desire or an inability to enjoy sex, which can be signs of sexual dysfunction. This issue is quite common and can often be treated effectively. Factors such as stress, health problems, medications, or previous sexual trauma can contribute to its development¹. 

Erectile dysfunction, or impotence, is characterized by the inability to achieve or maintain an erection for sexual intercourse². 

Causes of Sexual Dysfunction and Impotence

Causes of sexual dysfunction can be due to physical and psychological reasons.

Physical Causes

• Hormonal changes: Conditions that impact hormone levels, such as thyroid disorders, can create imbalances that interfere with sexual function. Hormonal fluctuations can also occur naturally, such as during menopause in women or as a result of declining testosterone levels in ageing men.
• Metabolic conditions: Metabolic disorders, including obesity and high cholesterol, can lead to sexual dysfunction, affecting both libido and erectile function. These conditions may disrupt blood flow and hormone balance, contributing to sexual health issues.
• Heart conditions: Heart diseases like heart failure can cause sexual dysfunction by reducing blood flow to the sexual organs and leading to symptoms like fatigue and shortness of breath during sexual activity, making intimacy difficult.
• Disorders that disrupt sexual function: Conditions like prostatitis in men or endometriosis in women can cause significant pain during sexual activity, disrupting the sexual response and reducing desire or enjoyment.
• Neurological disorders: Neurological conditions, such as Parkinson’s disease and multiple sclerosis (MS), can damage the nerves involved in sexual arousal and response, leading to difficulties like erectile dysfunction or loss of sexual sensitivity.
• Substance use, including alcohol use: Excessive use of alcohol or other substances can interfere with sexual function in both men and women, causing issues like reduced libido, erectile dysfunction, or difficulty reaching orgasm.
• Medications: Certain medications, including birth control pills, antidepressants, and blood pressure drugs, can contribute to sexual dysfunction by altering hormone levels, affecting libido, or causing physical side effects that impact sexual performance³.

Psychological Causes

• Stress: High levels of stress, whether from work, personal life, or external pressures, can significantly impact sexual desire and performance. Stress triggers the body's "fight or flight" response, which can interfere with arousal and make it difficult to relax during sexual activity.
• Anxiety: Anxiety, whether generalized or specifically related to sexual performance, can create mental barriers that prevent full sexual enjoyment. Worrying about how one will perform or about potential outcomes can diminish libido and lead to difficulties with arousal or achieving orgasm.
• Depression: Depression can reduce interest in activities that once brought pleasure, including sex. The emotional and physical symptoms of depression, such as fatigue, sadness, and hormonal imbalances, can make sexual intimacy feel unappealing or difficult.
• Past trauma: Experiencing past trauma, such as sexual abuse or assault, can lead to lasting emotional and psychological scars. These experiences may cause fear, distrust, or emotional pain during sexual activity, resulting in avoidance or difficulty enjoying intimacy.
• Relationship problems: Ongoing issues in a relationship, such as communication problems, unresolved conflicts, or lack of emotional intimacy, can contribute to sexual dysfunction. When emotional needs aren't being met, desire and connection during sex may diminish.
• Strict upbringing and sexual beliefs: A strict upbringing or rigid sexual beliefs can create feelings of guilt, shame, or discomfort around sex. These negative feelings can hinder sexual enjoyment and create barriers to intimacy, especially if an individual has been taught that sex is something to be ashamed of or avoided.
• Low self-esteem: Low self-esteem or negative body image can make individuals feel insecure about their appearance or performance in bed. These feelings of inadequacy can lead to anxiety or self-consciousness, reducing sexual desire and making it hard to engage in intimate relationships.
• Fear related to sexual performance: Fear of poor sexual performance, such as concerns about erectile dysfunction or inability to satisfy a partner, can create significant anxiety. This fear can become a self-fulfilling prophecy, leading to performance issues and diminished enjoyment of sex³.

Signs of Sexual Dysfunction for Men and Women

• For men, sexual dysfunction can manifest in various ways. One common issue is the inability to achieve or maintain a full erection, which may be caused by physical or psychological factors. Another problem is delayed or absent ejaculation, where a man may struggle to ejaculate even when sexually aroused, leading to frustration and reduced satisfaction. Premature ejaculation is also a frequent concern, where a man ejaculates too quickly during intercourse, often before he or his partner is ready, which can affect intimacy and self-esteem.
• For women, sexual dysfunction can include the inability to achieve orgasm, which may be caused by physical or emotional factors, such as hormonal imbalances, stress, or relationship issues. Vaginal dryness is another common issue, especially during periods of hormonal change, such as menopause or breastfeeding, making intercourse uncomfortable or even painful. Additionally, dyspareunia, or pain during sexual intercourse, can occur due to various reasons, such as spasms of the vaginal muscles or inflammation of the vulva (vulvodynia), both of which can significantly impact a woman's ability to enjoy sex⁴.

Signs of Impotence in Men

• Unable to get an erection: This refers to the inability to achieve an erection sufficient for sexual activity, which can be caused by physical factors like low testosterone, poor blood circulation, or psychological factors such as stress or anxiety.

• Unable to keep an erection for long enough to have sex: This involves difficulty maintaining an erection throughout sexual activity, leading to premature loss of rigidity. It can result from similar causes as the inability to get an erection, including health conditions like erectile dysfunction or performance anxiety⁵.

Sexual Dysfunction and Impotence and TCIH Approaches

Acupuncture: The concept behind acupuncture for treating erectile dysfunction (ED) is that it helps to balance nerve sensitivity and improve blood circulation, which are key factors in sexual function. By inserting thin needles into specific points in the body, acupuncture is thought to stimulate the nervous system and release endorphins, which can reduce stress and promote relaxation. It also encourages blood flow to the pelvic area, which is essential for achieving and maintaining an erection.