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Intimacy and Sexuality

Sexual Dysfunction

It is becoming increasingly apparent that dysfunction in matters of intimacy is a problem of increasing prevalence. The public is becoming more open about discussing these matters, and with the increased medical understanding of neural and hormonal influences on matters of sexuality, treatment is becoming increasingly available.

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What is sexual dysfunction?

Sexual dysfunction (SD) can be defined in a variety of ways, depending upon the attitude, orientation and social parameters in which an individual exists. That is, what is normal or appropriate for one person may be entirely unacceptable to the next. Societal pressures, religious orientation, political climate and other influences will change the nature and definition of SD.

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For purposes here, SD will be addressed entirely from the viewpoint of physiology, without any intended endorsement of any particular orientation or attitude.

NOTE: For the purposes of discussion, SD will be defined as a physical impairment that prevents the enjoyment of satisfactory sexual activity.

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Physical inability to perform

-Nerve impairment

-Chemical imbalance

-Hormonal imbalance

-Medication side-effect

-Nutritional deficiency

-Disease State

Emotional inability to perform

-Post-traumatic effect

-Hormonal imbalance

-Fear

-Social/religious attitude or impairment

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Loss of emotional momentum, or loss of libido

  • Age

  • Fatigue

  • Boredom

Marital Discord

  • Trust

  • Fatigue

  • Boredom

  • Abuse

  • Availability

  • Appearance

  • Location

  • Personality

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I will attempt to address the medical/physical problems in a systematic way.

  1. Matters of marital discord are beyond the focus of attention here.

  2. Problems with ‘availability’ are probably unsolvable.

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Physical Impairment

The most common cause of sexual impairment resulting from pain stems from the sequelae of lower back injury. Next to headache, more time is lost from work due to low back pain than from any other cause. With increasing frequency, patients are undergoing spinal surgery for pain alone,
that is, pain in the absence of bladder/bowel dysfunction, muscular atrophy and numbness.

This stems from the prevalence of imaging centers that are readily available to perform MRI’s, CAT scans, and such. It should be better recognized that the mere presence of an ‘abnormality’ on image does not imply causality. A ‘structural’ abnormality may not be abnormal at all.

Imagine yourself sitting in a nearby shopping mall.

  1. Approximately 1/3 of all persons walking about the mall will have a ‘structural abnormality’ on MRI.

  2. These abnormalities may be labeled as “bulging disc” “herniated disc,” or “degenerated disc.”

  3. These persons are functioning normally, without meaningful impairment.

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Now imagine the same population simultaneously running into each other and pulling a muscle.

  1. If all of these persons received MRI’s, 1/3 would demonstrate the (pre-existing and asymptomatic) abnormal scan.

  2. The muscle pull will then be misdiagnosed as a herniated disc, and too many of these end up having surgery.

  3. It should then come as no surprise that only 1/3 of patients undergoing spinal surgery will experience pain relief. (NOTE: this means some decrease in pain, not an elimination of pain.)

  4. 1/3 of a patient undergoing spinal surgery will come out of it without any net change in symptoms.

  5. 1/3 of patients undergoing spinal surgery will come out with worsened pain.

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Many patients find themselves having undergone surgery without meaningful benefit. Unfortunately, too many of these patients find themselves returning to the same surgery center for spinal surgery #2, surgery #3, and so forth.

The familiar progression is as follows:

  1. Epidural Steroid Injections (ESI, LES) performed 3 times (the reason for the 3 or 4 injections is more a matter of tradition than of outcome measurement.

  2. After the ESI’s fail, as they most frequently do, the patient undergoes surgery #1, or lumbar discectomy/laminectomy.

  3. Failure of Surgery #1 leads to surgery #2, or repeat laminectomy/discectomy.

  4. Failure of Surgery #2 leads to surgery #3, or spinal fusion.

  5. Failure of Surgery #3 leads to surgery #4, or fusion with a cage, mesh, or some other fixation device.

The obvious problem is in patient selection. There are too many surgeons anxious to perform the surgery, and the criteria become softer and softer.

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If the problem is that the ‘abnormality’ on MRI is not causing the pain, then an effort must be made to establish causality between the pain and the disc. To do this, the physician should obtain evidence that this is the case.

Performing EMG, NCV, SSEP provides evidence of causality, if it exists. If a corroborating NCV does not demonstrate findings of lumbar/cervical radiculopathy, then surgery is unlikely to be successful.

  • Lumbar Disc Surgery

  • Spinal Cord Injury

  • Sleep disorders and depression resulting from pain and/or opiates

  1. First and foremost, it is important to understand that libido and potency are dependent upon a proper ratio of testosterone to estrogen.

  2. As men age, estrogen levels increase, as testosterone levels decrease.

  3. When the ratio drops from a healthy 7:1 to 2:1, erectile difficulties begin to manifest.

  4. This typically occurs around the age of 35.

  5. Weight lifters, athletes and those who take xenotestosterone (injections) reach this unhealthy ratio much earlier in life.

In order to restore libido and treat ED, testosterone levels must be increased, but more importantly, estrogen levels must be decreased.

This is achievable, but it is anything but simple. The approach is to decrease degradation of testosterone to estradiol through inhibition of certain enzymes, increase testosterone production, and enhance estrogen excretion through the biliary tract.

This takes a combination of supplements, taken in concert. Timing is essential, and periodic hormone levels should be determined through laboratory examination.

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Personal Lubricants

Women commonly suffer from problems that result in vaginal dryness, and for this reason, it is necessary to have a good personal lubricant immediately handy.

The best ones are water-soluble. KY has a good product out that is easily obtained from the local drug store. Try to avoid petroleum-based products because they can cause difficulties for women the day after.

I will put together a detailed treatment regimen, available for download. Until then, a good start is outlined, below:

  1. Stud-Mix: One capsule per day. Best taken at bedtime. Contains Saw Palmetto extract 300 mg, Nettle Root Extract 120 mg, Pygeum Bark Extract 50 mg, Zinc 8 mg, Selenium 50 mcg, and Copper 500 mcg.

  2. Tribulus Fruit Extract 500 mg taken twice or three times daily.

Give it 3 months, and add the other agencies listed above. This approach inhibits both 5-alpha reductase and aromatase pathways of testosterone degradation. By introducing the Stud Mix and Tribulus products in sequence, the effectiveness is increased, and it may demonstrate that only one of the two supplements was necessary, in any particular case.

To decrease estrogens through biliary excretion, use the following:

  1. Silymarin/curcumin mixture: one capsule three times, daily.

  2. Fiber Plus : 3 capsules, twice, daily.

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