Erectile Dysfunction and Female Sexual Dysfunction
In today’s world, Erectile Dysfunction is one of the most common dysfunctions affecting men’s sexual health [1]. Erectile dysfunction is a condition in which certain physiological and psychological factors prevent an individual from achieving or maintaining an erection [2]. This is directly correlated with reduced to non-existent sexual satisfaction leading to an overall reduced quality of life.
In 2018, a study was conducted to examine the relationship between physical activity and erectile dysfunction which discovered that erectile dysfunction affects about one third of all men [3]. Further studies conducted in 2019 confirm this by noting that the global prevalence of erectile dysfunction was between 3-76.5% and that about 140 million men are affected by this sexual dysfunction [4].
Although ED is generally regarded as a dysfunction associated with age, studies show that this condition affects men of all ages; however, the prevalence of erectile dysfunction does increase with age. The Massachusetts Male Aging Study conducted in 1994 found that 52% of men had experienced some form of Erectile dysfunction in their lifetime [5]. About 5-15% of the men who had experienced it were between the ages of 40-70.
Although the possibility of ED increases with age, research published in the Journal of Sexual Medicine in 2013 concluded that 1 in every four patients with erectile dysfunction is a young man, which amounted to 26% at the end of the study. In the International Index of Erectile Function, it was observed that severe ED rates were about 48.8% in younger men and 40% in older men [6].
Erectile dysfunction could result in low self-esteem, depression, and poor sexual performance, which could impose on the relationship between a man and his partner [7,8]. It is important to note that a man’s inability to get or keep an erection occasionally, may not be a sign of erectile dysfunction unless its occurrence is frequent and prolonged. A man said to have ED must be exhibiting the following symptoms [9].
- Inability to get an erection when engaging in sexual activity.
- Inability to keep an erection long enough to have satisfactory sexual activity.
- Low sexual desire.
Several factors can be responsible for causing erectile dysfunction in men. These causes could range from problems affecting the vascular system, endocrine system, and nervous system [10]. Furthermore, these causes could result from diseases such as
- Heart and blood vessel disease
- Type 2 diabetes
- High blood pressure
- Chronic kidney disease
- Multiple sclerosis
- Atherosclerosis and;
- Peyronie’s disease
Physical causes of erectile dysfunction in men are outlined below [11].
- Inadequate blood flow to the penis: Health issues such as hardened arteries and smoking can reduce the chances of blood flowing to the penis.
- Inability to keep blood in the penis: There is an increase in blood flow to the penis during the occurrence of sexual activity. Where blood cannot remain in the penis for the duration of sexual intercourse, erection cannot be maintained.
- Cancer treatments: Surgeries for cancers such as bladder, colon, and prostate cancer can cause erectile dysfunction in men. Furthermore, injuries that occur during treatments such as radiation therapy could result in ED.
- Negative impact of drugs: Certain drugs used for the treatment of health problems can have negative side effects, which in turn affect the ability of a man to get and maintain an erection.
- The penis does not receive nerve signals from the brain or spinal cord: Certain injuries, diseases such as Parkinson’s disease, and surgery can have adverse effects on the nerves connected to the penis and prevent it from receiving nerve signals transmitted from the brain or spinal cord. This occurrence often results in erectile dysfunction in men. Moreover, altering testosterone levels and thyroid function, which could affect sex drive, might be an indirect cause of ED [12].
Further, emotional factor can also cause or worsen erectile dysfunction. These emotional factors could be:
- Anxiety
- Relationship problems
- Depression
- Stress from work, family, and cultural conflicts
- Worry about sexual performance
- Lack of self-confidence
Discovering the cause of ED is essential towards finding solutions and treatment options. To have a proper diagnosis, the patient must provide an accurate account of his history of ED if any, and the health care practitioner involved should consider any social, religious, cultural, and personal factors that could be the main source of the problem [13].
Questions to be asked to the patient should be unambiguous, with the aim being to ascertain facts. The health practitioner involved should also seek clarity on cardiovascular, endocrinological, and neurological factors that could be responsible for erectile dysfunction. Questionnaires such as the International Index of Erectile Function (IIEF) contain relevant questions to be asked in order to determine the issue, and measure the improvement of the patient’s condition over a period of time [14].
For physical examinations, the clinician is required to perform the general examination required as well as some blood investigations depending on what has been discovered through the general examinations.
Contemporary and Alternative Medicine for Erectile Dysfunction
The available treatment for ED in men has changed considerably over the years as more studies have been conducted along with the advancements in science and technology. There are several licensed drugs available for the treatment of ED, and they are available in 3 forms:
First Line(Oral) Therapies
The oral drugs available for the treatment of erectile dysfunction are sildenafil (Viagra), phosphodiesterase 5 inhibitors (PDE), verdanafil, tadalafil, apomorphine, and yohimbine. Oral therapies are essential in the treatment of ED due to their non-invasive nature. The use of these injections result in no urethral or penile pain, and patients can take it discretely but must ensure they follow the recommended dosage or prescription for any visible results [10].
Sildenafil is perhaps the most well-received among the oral agents as 84% of the men who participated in the studies showed positive response whereas about less than 3% of men discontinued use of it [15]. Although most oral therapies are licensed, Yohimbine is only drug available on prescription [16].
Second Line Treatments (Injectable and Intraurethral)
Injectable and Intraurethral treatments are only considered in the treatment of erectile dysfunction after oral therapies have been tried and rejected. These second-line treatments are primarily used by patients whose ED is rooted in organic factors. These treatments are put into consideration after the use of oral treatments as patients are required to use them with extreme care and would need proper instruction on how to introduce the drugs into their system. Improper application of second line treatments could result in fibrosis and penile pain [11][17].
The second-line treatments available for the ED are moxisylyte, papaverine, phentolamine, and alprostadil. Patients are expected to be monitored when receiving their initial doses to reduce the risk of a hypotensive episode, which would require medical attention.
Third Line Therapies
The third line therapies are vacuum constriction devices or rings placed over the penis. Once the device or ring has been placed, a vacuum is created manually or with the use of a battery-powered motor. This third-line therapy is used by men who can achieve an erection but cannot maintain one for satisfactory sexual experience. It is also utilized by men who cannot take oral therapies and want to avoid the use of second-line therapies [18]. However, the use of vacuum constriction devices must be avoided by men with leukaemia, sickle cell disease, and those under anticoagulation therapy to prevent further complications [10].
What is Female Sexual Dysfunction?
Female sexual dysfunction (FSD) is a condition resulting from certain physiological or psychological factors that prevents a woman from having sexual satisfaction [19,20]. The Second International Consensus of Sexual Medicine further defines female sexual dysfunction to be ‘lifelong (primary) or acquired (secondary) and as situational (occurs in all situations and with all partners) [21]. It is defined by the World Health Organization as ‘the various ways in which a woman is unable to participate in a sexual relationship as she would wish.’ In 1992, the National Health and Social Life Survey noted that about 43% of women had sexual complaints [22]. An international survey conducted in 2004 with women around the ages of 40-80 found that about 39% of women who were sexually active had problems that affected their sexual experience.
The 4th edition of the Diagnostic and Statistical Manual of Mental Disorders released in 2000, classified female sexual dysfunction into four categories:
- Sexual arousal disorder: The woman experiences difficulty in getting or remaining aroused during sexual intercourse, even though she has a desire for sex.
- Sexual desire disorder: This involves a lack of interest in sexual activity or the willingness to engage in it.
- Orgasmic disorder: Recurring difficulty in having an orgasm despite sufficient stimulation and sexual arousal.
- Sexual pain disorder: Pain during sexual intercourse or stimulation.
FSD becomes more prevalent in women as they age and is generally associated with symptoms such as pain and discomfort during sexual intercourse, vaginal dryness, and low sex drive or arousal [23]. Furthermore, there are several factors that could result in sexual dysfunction in women. Physical causes include:
- Certain drugs: Chemotherapy and other forms of cancer treatment, selective serotonin uptake inhibitors (SSRIs), and drugs such as antidepressants can have an effect on a woman’s sexual drive and ability to achieve an orgasm during sexual activity. These drugs cause hormonal levels to change when used, leading to such problems.
- Vascular disorders: Like the penis, the vagina, labia, and clitoris require increased blood flow to remain sexually aroused. Inadequate blood flow to the reproductive system can result in unsatisfactory sexual activity.
- Health conditions: Conditions such as diabetes, multiple sclerosis, arthritis, alcohol abuse, and drug addiction can affect the sexual experience of a woman. Other health conditions like vaginismus, endometriosis, ovarian cysts, vaginitis, uterine fibroids make intercourse painful and uncomfortable.
- Hormonal changes: Vaginal dryness or atrophy, which results in a painful sexual experience, may be caused by hormonal imbalances. Menopause, surgery, and pregnancy can also lead to hormonal imbalance.
Psychological factors have a role to play in female sexual dysfunction [24]. These factors include:
- Stress: Stress from work and home can make a woman unable to have an enjoyable sexual experience. Experiencing high levels of stress increases hormone cortisol levels which in turn reduces sex drive.
- Trauma: Past trauma could lead to lack of sexual satisfaction due to the fear of intimacy and anxiety that arise from it.
- Depression: Depression indicates a lack of interest in the things you do and your environment in general. This could also translate to a lack of interest in sexual intercourse.
- Relationship troubles: Women in unhappy relationships may experience sexual dysfunction due to the stress of those relationships.
When diagnosing sexual dysfunction in women, the physician or healthcare provider should ensure that the patient provides complete and accurate information on his history of sexual dysfunction [19]. The questions asked should be unambiguous and focus on establishing the physical or psychological factors that could be related to sexual dysfunction [25]. Questions related to family, sexuality, past sexual trauma or abuse, and the status of current relationships should be considered to narrow the cause of sexual dysfunction. The Brief Sexual Symptom Checklist is a tool employed by health care professionals to ensure that they have comprehensive knowledge of their patient’s sexual history as it contains basic questions to determine the patient’s past sexual experiences [26].
A physical examination, including a pelvic examination and pap smear, should be conducted to ensure that no abnormality is present. Abnormal findings during physical examinations are more likely to be prevalent in older women, women who do not receive medical care, and women with chronic system disease [27].
Contemporary and Alternative Medicine for Female Sexual Dysfunction
Treatment for female sexual dysfunction is currently understudied and there is not much available for women who suffer from this condition, unlike the availability of different forms of treatment for men [28]. The available treatments are: [29]
- Counselling: Women suffering from this condition can seek assistance from a health professional. Together, they can overcome emotional barriers that prevent her from having a satisfactory sexual experience. She can engage in this counselling with her partner or go alone.
- Arousal techniques: Such patient is advised to consider various arousal techniques to increase her interest in sexual activity. This could be by making changes to your routine or incorporating some sexual materials to help with arousal.
- Medication: Premenopausal women with low sex drive, can use drugs such as Flibanserin and Bremelanotide to improve their sex drive.
- Pain management techniques: Using lubricants and trying different positions and sexual approaches could help relieve pain during sexual intercourse.
How does Yoga help with Erectile Dysfunction and Female Sexual Dysfunction?
Yoga is recognized as a form of alternative therapy and is adopted by people worldwide. It combines physical postures called asanas with meditation and breathwork to improve health and well-being. Yoga is practiced today as a form of relaxation and exercise and is considered an alternative treatment for pain disorders, depression, anxiety, posttraumatic stress disorder, and cancer recovery [30]. Regular yoga practice has been known to improve blood flow, aid flexibility and balance, strengthen the body, and help in the practice of mindfulness.
Practicing yoga has been established to have beneficial effects on a person’s health, but recent studies have shown that its benefits extend to a person’s sexual health.
In a study conducted in 2007, 65% of the men who participated in the study experienced a significant improvement in premature ejaculation after yoga workouts. In another study conducted with women between the ages of 22 to 55 years, volunteers experienced a 30.38% improvement in all sexual functions after 12 weeks of yoga practice [31]. Older volunteers experienced an improvement in their arousal scores, while younger participants noticed an improvement in orgasmic quality.
In a third study conducted in 2010 with males between the ages of 24 to 60 years, it was found that there was an improvement in sexual desire, performance, intercourse, satisfaction, orgasm, erection, and partner synchronization after 12 weeks of yoga sessions [32].
Performing yoga exercises over an extended period of time will help with erectile function by improving blood flow and cardiorespiratory fitness, as well as reducing stress. In addition, regular yoga aids in developing a person’s confidence and overall health.
Female sexual dysfunction remains largely unexplored, it is gradually garnering the interest of health professionals and adequate research is being conducted to examine this condition, and that includes the use of yoga. Although health professionals have not confirmed how yoga helps in improving sexual functions in females, it has shown impressive results that will be analyzed in further studies [31].
Yoga poses that can help with erectile dysfunction and female sexual dysfunction include:
- Vajarasana
- Kapalbhati
- Yog mudra
- Marjarasan
- Pavanmukatasan
- Viparita karani mudra
- Matsyasana
- Halasan
- Ardhmatsyendra mudra
- Paschimottoasana
- Paravatasan
- Bhujangasan
- Shalabhasan
- Naukasana
- Bhushirasana
- Dhanurasan
- Hansasana
- Chakarasan
- Trikonasana
- Uddiyana bandha/agnisara
- Paranayama
- Shava asana
These asanas are to be practiced over an extended period of time, and three repetitions of each asana are suggested [31]. Those who cannot perform the full versions of the asana can select the easier versions available to them.