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Healthy sex life indicates good health

Posted Oct 04 2009 11:11pm
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St. Louis Post-Dispatch

Ahealthy sex life means you're healthy; an unhealthy sex life means you may not be.

Experts emphasize that sexual dysfunction is often a symptom of bigger problems, ranging from heart disease, diabetes, high blood pressure, hormonal deficiencies, depression, relationship problems or a combination of those things.

What is sexual dysfunction?

You suffer from sexual dysfunction if you don't like what's going on in the parts of your life that involve sex.

That said, more specifically, sexual dysfunction is "an impairment of a couple's usual pattern of sexual interest," says Heather Raznick, a clinical sex therapist with St. John's Mercy Medical Center in West County, Mo.

Because of this, the percentage of people who suffer from sexual dysfunction is difficult to gauge.

For example, a significant number of people have low libido or lack of interest. But they don't care. These folks don't get counted.

"It's only a problem if you feel like you're having a problem," says Dr. James Cummings, professor of urology at St. Louis University School of Medicine. "Some people have low libido or erectile dysfunction and don't miss the (interaction) and don't have a problem."

Otherwise, statistics on sexual dysfunction tend to be extrapolated from other statistics. For example, about 75 percent of men being treated for heart disease and vascular problems suffer from erectile dysfunction, according to the National Institutes of Health.

Causes: Men

More often than not, a man gauges his sexual health by his ability to achieve an erection. The closer he gets to that ideal, the better he feels; the further, the more worried he gets.

Regardless, this litmus gives the medical community an easy way to gauge sexual dysfunction in men-if it's happening, good; if it's not, why not?

"Maybe 95 percent of the men I see for sexual dysfunction are here because of erectile dysfunction," Cummings says. The other percentage is divided among low libido (low desire for sex), premature ejaculation and emotional problems.

So, when men ask doctors what's wrong, they're referring to the obedience of their sex organs. But that may not be where to look, Cummings says.

"Problems with sexual dysfunction can be a sign something is going on with your (vascular system), with your blood vessels; when the arteries harden, they harden everywhere," Cummings says. "Or it could be a sign of diabetes."

A sudden or even gradual appearance of erectile dysfunction may signal that a heart attack or stroke is two or three years away, Cummings said. That's why he's glad that drugs that help men achieve erections require prescriptions-men must visit their doctors to get them.

For a man who says he's ready to get back into the social swing of things and is worried about his sexual response, Cummings recommends physical exercise. The healthier your body, the healthier . . . well . . . your body.

Causes: Women

Sexual dysfunction for women tends to work in the opposite direction of men's. It's more linked to emotional problems than with men, doctors say. Also, age and menopause play a tremendous part.

Any dysfunction tends to start with a woman's perception of the quality of her life - her partner, job, perception of her physical attractiveness, finances, anything that can cause stress. The resulting sexual dysfunction includes inability to achieve orgasm, pain during sex, no fun during sex, lack of interest, low desire and anxiety about performance.

Therefore, says Raznick of St. John's Mercy, women may need a combination of therapies, not just a doctor's visit or not simply counseling. Women's emotional health and physical health are tightly intertwined, she says.

Hormonal imbalance has received much attention in the past four years since the Women's Health Initiative said estrogen therapy caused heart attacks. The study said that estrogen replacement therapy for post-menopausal women, whose bodies stopped producing enough estrogen, was bad and even harmful.

Dr. Octavio Chirino says that study's findings were at best soft and may be flawed. Chirino is the chairman of the obstetrics and gynecology department at St. John's Mercy Medical Center.

He explains, "When the WHI study came out in 2002, many women stopped estrogen as a post-menopause therapy, especially those who didn't see gynecologists."

Without estrogen replacement therapy, many women found their sex lives hampered by problems, mainly a lack of arousal and vaginal atrophy, Chirino says.

"That's the most common physiological problem we see today," he says. "The WHI was way overdone, and since that time there's been a lot of backpedaling going on."

Remedies: Men

Men associate a lot of their social competence with the competence of their erection, experts say. That's why the pills available through a doctor are so valuable.

In the past, men with problems that ranged from post-surgical to emotional simply were out of luck. Now, the big three medications - Cialis, Viagra and Levitra - have solved the physical problems for millions of men.

"I think we're at a day and age where people don't have to be embarrassed to talk about problems sexually," says Cummings of St. Louis University. "I hope we're producing physicians who are sensitive to those sorts of things, and I think that if you're worried about your sex life, the one person who can help you is the doctor you go to see."

Still, when the pills don't work, the next step is an injection that men can give themselves. "That works best for someone in a stable relationship," Cummings says.

Less frequently, the problem is low testosterone. Cummings explains that factors in low testosterone often are misunderstood. Testosterone and the ability to achieve an erection are not that closely connected.

"Testosterone makes you want to (have sex)," he says. That can work independently of the ability to have sex. One or the other may need to be adjusted, he says.

Remedies: Women

Regardless of the source of the problems, Raznick says, the best way to start therapy for women's sexual dysfunction is to listen. Women need empathy from their doctors, mainly their gynecologists, who will ask questions and try to address the underlying causes of a woman's problems.

"That's not always the case," Raznick says. "Too many doctors still feel uncomfortable talking to women about (their sex lives), so that can go unaddressed.

"Often a doctor who empathizes will see a problem, identify or rule out all of the physical possibilities. Then the next thing to address is the relationship."

Chirino agrees. It's the job of the gynecologist to make sure a woman's sex life is as healthy as all other parts of her life.

"Often, patients won't bring it up unless you ask about it," Chirino says. "Otherwise, you only get the tip of the iceberg.

"A gynecologist's job is to make women at ease with discussing any types of problems, including sexual dysfunction. Otherwise, the doctor might not be getting to all of the physical and emotional problems a woman might be facing."

"We should know about any physical problem, but particularly with sexual dysfunction, making them know it's OK to talk about it and they're not going to be ridiculed or put down. The common problem is that many women think they're the only ones in the world with this problem."

In any event, something needs to be stepped up, Raznick says, because women who get to her office for counseling tend to show up for help two to three years late. That makes remedies that much more difficult.

More often than not, dealing with a woman's sexual dysfunction will take a combination of medical and counseling services, experts say.

That would explain why it's so difficult to find a female counterparts for male performance pills.

"In women, the libido is more likely to be tied to something else and requires a different sort of therapy," Raznick says.

Chirino agrees: "The doctor shouldn't be afraid to ask about it; patients shouldn't be afraid to talk about it. It's very common, and doctors need to be willing to listen and ask the right questions to bring out these problems."
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