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An Approach To Managing Sexual Disorders: Prioritizing Sexual Health
Sexual disorders are various conditions that cause distress or prevent a person and/or their partner from attaining satisfaction during sexual activity. In Nigeria, cases of sexual disorders are underreported and not considered an alarming issue due to lack of specialist sexual health facilities, cultural taboo, and stigma on the part of sufferers. Erectile dysfunction, premature ejaculation, and hypoactive sexual disorders are among the many sexual illnesses that are estimated to affect 20–30% of Nigerian men and women in the country. The recognition and treatment of these diseases are made more difficult by cultural and socioeconomic factors, such as poverty, illiteracy, the shame associated with female sexual desire, and the emphasis on male sexual dominance. According to the diagnostic and statistical manual of disease, 5th edition (DSM-5), it lists sexual disorders as female sexual arousal/interest disorder, female orgasmic disorder, genito-pelvic pain/penetration disorder, male hypoactive sexual desire disorder, erectile disorder, premature(early) ejaculation and delayed ejaculation.
Symptoms
The following are typical signs of sexual dysfunction, though they vary depending on the particular condition:
- Erectile Dysfunction: This is a sexual ailment in men that occurs due to inability to attain or maintain an erection firm enough for sexual intercourse
- Premature Ejaculation: This is one of the most common sexual disorders. It occurs when a man ejaculates sooner than he or his partner desires during sexual intercourse.
- Hypoactive Sexual Desire Disorder: This is characterized by persistent or recurrent lack of sexual fantasies or desire for sexual activity (have no sex drive or a low sex drive)
- Female Sexual Arousal Disorder: A condition where there's no response to sexual stimulation, which makes it hard to get aroused during sexual intercourse
- Dyspareunia: A lasting or recurrent pain in the genital area during or after sexual intercourse. It can affect both men and women. Dyspareunia in female can be superficial (due to conditions like vaginismus, vaginal candidiasis or dryness) or deep ( due to pelvic inflammatory disease).
Sexual illnesses are frequently linked to serious problems with relationships, self-esteem, and general quality of life in Nigeria.
Clinical Findings
Clinical findings in sexual disorders include:
- Psychiatric Examination: Patients may show signs of unstable emotions and feelings due marital or relationship problems, stress or anxiety, poor body image, sexual trauma or abuse, concerns about sexual performance and depression
- Physical Examination: Though might vary from one sexual dysfunction to another, significant signs observed include; anatomical abnormalities, symptoms of chronic conditions, hormonal imbalances, side effects of some drugs like, antidepressant medicines.
Differential Diagnosis
The signs and symptoms of sexual disorders are not exclusive to the condition; various conditions can also exhibit similar signs or coexist with sexual disorders. Some of these conditions include:
- Mood Disorders: Mood swing as a result of depression, stress anxiety etc
- Medical Conditions: Chronic conditions such as Neurological disorders like multiple sclerosis (MS) or nerve damage, cardiovascular diseases, kidney or liver failure, Diabetes can lead to sexual health issues.
- Substance Use Disorders: Alcohol use disorder and drug abuse often present with sexual dysfunction
- Other Sexual Disorders: There is a need to accurately differentiate between various types of sexual disorders such as erectile dysfunction and premature ejaculation, in order to deliver an effective treatment approach.
Investigations
Some medical evaluations and specialized tests needed for the diagnosis of sexual disorders include:
- Laboratory Tests: Blood sugar test, cholesterol, and hormonal assays (such as those for prolactin and testosterone) are used to screen and identify the medical causes of sexual dysfunction.
- Imaging: Pelvic or Penile Doppler ultrasound, MRI, Computed Tomography, and other radiological methods aid in examining internal and external genitalia identify abnormalities, and guide surgical interventions.
- Psychological Assessments: Assessments can be carried out through questionnaires and patients testing to understand their behavior towards sex, relationship concerns, anxiety, and sexual history. The International Index of Erectile Function (IIEF) and the Female Sexual Function Index (FSFI) are helpful machines during this diagnosis.
Treatment
The standard treatment for sexual disorders is by addressing the underlying problem or conditions that are causing the dysfunction. The various treatment approach includes:
- Pharmacotherapy: Use of medications to treat various conditions. For example, the use of drugs like phosphodiesterase inhibitors (e.g., sildenafil) to increase blood flow to the penis for erectile dysfunction; selective serotonin reuptake inhibitors (SSRIs) to reduce sensitivity and delay ejaculation for premature ejaculation, and hormone replacement therapy for Hypoactive Sexual Desire Disorder (HSDD) can be effective.
- Psychotherapy: addressing the psychological and emotional factors that contribute to sexual dysfunction through practices like Cognitive-behavioral therapy (CBT), mindfulness practice, couples therapy and sensate focus exercises.
- Other Interventions: Use of natural remedies like plants and herbs may improve outcomes. Use of water-based lubricants to ease dyspareunia, treatment of underlying infections and mental health conditions like depression and anxiety. Sex education.
Follow-Up
Regularly scheduled follow-up sessions are needed during sexual disorder treatment in order to monitor progress and review the treatment plan when necessary.
- Frequency: The first follow-up should take place within two to four weeks of beginning treatment, and then every four to six weeks after that.
- Monitoring: Assessing response to treatment and potential complications if any. Use of standardized tools like the IIEF and FSFI can help track progress.
Prevention and Control
Preventive strategies to reduce the risk of certain types of sexual disorders in Nigeria include:
- Lifestyle Modification: Simple healthy living practices like getting regular exercise, quitting smoking, limiting alcohol and drug use, maintaining healthy weight, eating a balanced diet and safe sex practice play an important role in preventing sexual disorders.
- Screening: Regular checkup and routine medical tests help for early diagnosis and identifying other health issues that may lead to sexual disorders.
- Public Education and Policy Measures: Organizing awareness programs to educate the public about sexual health, promoting the availability of sexual health services, and reducing the stigma associated with sexual disorders.
Conclusion
Sexual disorder is a challenging public health concern that is often overlooked in Nigeria. Most cases of sexual disorders can be managed with early detection, counseling, public education, integrated care and improved communication between partners. Community health providers can work together with traditional leaders to enhance the acceptability of interventions and enlighten the people against the stigmatization of sufferers among them.
A patient suffering from a type of sexual discomfort and low self-esteem went to the hospital for treatment. He claimed that his symptoms, which had caused serious stress in his marriage, started after a traumatic job loss and had continued for more than a year. Based on normal test results and clinical evaluation, psychogenic erectile dysfunction was diagnosed. He was started on sildenafil and referred for cognitive-behavioral therapy and couples counseling. With proper adherence to treatment and follow-up, his symptoms considerably improved and he reported increased sexual function and relationship satisfaction. This case emphasizes the importance of not neglecting sexual health, especially in environments with little resources.
- Adekunle, A. O., Oladipo, O. O., & Akinloye, O. (2010). Prevalence and correlates of sexual dysfunction among Nigerian men with diabetes mellitus. African Journal of Urology, 16(3), 89-94.
- Gureje, O., Lasebikan, V. O., Kola, L., & Makanjuola, V. A. (2010). Lifetime and 12-month prevalence of mental disorders in the Nigerian Survey of Mental Health and Well-Being. The British Journal of Psychiatry, 188(5), 465-471.
- Oladeji, B. D., & Gureje, O. (2013). The comorbidity between sexual disorders and other mental health conditions in low- and middle-income countries. Current Opinion in Psychiatry, 26(1), 1-7.
Author's details
Reviewer's details
An Approach To Managing Sexual Disorders: Prioritizing Sexual Health
Sexual disorders are various conditions that cause distress or prevent a person and/or their partner from attaining satisfaction during sexual activity. In Nigeria, cases of sexual disorders are underreported and not considered an alarming issue due to lack of specialist sexual health facilities, cultural taboo, and stigma on the part of sufferers. Erectile dysfunction, premature ejaculation, and hypoactive sexual disorders are among the many sexual illnesses that are estimated to affect 20–30% of Nigerian men and women in the country. The recognition and treatment of these diseases are made more difficult by cultural and socioeconomic factors, such as poverty, illiteracy, the shame associated with female sexual desire, and the emphasis on male sexual dominance. According to the diagnostic and statistical manual of disease, 5th edition (DSM-5), it lists sexual disorders as female sexual arousal/interest disorder, female orgasmic disorder, genito-pelvic pain/penetration disorder, male hypoactive sexual desire disorder, erectile disorder, premature(early) ejaculation and delayed ejaculation.
- Adekunle, A. O., Oladipo, O. O., & Akinloye, O. (2010). Prevalence and correlates of sexual dysfunction among Nigerian men with diabetes mellitus. African Journal of Urology, 16(3), 89-94.
- Gureje, O., Lasebikan, V. O., Kola, L., & Makanjuola, V. A. (2010). Lifetime and 12-month prevalence of mental disorders in the Nigerian Survey of Mental Health and Well-Being. The British Journal of Psychiatry, 188(5), 465-471.
- Oladeji, B. D., & Gureje, O. (2013). The comorbidity between sexual disorders and other mental health conditions in low- and middle-income countries. Current Opinion in Psychiatry, 26(1), 1-7.
Content
Author's details
Reviewer's details
An Approach To Managing Sexual Disorders: Prioritizing Sexual Health
Background
Sexual disorders are various conditions that cause distress or prevent a person and/or their partner from attaining satisfaction during sexual activity. In Nigeria, cases of sexual disorders are underreported and not considered an alarming issue due to lack of specialist sexual health facilities, cultural taboo, and stigma on the part of sufferers. Erectile dysfunction, premature ejaculation, and hypoactive sexual disorders are among the many sexual illnesses that are estimated to affect 20–30% of Nigerian men and women in the country. The recognition and treatment of these diseases are made more difficult by cultural and socioeconomic factors, such as poverty, illiteracy, the shame associated with female sexual desire, and the emphasis on male sexual dominance. According to the diagnostic and statistical manual of disease, 5th edition (DSM-5), it lists sexual disorders as female sexual arousal/interest disorder, female orgasmic disorder, genito-pelvic pain/penetration disorder, male hypoactive sexual desire disorder, erectile disorder, premature(early) ejaculation and delayed ejaculation.
Further readings
- Adekunle, A. O., Oladipo, O. O., & Akinloye, O. (2010). Prevalence and correlates of sexual dysfunction among Nigerian men with diabetes mellitus. African Journal of Urology, 16(3), 89-94.
- Gureje, O., Lasebikan, V. O., Kola, L., & Makanjuola, V. A. (2010). Lifetime and 12-month prevalence of mental disorders in the Nigerian Survey of Mental Health and Well-Being. The British Journal of Psychiatry, 188(5), 465-471.
- Oladeji, B. D., & Gureje, O. (2013). The comorbidity between sexual disorders and other mental health conditions in low- and middle-income countries. Current Opinion in Psychiatry, 26(1), 1-7.
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