Sexual Dysfunction

Eleanor is a 48 year old woman who enjoyed a healthy sexual relationship with her husband.  However, since her total hysterectomy five years ago, she has noted a sharp decline in her sex drive. It has also become uncomfortable to have sex and it’s causing problems in her marriage. Her husband is very loving and tries to be understanding but she worries that he will lose patience with her. She wonders if she is just too old to still enjoy sex as she once did.

Gerald is a 40 year old man who finally settled down to marry his girlfriend of many years.  Since he was older when they married, they were both anxious to start a family. However, he has recently noted the gradual onset of erectile dysfunction. The first time it happened, he passed it off as being tired and sleep-deprived. He was sure it would be better when they could get away on a romantic weekend. The special week- end arrived and it was no better. He has started having chronic headaches and is now taking 4 to 6 tablets of Tylenol daily. His 38 year old wife feels her biological clock ticking away and she is getting a little resentful of his seeming lack of interest. He is thinking about asking his doctor for Viagra.

Both of these two individuals have treatable medical conditions. Left untreated these conditions compromise their ability to be sexually active.

Eleanor is deficient in estrogen and testosterone. In addition to decreased libido and discomfort with sex, she also has problems with insomnia, depression, fatigue and irritability. Since her hysterectomy, she has gained 30 pounds and feels like she is rapidly aging. Most distressing of all she has trouble with memory and concentration. She feels like she is in a fog all the time and worries about getting premature Alzheimer’s. In a woman with deficient levels, providing natural bioidentical hormone replacement, including testosterone, can often produce marked improvement in many of these symptoms.

Gerald has a prolactin-secreting pituitary tumor (prolactinoma), which is compressing the part of the pituitary, which stimulates production of testosterone.  One in four persons will develop a pituitary tumor in their lifetime. Prolactinomas occur more frequently in women but when they occur in men, the most common initial symptom is erectile dysfunction.

Women or men can also develop a functional hyperprolactinemia, which is not a tumor but still interferes with fertility and can cause loss of sexual function. Viagra is a treatment that has been very useful for many men with various degrees of erectile dysfunction. Understandably, men are often reluctant to discuss sexual problems with their physician and the idea of taking a pill to quickly solve the problem is very tempting.   However, before you rush off for your prescription of Viagra, be aware that erectile dysfunction can be a sign of an underlying endocrine problem, which if diagnosed and treated could restore totally normal sexual function without the need for Viagra.

Hypothyroidism, a deficiency of thyroid hormone, is another common cause of sexual dysfunction and infertility both in men and women.  With moderate to severe hypothyroidism, the symptoms such as depression, fatigue, increased sleep requirements; weight gain and constipation are usually easily diagnosed. However, with subtle degrees of hypothyroidism, the symptoms may be only mild fatigue and mild sexual dysfunction. Hyperthyroidism, which is an over-production of thyroid hormone can also lead to sexual dysfunction and infertility.   It can be also be associated with weight loss, nervousness, restlessness, insomnia, racing heart and decreased stamina.

Deficiency or excess of cortisol hormone can lead to problems with erectile dysfunction and infertility.  In addition, various nutritional or metabolic deficiencies can lead to erectile dysfunction. Chronic stress can adversely affect the hypothalamus, the part of the brain, which stimulates the pituitary, which is responsible for stimulating production of all the hormones.  When cortisol or thyroid hormone is missing, a person can only survive weeks to months depending on the severity of the deficiency.  In comparison, the sex hormones, estrogen and testosterone, are not essential for immediate survival. Therefore, the body in its wisdom tends to preferentially “sacrifice” production of these hormones in times of mental or physical stress.

However, chronically low levels of the sex hormones in both men and women are associated with long-term complications including osteoporosis, premature heart disease and Alzheimer’s disease. Andropause or male menopause occurs in about 40% of men. Men with low testosterone often develop a characteristic “beer-belly” even when they are not beer-drinkers!

This same pattern of abdominal obesity can also develop in people with insulin resistance and is associated with a high risk of hypertension, diabetes, elevated triglycerides and premature heart disease. This characteristic pattern of abdominal fat is usually normalized when hormonal balance is restored.

In summary, sexual function is a product of multiple complex interactions among endocrine, metabolic, psychological and nutritional factors. Deficiency or excess of hormone levels can markedly interfere with sexual function and fertility. New therapy like Viagra is an important option that offers hope to many individuals. However, it is important to recognize that symptoms of sexual dysfunction in men or women can represent an underlying medical problem that if properly diagnosed and treated can restore normal function.