Sexuality is the ultimate union of mind and body. Not surprisingly, illness in either realm often first manifests as sexual impairment. Only recently has modern medicine acknowledged the inseparable relationship between body and mind, and formal scientific inquiry has lagged behind. Thus, many diseases are fully described as to the effects on the specific organ systems involved, but not on how they influence sexuality. Also studying sexuality challenges the scientist to bring the most private, intimate interaction between people into the public, sterile laboratory environment in hopes of quantifying and understanding this boundless, universal act. This has often led to the oversimplification of sexual acts to those of measurable ends like erectile dysfunction in men and vaginal lubrication in women.
In order to simplify this seemingly indescribable task, several authors have conceptualized sexual problems arising from illness as primary, secondary or tertiary. Primary refers to dysfunction that is organic in origin related directly to specific illness effects. All individuals with each particular condition present with similar primary symptoms. Secondary sexual dysfunction relates to the physical changes that cause indirect impairment such as fatigue, weakness and bowel/bladder incontinence. Finally, tertiary sexual dysfunction suggests the psychological stress of illness such as low self-esteem due to changed body image, depression from loss of previous function, and anger or fear of rejection from one’s partner or society.
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Diagnosing primary, secondary or tertiary dysfunction or the combination thereof is complicated but must be attempted as it profoundly affects treatment. Neurological Disorders For many, loss of sexual function is the most devastating aspect of neurologic illness. All phases of the sexual response cycle can be affected, from the inability to process sexual stimuli to arousal dysfunction and anorgasmia. Specific to neurologic illness is also heightened sexual function such as spontaneous orgasm in epilepsy or hyperarousal in traumatic brain injury. Hypersexuality is not an increase in sexual needs but characterized more as a general disinhibition. Although neurologic illness extends from the brain to the peripheral nerves, only a select few topics of traumatic brain injury, multiple sclerosis and spinal cord injury will be discussed here. Diabetic neuropathy will be considered later in the endocrine section.
Traumatic Brain Injury
Studies on brain trauma are limited by their subjects’ ability to participate related to the biological effects of neuronal trauma and by comorbid mood and pain issues. Many survivors are in the midst of adolescence, just becoming aware of themselves as sensual beings and have yet to have any sexual encounters.
Sexual outcomes can be determined globally by the total amount of brain tissue destroyed versus focal deficits associated with the specific area of the brain affected. Globally, arousal may be influenced by verbal and nonverbal communication problems as well as increased impulsivity and altered concentration. Locally, injury to the prefrontal cortex generates apathy with hyposexuality, or less commonly, disinhibition with hypersexuality. Lobar injuries most often produce hyposexuality with the exception of bilateral necrosis of the temporal lobes (Klьver-Bucy syndrome), which causes hypersexuality and hyperorality.
Hypothalamic and pituitary damage may be missed at the initial event as basal fractures that injure the pituitary stalk have low detection rates on MRI and CT. Complaints of decreased libido, impotence, and dysmenorrhea may be the first signs of decreased hormone levels. If these endocrine alterations occur early, they may trigger puberty leading to body image struggles and social withdrawal. Although panhypopituitarism is rare in head injury survivors, isolated pituitary deficits, specifically low gonadotropin and low growth hormone, are frequent sequela. Resulting low testosterone levels hinder sexual well being in both genders as do low growth hormone titers which result in a loss of vitality.
Multiple Sclerosis
The etiology of sexual impairment in multiple sclerosis involves both spinal cord lesions and psychologic factors. Primary sexual dysfunction includes altered genital sensation, decreased lubrication, difficulties keeping and maintaining an erection and decreased ability to achieve orgasm. Muscle weakness, spasticity, tremor and sphincter dysfunction comprise the secondary dysfunction. These symptoms may lead to tertiary dysfunction with psychological dissatisfaction and depression. Sexual dysfunction increases with age and disease duration and is associated with anxiety and lower levels of education. Overall, sexual dysfunction contributes to decreased quality of life scores in those living with multiple sclerosis. Kamagra australia online pharmacy – cheap sexual dysfunction drugs.
Spinal Cord Injury
Level and completeness of spinal cord damage determines sexual capacity. Psychogenic erections are lost with high lesions but reflex erections remain intact. For women, those younger at age of trauma were more likely to have sexual encounters after injury. Women’s preferred intimate activities after injury included kissing, hugging and touching. Women with complete lower motor neuron dysfunction cannot achieve orgasm with clitoral stimulation, but those with lesions at any level may be able to climax with cervical vibrostimulation. Similar to other neurologic disorders, spasticity, motor restrictions and catheter limitations interfere with sexual activity.