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132-762: Erectile dysfunction ( ED ), also referred to as impotence , is a form of sexual dysfunction in males characterized by the persistent or recurring inability to achieve or maintain a penile erection with sufficient rigidity and duration for satisfactory sexual activity . It is the most common sexual problem in males and can cause psychological distress due to its impact on self-image and sexual relationships. The majority of ED cases are attributed to physical risk factors and predictive factors. These factors can be categorized as vascular, neurological, local penile, hormonal, and drug-induced. Notable predictors of ED include aging, cardiovascular disease , diabetes mellitus , high blood pressure , obesity, abnormal lipid levels in

264-448: A class of drugs that are typically used as antidepressants in the treatment of major depressive disorder , anxiety disorders , and other psychological conditions. SSRIs increase the extracellular level of the neurotransmitter serotonin by limiting its reabsorption (reuptake) into the presynaptic cell . They have varying degrees of selectivity for the other monoamine transporters , with pure SSRIs having strong affinity for

396-459: A triptan for migraine does not appear to heighten the risk of the serotonin syndrome. Taking monoamine oxidase inhibitors (MAOIs) in combination with SSRIs can be fatal, since MAOIs disrupt monoamine oxidase , an enzyme which is needed to break down serotonin and other neurotransmitters. Without monoamine oxidase, the body is unable to eliminate excess neurotransmitters, allowing them to build up to dangerous levels. The prognosis for recovery in

528-573: A "high risk of bias", but agreed with the EMA assessment that cautionary labeling on SSRIs was warranted. On the 20th of march of 2024, a lawsuit was filed by the organization Public Citizen , representing Dr. Antonei Csoka , against the United States Food and Drug Administration (FDA) for failing to act on a citizen petition submitted in 2018. The petition seeks to have the risk of serious sexual side effects persisting after discontinuation mentioned in

660-837: A 10-week randomized controlled, double-blind trial escitalopram was more effective than placebo. Fluvoxamine , another SSRI, has shown positive results. However, evidence for their effectiveness and acceptability is unclear. Antidepressants are recommended as an alternative or additional first step to self-help programs in the treatment of bulimia nervosa . SSRIs (fluoxetine in particular) are preferred over other anti-depressants due to their acceptability, tolerability, and superior reduction of symptoms in short-term trials. Long-term efficacy remains poorly characterized. Similar recommendations apply to binge eating disorder . SSRIs provide short-term reductions in binge eating behavior, but have not been associated with significant weight loss. Clinical trials have generated mostly negative results for

792-521: A 2004 U.S. Food and Drug Administration (FDA) analysis of clinical trials on children with major depressive disorder found statistically significant increases of the risks of "possible suicidal ideation and suicidal behavior" by about 80%, and of agitation and hostility by about 130%. According to the FDA, the heightened risk of suicidality is within the first one to two months of treatment. The National Institute for Health and Care Excellence (NICE) places

924-821: A 2015 literature review. According to Gunter de Win , a Belgian professor and sex researcher, "Put simply, respondents who watch 60 minutes a week and think they're addicted were more likely to report sexual dysfunction than those who watch a care-free 160 minutes weekly." In seemingly rare cases, medications such as SSRIs, isotretinoin (Accutane) and finasteride (Propecia) are reported to induce long-lasting iatrogenic disorders characterized by sexual dysfunction symptoms, including erectile dysfunction in males; these disorders are known as post-SSRI sexual dysfunction (PSSD), post-retinoid sexual dysfunction/post-Accutane syndrome (PRSD/PAS), and post-finasteride syndrome (PFS) . These conditions remain poorly understood and lack effective treatments, although they have been suggested to share

1056-498: A 2023 study a possible connection between SSRI usage and the onset of mitral valve regurgitation was identified, indicating that SSRIs could hasten the progression of degenerative mitral valve regurgitation (DMR), especially in individuals carrying 5-HTTLPR genotype. The study’s authors suggest that genotyping should be performed on people with DMR to evaluate serotonin transporter (SERT) activity. They also urge practitioners to exercise caution when prescribing SSRIs to individuals with

1188-448: A biosocial approach to ED considers a person's decision to undergo clinical treatment more likely a result of "society, political economy, history, and culture" than a matter of personal choice. In rejecting biomedical treatment for ED, males can challenge common forms of medicalized social control by deviating from what is considered the normal approach to dysfunction. The Latin term impotentia coeundi describes simple inability to insert

1320-409: A common etiology. Penile erection is managed by two mechanisms: the reflex erection, which is achieved by directly touching the penile shaft, and the psychogenic erection, which is achieved by erotic or emotional stimuli. The former involves the peripheral nerves and the lower parts of the spinal cord, whereas the latter involves the limbic system of the brain . In both cases, an intact neural system

1452-415: A daily basis is consistent with clinical observations that the therapeutic effects of SSRIs generally take several weeks to emerge. Sexual dysfunction ranging from decreased libido to anorgasmia is usually considered to be a significantly distressing side effect which may lead to noncompliance in patients receiving SSRIs. However, for those with premature ejaculation, this very same side effect becomes

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1584-421: A decrease in bone mineral density, as well as increased fracture risk, a relationship that appears to persist even with adjuvant bisphosphonate therapy. However, because the relationship between SSRIs and fractures is based on observational data as opposed to prospective trials, the phenomenon is not definitively causal. There also appears to be an increase in fracture-inducing falls with SSRI use, suggesting

1716-401: A familial history of DMR. SSRIs directly increase the risk of abnormal bleeding by lowering platelet serotonin levels, which are essential to platelet-driven hemostasis. SSRIs interact with anticoagulants , like warfarin , and antiplatelet drugs , like aspirin . This includes an increased risk of GI bleeding , and post operative bleeding. The relative risk of intracranial bleeding

1848-451: A favorable risk-benefit ratio in children with depression, though it was also associated with a slight increase in the risk of self-harm and suicidal ideation. Only two SSRIs are licensed for use with children in the UK, sertraline (Zoloft) and fluvoxamine (Luvox), for the treatment of obsessive–compulsive disorder . Fluoxetine is not licensed for this use. It is unclear whether SSRIs affect

1980-420: A few of these have ever been the object of empirical research. Sexual arousal disorders were previously known as frigidity in women and impotence in men, though these have now been replaced with less judgmental terms. Impotence is now known as erectile dysfunction , and frigidity has been replaced with a number of terms describing specific problems that can be broken down into four categories as described by

2112-428: A hospital setting is generally good if serotonin syndrome is correctly identified. Treatment consists of discontinuing any serotonergic drugs and providing supportive care to manage agitation and hyperthermia , usually with benzodiazepines . Meta analyses of short duration randomized clinical trials have found that SSRI use is related to a higher risk of suicidal behavior in children and adolescents. For instance,

2244-513: A last resort, if other treatments have failed, the most common procedure is prosthetic implants which involves the insertion of artificial rods into the penis. Some sources show that vascular reconstructive surgeries are viable options for some people. The Food and Drug Administration (FDA) does not recommend alternative therapies to treat sexual dysfunction. Many products are advertised as " herbal viagra " or "natural" sexual enhancement products, but no clinical trials or scientific studies support

2376-432: A normal, and sometimes even welcome sign of healthy aging. Wentzell's study of 250 Mexican males in their 50s and 60s found that "most simply did not see decreasing erectile function as a biological pathology". The males interviewed described the decrease in erectile function "as an aid for aging in socially appropriate ways". A common theme amongst the interviewees showed that respectable older males shifted their focus toward

2508-445: A pathology of either the immune system or autonomic nervous systems. It is defined as a rare disease by the NIH, but the prevalence is unknown. It is not thought to be psychiatric in nature, but it may present as anxiety relating to coital activities and thus may be incorrectly diagnosed as such. There is no known cure or treatment. Dhat syndrome is another condition which occurs in men: it

2640-414: A pathology was antithetical to the social view these males held of themselves, and their purpose at this stage of their lives. In the 20th and 21st centuries, anthropologists investigated how common treatments for ED are built upon assumptions of institutionalized social norms. In offering a range of clinical treatments to 'correct' a person's ability to produce an erection, biomedical institutions encourage

2772-450: A reduction or loss of sensitivity in the genitals or other erogenous zones . Additional non-sexual symptoms are also commonly described, including emotional numbing , anhedonia , depersonalization or derealization , and cognitive impairment . The duration of PSSD symptoms appears to vary among patients, with some cases resolving in months and others in years or decades; one analysis of patient reports submitted between 1992 and 2021 in

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2904-668: A set of symptoms reported by some people who have taken SSRIs or other serotonin reuptake-inhibiting (SRI) drugs, in which sexual dysfunction symptoms persist for at least three months after ceasing to take the drug. The status of PSSD as a legitimate and distinct pathology is contentious; several researchers have proposed that it should be recognized as a separate phenomenon from more common SSRI side effects. The reported symptoms of PSSD include reduced sexual desire or arousal , erectile dysfunction in males or loss of vaginal lubrication in females, difficulty having an orgasm or loss of pleasurable sensation associated with orgasm, and

3036-468: A small and unimportant way compared with placebo." However, it also noted significant methodological limitations that make drawing definitive conclusions about efficacy difficult. Fluoxetine is the only SSRI authorized for use in children and adolescents with moderate to severe depression in the United Kingdom . Some SSRIs are effective for social anxiety disorder, although their effects on symptoms

3168-425: A type of physical therapy designed to restore the health and function of the pelvic floor and surrounding areas. Several theories have looked at female sexual dysfunction, from medical to psychological perspectives. Three social psychological theories include: the self-perception theory, the overjustification hypothesis, and the insufficient justification hypothesis: The prevalence of sexual dysfunction in women

3300-678: A vicious cycle that often leads to female sexual dysfunction. According to Emily Wentzell, American culture has anti-aging sentiments that have caused sexual dysfunction to become "an illness that needs treatment" instead of viewing it as a natural part of the aging process. Not all cultures seek treatment; for example, a population of men living in Mexico often accept ED as a normal part of their maturing sexuality. Sexual problems are common with SSRIs, which can cause anorgasmia , erectile dysfunction , diminished libido , genital numbness, and sexual anhedonia (pleasureless orgasm). Poor sexual function

3432-458: Is major depressive disorder ; however, they are frequently prescribed for anxiety disorders , such as social anxiety disorder , generalized anxiety disorder , panic disorder , obsessive–compulsive disorder (OCD), eating disorders , chronic pain , and, in some cases, for posttraumatic stress disorder (PTSD). They are also frequently used to treat depersonalization disorder , although with varying results. Antidepressants are recommended by

3564-406: Is priapism . Sexual dysfunction A thorough sexual history and assessment of general health and other sexual problems (if any) are important when assessing sexual dysfunction, because it is usually correlated with other psychiatric issues, such as mood disorders, eating and anxiety disorders, and schizophrenia. Assessing performance anxiety, guilt , stress , and worry are integral to

3696-719: Is a culture-bound syndrome which causes anxious and dysphoric mood after sex. It is distinct from the low-mood and concentration problems (acute aphasia) seen in POIS. Sexual pain disorders in women include dyspareunia (painful intercourse) and vaginismus (an involuntary spasm of the muscles of the vaginal wall that interferes with intercourse). Dyspareunia may be caused by vaginal dryness . Poor lubrication may result from insufficient excitement and stimulation, or from hormonal changes caused by menopause , pregnancy , or breastfeeding. Irritation from contraceptive creams and foams can also cause dryness, as can fear and anxiety about sex. It

3828-621: Is a blood vessel disorder that affects blood flow to tissue in the penis. The treatment is painless and has no known side effects. Treatment with shockwave therapy can lead to a significant improvement of the IIEF (International Index of Erectile Function). Men with low levels of testosterone can experience ED. Taking testosterone may help maintain an erection. Males with type 2 diabetes are twice as likely to have lower levels of testosterone, and are three times more likely to experience ED than non-diabetic men. A vacuum erection device helps draw blood into

3960-471: Is a common disorder of which the central feature is excessive worry about a number of different events. Key symptoms include excessive anxiety about multiple events and issues, and difficulty controlling worrisome thoughts, that persists for at least 6 months. Antidepressants provide a modest-to-moderate reduction in anxiety in GAD, and are superior to placebo in treating GAD. The efficacy of different antidepressants

4092-405: Is a feeling of melancholy and anxiety after sexual intercourse that lasts for up to two hours. Sexual headaches occur in the skull and neck during sexual activity, including masturbation , arousal or orgasm. In men, POIS causes severe muscle pain throughout the body and other symptoms immediately following ejaculation . These symptoms last for up to a week. Some doctors speculate that

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4224-468: Is a relatively rare cause of erectile dysfunction. In individuals with testicular failure, as in Klinefelter syndrome , or those who have had radiation therapy , chemotherapy , or childhood exposure to the mumps virus , the testes may fail to produce testosterone. Other hormonal causes of erectile failure include brain tumors, hyperthyroidism , hypothyroidism , or adrenal gland disorders. Anorgasmia

4356-501: Is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis . There are various underlying causes of ED, including damage to anatomical structures, psychological causes, medical disease, and drug use. Many of these causes are medically treatable. Psychological ED can often be treated by almost anything that the patient believes in; there is a very strong placebo effect. Physical damage can be more difficult to treat. One leading physical cause of ED

4488-625: Is also associated with preterm birth . According to some researches, decreased body weight of the child, intrauterine growth retardation, neonatal adaptive syndrome, and persistent pulmonary hypertension also was noted. A systematic review of the risk of major birth defects in antidepressant-exposed pregnancies found a small increase (3% to 24%) in the risk of major malformations and a risk of cardiovascular birth defects that did not differ from non-exposed pregnancies. Other studies have found an increased risk of cardiovascular birth defects among depressed mothers not undergoing SSRI treatment, suggesting

4620-406: Is also one of the most common reasons people stop the medication. In some cases, symptoms of sexual dysfunction may persist after discontinuation of SSRIs. This combination of symptoms is sometimes referred to as post-SSRI sexual dysfunction . Pelvic floor dysfunction can be an underlying cause of sexual dysfunction in both women and men, and is treatable by pelvic floor physical therapy ,

4752-401: Is available to determine whether there are long-term effects. Persistent pulmonary hypertension (PPHN) is a serious and life-threatening, but very rare, lung condition that occurs soon after birth of the newborn. Newborn babies with PPHN have high pressure in their lung blood vessels and are not able to get enough oxygen into their bloodstream. About 1 to 2 babies per 1000 babies born in

4884-612: Is characterized by the persistent or recurring inability to achieve or maintain an erection of the penis with sufficient rigidity and duration for satisfactory sexual activity . It is defined as the "persistent or recurrent inability to achieve and maintain a penile erection of sufficient rigidity to permit satisfactory sexual activity for at least 3 months." ED often has an impact on the emotional well-being of both males and their partners. Many males do not seek treatment due to feelings of embarrassment. About 75% of diagnosed cases of ED go untreated. Causes of or contributors to ED include

5016-510: Is classified as persistent delays or absence of orgasm following a normal sexual excitement phase in at least 75% of sexual encounters. The disorder can have physical, psychological, or pharmacological origins. SSRI antidepressants are a common pharmaceutical culprit, as they can delay orgasm or eliminate it entirely. A common physiological cause of anorgasmia is menopause ; one in three women report problems obtaining an orgasm during sexual stimulation following menopause. Premature ejaculation

5148-546: Is concerned, in most cases, and in the absence of postoperative complications, the operative repair can lead to a recovery of the sexual life of people with preoperative sexual dysfunction, while, in most cases, it does not affect people with a preoperative normal sexual life. ED can also be associated with bicycling due to both neurological and vascular problems due to compression. The increased risk appears to be about 1.7-fold. Concerns that use of pornography can cause ED have little support in epidemiological studies, according to

5280-582: Is continual or severe damage taken to the nervi erigentes , which can prevent or delay erection. These nerves course beside the prostate arising from the sacral plexus and can be damaged in prostatic and colorectal surgeries . Diseases are also common causes of erectile dysfunction. Diseases such as cardiovascular disease , multiple sclerosis , kidney failure , vascular disease , and spinal cord injury can cause erectile dysfunction. Cardiovascular disease can decrease blood flow to penile tissues, making it difficult to develop or maintain an erection. Due to

5412-461: Is effective. The mechanism by which SRIs may induce PSSD is unclear; neurobiological and cognitive factors may act in combination to cause the problem. As of 2023, prevalence is unknown. A 2020 review stated that PSSD is rare, underreported, and "increasingly identified in online communities". A 2024 study investigating the prevalence of persistent post-treatment genital numbness among sexual and gender minority youth found 13.2% of SSRI users between

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5544-428: Is especially common among people who have anxiety disorders . Ordinary anxiety can cause erectile dysfunction in men without psychiatric problems, but clinically diagnosable disorders such as panic disorder commonly cause avoidance of intercourse and premature ejaculation. Pain during intercourse is often a comorbidity of anxiety disorders among women. Physical factors that can lead to sexual dysfunctions include

5676-431: Is helpful. In some cases, the simple search for a previously undetected groin hernia can prove useful since it can affect sexual functions in males and is relatively easily curable. The current diagnostic and statistical manual of mental diseases ( DSM-IV ) lists ED. Penile ultrasonography with doppler can be used to examine the erect penis. Most cases of ED of organic causes are related to changes in blood flow in

5808-418: Is important to normal sexual function in men and women. Dihydrotestosterone is the most prevalent androgen in both men and women. Testosterone levels in women at age 60 are on average about half of what they were before the women were 40. Although this decline is gradual for most women, those who have undergone bilateral oophorectomy experience a sudden drop in testosterone levels, as the ovaries produce 40% of

5940-484: Is increased, but the absolute risk is very low. SSRIs are known to cause platelet dysfunction. This risk is greater in those who are also on anticoagulants, antiplatelet agents and NSAIDs (nonsteroidal anti-inflammatory drugs), as well as with the co-existence of underlying diseases such as cirrhosis of the liver or liver failure. Evidence from longitudinal, cross-sectional, and prospective cohort studies suggests an association between SSRI usage at therapeutic doses and

6072-450: Is independently associated with negative pregnancy outcomes, determining the extent to which observed associations between antidepressant use and specific adverse outcomes reflects a causative relationship has been difficult in some cases. In other cases, the attribution of adverse outcomes to antidepressant exposure seems fairly clear. SSRI use in pregnancy is associated with an increased risk of spontaneous abortion of about 1.7-fold. Use

6204-436: Is less clear. The hormonal changes that take place during the menopausal transition have been suggested to affect women's sexual response through several mechanisms, some more conclusive than others. Whether or not aging directly affects women's sexual functioning during menopause is controversial. However, many studies have demonstrated that aging has a powerful impact on sexual function and dysfunction in women, specifically in

6336-475: Is most common in young men and children. Individuals with sickle-cell disease and those who use certain medications can often develop this disorder. There are many factors which may result in a person experiencing a sexual dysfunction. These may result from emotional or physical causes. Emotional factors include interpersonal or psychological problems, which include depression , sexual fears or guilt, past sexual trauma, and sexual disorders. Sexual dysfunction

6468-427: Is no agreement on standards for diagnosis. It is considered a distinct phenomenon from antidepressant discontinuation syndrome , post-acute withdrawal syndrome , and major depressive disorder , and should be distinguished from sexual dysfunction associated with depression and persistent genital arousal disorder . There are limited treatment options for PSSD as of 2023 and no evidence that any individual approach

6600-504: Is not always robust and their use is sometimes rejected in favor of psychological therapies. Paroxetine was the first drug to be approved for social anxiety disorder and it is considered effective for this disorder; sertraline and fluvoxamine were later approved for it as well. Escitalopram and citalopram are used off-label with acceptable efficacy, while fluoxetine is not considered to be effective for this disorder. The effect sizes ( Cohen's d ) of SSRIs in terms of improvement on

6732-459: Is not well known due to a paucity of epidemiological studies, inconsistent criteria for sexual dysfunction across different studies and incomplete recruitment, with studies often excluding women who were without a partner or who were sexually inactive. However, based on incomplete population based studies from the United States, Europe and Australia, unspecified arousal dysfunction (in which a woman

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6864-530: Is often added. Visual and tactile stimulation produces better results. Some authors recommend the use of sildenafil by mouth to replace the injectable drugs in cases of contraindications, although the efficacy of such medication is controversial. Before the injection of the chosen drug, the flow pattern is monophasic, with low systolic velocities and an absence of diastolic flow. After injection, systolic and diastolic peak velocities should increase, decreasing progressively with vein occlusion and becoming negative when

6996-440: Is one of the most common reasons people stop the medication. The mechanism by which SSRIs may cause sexual side effects is not well understood as of 2021 . The range of possible mechanisms includes (1) nonspecific neurological effects (e.g., sedation) that globally impair behavior including sexual function; (2) specific effects on brain systems mediating sexual function; (3) specific effects on peripheral tissues and organs, such as

7128-431: Is required for a successful and complete erection. Stimulation of the penile shaft by the nervous system leads to the secretion of nitric oxide (NO), which causes the relaxation of the smooth muscles of the corpora cavernosa (the main erectile tissue of the penis), and subsequently penile erection. Additionally, adequate levels of testosterone (produced by the testes ) and an intact pituitary gland are required for

7260-524: Is similar. In Canada, SSRIs are a first-line treatment of adult obsessive–compulsive disorder (OCD). In the UK, they are first-line treatment only with moderate to severe functional impairment and as second line treatment for those with mild impairment, though, as of early 2019, this recommendation is being reviewed. In children, SSRIs can be considered a second line therapy in those with moderate-to-severe impairment, with close monitoring for psychiatric adverse effects. SSRIs, especially fluvoxamine , which

7392-411: Is the first one to be FDA approved for OCD, are efficacious in its treatment; patients treated with SSRIs are about twice as likely to respond to treatment as those treated with placebo. Efficacy has been demonstrated both in short-term treatment trials of 6 to 24 weeks and in discontinuation trials of 28 to 52 weeks duration. Paroxetine CR was superior to placebo on the primary outcome measure. In

7524-406: Is typically caused by the use of two or more serotonergic drugs, including SSRIs. Serotonin syndrome is a condition that can range from mild (most common) to deadly. Mild symptoms may consist of increased heart rate , fever , shivering, sweating , dilated pupils , myoclonus (intermittent jerking or twitching), as well as hyperreflexia . Concomitant use of SSRIs or SNRIs for depression with

7656-416: Is unable to achieve desirable genital or non-genital sexual arousal despite adequate stimulation and desire) was present in 3-9% of women aged 18–44, 5-7.5% aged 45–64 and 3-6% in women older than 65. Anorgasmia with distress (in which women were unable to achieve an orgasm) was present in 7-8% of women younger than 40, 5-7% aged 40–64 and 3-6% of those older than 65. Poor sexual self image leading to distress

7788-405: Is unclear exactly what causes vaginismus, but it is thought that past sexual trauma (such as rape or abuse ) may play a role. Another female sexual pain disorder is vulvodynia , or vulvar vestibulitis when localized to the vulval vestibule . In this condition, women experience burning pain during sex, which seems to be related to problems with the skin in the vulvar and vaginal areas. Its cause

7920-470: Is unknown. In men, structural abnormalities of the penis like Peyronie's disease can make sexual intercourse difficult and/or painful. The disease is characterized by thick fibrous bands in the penis that lead to excessive curvature during erection. It has an incidence estimated at 0.4–3% or more, is most common in men 40–70, and has no certain cause. Risk factors include genetics, minor trauma (potentially during cystoscopy or transurethral resection of

8052-503: Is unknown; however, it is believed to be a pathology of either the immune system or autonomic nervous systems. It is defined as a rare disease by the National Institute of Health , but the prevalence is unknown. It is not thought to be psychiatric in nature, but it may present as anxiety relating to coital activities and may be incorrectly diagnosed as such. There is no known cure or treatment. Erectile dysfunction (ED), or impotence,

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8184-610: Is used off-label, but with mixed results; venlafaxine, an SNRI, is considered somewhat effective, although its use is also off-label. Fluvoxamine, escitalopram and citalopram are not well tested in this disorder. Paroxetine remains the most suitable drug for PTSD as of now, but with limited benefits. SSRIs are recommended by the National Institute for Health and Care Excellence (NICE) for the treatment of generalized anxiety disorder (GAD) that has failed to respond to conservative measures such as education and self-help activities. GAD

8316-456: Is when ejaculation occurs before the partner achieves orgasm, or a mutually satisfactory length of time has passed during intercourse. There is no correct length of time for intercourse to last, but generally, premature ejaculation is thought to occur when ejaculation occurs in under two minutes from the time of the insertion of the penis. For a diagnosis, the patient must have a chronic history of premature ejaculation, poor ejaculatory control, and

8448-671: The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders : lack of desire, lack of arousal, pain during intercourse, and lack of orgasm. For both men and women, these conditions can manifest themselves as an aversion to and avoidance of sexual contact with a partner. In men, there may be partial or complete failure to attain or maintain an erection, or a lack of sexual excitement and pleasure in sexual activity. There may be physiological origins to these disorders, such as decreased blood flow or lack of vaginal lubrication. Chronic disease and

8580-582: The Liebowitz social anxiety scale in individual published trials of the drugs for social anxiety disorder have ranged from –0.029 to 1.214. PTSD is relatively hard to treat and generally treatment is not highly effective; SSRIs are no exception. They are not very effective for this disorder and only two SSRI are FDA approved for this condition: paroxetine and sertraline. Paroxetine has slightly higher response and remission rates for PTSD than sertraline, but both are not fully effective for many patients. Fluoxetine

8712-497: The Netherlands listed a case which had reportedly persisted for 23 years. The symptoms of PSSD are largely shared with post-finasteride syndrome (PFS) and post-retinoid sexual dysfunction (PRSD) , two other poorly-understood conditions which have been suggested to share a common etiology with PSSD despite being associated with different types of medication. Diagnostic criteria for PSSD were proposed in 2022, but as of 2023, there

8844-405: The serotonin transporter and only weak affinity for the norepinephrine and dopamine transporters . SSRIs are the most widely prescribed antidepressants in many countries especially the world. The efficacy of SSRIs in mild or moderate cases of depression has been disputed and may or may not be outweighed by side effects, especially in adolescent populations. The main indication for SSRIs

8976-421: The 1980s research took the opposite direction of searching for physical causes of sexual dysfunction, which also happened in the 1920s and 30s. Physical causes as explanations continue to dominate literature when compared with psychological explanations as of 2022. Treatments in the 80s for ED included penile implants and intracavernosal injections . The first successful vacuum erection device, or penis pump ,

9108-581: The EMA assessment, a safety review by Health Canada "could neither confirm nor rule out a causal link   ... which was long lasting in rare cases", but recommended that "healthcare professionals inform patients about the potential risk of long-lasting sexual dysfunction despite discontinuation of treatment". A 2023 review stated that ongoing sexual dysfunction after SSRI discontinuation was possible, but that cause and effect were undetermined. The 2023 review cautioned that reports of sexual dysfunction cannot be generalized to wider practice as they are subject to

9240-560: The U.S. develop PPHN shortly after birth, and often they need intensive medical care . It is associated with about a 25% risk of significant long-term neurological deficits. A 2014 meta analysis found no increased risk of persistent pulmonary hypertension associated with exposure to SSRI's in early pregnancy and a slight increase in risk associates with exposure late in pregnancy; "an estimated 286 to 351 women would need to be treated with an SSRI in late pregnancy to result in an average of one additional case of persistent pulmonary hypertension of

9372-712: The UK National Institute for Health and Care Excellence (NICE) as a first-line treatment of severe depression and for the treatment of mild-to-moderate depression that persists after conservative measures such as cognitive therapy . They recommend against their routine use by those who have chronic health problems and mild depression. There has been controversy regarding the efficacy of SSRIs in treating depression depending on its severity and duration. The use of SSRIs in children with depression remains controversial. A 2021 Cochrane review concluded that, for children and adolescents, SSRIs "may reduce depression symptoms in

9504-529: The UK without a prescription. Additionally, a cream combining alprostadil with the permeation enhancer DDAIP has been approved in Canada as a first line treatment for ED. Penile injections, on the other hand, can involve one of the following medications: papaverine , phentolamine , and prostaglandin E1 , also known as alprostadil . In addition to injections, there is an alprostadil suppository that can be inserted into

9636-609: The ages 15 and 29 reporting the symptom compared to 0.9% who had used other medications. Reports of PSSD have occurred with almost every SSRI ( dapoxetine is an exception). In 2019, the Pharmacovigilance Risk Assessment Committee of the European Medicines Agency (EMA) recommended that packaging leaflets of selected SSRIs and SNRIs should be amended to include information regarding a possible risk of persistent sexual dysfunction. Following

9768-453: The appearance of the cavernous arteries, which can be tortuous or atheromatous. Erection can be induced by injecting 10–20 μg of prostaglandin E1, with evaluations of the arterial flow every five minutes for 25–30 min (see image). The use of prostaglandin E1 is contraindicated in patients with predisposition to priapism (e.g., those with sickle cell anemia), anatomical deformity of the penis, or penile implants. Phentolamine (2 mg)

9900-519: The areas of desire, sexual interest, and frequency of orgasm. The primary predictor of sexual response throughout menopause is prior sexual functioning, which means that it is important to understand how the physiological changes in men and women can affect sexual desire. Despite the apparent negative impact that menopause can have on sexuality and sexual functioning, sexual confidence and well-being can improve with age and menopausal status. Testosterone, along with its metabolite dihydrotestosterone ,

10032-643: The blood , hypogonadism , smoking, depression , and medication use . Approximately 10% of cases are linked to psychosocial factors, encompassing conditions like depression, stress, and problems within relationships. The term erectile dysfunction does not encompass other erection-related disorders, such as priapism . Treatment of ED encompasses addressing the underlying causes, lifestyle modification, and addressing psychosocial issues. In many instances, medication-based therapies are used, specifically PDE5 inhibitors like sildenafil . These drugs function by dilating blood vessels, facilitating increased blood flow into

10164-563: The body's circulating testosterone. Sexual desire has been related to three separate components: drive, beliefs and values, and motivation. Particularly in postmenopausal women, drive fades and is no longer the initial step in a woman's sexual response. The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders lists the following sexual dysfunctions: Selective serotonin reuptake inhibitor#Sexual dysfunction Selective serotonin reuptake inhibitors ( SSRIs ) are

10296-484: The corpora cavernosa, represented by occlusive artery disease (in which less blood is allowed to enter the penis), most often of atherosclerotic origin, or due to failure of the veno-occlusive mechanism (in which too much blood circulates back out of the penis). Before the Doppler sonogram, the penis should be examined in B mode, in order to identify possible tumors, fibrotic plaques, calcifications, or hematomas, and to evaluate

10428-575: The degree of erection observed. If the peak systolic velocities are normal, the final diastolic velocities should be evaluated, those above 5 cm/s being associated with venogenic ED. Treatment depends on the underlying cause. In general, exercise , particularly of the aerobic type, is effective for preventing ED during midlife. Counseling can be used if the underlying cause is psychological, including how to lower stress or anxiety related to sex. Medications by mouth and vacuum erection devices are first-line treatments, followed by injections of drugs into

10560-452: The desired effect . SSRIs such as sertraline have been found to be effective in decreasing anger . Side effects vary among the individual drugs of this class. They may include akathisia . SSRIs can cause various types of sexual dysfunction such as anorgasmia , erectile dysfunction , diminished libido , genital numbness, and sexual anhedonia (pleasureless orgasm). Sexual problems are common with SSRIs. Poor sexual function

10692-539: The development of a healthy erectile system. As can be understood from the mechanisms of a normal erection, impotence may develop due to hormonal deficiency, disorders of the neural system, lack of adequate penile blood supply or psychological problems. Spinal cord injury causes sexual dysfunction , including ED. Restriction of blood flow can arise from impaired endothelial function due to the usual causes associated with coronary artery disease , but can also be caused by prolonged exposure to bright light . In many cases,

10824-541: The diagnosis can be made based on the person's history of symptoms. In other cases, a physical examination and laboratory investigations are done to rule out more serious causes such as hypogonadism or prolactinoma . One of the first steps is to distinguish between physiological and psychological ED. Determining whether involuntary erections are present is important in eliminating the possibility of psychogenic causes for ED. Obtaining full erections occasionally, such as nocturnal penile tumescence when asleep (that is, when

10956-520: The domestic sphere into a "second stage of life". The Mexican males of this generation often pursued sex outside of marriage; decreasing erectile function acted as an aid to overcoming infidelity thus helping to attain the ideal "second stage" of life. A 56-year-old about to retire from the public health service said he would now "dedicate myself to my wife, the house, gardening, caring for the grandchildren—the Mexican classic". Wentzell found that treating ED as

11088-493: The effectiveness of these products for the treatment of ED, and synthetic chemical compounds similar to sildenafil have been found as adulterants in many of these products. The FDA has warned consumers that any sexual enhancement product that claims to work as well as prescription products is likely to contain such a contaminant. A 2021 review indicated that ginseng had "only trivial effects on erectile function or satisfaction with intercourse compared to placebo". Attempts to treat

11220-816: The environment where sex occurs being uncomfortable, or an inability to concentrate on the sexual activity due to a bad mood or burdens from work. Other factors include physical discomfort or difficulty in achieving arousal, which could be caused by aging or changes in the body's condition. Sexual assault has been associated with excessive menstrual bleeding, genital burning, and painful intercourse (attributable to disease, injury, or otherwise), medically unexplained dysmenorrhea, menstrual irregularity, and lack of sexual pleasure. Physically violent assaults and those committed by strangers were most strongly related to reproductive symptoms. Multiple assaults, assaults accomplished by persuasion, spousal assault, and completed intercourse were most strongly related to sexual symptoms. Assault

11352-702: The excess risk in the "early stages of treatment". The European Psychiatric Association places the excess risk in the first two weeks of treatment and, based on a combination of epidemiological, prospective cohort, medical claims, and randomized clinical trial data, concludes that a protective effect dominates after this early period. A 2014 Cochrane review found that at six to nine months, suicidal ideation remained higher in children treated with antidepressants compared to those treated with psychological therapy. A recent comparison of aggression and hostility occurring during treatment with fluoxetine to placebo in children and adolescents found that no significant difference between

11484-463: The failure of various organ systems (such as the heart and lungs), endocrine disorders ( thyroid , pituitary , or adrenal gland problems), hormonal deficiencies (low testosterone , other androgens , or estrogen ), and some birth defects . In the context of heterosexual relationships, one of the main reasons for the decline in sexual activity among these couples is the male partner experiencing erectile dysfunction. This can be very distressing for

11616-406: The fields of andrology and gynecology respectively. Sexual desire disorders or decreased libido are characterized by a lack of sexual desire , libido for sexual activity , or sexual fantasies for some time. The condition ranges from a general lack of sexual desire to a lack of sexual desire for the current partner. The condition may start after a period of normal sexual functioning, or

11748-477: The fluoxetine group and a placebo group. There is also evidence that higher rates of SSRI prescriptions are associated with lower rates of suicide in children, though since the evidence is correlational , the true nature of the relationship is unclear. In 2004, the Medicines and Healthcare products Regulatory Agency (MHRA) in the United Kingdom judged fluoxetine (Prozac) to be the only antidepressant that offered

11880-423: The following: Surgical intervention for a number of conditions may remove anatomical structures necessary to erection, damage nerves, or impair blood supply. ED is a common complication of treatments for prostate cancer, including prostatectomy and destruction of the prostate by external beam radiation , although the prostate gland itself is not necessary to achieve an erection. As far as inguinal hernia surgery

12012-413: The frequency of POIS "in the population may be greater than has been reported in the academic literature", and that many with POIS are undiagnosed. POIS may involve adrenergic symptoms: rapid breathing, paresthesia , palpitations , headaches , aphasia , nausea , itchy eyes, fever , muscle pain and weakness , and fatigue . The etiology of this condition is unknown; however, it is believed to be

12144-433: The late 19th century as a medical instrument for pain relief and the treatment of various ailments. Sometimes described as a massager, the vibrator is used on the body to produce sexual stimulation . Several clinical studies have found vibrators to be an effective solution for Erectile Dysfunction. Examples of FDA registered vibrators for erectile dysfunction include MysteryVibe 's Tenuto and Reflexonic's Viberect. Often, as

12276-456: The male partner, causing poor body image, and it can also be a major source of low desire for these men. In aging women, it is natural for the vagina to narrow and atrophy . If a woman does not participate in sexual activity regularly (in particular, activities involving vaginal penetration), she will not be able to immediately accommodate a penis without risking pain or injury if she decides to engage in penetrative intercourse. This can turn into

12408-424: The medication, or switching to a different antidepressant that may have less propensity for causing this side effect. Acute narrow-angle glaucoma is the most common and important ocular side effect of SSRIs, and often goes misdiagnosed. SSRIs do not appear to affect the risk of coronary heart disease (CHD) in those without a previous diagnosis of CHD. A large cohort study suggested no substantial increase in

12540-694: The mind and psychological issues, if any, are less present), tends to suggest that the physical structures are functionally working. Similarly, performance with manual stimulation , as well as any performance anxiety or acute situational ED, may indicate a psychogenic component to ED. Another factor leading to ED is diabetes mellitus , a well known cause of neuropathy . ED is also related to generally poor physical health, poor dietary habits, obesity , and most specifically cardiovascular disease , such as coronary artery disease and peripheral vascular disease . Screening for cardiovascular risk factors, such as smoking , dyslipidemia , hypertension , and alcoholism ,

12672-564: The most optimistic about menopausal life; Caucasian women are the most anxious, Asian women are the most inhibited about their symptoms, and Hispanic women are the most stoic. Since these women have sexual problems, their sexual lives with their partners can become a burden without pleasure, and may eventually lose complete interest in sexual activity. Some of the women found it hard to be aroused mentally, while others had physical problems. Several factors can affect female dysfunction, such as situations in which women do not trust their sex partners,

12804-404: The need for increased attention to fall risk in elderly patients using the medication. The loss of bone density does not appear to occur in younger patients taking SSRIs. SSRI and SNRI antidepressants may cause jaw pain/jaw spasm reversible syndrome (although it is not common). Buspirone appears to be successful in treating bruxism on SSRI/SNRI induced jaw clenching. Serotonin syndrome

12936-414: The newsworthiness of stories about it and heavy advertising . It is estimated that around 30 million men in the United States and 152 million men worldwide have erectile dysfunction. However, social stigma , low health literacy , and social taboos lead to under reporting which makes an accurate prevalence rate hard to determine. The Latin term impotentia coeundi describes the inability to insert

13068-436: The optimal management of sexual dysfunction. Many of the sexual dysfunctions that are defined are based on the human sexual response cycle proposed by William H. Masters and Virginia E. Johnson , and modified by Helen Singer Kaplan . Sexual dysfunction can be classified into four categories: sexual desire disorders , arousal disorders , orgasm disorders , and pain disorders . Dysfunction among men and women are studied in

13200-434: The partners' relationship can also contribute to dysfunction. Additionally, postorgasmic illness syndrome (POIS) may cause symptoms when aroused, including adrenergic-type presentation: rapid breathing, paresthesia , palpitations, headaches, aphasia , nausea, itchy eyes, fever, muscle pain and weakness, and fatigue. From the onset of arousal, symptoms can persist for up to a week in patients. The cause of this condition

13332-415: The path to restored male virility, including operations by surgeon Serge Voronoff . Modern drug therapy for ED made a significant advance in 1983, when British physiologist Giles Brindley dropped his trousers and demonstrated to a shocked Urodynamics Society audience showing his papaverine -induced erection. The current most common treatment for ED, the oral PDE5 inhibitor known as sildenafil (Viagra)

13464-406: The penis becomes rigid (see image below). The reference values vary across studies, ranging from > 25 cm/s to > 35 cm/s. Values above 35 cm/s indicate the absence of arterial disease, values below 25 cm/s indicate arterial insufficiency, and values of 25–35 cm/s are indeterminate because they are less specific (see image below). The data obtained should be correlated with

13596-402: The penis by applying negative pressure. This type of device is sometimes referred to as penis pump and may be used just prior to sexual intercourse . Several types of FDA approved vacuum therapy devices are available under prescription. When pharmacological methods fail, a purpose-designed external vacuum pump can be used to attain erection, with a separate compression ring fitted to the base of

13728-633: The penis into the vagina , and has been mostly replaced by more precise terms. ED from vascular disease is seen mainly amongst older individuals who have atherosclerosis . Vascular disease is common in individuals who smoke or have diabetes , peripheral vascular disease , or hypertension . Any time blood flow to the penis is impaired, ED can occur. Drugs are also a cause of erectile dysfunction. Individuals who take drugs that lower blood pressure , antipsychotics , antidepressants , sedatives, narcotics, antacids, or alcohol can have problems with sexual function and loss of libido. Hormone deficiency

13860-454: The penis into the vagina ; it is now mostly replaced by more precise terms, such as erectile dysfunction (ED). The study of ED within medicine is covered by andrology , a sub-field within urology . Research indicates that ED is common, and it is suggested that approximately 40% of males experience symptoms compatible with ED, at least occasionally. The condition is also on occasion called phallic impotence . Its antonym, or opposite condition,

13992-399: The penis to maintain it. These pumps should be distinguished from other penis pumps (supplied without compression rings) which, rather than being used for temporary treatment of impotence, are claimed to increase penis length if used frequently, or vibrate as an aid to masturbation . More drastically, inflatable or rigid penile implants may be fitted surgically. The vibrator was invented in

14124-405: The penis, as well as penile implants. Vascular reconstructive surgeries are beneficial in certain groups. Treatments, other than surgery, do not fix the underlying physiological problem, but are used as needed before sex. The PDE5 inhibitors sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) are prescription drugs which are taken by mouth. As of 2018, sildenafil is available in

14256-444: The penis, that mediate sexual function; and (4) direct or indirect effects on hormones mediating sexual function. Management strategies include: for erectile dysfunction the addition of a PDE5 inhibitor such as sildenafil ; for decreased libido, possibly adding or switching to bupropion ; and for overall sexual dysfunction, switching to nefazodone . Buspirone is sometimes used off-label to reduce sexual dysfunction associated with

14388-421: The person may always have had an absence or a lesser intensity of sexual desire. The causes vary considerably but include a decrease in the production of normal estrogen in women, or testosterone in both men and women. Other causes may be aging, fatigue, pregnancy, medications (such as SSRIs ), or psychiatric conditions, such as depression and anxiety . While many causes of low sexual desire are cited, only

14520-468: The possibility of ascertainment bias, e.g. that worried mothers may pursue more aggressive testing of their infants. Another study found no increase in cardiovascular birth defects and a 27% increased risk of major malformations in SSRI exposed pregnancies. The FDA issued a statement on July 19, 2006, stating nursing mothers on SSRIs must discuss treatment with their physicians. However, the medical literature on

14652-440: The problem must cause feelings of dissatisfaction as well as distress for the patient, the partner, or both. Premature ejaculation has historically been attributed to psychological causes, but newer theories suggest that premature ejaculation may have an underlying neurobiological cause that may lead to rapid ejaculation. Post-orgasmic disorders cause symptoms shortly after orgasm or ejaculation . Post-coital tristesse (PCT)

14784-695: The product labels of SSRIs and SNRIs. Certain antidepressants may cause emotional blunting , characterized by reduced intensity of both positive and negative emotions as well as symptoms of apathy , indifference , and amotivation . It may be experienced as either beneficial or detrimental depending on the situation. This side effect has been particularly associated with serotonergic antidepressants like SSRIs and SNRIs, but may be less with atypical antidepressants like bupropion , agomelatine , and vortioxetine . Higher doses of antidepressants seem to be more likely to produce emotional blunting than lower doses. It can be decreased by reducing dosage, discontinuing

14916-412: The prostate ), chronic systemic vascular diseases, smoking, and alcohol consumption. Priapism is a painful erection that occurs for several hours and occurs in the absence of sexual stimulation . This condition develops when blood is trapped in the penis and is unable to drain. If the condition is not promptly treated, it can lead to severe scarring and permanent loss of erectile function. The disorder

15048-443: The public to strive for prolonged sexual function. Anthropologists argue that a biomedical focus places emphasis on the biological processes of fixing the body thereby disregarding holistic ideals of health and aging. By relying on a wholly medical approach, Western biomedicine can become blindsided by bodily dysfunctions which can be understood as appropriate functions of age, and not as a medical problem. Anthropologists understand that

15180-643: The risk of cardiac malformations attributable to SSRI usage during the first trimester of pregnancy. A number of large studies of people without known pre-existing heart disease have reported no EKG changes related to SSRI use. The recommended maximum daily dose of citalopram and escitalopram was reduced due to concerns with QT prolongation . In overdose, fluoxetine has been reported to cause sinus tachycardia , myocardial infarction , junctional rhythms , and trigeminy . Some authors have suggested electrocardiographic monitoring in patients with severe pre-existing cardiovascular disease who are taking SSRIs. In

15312-462: The risk of suicidal behavior in adults. A 2017 meta-analysis found that antidepressants including SSRIs were associated with significantly increased risk of death (+33%) and new cardiovascular complications (+14%) in the general population. Conversely, risks were not greater in people with existing cardiovascular disease . SSRI use in pregnancy has been associated with a variety of risks with varying degrees of proof of causation. As depression

15444-413: The safety of SSRIs has determined that some SSRIs like Sertraline and Paroxetine are considered safe for breastfeeding. Several studies have documented neonatal abstinence syndrome , a syndrome of neurological, gastrointestinal, autonomic, endocrine and/or respiratory symptoms among a large minority of infants with intrauterine exposure. These syndromes are short-lived, but insufficient long-term data

15576-431: The shame and embarrassment felt by some with erectile dysfunction, the subject was taboo for a long time and is the focus of many urban legends. Folk remedies have long been advocated, with some being advertised widely since the 1930s. The introduction of perhaps the first pharmacologically effective remedy for impotence, sildenafil (trade name Viagra), in the 1990s caused a wave of public attention, propelled in part by

15708-446: The spongy tissue of the penis, analogous to opening a valve wider to enhance water flow in a fire hose. Less frequently employed treatments encompass prostaglandin pellets inserted into the urethra , the injection of smooth-muscle relaxants and vasodilators directly into the penis, penile implants , the use of penis pumps , and vascular surgery . ED is reported in 18% of males aged 50 to 59 years, and 37% in males aged 70 to 75. ED

15840-467: The symptoms described by ED date back well over 1,000 years. In the 8th century, males of Ancient Rome and Greece wore talismans of rooster and goat genitalia, believing these talismans would serve as an aphrodisiac and promote sexual function. In the 13th century, Albertus Magnus recommended ingesting roasted wolf penis as a remedy for impotence. During the late 16th and 17th centuries in France, male impotence

15972-465: The treatment of stroke patients, including those with and without symptoms of depression. A 2021 meta-analysis of randomized controlled clinical trials found no evidence pointing to their routine use to promote recovery following stroke. SSRIs are effective for the treatment of premature ejaculation. Taking SSRIs on a chronic, daily basis is more effective than taking them prior to sexual activity. The increased efficacy of treatment when taking SSRIs on

16104-454: The urethra. Once inserted, an erection can begin within 10 minutes and last up to an hour. Medications to treat ED may cause a side effect called priapism . In a study published in 2016, based on US health insurance claims data, out of 19,833,939 US males aged ≥18 years, only 1,108,842 (5.6%), were medically diagnosed with erectile dysfunction or on a PDE5I prescription ( μ age 55.2 years, σ 11.2 years). Prevalence of diagnosis or prescription

16236-501: The use of SSRIs in the treatment of anorexia nervosa . Treatment guidelines from the National Institute of Health and Clinical Excellence recommend against the use of SSRIs in this disorder. Those from the American Psychiatric Association note that SSRIs confer no advantage regarding weight gain, but that they may be used for the treatment of co-existing depression, anxiety, or OCD. SSRIs have been used off-label in

16368-592: The use of SSRIs. A number of non-SSRI drugs are not associated with sexual side effects (such as bupropion , mirtazapine , tianeptine , agomelatine , tranylcypromine , and moclobemide ). Several studies have suggested that SSRIs may adversely affect semen quality. While trazodone (an antidepressant with alpha adrenergic receptor blockade) is a notorious cause of priapism , cases of priapism have also been reported with certain SSRIs (e.g. fluoxetine, citalopram). Post-SSRI sexual dysfunction (PSSD) refers to

16500-675: The use of drugs, such as alcohol, nicotine , narcotics , stimulants, antihypertensives , antihistamines , and some psychotherapeutic drugs. For women, almost any physiological change that affects the reproductive system— premenstrual syndrome , pregnancy and the postpartum period, and menopause—can have an adverse effect on libido. Back injuries may also impact sexual activity, as can problems with an enlarged prostate gland, problems with blood supply, or nerve damage (as in sexual dysfunction after spinal cord injuries ). Diseases such as diabetic neuropathy , multiple sclerosis , tumors , and, rarely, tertiary syphilis may also impact activity, as can

16632-408: Was approved for use for Pfizer by the FDA in 1998, which at the time of release was the fastest selling drug in history. Sildenafil largely replaced SSRI treatments for ED at the time and proliferated new types of specialised pharmaceutical marketing which emphasised social connotations of ED and Viagra rather than its physical effects. Anthropological research presents ED not as a disorder but, as

16764-405: Was associated with sexual indifference only among Latinas. The most prevalent of female sexual dysfunctions that have been linked to menopause include lack of desire and libido; these are predominantly associated with hormonal physiology. Specifically, the decline in serum estrogens causes these changes in sexual functioning. Androgen depletion may also play a role, but current knowledge about this

16896-519: Was considered a crime, as well as legal grounds for a divorce. The practice, which involved inspection of the complainants by court experts, was declared obscene in 1677. The first major publication describing a broad medicalization of sexual disorders was the first edition of the Diagnostic and Statistical Manual of Mental Disorders in 1952. In the early 20th century, medical folklore held that 90-95% of cases of ED were psychological in origin, but around

17028-434: Was developed by Vincent Marie Mondat in the early 1800s. A more advanced device based on a bicycle pump was developed by Geddings Osbon, a Pentecostal preacher, in the 1970s. In 1982, he received FDA approval to market the product. John R. Brinkley initiated a boom in male impotence treatments in the U.S. in the 1920s and 1930s, with radio programs that recommended expensive goat gland implants and "mercurochrome" injections as

17160-399: Was occasionally associated more strongly with reproductive symptoms among women with lower income or less education, possibly because of economic stress or differences in assault circumstances. Associations with unexplained menstrual irregularity were strongest among African American women; ethnic differences in reported circumstances of assault appeared to account for these differences. Assault

17292-756: Was seen in 13.4% of women younger than 40 in an Australian population based study. The importance of how a woman perceives her behavior should not be underestimated. Many women perceive sex as a chore as opposed to a pleasurable experience, and they tend to consider themselves sexually inadequate, which in turn does not motivate them to engage in sexual activity. Several factors influence a women's perception of her sexual life. These can include race, gender, ethnicity, educational background, socioeconomic status, sexual orientation, financial resources, culture, and religion. Cultural differences are also present in how women view menopause and its impact on health, self-image, and sexuality. A study found that African American women are

17424-547: Was the highest for age group 60–69 at 11.5%, lowest for age group 18–29 at 0.4%, and 2.1% for 30–39, 5.7% for 40–49, 10% for 50–59, 11% for 70–79, 4.6% for 80–89, 0.9% for ≥90, respectively. Focused shockwave therapy involves passing short, high frequency acoustic pulses through the skin and into the penis. These waves break down any plaques within the blood vessels, encourage the formation of new vessels, and stimulate repair and tissue regeneration. Focused shockwave therapy appears to work best for males with vasculogenic ED, which

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