Sexual dysfunction: Treat the condition, not hide it

SEXUAL dysfunction is still an uncomfortable subject for many, but the increasing availability of treatments and awareness about them have led some people to be more forthcoming about problems in their sex lives.

Occupational therapist Shirlene Toh said she saw one or two patients a month when the Sexual Wellness Service was set up at Tan Tock Seng Hospital’s (TTSH) Rehabilitation Centre in 2009. She now sees two or three patients a week.

“Patients today are Internet- savvy and read up online. They then come to us seeking clarification.”

Dr Lee Fang Jann, a consultant in the department of urology at Singapore General Hospital (SGH), said: “We’ve noticed more patients opportunistically bringing up the issue during consultations for non-related conditions. They are generally more willing to attempt treatment as well.”

The bulk of patients who seek medical help for sexual dysfunction are married men aged between 40 and 70. Older men form the majority of patients.

Diagnosed cases of premature ejaculation and testosterone deficiency are also on the rise, with SGH seeing a 30% to 40% increase in the number of such patients in the last six to eight years.

Premature ejaculation patients are usually younger, ranging between 20 and 40 years old.

Dr Lee said: “This has very much to do with publicity in the media and the increasing availability of treatments.”

Women who go for help may be suffering from vaginal pain during intercourse, or low desire, among other symptoms.

There are also physically disabled patients of both genders whose sex lives have been affected by injury to the spinal cord or strokes.

Treatment options for sexual dysfunction have broadened in the last five years.

Toh started the Sexual Wellness Service to cater primarily to physically disabled patients but she has been seeing more able-bodied patients after TTSH’s Complex Erectile Management Clinic was set up in 2014.

The patients are referred to her for counselling after undergoing medical evaluation at the clinic.

SGH introduced a dedicated andrology clinic service for complex erectile dysfunction cases in 2014.

Hospitals here are increasingly using a multi-pronged approach to treat sexual dysfunction, where doctors and therapists work in tandem to address medical and psycho-social aspects respectively.

Since 2012, SGH has had a sub- fertility clinic where couples with fertility issues can be seen and screened together. One of the proble such couples face could be sexual dysfunction.

The clinic is run jointly by a male and a female fertility specialist.

SGH’s andrology and sub-fertility clinics see about 20 to 25 patients each every month.

The National University Hospital (NUH) has a similar set-up, with more patients today with erectile dysfunction or premature ejaculation. They are referred to the older andrology clinic from the Relationship Counselling Clinic, set up in 2012, for issues related to a couple’s inability to conceive .

“Sexual intimacy is not just about intercourse,” said Toh.

“It’s also about communicating and being open with your spouse, especially if you or your spouse are coming to ter with a disability.”

She said the most difficult patients were men wanting a quick medical solution for their conditions. “They think the problem is just about getting an erection but their wives tell me separately that their husband is not talking to them about the issue,” she added.

Dr Lee said: “A frank and open discussion will often draw out any potential psychological triggers. Relationship difficulties are best dealt with as a couple.”

Psychological causes of sexual dysfunction figure more prominently among patients in their 30s or younger, who are less likely to have age-related physical symptoms.

For example, erectile dysfunction in younger men could originate from job or marital stress, performance anxiety with a new partner, or guilt from the inability to satisfy their partner, said Dr Lee.

“The common distinguishing feature for men with psychological erectile dysfunction is that the erectile difficulty occurs only with sexual intimacy and does not affect his ability in achieving erection with masturbation,” said Dr Lee.

The younger patients Toh has seen are often married couples who have trouble consummating their marriage after a year or more, and who require a different approach from that of older patients.

“With older patients, we educate them on how they have been affected physically and what they can do to cope,” she said.

“With younger patients, we work on couple marital dynamics and strategies to improve intimacy.”

Physical or organic causes of sexual dysfunction are divided into the vasculogenic (affecting the blood flow to blood vessels in the sexual organs) and the neurogenic (affecting the nerves).

Vascular causes include chronic smoking, diabetes, hypertension and having an excess of cholesterol in the bloodstream. “These are the same conditions that predispose patients to heart attacks,” said Dr Lee.

Neurogenic causes include stroke, multiple sclerosis and Parkinson’s disease.

Toh has seen an increase in patients referred to her by colleagues in other departments.

She pointed out that healthcare professionals who encounter opportunistic queries from patients should put aside any personal discomfort with the touchy topic of sexual wellness temporarily when talking to patients.

“It is also a sensitive issue for patients and you don’t want to give them the perception that what they are asking about is wrong,” she said.

“If you are uncomfortable, you can still show them their concerns are important and offer to put them in touch with another colleague.”

Treating sexual dysfunction

Sexual dysfunction covers a wide range of disorders and conditions across both genders, and one patient’s case can be very different from the next.

Cases fall under three main categories – vascular (affecting blood flow to the sexual organs), neurological (damage to the nervous system) and psychological.

The first two refer to physical causes. Physical and psychological causes are not mutually exclusive.

Treatment for physical causes generally revolves around tackling commonly-seen risk factors such as diabetes, hypertension and heart disease.

Patients may be told to make lifestyle changes, such as to stop smoking, go on a weight-loss programme (if overweight) and maintain a balanced diet, said Dr Lee Fang Jann, a consultant at the Singapore General Hospital’s department of urology.

If these measures fail, patients may be put on oral medication. Injection therapy is also used, especially for patients with neurological disorders.

Surgery may be required in more severe cases. For psychological causes, therapists usually give couples advice on improving sexual intimacy.

For example, a couple with communication issues would be encouraged to work on strategies to enhance their understanding of each other’s intentions, said Shirlene Toh, an occupational therapist at Tan Tock Seng Hospital’s Sexual Wellness Service.

Couples with low sexual desire can explore ways to increase their quality time when getting intimate. – The Straits Times/ Asia News Network.

source: http://www.thestar.com.my/news/nation/2016/09/20/sexual-dysfunction-treat-the-condition-not-hide-it/