Overview Of Sexual Function And Sexual Disorders Of Women

The take the initiative or consent to sexual activity occurs in men and women for many reasons, including from sexual desire and physical pleasure and the experience of affection, love, romance or intimacy. However, the motivation in women is more likely to find in the emotional sphere such. B. To emotional intimacy to seek and learn to improve their well-being in order to confirm their attractiveness To please your partner or soothe him to want particular women in stable relationships feel initially often little or no sexual desire, but they obtain it (responsives demand) when the sexual stimulation for arousal and desire (subjective arousal) and vasocongestion of the genital organs (physical genital arousal) leads. The desire for sexual satisfaction, which may be accompanied by one or more orgasms or without an orgasm, grows with resume sexual activity and intimacy, and meets a physically and emotionally positive experience and enhances the original motivations of women. The sexual response cycle is strongly influenced by their mental state and quality of the relationship with their partner. The initial sexual desire tends to decrease with age, rising with a new partner but at any age again. The physiology of sexual response includes the following phases: motivation (including craving) Subjective arousal vasocongestion the genital orgasm regression The physiology of sexual response in women is only partially understood, but it hormonal and CNS factors are involved. Estrogens affect the sexual response. While it is believed, but it is not certain that androgens are involved and act via androgen and estrogen receptors (in estradiol after intracellular conversion of testosterone). In postmenopausal ovarian estrogen production ends, while ovarian androgen production fluctuates. However, increases in women over the age of 30-40 years from the adrenal production of prohormones (z. B. dehydroepiandrosterone sulfate [DHEAS]) that are converted to both androgens and estrogens in the peripheral cells. After menopause, the production of pro-hormones in the ovaries decreases. Whether this decrease plays a role in the reduction of sexual desire, interest or excitement, is unclear. The brain makes sex hormones (neurosteroids) of cholesterol, their production may increase after menopause. It is unclear whether this documented increase generally the case whether it promotes the excitement with the peripheral production decline and whether it is influenced by the administration of exogenous hormones. Motivation Motivation is the desire for sexual activity. There are many reasons for the desire for sexual activity, including sexual desire. Thoughts, words, visual stimuli, smells or touch can trigger a craving. Demand may already be present at the start or with the sexual arousal of the woman aufbauen.Sexuelle arousal brain areas that participate in cognition, emotion, motivation and activation of genital vasocongestion be activated. It involved neurotransmitters that bind to specific receptors. Because of ascribed the drugs and mechanisms of action on the basis of animal studies, it is assumed that some neurotransmitters are prosexuell; including dopamine, norepinephrine and melanocortin. Sexually retardant generally act serotonin and prolactin and ?-aminobutyric acid (GABA) .Genitale vasocongestion This vegetative reflex reaction begins within seconds of a sexual stimulus and triggers a blood filling and lubrication of the genitals from. The assessment of the brain that a stimulus biologically sexually – not necessarily erotic or arousing subjectively – is this reaction triggers. Smooth muscle dilate the Blutlakunen in vulva and clitoris and the vaginal arterioles, whereby the blood flow (blood filling) and the transudation of interstitial fluid through the vaginal epithelium (lubrication) increase. Women of genital vasocongestion are not always aware; younger women often report tingling and throbbing on genital. With age, the basal blood flow to the genitals reduced, but the genital vasocongestion can in response to sexual stimulation (eg., By erotic videos) received bleiben.Orgasmus It comes to an excitation peak caused by contractions of the pelvic muscles every 0.8 seconds and slow decline in genital vasocongestion is characterized. Although the efferent fibers of the thoracolumbar sympathetic trunk appear to play a role is an orgasm even after complete transection of the spinal cord possible (for Zervixstimulierung a vibrator is used). Prolactin, ADH and oxytocin are released during orgasm and can the subsequent sense of well-being, relaxation or fatigue contribute (regression). However, many women perceive a sense of well-being and relaxation, even without an orgasm erleben.Rückbildung The regression is a feeling of well-being and is accompanied by extensive muscle relaxation or fatigue, which usually follows the orgasm associated. However, the regression can proceed slowly thick very sexual arousal and activity without orgasm. Many women can react with almost no delay after resolved to re-stimulation. Classification The sexual dysfunction of women may be associated with reduced or increased sexual responses. The classification is based on symptoms. There are (persistent genital arousal) distinguished 5 main groups reduced reactions and a main group elevated reactions. Disorders of sexual desire or interest are the lack of or loss of sexual interest, desire, thoughts and fantasies, and the absence of a reactive desire. A sexual arousal disorder is a lack of subjective and / or genital arousal. In a orgasmic disorder an orgasm occurs despite a perceived as highly sexual arousal state either does not occur, is of greatly reduced intensity or set occurs greatly delayed in response to stimulation. Under vaginismus refers to the reflex narrowing of the vaginal orifice when trying to enter all or part of the vagina, despite an expressly confirmed by the woman desire for penetration without structural or other physical abnormalities would vorleigen. As dyspareunia pain during attempted or completed vaginal penetration or intercourse are called. Provoked Vestibulodynie (PVD, also called vestibulitis-vulvae syndrome) is the most common form of superficial (introitalen) dyspareunia, and chronic pain syndrome associated with altered immune sensitization and the nervous system. Persistent genital arousal is excessive genital arousal. A disorder is diagnosed when the woman suffers from the corresponding symptoms. Some women do not suffer or they were not disturbed by a decline or lack of sexual desire, interest, arousal or orgasm. Almost all women with sexual dysfunction have features of more than one disorder. For example, a chronic dyspareunia in PVD often leads to disorders of sexual desire and interest and excitability. A disturbance in the excitability may restrict the enjoyment in coitus or cause pain and therefore the likelihood of orgasm and as a result, reduce the sexual motivation. However, dyspareunia may happen due to faulty lubrication as an isolated symptom in women with a strong sexual desire, interest and subjective arousal. Sexual disorders of women can be divided secondarily as lifelong or acquired present, situation-specific or constantly available and as easy mäßiggradig or heavy, depending on the extent of the suffering they cause the woman. Although there are few studies to these disorders hit well for women in heterosexual as homosexual relationships alike. Etiology The usual separation of mental and physical etiologies is artificial. Mental stress causes changes in the hormonal and neurological physiology, and physical changes can lead to psychological reactions that accompany the disorder. Often the symptoms of multiple causes within and between different categories of sexual dysfunction are due, and the cause often remains unclear. Primary psychological causes Mood disorders are closely associated with low desire and arousal. With up to 80% of women with major depression and sexual arousal disorder, the sexual arousal disorder improves when the depression is effectively treated with antidepressants. Are antidepressants, however ineffective, sexual arousal disorder persists or worsens even. Women with anxiety disorder also suffer more often from sexual arousal disorder that can affect desire, arousal and / or orgasm, or a PVD. Various fears – of letting go, of hurt becoming, of Abgewiesenwerdens or loss of control – and low self-esteem can contribute. Past experiences can influence the psychosexual development of women, such as: Unpleasant sexual or other experiences can lead to low self-esteem or feelings of shame or guilt. Emotional, physical or sexual abuse during childhood or adolescence can teach children to control their emotions and hide – a useful defense mechanism. However, such inhibition may complicate expressing sexual feelings later. The early traumatic loss of a parent or other loved one may inhibit intimacy with a sexual partner for fear of a renewed loss. Fear of negative experiences (eg. As unwanted pregnancy, sexually transmitted diseases, orgasm inability erectile dysfunction partner) can also affect the sexual response. Among the contextual causes (those pertaining to the specific current situation of the woman) include the following: Personal reasons:. Low sexual self-image (eg by infertility, early menopause or surgical removal of the breast, uterus or other body part during sexual activity plays a role) in the relationship underlying causes. lack of confidence, negative feelings or reduced attraction to sexual partners (for example, due to his behavior or of the increasing awareness of a changing sexual orientation) sexual causes: for example, an environment that is regarded as insufficient erotic, private or secure cultural causes: for example, cultural limitations in sexuality distractions (. eg from family, work or finance), the excitement beeinflussen.Primär physical Urs Various surfaces genital lesions, systemic and hormonal factors, as well as medicines may cause interference or contribute to its development (see table: Physical causes of sexual disorders of women). Physical causes of sexual disorders of women category cause genital lesions Atrophic vaginitis Congenital malformations Genital herpes simplex lichen sclerosus Surgery-related narrowing of the vaginal orifice fibrosis after radiation therapy Recurrent rupture of the posterior commissure Vaginal infections muscular dystrophies Other physical causes Bilateral oophorectomy in premenopausal women weakness fatigue hyperprolactinemia thyroid disease, hypoadrenale states, pituitary states nerve damage ( Eg. By diabetes, multiple sclerosis, spinal cord disorders) medicinal liquor gonadotropin-releasing hormone agonists anticonvulsants ?-blocker Some antidepressants, SSRI particular SSRI are a particularly common drug-related cause. The future will probably be shown that androgens affect the sexual response of women, the current data situation, however, is weak. There is evidence that such women benefit excessively from a testosterone administration which have low publishers, but are able to experience sexual satisfaction. The overall androgen activity (determined for the metabolite) is similar in women with or without desire. Alcohol dependence can cause sexual dysfunction. to clarify diagnostic survey of both partners, individually and collectively, Gynecological examination, in particular the causes of dyspareunia The diagnosis of sexual dysfunction and its causes based on the medical history and physical examination. Ideally, the histories of both partners are collected, which should also be questioned both together and separately. First, the woman is asked to describe the problem in their own words; specific content should be considered (see Table: Contents of sexual history in the clarification of sexual dysfunction of women). At critical points (eg. As negative sexual experiences in the past, negative self-image) that are identified during the first visit, you can enter into a subsequent consultation. Contents of the sexual history in the clarification of sexual dysfunction of women Territorial contents Medical history (past and current problems) General state of health (including physical energy, stress and anxiety level, psychiatric history and mood), drugs, pregnancies, abortions, STD, contraception, Safe sex relationship with the partner Sexual orientation, emotional intimacy, trust, respect, attraction, communication, loyalty, anger, hostility, resentment Current sexual situations sexual functions of the partner, the end of the hours before the test of sexual activity, questions of adequate sexual stimulation, according to the goodness of sexual communication and after the time (eg. As late at night, under time pressure), lack of privacy cause of desire and arousal The frame; visual, written and spoken sexual aids; Activities (eg common showers, dancing, music.); Stimulation methods (not physical, not physically genital, nichtpenetrativ genital) excitation damper fatigue, stress, anxiety, depression, negative sexual experiences in the past, fear of the consequences (including loss of control, pain, unwanted pregnancy and infertility), everyday distractions orgasm occurs or stay out, reaction in the absence of (the woman is emotionally charged or not), different reactions to the partner and masturbation subsequent state Emotional and physical satisfaction or dissatisfaction Quality and location of Koitusschmerzen Burning, tearing, grinding, stretching or dull the surface, (introital) or deep in the pelvis at the time of Koitusschmerzen case of partial or full insertion, deep penetration, movement of the penis or the man’s ejaculation; immediately after the penetration or urination after coitus self-confidence, feelings with respect to the own attractiveness of the body, genitals or sexual competence childhood history related to caregivers and siblings, trauma, loss of loved ones, abuse (emotional, physical or sexual) , consequences of the expression of emotions in childhood, cultural or religious restrictions Sexual experience in the past kind (desired, forced and / or abused), subjective experience (exhilarating, abwech slungsreich and pleasant), consequences (positive or negative, for. As unplanned pregnancy, sexually transmitted diseases, disapproval by parents or society, guilt because of religious intuition) personality factors ability to trust, comfort at the mercy; suppressed anger, which leads to the suppression of sexual emotions; Need for control, unreasonable expectations of themselves, increased attention to self-harm (d. H. Fear of pain that inhibits the joy), obsession, anxiety, tendency to depression STD = sexually transmitted diseases (sexually transmitted diseases). Physical examination is most important to determine the causes of dyspareunia; the technique may be slightly different from that of a routine gynecological examination. A description of the procedure in the investigation of the woman can help to relax, and should be continued during the investigation. The woman should be asked if they sit up and want to see their sex organs during the investigation in a mirror; This gives the woman the feeling that they have the situation under control. gonorrhoeae, the microscopic assessment of the vaginal secretion as a wet mount and Gram stain, and the application of a culture or a DNA probe to Neisseria and Chlamydia are indicated when a history or study provides evidence of vulvitis, vaginitis or PID. Although a reduced oestrogenic activity may contribute to sexual dysfunction, the measurement of this parameter is only rarely indicated. A low value is estrogen clinically proven. The sexual functions do not correlate with levels of testosterone, regardless of how they were measured. There is a clinical suspicion of hyperprolactinemia, the prolactin level is determined. If thyroid disease is suspected, appropriate tests are carried out; in suspected hypothyroidism TSH is hyperthyroidism and thyroxine (T4) is determined, and occasionally other thyroid values. Treatment elucidation of the pair on the female sexual response correction of the causative factors replacement of the SSRI by other antidepressants or additional administration of bupropion Psychotherapien The therapy depends on the diagnosis and cause; often more than one treatment modality is used due to the overlap of the disease. A sensitive approach to the patient and careful examination may be in itself therapeutically effective. Causative factors, if possible, corrected. Affective disorders are treated. It may also be helpful to explain the factors that are involved in the female sexual response. Since SSRIs can contribute to various types of sexual dysfunction, it may be considered a switch to antidepressants that have fewer side effects on the sex life (eg. As bupropion, moclobemide, mirtazapine, duloxetine). Alternatively, the combined administration of bupropion and SSRIs may be helpful. Mainstay of treatment is psychotherapy. Cognitive behavioral therapy focuses on the negative and often extremely low self-esteem due to illness (including gynecological) or infertility. Mindfulness (Engl. Mindfulness), an eastern method originating in Buddhist meditation can be effective. It focuses on the value-free awareness of the present moment. Women are empowered by its use, not to be distracted by things that affect the concentration on sexual sensations. Mindfulness reduces sexual disorders in healthy women and in women with cancer in the pelvic area or provoked Vestibulodynie. Women can learn how to use mindfulness in social institutions or by means of offers on the Internet. Mindfulness-based cognitive therapy (MBCT) combines a special variant of cognitive behavioral therapy with mindfulness. Women are analogous to the cognitive behavioral therapy encouraged to identify maladaptive thoughts, but simply observe their presence, only to find that it is just mental events and they do not reflect reality. This method such thoughts may be less distracting. MBCT can prevent recurrent depression and are used in a form adapted for the treatment of sexual arousal disorders and disorders of sexual desire / interest as well as chronic pain in provoked Vestibulodynie. Summary Most play psychological and physical factors in the development of sexual dysfunction of women a role; the interference by interaction may deteriorate. Among the psychological factors mood disorders, impact of past experiences, concerns about negative consequences special circumstances of women include (z. B. low sexual self-image) and distractions. Among the physical factors include genital lesions, systemic and hormonal factors and drugs (especially SSRIs). Both partners are interviewed individually and collectively. Most psychotherapy is (z. B. cognitive behavioral therapy, mindfulness, a combination of the two methods [MBCT]) are used.