By Malingula John, S. Teku/bedcp/101550
Causes
of Sexual Dysfunctions
Lauren
Welsh
"Sexual dysfunctions are an important public health concern, to which
general health and emotional problems contribute"
(10).
What is a sexual dysfunction? A sexual dysfunction is any condition that
inhibits someone's ability to enjoy sex. Some common sexual dysfunctions are:
hypoactive desire disorder (low sex drive), hyperactive sexual disorder (high
sex drive), sexual aversion disorder, lack of lubrication (females), impotence
(male erectile disorder), premature ejaculation, vaginismus (prolonged
contractions of the vaginal wall that cause painful intercourse), or failure to
orgasm during sex
(8).
In a study of happily married couples, 14% of men and 15% of women reported
that they were either not very satisfied or not at all satisfied with their sex
lives. In another study by Laumann in 1992, it was found that the prevalence of
sexual dysfunction is 43% in women and 31% in men
(10).
Are these numbers surprising? What is causing this lack of sexual fulfillment?
Did you ever wonder why sexual desire varies from person to person? Or why
and how your sexual drive can change over time? Did you ever wonder what causes
things to go wrong sexually - sexual dysfunctions? What is controlling YOUR
sexual desire?
Innervations of the organs of sexuality are mediated primarily through the
autonomic nervous system
(12).
The autonomic nervous system is the part of the vertebrate nervous system that
regulates involuntary action, as of the intestines, heart, and glands, and that
is divided into the sympathetic nervous system and the parasympathetic nervous
system
(1).
It is generally assumed that the parasympathetic system activates the process
of erection via impulses that pass through the pelvic splanchnic nerves (S2,
S3, S4), which cause the smooth muscles of the penile arteries to dilate. The
sympathetic (adrenergic/adrenalin) system is responsible for ejaculation.
Similarly for women, the sympathic system facilitates smooth muscle contraction
of the vagina, urethra, and uterus that occurs during orgasm.
"The autonomic nervous system functions outside of voluntary control
and is influenced by external events (for example, stress, drugs) and internal
events (hypothalamic, limbic, and cortical stimuli)"
(12).
So, it is not surprising, therefore, that erection and orgasm are so vulnerable
to dysfunction.
There are many possible psychological disorders that could cause a person to
be sexually unsatisfied. If a person has a psychological disorder such as
bi-polar disorder, schizophrenia, epilepsy, or depression - they tend to enter
states of extreme fear, paranoia, or anxiety more often than a person without
their disorder. These states are not normal states of consciousness for a
healthy person, and many of these abnormal states of consciousness inhibit
sexual interest
(9).
For example, a bi-polar person experiences non-normal states of extreme bliss
or extreme depression. During each non-normal state of consciousness, the
bi-polar person will be too consumed by either their elation or their
depression to feel any sexual desire. Therefore, a person's sexual desire is
related to the amount of time spent in non-normal states of consciousness.
Not only the psychological disorder itself can cause abnormalities in sexual
desire, but so can the treatment of the disease. Drugs used to treat some
psychological disorders - such as depression - can alter sexual desires by
disturbing the normal processes in the brain that deal with desire and sexual
arousal. Certain chemical agents such as antihypertensive, anticonvulsant,
serotoninergic antidepressant and neuroleptic drugs may cause a loss of libido
- sex drive
(12).
These drugs alter the production and uptake of certain chemicals called
neurotransmitters in the brain that have been found to alter sexual
desire/performance. Some of these neurotransmitters are: dopamine, epinephrine,
norepinephrine, and serotonin. All have effects on sexual function. For
example, an increase in dopamine is presumed to increase libido. Serotonin
produced in the upper pons and mid-brain is presumed to have an inhibitory
effect on sexual function
(12).
There are other medical conditions in addition to psychological disorders
that can be the cause sexual problems. In the U.S. there are two million men
who are "impotent because they suffer from diabetes mellitus; an
additional 300,000 are impotent because of other endocrine diseases; 1.5
million are impotent as a result of vascular disease; 180,000 because of
multiple sclerosis; 400,000 because of traumas and fractures leading to pelvic
fractures or spinal cord injuries; and another 650,000 as a result of radical
surgery, including prostatectomies, colostomies, and cystectomies"
(12).
Some of the injuries are of the abdomen, lower spinal cord, or pelvic vascular
areas, which can compromise circulation to the genitalia or sensory nerves
to/from the genitalia - producing impotence or other changes in normal sexual
responses.
In addition to psychological disorders, drugs, and varying medical
conditions being the cause of sexual dysfunction, injury and/or brain surgery
can also cause a range of affects on a person's libido
(4).
Examining the outcome of damage to certain, specific areas of the brain can
help us understand the roles that those parts of the brain play in sexual
drive/performance.
There are 4000 serious head injuries that occur each year in the U.S., of which
about 100 are survivors. The disturbance of sexual functioning in these head
injury survivors is the rule rather than the exception
(4).
Sexual drive, having to do with structures deep in the brain, are rarely
disturbed by non-penetrating head injury. It is sexual motivation and
initiation that are damaged by blunt frontal lobe trauma.
Experimentation with animals has demonstrated that the limbic system is
directly involved with elements of sexual functioning. In all mammals the
limbic system is involved in behavior required for self-preservation and the
preservation of the species
(12).
The limbic system is the "link between higher cortical activity and the
lower systems that control behavior"
(3).
It controls the neuroendocrine system, autonomic system, olfactory sensory
processing, emotions and motivation, and memory. The limbic system is
interconnected nuclei of the olfactory bulb and orbitofrontal cortex, amygdala,
hippocampal formation, hypothalamus, anterior and mediodorsal nuclei of
thalamus, septal nuclei, and the Limbic ring of neocortex
(7).
Kluver and Bucy proved that the limbic system is involved with sexual
functioning in their experiment with monkeys. The monkeys in their experiment
were aggressive and raging prior to the operation. The operation consisted of
the removal of the monkey's temporal lobe. After the operation the monkeys were
docile, orally fixated, and had increased compulsive and sexual behaviors
(2).
Their findings led to the so-called Kluver-Bucy Syndrome. Humans can get
Kuver-Bucy Syndrome when their temporal lobes get damaged from such things as
tumors or surgery. Humans with this disorder also experience a disturbance in
sexual function just as the monkeys did
(3).
Temporal lobe epilepsy is another way in which the temporal lobe might
function inadequately and cause sexual dysfunction. There is a high frequency
of sexual disturbance in patients with temporal lobe epilepsy. Gastaut and
Collomb (1954) were the first to draw attention to hyposexuality after specific
inquiry in 36 patients with temporal lobe epilepsy. More than two-thirds showed
marked diminution or absence of interest, appetite or sexual activity. Other
forms of focal and generalized epilepsy appeared to be unassociated with such
problems. Frequently, there was "a remarkable lack of sexual curiosity,
fantasies or erotic dreams, yet little to suggest inhibition since the patients
talked easily and without reserve about such matters"
(12).
The amygdala has a large number of sexual phenomena associated with it. One
of the more interesting is the observation that gay men have more connections
between the amygdala on each side of the brain than straight men
(9).
The amygdala manages our emotions and helps to manage our states of
consciousness
(9).
These normal and non-normal states of consciousness have a lot to do with
sexual dysfunction (e.g. hyposexuality) as was discussed previously with
psychological disorders.
Physiological disorders, medications, certain medical conditions, injury
and/or brain surgery are only some of the causes of sexual dysfunction.
Examining the neurological causes of sexual dysfunction will allow us to better
understand the workings in our brain that have to do with sexual desire - and
with this knowledge and better understanding we can hopefully help the many
people in our society that suffer from sexual dysfunctions.
