Introduction

Sexual problems in men and women can be caused by diverse medical conditions - some of these have been considered in two earlier articles ( Sexual Problems in Women and Sexual Problems in Men). In this summary, the effects of some common medical conditions on sexual activity are considered in more depth, in particularly with regard to possible ways of treating the problem.

Physical disability

Interestingly, a survey of persons with physical disabilities showed that lack of partners was cited most frequently as the major reason for dissatisfaction with current sexual status; however, persons without disabilities also listed the same problem as being most common. Sexual desire is not usually diminished. Disabilities may impose physical, psychological and social barriers to sexual intercourse, but if a sympathetic, understanding, partner can be found, most of these barriers can be overcome. Nurses and sex therapists can advise and help persons integrate their beliefs and behaviors into a healthy, satisfying lifestyle.

Arthritis

Sexual dysfunction is reported by persons with both rheumatoid and osteoarthritis. In the former, it is commonly related to the disease process itself, or the use of disease-modifying agents such as methotrexate. In osteoarthritic subjects, pain and disability can interfere with performance. In both instances, there is accompanying sexual dissatisfaction and, often, depression. The affected couple should try to time sexual activity for times of the day when pain and stiffness are minimal, and use analgesics appropriately. Trying different sexual positions may be helpful - a sex therapist can advise.

Chronic obstructive pulmonary disease (COPD)

Shortness of breath inhibits all physical activity, so that COPD sufferers have impaired sexual performance. In addition, there is reduction of libido in both sexes, and erectile dysfunction (ED) in male patients; the latter is often physical, and may respond to sildenafil. Co-existent diabetes may be found. Treatment of the underlying disease (no smoking!) will be helpful, together with a training program to increase exercise tolerance. Appropriate sexual positions should be selected to reduce physical effort by the patient, and supplemental oxygen prescribed, if necessary.

Diabetes mellitus

Sexual problems in male diabetics may be due to microvascular complications or polyneuropathy, both of which can lead to ED. Vascular changes involving the pelvic vessels are similar to those seen in atherosclerotic subjects, and can cause the pelvic steal syndrome, in which erection is lost as soon as the man enters his partner - on thrusting, blood is directed by gravity away from the pelvis. In such cases, changing position can help; for instance, the man lies on his side or back. Autonomic neuropathy is common in type 2 diabetic patients. Its progression can be checked, or slowed, by intensive glycemic control. Tight monitoring is also important in controlling the vascular changes in diabetes.

Vaginal infections are quite common in women with diabetes, and can produce dyspareunia. Treatment by a gynecologist and sympathetic behavior by her partner should restore good sexual function.

Myocardial infarction

The patient should have a 2-3 month recuperation period before resuming tiring exercise, and this includes sexual activity. The fear of bringing on another attack may produce sexual dysfunction, as may the use of antidepressants to treat the commonly associated depression. A good rehabilitation program and reassurance by the physician is most important - having sex need not be more strenuous than climbing a flight of stairs. Post-infarct sexual satisfaction may be expected to improve so as to be the same as before infarction. However, the degree of ED in such patients correlates with the number of coronary arteries affected by occlusive disease. If necessary, sexual counseling should be offered.¹;

Similar advice is suitable for patients with coronary artery disease who have undergone coronary bypass surgery, although the period of abstinence from intercourse may be shortened, and masturbation can be used to replace more strenuous activity.

Heart failure

Both the condition itself and the medications used to treat it may give rise to sexual difficulties. Reassurance by a physician should be given that sex is a safe activity for heart failure patients. A 2-3 week recovery period before resuming sexual activity is advised after an episode of pulmonary edema. A supervised progressive exercise program can improve cardiac functioning and effort tolerance.

Stroke

Most stroke patients experience a marked decline in coital frequency, erectile and orgasmic ability, and sexual satisfaction. Their illness can affect their spouses, too. Psychological and social factors are paramount, although physical limitations due to paralysis may play a role. Spousal support and a readiness to make positional adjustments are important in restoring satisfactory sexual activity.

Hypertension

Hypertensive changes in vascular endothelium can cause ED. However, this is also a side effect of various medications used in treatment, although it's rare with the newer classes of antihypertensives. Sildenafil (Viagra) treatment is effective in treating ED of vascular origin, and may be used in conjunction with antihypertensives - but not together with nitrates taken for angina pectoris.

Renal disease

Chronic renal failure produces sexual dysfunction in both male and female patients. The main factor is uremia, which is associated with autonomic neuropathy. In men, impaired gonadal function is common, whereas central disturbances are more prominent in women. Optimal delivery of dialysis, correcting anemia, and avoiding secondary hyperparathyroidism will help; successful renal transplantation is the most effective means of restoring normal sexual function in both men and women with chronic renal failure.

Chronic prostatitis

If pain is present with prostatitis, sexual activity will probably be avoided. Antibiotics, warm sitz baths, and prostatic massage should reduce pain and permit intercourse. Kegel exercises can also be helpful.

Parkinson's disease

The disease's effect on the autonomic nervous system can impact sexual performance, as can the associated decreased agility and flexibility. Antiparkinson medications often negatively impact sexual performance, although certain dopaminergic agents occasionally produce hypersexuality. Depression, which is common in people with this disease, can decrease sexual desire and energy. Some men with Parkinson's experience problems with impotence; sildenafil is helpful in many cases, and can usually be used in combination with antiparkinson medications. As a practical step, sexual activity should be planned for times when medications are likely to be at peak effect, and symptoms are least intrusive.

Multiple sclerosis

Up to 80% of men and 72% of women with multiple sclerosis report sexual dysfunction - treatment should be directed at improving overall disability, as well as the erectile dysfunction or anorgasmia along the lines suggested in the summaries mentioned in the first paragraph.
Many common diseases have specific patient organizations, each with their own sites on the Internet; patients can often obtain information and encouragement in dealing with their sexual problems by visiting these sites. Some of these sites are listed at the end of the "patient version" of this summary.