Disease name confirmation
- This is an appropriate medical term. Korean: 성기능장애 / English: Sexual dysfunctions (a comprehensive diagnostic group: sexual desire disorders, sexual arousal disorders, orgasmic disorders, sexual pain disorders, etc.).
1) Disease description (causes and symptoms)
- Definition: A diagnostic group encompassing disorders of the sexual response cycle related to sexual activity or pain during intercourse. It is classified into sexual desire disorders, sexual arousal disorders, orgasmic disorders, and sexual pain disorders (e.g., painful intercourse and vaginismus).
- Major causes: Biological factors (hormonal imbalance, vascular or neurological problems, chronic diseases or pain, medication side effects, etc.) and psychological or interpersonal factors (stress, anxiety, depression, relationship problems between partners, past trauma, etc.) may occur independently or in combination.
- Pathophysiology: Depending on the cause, these may lead to decreased sexual desire (central or hormonal), arousal disorders (abnormalities in blood flow, nerves, or hormones, or anti-sexual medications), orgasmic disorders (sensory or psychological factors), and pain disorders (infection, hormone-related atrophy, muscle tension, or anatomical problems).
- Examples of symptoms: Decreased sexual desire, inadequate lubrication during arousal (women), erectile dysfunction (men), delayed or absent orgasm, and pain during intercourse (including vaginal dryness and vaginismus).
2) Treatment methods and precautions
- Non-pharmacological treatment (recommended as first-line)
- Sex therapy (gradual behavioral therapy such as sensate focus), couples therapy (dual-sex therapy: partner-inclusive treatment), sex education, and instruction in sexual techniques (stimulation locations, positions, caressing methods, etc.).
- Psychotherapy (cognitive behavioral therapy and specialized treatment for sex-related trauma).
- Pelvic floor muscle physical therapy (effective for vaginismus and sexual pain), and vaginal dilators (for treatment of vaginismus).
- Pharmacological treatment (selected according to the cause)
- Male erectile dysfunction: PDE5 inhibitors (sildenafil, tadalafil, etc.), vacuum devices, topical or intracavernosal injections (into the penis), and penile prostheses (in severe cases).
- Premature ejaculation: Topical anesthetics (creams), short-term administration of selective serotonin reuptake inhibitors (SSRIs), and behavioral therapy.
- Female sexual desire or arousal disorders: Topical lubricants and moisturizers (for vaginal dryness), topical estrogen for menopause-related vaginal atrophy, and in certain cases, hormone therapy (testosterone) at the discretion of a specialist (often unapproved/off-label, so caution is required).
- Sexual pain: Treatment of infection (elimination of the causative organism), topical analgesics or anti-inflammatory agents, hormone therapy (for menopause-related atrophy), and pelvic relaxation therapy.
- Surgical treatment
- When an anatomical lesion is confirmed (e.g., adhesions between the clitoral hood and glans), symptoms may improve through separation surgery (adhesiolysis). The patient’s consent and specialist evaluation are essential.
- Precautions
- Drug side effects and interactions must be assessed (e.g., PDE5 inhibitors are contraindicated with nitrate medications), as must the presence or absence of cardiovascular disease.
- Antidepressants (including SSRIs) may worsen sexual dysfunction.
- A multidisciplinary approach (urology/gynecology/psychiatry and mental health medicine/sex therapy specialists/physical therapy) is recommended.
- Risk of complications
- Relationship conflicts, worsening depression or anxiety symptoms, sexual avoidance, and reduced quality of life.
3) Checklist before an outpatient visit (items to bring and information to provide to medical staff)
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Items/materials to bring
- A list of all medications and supplements currently being taken (including prescription drugs, over-the-counter medicines, and Korean herbal medicines).
- The time of symptom onset and progression (acute/gradual, persistent/intermittent).
- Notes summarizing the type of sexual problem (erection, lubrication, orgasm, pain, etc.) and the situations in which symptoms occur (when with a partner, when alone, in specific positions, etc.).
- Relevant test results (blood tests: hormone tests, blood glucose, lipids, liver function, etc.; previous imaging and internal medicine, gynecology, or urology findings).
- Mental health history (depression, anxiety, trauma, and history of taking psychiatric medications).
- Lifestyle information (smoking, alcohol use, sleep, exercise, and stressors).
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Additional useful materials to provide at the outpatient visit
- A sexual activity diary (a brief record showing changes before and after onset: frequency and situations in which problems occur).
- The partner’s relevant medical history and medications (when considering joint treatment).
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Example questions to organize in advance for the physician
- An accurate description of the symptoms (frequency, severity, and factors that trigger or relieve them).
- Necessary tests for differential diagnosis (hormones, diabetes, cardiovascular risk assessment, etc.).
4) Examples of general questions to ask the doctor
- What effects can be expected from this treatment (medication/therapy), and how long will recovery take?
- What are the major side effects of the prescribed medication, and what interactions does it have with other medications?
- How might my underlying conditions (e.g., heart disease or diabetes) affect my sexual dysfunction?
- Is it recommended that my partner participate in the treatment process? If necessary, which specialist (sex counselor or couples counselor) can I be referred to?
- What is the goal of treatment, and is complete recovery possible?
5) Examples of condition-specific questions
- (Primarily decreased sexual desire) "Could the medication I am currently taking (e.g., antidepressants or antihypertensive drugs) be a cause of decreased sexual desire? Are there alternatives, such as changing the medication?"
- (Erectile dysfunction/history of chest disease) "Is it safe for me to use a PDE5 inhibitor (such as sildenafil)? I am taking a nitroglycerin-based medication; is it contraindicated to use them together?"
- (Vaginal dryness and pain in women) "Menopause-related vaginal atrophy is suspected. Would topical estrogen treatment be appropriate? If I am breastfeeding or have a history of hormone-related cancer, what alternatives are available?"
References (clinical summary)
- Diagnosis and treatment should be based on identifying the cause (medical, hormonal, neurological, and psychosocial evaluation), and a multidisciplinary approach and partner participation increase the likelihood of treatment success.
- Some symptoms (e.g., adhesions between the clitoral hood and glans) may improve with surgical correction, but whether to perform surgery requires specialist evaluation and the patient’s consent.
(If necessary, additional information can be provided, such as a list of tests according to specific symptoms and detailed doses and contraindications for each medication.)