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Mind, Body and Sexual Dysfunction

A Complicated Business

Each evening for two months, Ben arrived home from work to find his wife, Leslie, still wearing her nightgown. But it wasn’t seduction she had on her mind. She was simply unable to get up, get dressed and get going each day.

Leslie, 33, and Ben, 35, (not their real names) had always enjoyed an active, creative and compatible sexual relationship during their nine-year marriage. But now, instead of responding to Ben’s sexual overtures or initiating any herself, Leslie was distant, preoccupied, tearful and too tired to make love. She no longer cared about her appearance. In short, she barely functioned in the bedroom or elsewhere.

“The house was a mess, our marriage was a disaster, we had no social life and I was sleeping in the den,” Ben said. “I had no idea where she was coming from.”

Eventually, he said, he “lost it” and gave Leslie an ultimatum: Either she see a doctor or he would move out. Soon afterward, she was diagnosed with hypothyroidism, a thyroid hormone deficiency that can cause lethargy, reduced sexual desire, depression and other symptoms. The doctor prescribed thyroid-replacement medication and also started Leslie on one of the newer antidepressants. Because her depression was so disabling, he referred her to a psychiatrist.

Mental conditions, such as depression, have profound effects not only on the victims, but also on spouses or partners. Nowhere is that more evident than in the bedroom, where sexual drive and intimacy often are displaced by despair, anger and other symptoms of the illness.

But not all sexual dysfunction such patients experience can be blamed on their mental states. In fact, most of the time, an organic problem or medication is the real culprit, says Dr. Stephen Owens Morris, a Paradise Valley, Ariz., psychiatrist.

Many conditions — such as diabetes and thyroid dysfunction, as well as neurological, urinary, gynecological or vascular diseases that interrupt nerve impulses or restrict blood flow — can lower sexual desire or reduce one’s ability to perform sexually.

So can local trauma, injury, alcoholism and various medications, including — ironically — some antidepressants and anti-psychotic drugs that are notorious for causing decreased libido and/or an inability to sexually function, Morris said.
Treating More Than One Problem
Once her medications kicked in, Leslie’s energy level began to improve, but she still had no sex drive, which fueled her depression further. Her psychiatrist switched her to another antidepressant that had a different chemical makeup. Within a few months, the couple had rekindled their sexual relationship.

“All but two of the presently available antidepressants can cause sexual dysfunction in the form of lack of desire or the lack of ability to function,” Morris said. A board-certified private practitioner, Morris is also a staff psychiatrist for a program that serves Arizona’s indigent mentally ill and is known for his expertise in psychopharmacology, which focuses on the interaction between brain chemistry and psychiatric medications.

Anti-psychotic drugs are similarly offensive because they block the production of some brain chemicals (neurotransmitters) or increase production of prolactin, a hormone that suppresses sexual drive. They also suppress areas of the brain that stimulate sexual function, he added.

Some steroids and hypertension drugs also can alter moods or trigger clinical depression.

“Many medications used in other medical specialties can cause sexual dysfunction as well, including birth control pills and blood pressure medication. Sexual organ function is very dependent upon adequate vascular [blood] supplies — as Viagra has shown — and also requires a mindset that sex with this partner is good, or at least acceptable,” Morris said.

These drugs can be changed or adjusted to minimize other side effects, but often, a patient’s sexual dysfunction isn’t addressed, he said.

“It’s clearly a complicated business that can go amiss at any turn in the very best of circumstances,” Morris said of the relationship between physical, mental and sexual dysfunction.
To Confuse Matters Further
Sometimes, sexual dysfunction is one of a group of symptoms involved with major depression that interferes with one’s ability to enjoy anything at all, as in Leslie’s case. Or it may be caused by post-traumatic stress disorder, personality disorders or some forms of schizophrenia characterized by an inability to relate closely to others, Morris said.

Only in the past five or six years have doctors and pharmaceutical companies begun to tackle the issue of sexual dysfunction in mentally ill people as a separate concern. With few studies to review, it is difficult to establish a cause-and-effect relationship, Morris said.

“The presumption of a psychological cause only should occur after a complete physical evaluation,” he said. “The astute psychiatrist will also look at medication.”

An anxiety disorder may set the groundwork for sexual dysfunction, or low self-esteem related to a real or imagined deficiency may be at the root of the problem.

“When the cause is, indeed, psychological, it often involves anxiety and/or fear regarding any social intimacy or sexual encounter,” Morris said. “The attitude about sex is important to explore and may be related to negative concepts incorporated from family members or simply related to a lack of education.”

The bottom line, Morris says, is that good physical health and freedom from anxiety, panic and phobias all are needed for good sexual function.

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