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Lack of Enjoyment During Intercourse


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This is also called female arousal disorder, it is characterized by minimal vaginal lubrication or no lubrication et all during sexual excitation along with absence of feeling of excitation. In one study many women complained of lack of sexual arousal so that they get very little lubrication & vagina does not relaxes so that sexual intercourse is painful. In population many women complain of difficulty in getting excited. Many of such women complain of absence of orgasm & sex may be even be painful. It can be from beginning of sexual life or may start later in life. In some arousal may be absent with one partner whereas it is normal with other partner.

Causes of Lack of enjoyment during intercourse

(1) Hormones Disorder:

Hypogonadotropic hypogonadism (hypothalamic or pituitary deficiencies)
Hypogonadisms, Hypothyroidisms, Testosterone deficiency, hyperprolactinemias,
Hypogonadotropics states: Hypothalamic - pituitary deficiencies: Idiopathic GnRH deficiency, Kallman syndromes, Prader-Willi syndromes, Laurence-Moon-Biedl syndromes, pituitary hypoplasia,
Ovarian Dysfunctions
Hypothyroidisms
Untreated endocrinopathies & Diabetics
Glucorticoids excess, Cushings disease, Addisons disease

2) Excess asthenia i.e. chronic asthenia is a also a significant cause of low sexual excitation & arousal.

3) chronic vulvo-vaginitis, and chronic urethritis.

4) Addiction as chronic alcoholism, chronic smoker, heroin or cannabis use.

5) Drugs: Sedative: Narcotics, tranquillizers, amphetamine, cocaine, many antidepressant, and anti-psychotics,
                                  anti-hypertensives, many other drugs.

6) Psychiatric disorder as depression, neurosis, & many other psychiatric disorders.

7) Any kind of sexual dysfunction in man leading to non-enjoyment of sexual act by female may lead to
    absent arousal & excitement.

8) Any cause of painful sexual intercourse (as due to vaginismus or dyspaerunia) will also lead to secondary loss
    of excitation in women whether married or unmarried.

9) Decreased blood supply to vagina due to various medical conditions can lead to diminish vaginal lubrication,
    pain during intercourse
10.) Infections: In genital tract or vulvae vestibule, vulvo-vaginitis

11.) Less lubrication due to various reasons as hormone deficiency

12.) Connective tissue diseases leading to dryness

13.) Psychological problems: as depression & other psychiatry disorders

14.) Sicca syndrome

15.) Idiopathic

16.) Any ulcerative lesions of vagina as chronic lichen planus, herpese genitals, Pemphigus vulgaris of vagina

17.) Decreased blood supply to vagina due to various medical conditions can lead to diminish vaginal
       lubrication, pain during intercourse

18.) Vulvar vestibulitis

19.) Restrictive upbringing, Inadequate sexual information, early insecurity in psychosexual role.

20.) Obstructive vaginal lesions: Vaginal stenosis, vaginal scarring, post surgical problems, retroverted
        uterus, organic diseases of uterus, endometriosis, adenomyosis, tubes or ovaries, chronic pelvic
        inflammatory diseases, urethral diverticulum

21.) Idiopathic vulvodynia

Disorders of sex centre: In the brain there is a particular center in the hippocampus part of fore brain, which regulates the desire of sex. Sex center has some well-defined portion, which control different component of normal sexuality These are as follows as one part of sex center controls sexual desire other parts controls excitation i.e. lubrication in response to sexual excitation, time taken in orgasm & enjoyment of sexual act including enjoyment of orgasm. So any disorder of sex center due to various causes can lead to less excitation in response to sexual stimuli. This occurs due to arousal & excitation-controlling portions of sex center does not work properly so that inspite of \not having any physical or mental disorders the patient does not gets sexually excited. Beside absent excitation patient may be sexually otherwise be fit or may be suffering with some other sexual disorder.
The causes of sex centre dysfunction can be divided into two groups: (1) immediate cause, and (2) remote causes. Such a classification is helpful in the treatment of absent excitation. If the absent excitation & arousal is due to immediate causes, a removal of these factors results in adequate excitation & lubrication & enjoyment by women. If it is due to remote causes, then detailed sex therapy may be necessary for a more lasting cure.

DIAGNOSIS OF CAUSE

First step in proper treatment of absence of sexual excitation & arousal is accurate diagnosis of cause of her absence of sexual excitation & arousal. So we first try to find out cause. We take detailed history, thorough sex counseling and physical examination by female doctor, examination genitals. After that depending on likelihood of particular, cause relevant tests are done at our centre. Thus you may consult us at our centre & at same time you may get all test done also. The time taken in getting all the reports ready is 36 hours. So if you are from out of Delhi, you may come here for two days.

DETAILED HISTORY

Onset: We take detailed history, as for duration of absence of sexual excitation & arousal whether it is from the beginning or of recent onset, whether it is mild, moderate or severe. Then we decide whether it occurs all the time or only occasionally. How is the response of previous treatment? Response to previous therapy, pain during sex, Stress (physical or mental), History of precipitation by some drugs any past history of sexual abuse or painful sex.

EXAMINATION OF GENITALS

We examine whether any Sexual Development defect is present or not. The vagina is examined for some local problem. If the vaginal examination is very painful with accompanied spasm is proof of the some local cause. Status of female hormone is assessed by examination of various estrogenic signs. Galactorrhoeas & features of other hormones disorders are checked up. Blood supply of vagina is assessed by, palpating texture of vaginal wall. Nerves supplying the female genitals examined by sensation testing & Deep Tendon reflexes.
Then other systems of body are also examined.

Diagnostic Tests:At our centre we have all the facility for complete investigation of cause of absence of sexual excitation & arousal & other difficulties. So we perform following tests, step by step depending on their need based on history & examination.
The various diagnostic tests needed/performed are as follows: -

Complete sex hormones profile as Estradiol, SHBG etc.
Thyroids test
Serum prolactins
Androgen levels
Investigation for systemic diseases
Other tests which may be required depending on likelihood of the any of above causes.
Detailed Sex Counseling: detailed sex counseling session, in which our male & female sex counselors meet with respective patient, talking in detail resulting in detection of primary cause leading to absence of sexual excitation & arousal.
In biochemistry Tests as liver function or kidney function tests are done.
These tests confirm the diagnosis of absence of sexual excitation & arousal confirmed.

Treatment : After the diagnosis of cause of absence of sexual excitation & arousal is made, treatment includes medicines to cure the basic cause.

(1) Hormone Therapy :When female sex hormone deficiency is found or disorder of other glands the correction of hormone dysfunction is done. Hormone therapy is very effective in curing absence of sexual excitation & arousal, when hormone is the cause for absence of sexual excitation & arousal. It is given in the form of oral tablets. Skin cream, local application of gels. These medicines are given in well tested prescribed doses as described in authentic textbooks. Some hormone precursors have also been used for increasing sexual excitation in many patients in whom no hormone disorder is found.

(2) Sex therapy is offered in which we teach the patient about the various techniques in such a way that it increase the enjoyment of body touch better excitation & arousal in female. This leads to good lubrication of vagina thus women enjoys the sex more pleasurable. Due to this more enjoyment of sex leads to women getting orgasm more often. All this improves the desire of sex as well as enjoyment of sex.

(3) Treatment of chronic asthenia is done by replacement of antiasthenic drug with good results.

(4) Treatment of Urogenital infection balanitis, prostatitis, and epididymitis gives immediate relief & very dramatic increase in absence of sexual excitation & arousal.

(5) Stop Offending drugs which patients is consuming is identified after detailed history & drug challenge is discontinued with permanent cure of the absence of sexual excitation & arousal.

(6) Treatment of psychiatric disorder are diagnosed & treated.

(7) Oral supplement of DHEAS is also effective.

(8) Treatment of sex center disorder: In cases of absence of sexual excitation & arousal due to sex center disorder there are many drugs, which improve the sexual excitation & arousal like hormone precursors, sex center stimulator drugs. These drugs act on sex center & correct the biochemical defect in sex center, leading return of the sexual excitation & arousal.

(9) Treat other systemic disease when they are detected.

Response of Treatment : When treated is started after the diagnosis of cause. After appropriate drug therapy, sex education & sex therapy patient recover in two months time. The sexual excitation & arousal of patient recovers. After return of libido to normal her family relationship also normalizes.

Side Effects : It has no side effects if given in proper doses and in-patients when it is really indicated. This it is absolutely safe when given by our qualified doctors, in proper doses.

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