|Intimacy and Sexuality|
It is becoming increasingly apparent that dysfunction in matters of intimacy is a problem of increasing prevalence. The public is becoming more open about discussing these matters, and with the increased medical understanding of neural and hormonal influences on maters of sexuality, treatment is becoming increasingly available.
What is sexual dysfunction?
Sexual dysfunction (SD) can be defined in a variety of ways, depending upon the attitude, orientation and social parameters in which an individual exists. That is, what is normal or appropriate for one person may be entirely unacceptable to the next. Societal pressures, religious orientation, political climate and other influences will change the nature and definition of SD. For purposes here, SD will be addressed entirely from the viewpoint of physiology, without any intended endorsement of any particular orientation or attitude.
NOTE: Nobody is 'normal' (except for me, of course) dsk
For the purposes of discussion, SD will be defined as a physical impairment that prevents the enjoyment of satisfactory sexual activity.
Emotional inability to perform
Loss of emotional momentum, or loss of libido
I will attempt to address the medical/physical problems in a systematic way.
The most common cause of sexual impairment resulting from pain stems from the sequelae of lower back injury. Next to headache, more time is lost from work due to low back pain than from any other cause. With increasing frequency, patients are undergoing spinal surgery for pain alone, that is, pain in the absence of bladder/bowel dysfunction, muscular atrophy and numbness.
This stems from the prevalence of imaging centers that are readily available to perform MRI's, CAT scans, and such. It should be better recognized that the mere presence of an 'abnormality' on image does not imply causality. A 'structural' abnormality may not be abnormal at all.
Imagine yourself sitting in a nearby shopping mall.
Now imagine the same population simultaneously running into each other and pulling a muscle.
Many patients find themselves having undergone surgery without meaningful benefit. Unfortunately, too many of these patients find themselves returning to the same surgery center for spinal surgery #2, surgery #3, and so forth.
The familiar progression is as follows:
The obvious problem is in patient selection. There are too many surgeons anxious to perform the surgery, and the criteria become softer and softer.
If the problem is that the 'abnormality' on MRI is not causing the pain, then an effort must be made to establish causality between the pain and the disc. To do this, the physician should obtain evidence that this is the case.
Performing EMG, NCV, SSEP provides evidence of causality, if it exists. If a corraborating NCV does not demonstrate findings of lumbar/cervical radiculopathy, then surgery is unlikely to be successful.
In order to restore libido and treat ED, testosterone levels must be increased, but more importantly, estrogen levels must be decreased.
This is achievable, but it is anything but simple. The approach is to decrease degradation of testosterone to estradiol through inhibition of certain enzymes, increase testosterone production, and enhance estrogen excretion through the biliary tract.
This takes a combination of supplements, taken in concert. Timing is essential, and periodic hormone levels should be determined through laboratory examination.
In the event that you should get 'lucky,' it is important to be prepared for situations that require a good personal lubricant. Women commonly suffer from problems that result in vaginal dryness, and for this reason, it is necessary (kind & considerate, as well) to have a good personal lubricant immediately handy.
The best ones are water soluble. KY has a good product out that is easily obtained from the local drug store. Try to avoid petroleum based products because they can cause difficulties for women the day after. You may get 'lucky' once, but if you are not careful to make it a good experience for all parties involved, your luck may be short-lived.
I will put together a detailed treatment regimen, available for download. Until then, a good start is outlined, below:
Give it 3 months, and add the other agent listed above. This approach inhibits both 5-alpha reductase and aromatase pathways of testosterone degredation. By introducing the Stud Mix and Tribulus products in sequence, the effectiveness is increased, and it may demonstrate that only one of the two supplements was necessary, in any particular case. Patience, here, is clearly a virtue.
To decrease estrogens through biliary excretion, use the following:
Options for the Physically Impaired
After trying the 'little blue pill,' which is quite helpful for many people, there are other options available for those persons motivated enough to go a little bit outside of the conventional.
On the way..................................
Mechanical Options Page- Not so commonly considered options for the physically impaired or injured.
Hormonal Options Page- Herbal and hormonal strategies.
David S. Klein, MD, FACA, FACPM, FACMIMS
here to send an email
site by TAYLORWORKS, INC