Sexual dysfunctions cover a wide variety of disorders, including male impotence, premature ejaculation in males, spasms of the vagina, pain with sexual intercourse, and problems with sexual desire (libido) and response. Men over age 65 are at increased risk for impotence. Impotence, however, is not a normal part of aging. The causes of sexual disorders vary, and include psychological causes and some medical conditions, such as illness or injury.

• Premature or abnormal ejaculation in men
• Inability to achieve or maintain an erection (impotency)
• Pain during intercourse
• Lack or loss of sexual desire
• Difficulty achieving orgasm
• Inadequate vaginal lubrication in women

• Age 65 and over in men
• Depression or anxiety
• Stressful life events
• Certain medical conditions

Your health care provider will do a physical examination. He or she may ask about your ethnic, cultural, religious, and social background, which can influence your sexual desires, expectations, and attitudes. Blood tests can help distinguish between psychological and physical causes for sexual dysfunctions. Other tests for men may include penile tumescence measurements, which are done while you are sleeping to determine whether an impotence problem is psychological or physical.

Antidepressants can be taken by men and women whose sexual dysfunction is related to depression. Vasodilators administered by injection are sometimes used for impotence. Viagra (sildenafil citrate), a relatively new drug for treating impotence, can have serious side effects in some men. Over-the-counter products are available as creams or gels for women whose bodies produce inadequate lubrication.

A variety of psychological, behavioral, and interpersonal therapies are also available for many sexual disorders.

Surgery on the veins in the penis can be performed in severe cases, but this treatment is still considered experimental. An implant in the penis may help impotence if the problem does not respond to other treatment.

Sexual dysfunction secondary to decreased circulation, hormonal imbalance, depression, or anxiety may be reduced with alternative therapies.

• Vitamin C (250 to 500 mg one to two times per day) supports vascular integrity.
• Vitamin E (400 IU per day), B6 (50 to 100 mg per day), and zinc (30 mg per day) to support hormone production.
• Magnesium (200 mg twice a day) supports hormone production.
• B-complex (50 to 100 mg per day) helps reduce stress.

Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots.

For sexual dysfunction related to poor circulation:

• Ginkgo (Ginkgo biloba, 50 to 100 mg per day) increases peripheral circulation and may improve sexual function.
• Hawthorn (Crataegus monogyna), rosemary (Rosmarinus officinalis), ginger root (Zingiber officinalis), and prickly ash bark (Xanthoxylum clava-herculis) are circulatory stimulants. Use singly or in combination, 3 cups of tea per day or 20 to 30 drops tincture three times per day.
• Yohimbe bark (Pausinystalia yohimbe) can be used for sexual dysfunction, under the supervision of your provider.

For sexual dysfunction secondary to hormonal imbalance:

• Chaste tree (Vitex agnus cactus) helps normalize pituitary function but must be taken long term (12 to 18 months) for effectiveness.
• Saw palmetto (Serenoa repens) may help hormone balance.
• Damiana (Turnera diffusa) may support testosterone levels. It also tones the central nervous system and may help relieve anxiety.
• Milk thistle (Silybum marianum), dandelion root (Taraxacum officinale), and vervain (Verbena officinalis) support the liver and may help restore hormone ratios. Use equal parts in a tea (1 cup before meals), or tincture (15 to 20 drops before meals).

For sexual dysfunction associated with depression or anxiety:

St. John's wort (Hypericum perforatum), kava kava (Piper methysticum), skullcap (Scutellaria lateriflora), lemon balm (Melissa officinalis), passionflower (Passiflora incarnata), and gotu kola (Centella asiatica). Combine equal parts in a tea (1 cup twice a day) or tincture (20 to 30 drops twice a day). May take six weeks for results.

Contrast sitz baths promote circulation. You will need two basins that you can comfortably sit in. Sit in hot water for three minutes, then in cold water for one minute. Repeat this three times to complete one set. Do one to two sets per day three to four days per week.

Therapeutic massage can reduce the effects of stress.

Most sexual dysfunctions are long-term and require professional care.

Certain drugs and herbs used for treating these psychological or physical disorders may have serious side effects. Marital counseling and other forms of interpersonal therapy are also important.

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