Sexual dysfunctions (SD) are a heterogeneous group of disorders that are characterized by significant disturbance in a person’s ability to respond sexually or to experience sexual pleasure. An individual may have several SDs at the same time.
According to DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition), SDs include delayed ejaculation, erectile dysfunction, female orgasmic disorder, female sexual arousal disorder, genito-pelvic pain/penetration disorder, male hypoactive sexual desire disorder, and premature ejaculation. SD can also result due to substance use and side effects of certain medications. Other medical conditions can also result in SDs.
The normal human sexual response cycle consists of four phases;
The desire phase consists of fantasies and the desire to have sexual activity
The excitement phase consists of the subjective sense of sexual pleasure along with physiological changes like penile erection and vaginal lubrication.
The orgasm phase marks the peak of sexual excitement with the release of sexual tension. In men, the urge to ejaculate followed by ejaculation, and in women, rhythmic contractions of cervix and vagina.
The resolution phase brings a sense of muscular relaxation and general well-being. Men are not ready for another erection for some time. However, women may be able to respond to stimulation immediately.
Sexual Dysfunction is a persistent, distressing change in any of these stages, thus an individual can have several SDs at a time, and all of them need to be evaluated and treated.
Defining Depression
Depression is a major mental illness characterized by a pervasive sad mood, loss of interest in almost all activities along with changes in appetite or weight, sleep and activity levels, fatigue, and difficulty in concentration. Depressed individuals may have negative thoughts about themselves and the world around them with pessimistic thinking, feelings of worthlessness, hopelessness, helplessness, occasional or continuous thoughts about suicide. These symptoms must be clearly a worsened state compared to pre-morbid functioning and the symptoms should be present for more than two weeks continuously and should lead to significant dysfunction in all aspects of life, to make a diagnosis of Major Depressive Disorder
The complex Bi-directional relationship between Sexual Dysfunction and Depression
There exists a complex bi-directional relationship between Sexual Dysfunction and Depression. Depression is associated with a 50-60% increased risk of sexual dysfunction, while SD can raise the risk of depression by 130-200% (according to a study done in India). According to Avasthi et al; 2017, a review article published in the Indian Journal of Psychiatry, the prevalence of SD in the general population is very high, 43% in women and 31% in men. Research across the globe suggests that roughly 60% of depressed individuals report SD. It is understandable that depression, characterized by loss of interest in all activities encompasses a loss of interest in sexual activity. Loss of libido is also one of the “VITAL” symptoms of depression which is an indicator that the depression is severe. It has been well established that regardless of medication, improvement in depression can improve the overall quality of life and thus improve sexual functioning too. This bidirectional relationship is further compounded by antidepressant-induced sexual dysfunction or Treatment-Emergent Sexual Dysfunction (TESD). On the one hand, antidepressants can improve the mood thus improving the quality of life but on the other hand, they can worsen existing dysfunction and can also be responsible for new-onset SDs.
This confounding relationship between SD and Depression often leads to under-reporting, poor assessment, and management. It is easily overlooked by the treating psychiatrist which is also contributed by the general lack of awareness and stigma prevalent among the population.
#CBT #depression #SexualDysfunction
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