STUDY OF HERBAL DRUGS FOR THE TREATMENT OF SEXUAL DYSFUNCTION

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ABOUT AUTHOR
Nayan Jain*
Mandsaur Institute of Pharmacy, Mandsaur

ABSTRACT
Sexual dysfunction or sexual disorder is difficulty experienced by a couple or an individual during any stage of a normal sexual activity, including physical pleasure, preference, desire, arousal or orgasm. Sexual arousal disorders were previously known as impotence in men and frigidity in women, though these have now been replaced with less judgmental terms. The causes vary considerably but include a possible decrease in the production of normal estrogen in women or testosterone in both men and women. Causes of dysfunction are aging, fatigue, pregnancy, medications or psychiatric conditions, such as depression and anxiety.

Herbal medicines may cure or prevent certain ailments. However, there are very little recorded data available to support the dose, efficacy, side effects and interactions. Because the safety and efficacy of herbal remedies they are likely to be used then synthetic medicines. The amount of active ingredients in herbals may vary among preparations. Thus, standardization of herbal medicines is required.

Reference Id: PHARMATUTOR-ART-2636

PharmaTutor (Print-ISSN: 2394 - 6679; e-ISSN: 2347 - 7881)

Volume 7, Issue 01

Received On: 22/11/2018; Accepted On: 14/12/2018; Published On: 01/01/2019

How to cite this article: Jain, N. 2019. Study of Herbal Drugs for the treatment of Sexual Dysfunction. PharmaTutor. 7, 1 (Jan. 2019), 11-24. DOI:https://doi.org/10.29161/PT.v7.i1.2019.11

SEXUAL DYSFUNCTION:
Sexual dysfunction or sexual disorder is difficulty experienced by a couple or an individual during any stage of a normal sexual activity, including physical pleasure, preference, desire, arousal or orgasm.

According to the DSM – 5, sexual dysfunction requires a person to feel extreme distress and interpersonal strain for a minimum of six months. (Nolen Hoeksema, Susan) The causes vary considerably but include a possible decrease in the production of normal estrogen in women or testosterone in both men and women. Other causes may be aging, fatigue, pregnancy, medications or psychiatric conditions, such as depression and anxiety. While a number of causes for low sexual desire are often cited, only some of these have ever been the object of empirical research. Sexual dysfunctions can have a profound impact on an individual's perceived quality of sexual life. ( Eden K.J., Wylie K.R.)
The term sexual disorder may not only refer to physical sexual dysfunction, but to paraphilias as well; this is sometimes termed disorder of sexual preference. (Johnson, William H. Masters) Sexual dysfunction can take many forms – it’s not limited to a lack of interest in sex or erectile dysfunction, often referred to as a low libido. Sexual dysfunction can involve an inability to maintain an erection, pain during intercourse, or difficulty experiencing an orgasm. Though there are many causes of diminished libido and sexual dysfunction in women and men, there are also many ways to increase libido and rekindle the joy of sex once you identify the problem.

The sexual response cycle traditionally includes excitement, orgasm, plateau, and resolution. Arousal and desire are both parts of the excitement phase of the sexual response. While research suggests that sexual dysfunction is common, about 31 percent of men and 43 percent of women report some degree of difficulty, it is a topic that many people are hesitant to discuss with their physicians. It is important to share your concerns with your partner and physicians.

Figure No.1: Erectile dysfunction

CLASSIFICATION OF SEXUAL DYSFUNCTION:
Sexual dysfunction is classified into four categories:
1. Arousal disorders — inability to become physically aroused or excited during sexual activity
2. Desire disorders — lack of sexual desire or interest in sex
3. Pain disorders — pain during intercourse
4. Orgasm disorders — delay or absence of orgasm (climax)
Sexual desire disorders:
Sexual desire disorders or decreased libido are characterized by an absence or lack for some period of time of sexual desire or libido for sexual fantasies or of sexual activity. The condition ranges from a general lack of sexual desire to a lack of sexual desire for the partner. The condition may have started after a period of sexual functioning or the person may always have had no or low sexual desire.
The causes vary considerably but include a possible decrease in the production of testosterone in both men and women or normal estrogen in women. Other causes may be aging, pregnancy, medications, fatigue, or psychiatric conditions, such as anxiety and depression. (Maurice, William, https://my.clevelandclinic.org/health/diseases/9121-sexual-dysfunction)

Sexual arousal disorders:
Sexual arousal disorders were previously known as impotence in men and frigidity in women, though these have now been replaced with less judgmental terms.
Impotence is now known as erectile dysfunction, and frigidity has been replaced with a number of terms describing specific problems that can be broken down into four categories:
• Pain during intercourse
• Lack of desire
• Lack of arousal and
• Lack of orgasm.
For both women and men, these conditions can manifest themselves as an aversion to, and avoidance of sexual contact with a partner.
In men, there may be complete or partial failure to maintain or attain an erection, or a lack of sexual excitement and pleasure in sexual activity.
There may be physiological origins to these disorders, such as lack of vaginal lubrication or decreased blood flow.
The etiology of this condition is unknown. It is believed to be a pathology of either the autonomic nervous systems or immune system. It is defined as an uncommon disease by the NIH but the prevalence is unknown. There is no known cure or treatment. (Hartley H (2006)

Erectile dysfunction:
Impotence or Erectile dysfunction is a sexual dysfunction characterized by the inability to maintain an erection of the penis. There are various underlying causes, such as damage to the Nervi erigentes which delays or prevents erection, or diabetes as well as cardiovascular disease, which simply decreases blood flow.

Figure No. 2: Erectile dysfunction

The erectile dysfunction may be caused by physically or psychologically. Psychologically caused erectile dysfunction can often be helped by almost anything that the patient believes in; there is a very strong placebo effect. Physical damage is much more severe. One leading physical cause of erectile dysfunction is continual or severe damage taken to the Nervi erigentes. These nerves course besides the prostate arising from the sacral plexus and can be damaged in prostatic and colorectal surgeries. (Montague DK, Jarow JP)
Diseases are also common causes of erectile dysfunctional, mostly in men. Diseases such as –
• Cardiovascular disease
• Kidney failure
• Vascular disease
• Multiple sclerosis and
• Spinal cord injuries are the source of erectile dysfunction.

Due to its embarrassing nature and the shame felt by sufferers, the subject was taboo (prohibited) for a long time and is the subject of many urban legends.
Folk remedies have been advertised widely since the 1930s. The introduction of perhaps the first pharmacologically effective remedy for impotence, Sildenafil (Viagra), in the 1990s caused a wave of public attention, propelled in part by the news-worthiness of stories about it and heavy advertising.
It is estimated that around 30 million men in the United States and 152 million men worldwide suffer from erectile dysfunction. However, social stigma, low health literacy, and social taboos lead to under reporting which makes an accurate prevalence rate hard to determine. (NIH. Consensus Development Panel on Impotence., Ayta I, Mckinlay J, Krane R (1999))
The Latin term ‘impotentia coeundi’ describes simple inability to insert the penis into the vagina. It is now mostly replaced by more precise terms.

Orgasm disorders
Orgasm disorders, specifically anorgasmia, present as persistent delays or absence of orgasm following a normal sexual excitement phase in at least 75% of sexual encounters. The disorder can have physical, psychological, or pharmacological origins. SSRI antidepressants are a common pharmaceutical culprit, as they can delay orgasm or eliminate it entirely. A common physiological culprit of anorgasmia is menopause, where one in three women report problems obtaining an orgasm during sexual stimulation following menopause. (Nolen-Hoeksema, Susan)
Further to this, there is what is called post-orgasm disorders, which would better categorize the condition: post orgasm illness syndrome.

Premature ejaculation
Premature ejaculation is when ejaculation occurs before the partner achieves orgasm, or a mutually satisfactory length of time has passed during intercourse. There is no correct length of time for intercourse to last. Premature ejaculation is thought to occur when ejaculation occurs in less than two minutes from the time of the insertion of the penis. (Waldinger M.D., Berenden H.H) For a diagnosis, the patient must have a chronic history of premature ejaculation, poor ejaculatory control, and the problem must cause feelings of dissatisfaction as well as distress the patient, the partner or both.
Historically attributed to psychological causes, new theories suggest that premature ejaculation may have an underlying neurobiological cause which may lead to rapid ejaculation.

Sexual pain disorders
Sexual pain disorders affect women almost exclusively and are also known as dyspareunia (painful intercourse) or veganism.
Dyspareunia may be caused by insufficient lubrication (vaginal dryness) in women. Poor lubrication may result from insufficient excitement and stimulation, or from hormonal changes caused by menopause, pregnancy, or breastfeeding. Irritation from contraceptive creams and foams can also cause dryness, as can fear and anxiety about sex.

It is unclear exactly the causes of veganism’s, but it is thought that past sexual trauma (such as rape or abuse) may play a role.
Another female sexual pain disorder is called vulvodynia or vulvar vestibulitis. In this condition, women experience burning pain during sex which seems to be related to problems with the skin in the vulvar and vaginal areas. The cause is unknown. (Balon R, Segraves RT)

Sexual dysfunction classified into two categories based on gender:
1. In men
• Erectile dysfunction (ED)
• Low libido
• Ejaculation problems
2. In women
a. Vaginal dryness
b. Difficulty achieving orgasm
c. Low libido
d. Pain during sex

CAUSES OF SEXUAL DYSFUNCTION:
There are a number of causes of sexual dysfunction. They are grouped into two categories:
• Physical causes and
• Psychological causes
• Physical causes:
There are many physical causes of sexual dysfunction.
The following diseases and conditions can lead to problems with sexual function:
• Urological infections or cancer
• Diabetes
• Cardiovascular disease
• High blood pressure
• High cholesterol
• Hormonal imbalances
• Alcoholism
• Drug abuse
• Neurological disorders
• Chronic diseases, such as kidney failure
• Nerve damage.
Many medications can cause problems with normal sexual functioning, including blood pressure medications and antidepressants, as can alcohol and recreational drug use. Some medical treatments can affect sexual function as well. For example, some surgical procedures can cause nerve damage that can affect sexual function.

Figure No.3: Physical causes of Sexual dysfunction

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