Editing Sexual dysfunction (section)

==Treatment==

===Males===
Several decades ago, the medical community believed most sexual dysfunction cases were related to psychological issues.  Although this may be true for a portion of men, the vast majority of cases have now been identified to have a physical cause or a correlation.<ref>{{cite journal | vauthors = Jarow JP, Nana-Sinkam P, Sabbagh M, Eskew A | title = Outcome analysis of goal directed therapy for impotence | journal = The Journal of Urology | volume = 155 | issue = 5 | pages = 1609–1612 | date = May 1996 | pmid = 8627834 | doi = 10.1016/s0022-5347(01)66142-1 }}</ref> If the sexual dysfunction is deemed to have a psychological component or cause, [[psychotherapy]] can help. Situational anxiety arises from an earlier bad incident or lack of experience, and often leads to development of fear towards sexual activity and avoidance which enters a cycle of increased anxiety and [[Desensitization (medicine)|desensitization]] of the penis. In some cases, erectile dysfunction may be due to marital disharmony. Marriage [[Relationship counseling|counseling]] sessions are recommended in this situation.

Lifestyle changes such as discontinuing [[tobacco smoking]] or substance use can also treat some types of ED.<ref>Merck Sharpe & Dohme. [http://www.merck.com/pubs/mmanual_ha/sec3/ch59/ch59a.html "Male genital and sexual disorders"] 2010-02-18.</ref> Several oral medications like [[Sildenafil|Viagra]], [[Tadalafil|Cialis]], and [[Vardenafil|Levitra]] have become available to alleviate ED and have become first line therapy. These medications provide an easy, safe, and effective treatment solution for approximately 60% of men. In the rest, the medications may not work because of wrong diagnosis or [[chronic (medicine)|chronic]] history.{{Citation needed|date=September 2021}}

Another type of medication that is effective in roughly 85% of men is called intracavernous pharmacotherapy, which involves injecting a vasodilator drug directly into the penis to stimulate an erection.<ref>{{cite journal | vauthors = Rodríguez Vela L, Moncada Iribarren I, Gonzalvo Ibarra A, Sáenz de Tejada y Gorman I | title = [Treatment of erectile dysfunction using intracavernous pharmacotherapy] | journal = Actas Urologicas Espanolas | volume = 22 | issue = 4 | pages = 291–319 | date = April 1998 | pmid = 9658642 | author4 = Sáenz de Tejada y Gorman I }}</ref> This method has an increased risk of priapism if used in conjunction with other treatments, and localized pain.<ref name=Diaz />

[[Premature ejaculation]]s are treated by behavioural techniques Squeeze technique and Stop Start Technique. In Squeeze technique the area between head and shaft of penis is pressed using index finger and thumb just before ejaculation. In Stop Start Technique the male partner stops having sexual intercourse just before ejaculation and waits for the sense of ejaculation to pass away. Both Techniques are repeated many times.<ref>{{Cite book | vauthors = Jannini EA, McMahon CG, Waldinger MD |url=https://books.google.com/books?id=iCXF3sWtgegC |title=Premature Ejaculation: From Etiology to Diagnosis and Treatment |date=2012-08-31 |publisher=Springer Science & Business Media |isbn=978-88-470-2646-9 |language=en}}</ref>

When conservative therapies fail, are an unsatisfactory treatment option, or are contraindicated for use, the insertion of a [[penile implant]] may be selected by the patient. Technological advances have made the insertion of a penile implant a safe option for the treatment of ED, which provides the highest patient and partner satisfaction rates of all available ED treatment options.<ref>{{cite journal | vauthors = Rajpurkar A, Dhabuwala CB | title = Comparison of satisfaction rates and erectile function in patients treated with sildenafil, intracavernous prostaglandin E1 and penile implant surgery for erectile dysfunction in urology practice | journal = The Journal of Urology | volume = 170 | issue = 1 | pages = 159–163 | date = July 2003 | pmid = 12796670 | doi = 10.1097/01.ju.0000072524.82345.6d }}</ref>

Pelvic floor physical therapy has been shown to be a valid treatment for men with sexual problems and pelvic pain.<ref>{{Cite web | url=http://www.healpelvicpain.com/about-book | title=About Book &#124; Heal Pelvic Pain | access-date=2016-08-31 | archive-date=2019-04-26 | archive-url=https://web.archive.org/web/20190426072541/http://www.healpelvicpain.com/about-book | url-status=dead }}</ref>

The 2020 guidelines from the [[American College of Physicians]] support the discussion of [[testosterone (medication)|testosterone]] treatment in adult men with age-related [[Low T|low levels of testosterone]] who have sexual dysfunction. They recommend yearly evaluation regarding possible improvement and, if none, to discontinue testosterone; intramuscular treatments should be considered rather than transdermal treatments due to costs and since the effectiveness and harm of either method is similar. Testosterone treatment for reasons other than possible improvement of sexual dysfunction may not be recommended.<ref name="ANN-20200106">{{cite journal | vauthors = Qaseem A, Horwitch CA, Vijan S, Etxeandia-Ikobaltzeta I, Kansagara D, Forciea MA, Crandall C, Fitterman N, Hicks LA, Lin JS, Maroto M, McLean RM, Mustafa RA, Tufte J | display-authors = 6 | title = Testosterone Treatment in Adult Men With Age-Related Low Testosterone: A Clinical Guideline From the American College of Physicians | journal = Annals of Internal Medicine | volume = 172 | issue = 2 | pages = 126–133 | date = January 2020 | pmid = 31905405 | doi = 10.7326/M19-0882 | doi-access = free }}</ref><ref name="MSCP-20200107">{{cite news | vauthors = Parry NM |title=New Guideline for Testosterone Treatment in Men With 'Low T' |url=https://www.medscape.com/viewarticle/923449 |date=7 January 2020 |work=Medscape.com |access-date=7 January 2020 }}</ref>

===Females===
In 2015, [[flibanserin]] was approved in the US to treat decreased sexual desire in women. While it is effective for some women, it has been criticized for its limited efficacy, and has many warnings and contraindications that limit its use.<ref>{{cite web|url=https://www.webmd.com/women/news/20150818/fda-approves-addyi-drug-boost-womens-sex-drive#1|title=FDA Approves First Drug to Boost Women's Sex Drive|website=www.webmd.com|access-date=2019-05-31}}</ref> Flibanserin was found to increase pleasurable sexual experiences by 0.5 events per month in trials. Possible side effects include dizziness, drowsiness, nausea and fatigue.<ref name="Davis 2024" /> Flibanserin should not be taken with alcohol.<ref name="Davis 2024" /> [[Bremelanotide]] has been shown to modestly increase sexual desire in women, but it has not shown evidence of increasing the number of satisfactory sexual experiences per month. Possible side effects include nausea, flushing and headaches.<ref name="Davis 2024" /> Women experiencing pain with intercourse are often prescribed pain relievers or desensitizing agents; others are prescribed [[personal lubricant|vaginal lubricants]]. Many women with sexual dysfunction are also referred to a [[mental health counselor|counselor]] or [[sex therapy|sex therapist]].<ref name=Amato>{{cite web | vauthors = Amato P | title = An update on therapeutic approaches to female sexual dysfunction | url = http://www.femalesexualdysfunctiononline.org/commentaries/commentaries.cfm?abs_id%3Dabs_007 | work = Female Sexual Dysfunction Online &#124; A Blog to Document the High's and Low's of My Life |access-date=2008-10-24 |url-status=dead |archive-url=https://web.archive.org/web/20081004092107/http://www.femalesexualdysfunctiononline.org/commentaries/commentaries.cfm?abs_id=abs_007 |archive-date=2008-10-04 }}</ref> Counselling for female sexual dysfunction, including [[sex therapy|sexual counselling]], [[cognitive behavioral therapy]], body awareness counselling, and [[couples counselling]] have been found to be helpful.<ref name="Davis 2024" />

Estrogen replacement therapy, outside of the indicated use for menopausal symptoms, is not recommended for the treatment of sexual dysfunction in women.<ref name="Davis 2024" />

====Menopause====
Estrogens are responsible for the maintenance of collagen, elastic fibers, and vasculature of the urogenital tract, all of which are important in maintaining vaginal structure and functional integrity; they are also important for maintaining vaginal pH and moisture levels, both of which help to keep the tissues lubricated and protected.<ref name="eden" /> Prolonged estrogen deficiency leads to atrophy, fibrosis, and reduced blood flow to the urogenital tract, which cause menopausal symptoms such as vaginal dryness and pain related to sexual activity and/or intercourse.<ref name="eden" /> Women experiencing vaginal dryness who cannot use commercial lubricants may be able to use coconut oil as an alternative.<ref>{{Cite journal |last1=Evangelista |first1=Mara Therese Padilla |last2=Abad-Casintahan |first2=Flordeliz |last3=Lopez-Villafuerte |first3=Lillian |date=January 2014 |title=The effect of topical virgin coconut oil on SCORAD index, transepidermal water loss, and skin capacitance in mild to moderate pediatric atopic dermatitis: a randomized, double-blind, clinical trial |journal=International Journal of Dermatology |language=en |volume=53 |issue=1 |pages=100–108 |doi=10.1111/ijd.12339|pmid=24320105 |doi-access=free }}</ref>

Androgen therapy for hypoactive sexual desire disorder has a small benefit but its safety is not known.<ref name=Wri2015/> It is not approved as a treatment in the United States.<ref name=Wri2015>{{cite journal | vauthors = Wright JJ, O'Connor KM | title = Female sexual dysfunction | journal = The Medical Clinics of North America | volume = 99 | issue = 3 | pages = 607–628 | date = May 2015 | pmid = 25841603 | doi = 10.1016/j.mcna.2015.01.011 }}</ref> It is more commonly used among women who have had an oophorectomy or are in a postmenopausal state. However, like most treatments, this is also controversial. One study found that after a 24-week trial, women taking androgens had higher scores of sexual desire compared to a placebo group.<ref name="eden" /> As with all pharmacological drugs, there are side effects in using androgens, which include [[hirsutism]], acne, [[Polycythemia|polycythaemia]], increased high-density lipoproteins, cardiovascular risks, and [[endometrial hyperplasia]].<ref name="eden" /> Alternative treatments include topical estrogen creams and gels that can be applied to the vulva or vagina area to treat vaginal dryness and atrophy.<ref name="eden" />