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Hypoactive sexual desire disorder: persistent or recurrent deficiency
of sexual fantasies and desire for sex
Sexual aversion disorder: extreme aversion to and avoidance
of genital sexual contact
Female sexual arousal disorder: persistent or recurrent difficulty
in achieving and/or maintaining vaginal swelling and lubrication
during sexual activity
Male erectile disorder (impotence): persistent or recurrent inability
to attain and/or maintain an erection adequate for sexual
Female or male orgasmic disorder: persistent or recurrent delay
in or absence of orgasm in response to sexual stimulation
persistent or recurrent uncontrollable, rapid ejaculation that occurs
just before or shortly after penetration
Dyspareunia: recurrent or persistent genital pain associated with
Vaginismus: recurrent or persistent involuntary spasm
of vaginal muscles that limits or prohibits vaginal penetration
Anxiety disorders (generalized anxiety disorder, obsessive-compulsive
disorder, panic disorder)
Arthritis and other degenerative joint diseases
Atherosclerosis (peripheral vascular disease, cerebrovascular
Cancer (especially urologic and genital cancers and
Cardiac disease (coronary artery disease, congestive
heart failure, myocardial infarction)
Chronic obstructive pulmonary disease
Chronic organ failure (renal, hepatic)
Dementia (e.g., Alzheimer's disease, vascular
Major depressive disorder and other mood disorders
Prostate disease and prostate surgery
Schizophrenia and other chronic psychotic disorders
Antiandrogens (leuprolide, ketoconazole)
Antidepressants (MAOIs, TCAs, SSRIs, venlafaxine)
Antihypertensives (thiazide diuretics, -blockers,
ACE inhibitors, clonidine, spironolactone, calcium-channel blockers,
Antipsychotics (conventional and atypical)
Cancer chemotherapeutic agents
Cardiac medications (e.g., digoxin, amiodarone)
Histamine subtype 2 (H2)
Mood stabilizers (lithium, valproic acid, carbamazepine)
Note. ACE = angiotensin-converting
enzyme; MAOI = monoamine oxidase inhibitor; SSRI = selective
serotonin reuptake inhibitor; TCA = tricyclic antidepressant.
Source. Goodwin and Agronin 1997; Kligman 1991.
a positive attitude toward sexuality in later life.
optimal health and fitness. Avoid use of tobacco and excessive use
open and honest communication with your partner about how your sexual
responsiveness has changed over time.
on foreplay as much as on intercourse. Be open-minded about adapting
sexual practices to your needs.
treatment of medical problems or disabilities that are interfering
with sexual function. Consult a physician about any concerns regarding
excess exertion during sex. To achieve adequate stamina, use appropriate
exercise to build up strength and self-confidence.
6. Before sex,
maximize treatment of symptoms that affect sex. For pain, consider
taking a warm shower or bath, having a relaxing massage, or taking
analgesics before sex. For shortness of breath, adapt sexual activity
to minimize exertion and use prescribed inhalers ahead of time.
Choose times of day for sex when pain is at a minimum.
you are a woman, consider the use of estrogen cream, which can relieve
vaginal dryness and improve vasocongestion in peri- or postmenopausal
women. Tender genital or breast tissue may require more gentle stimulation,
sometimes along with the use of an external lubricant.
problematic medications and investigate alternative agents or strategies.
unrealistic expectations that sex must be the same as when you were
sexual positions that decrease exertion or account for equipment
such as oxygen tanks or ostomy bags. Suggested positions for intercourse include
lying side by side or sitting face-to-face.
Source. Butler and Lewis 1986; Goodwin and Agronin 1997.