Introduction
The connection between sexual dysfunction is often difficult to recognize as it may not always be directly involved. Psychosexual diseases are those sexual disorders that arise from an individual's psychological issues. Some skin conditions significantly affect the quality of life of a patient, and it disturbs their confidence and self-esteem. This will, in turn, be presented as sexual dysfunctions. Human sexuality is intricate in nature, with various dimensions such as biological, social, cultural, and psychological factors, making diagnosing and treating any disorders complex.
What Are the Causes?
Sexual dysfunctions are often a multifactorial problem. Chronic illness, general health and well-being, psychiatric disorders, and sociocultural factors can be responsible for the development of various psychosexual issues.
They may be categorized into:
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Sexual dysfunction.
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Gender identity disorders.
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Paraphilias - recurrent sexual interest in objects or things that are abnormal or atypical in nature.
They may be caused by a psychological factor or an underlying issue that leads to a problem. For example, diabetes may be a predisposing factor for erectile dysfunction. This, again, may give rise to guilt or shame that, in turn, may give rise to hypoactive sexual desire.
Some psychological factors include stress, nervousness, anxiety, worry, depression, negative body image, fear, guilt, trauma, rape, and abuse.
What Is the Correlation Between Dermatology And Sexual Dysfunction?
Dermatologists may be able to identify, prevent and manage psychosexual problems. Venereology is directly linked with sexual activity as it deals with both the female and male reproductive systems. Common skin disorders such as psoriasis, vitiligo, and other such diseases may ultimately lead to psychosexual problems. Chronic dermatoses may significantly impact an individual's quality of life and self-esteem. Recent studies have demonstrated the linkage between psoriasis and psychosexual disorders.
Dermatological causes for sexual dysfunction can be directly related or psychological:
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Directly Related: In cases such as penile vascular damage caused by systemic sclerosis.
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Psychological: Due to decreased self-esteem.
What Are the Various Disorders?
1. Male Sexual Dysfunction:
It may be acquired or primary. Primary or lifelong is a condition present during an individual's life. Secondary or acquired is a condition that begins after relatively normal sexual activity.
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Ejaculatory dysfunction.
Erectile Dysfunction:
It is the condition in which the individual has the inability to maintain or attain an erection sufficient for intercourse. It is seen in men between the ages of 40 to 70.
It may be psychogenic, physiological, or a combination. Psychogenic may be due to decreased self-esteem, shame, performance anxiety, and stress. Physiological causes may be infections or dermatological disorders such as herpes, deformity in the foreskin, penile curvature, and benign or malignant genital dermatoses. Some physiological disorders may cause shame or decreased confidence, leading to erectile dysfunction.
Management:
After identifying the issue after a thorough medical history, the condition can be managed by medications and lifestyle modification, psychosexual therapy, testosterone, and injection therapy. Smoking cessation, routine exercise, and weight reduction are also helpful in avoiding the disorder.
Ejaculatory Dysfunction:
Ejaculatory dysfunction or premature ejaculation is common in 20-30 % of men. It can lead to reduced self-esteem and psychological distress in patients, further worsening the quality of life of the individual.
Management:
It requires a combination of pharmacological, psychological, and behavioral treatment modalities.
Behavioral Changes Include:
a. Stop-start technique- ceasing genital stimulation until arousal sensation passes.
b. Squeeze technique- glans are squeezed at heightened arousal.
c. Pelvic floor exercises.
Medications include selective serotonin reuptake inhibitors and tricyclic antidepressants. But these medications have adverse effects and hence must be prescribed with caution.
Hypoactive Sexual Desire Disorder:
It is identified if:
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There is a decrease in sexual desire or fantasy.
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The condition gives rise to interpersonal difficulty.
Somatoform Disorders:
These are dermatological disorders arising from psychological factors, in which sociocultural factors are the chief factor.
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Koro syndrome and Dhat syndrome are two significant disorders associated with it.
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Dhat syndrome is characterized by loss of semen during urination, defecation, or night falls. It is also associated with fatigue, loss of appetite, reduced concentration, lack of physical strength, and forgetfulness.
Management:
Medications such as benzodiazepines and antidepressants may be helpful. Psychotherapy is known to be effective.
2. Female Sexual Dysfunction:
Dermatological disorders such as vulval bullous pemphigoid, lichen sclerosus, Crohn's disease, and contact dermatitis may lead to the condition.
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Female hypoactive sexual desire disorder.
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Genital pain syndromes.
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Vulvodynia.
Female Hypoactive Sexual Desire Disorder:
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It is associated with low sexual desire and can be seen in women of all ages.
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Low estrogen levels, a trauma in childhood, negative body image, and stress may precipitate the condition. Medications such as antidepressants, antihypertensives, and antipsychotics may also reduce sexual desire.
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Dermatological conditions such as vitiligo and lichen sclerosis may also be a cause.
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It is managed by a multidisciplinary approach. Counseling and behavioral therapy are effective in addition to medications.
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Flibanserin is frequently used to treat the condition.
Genital Pain Syndromes:
It is a chronic pain with no known cause in the genital or pelvic region. Vulvodynia is a common condition associated with it.
Vulvodynia:
It is a long-standing pain involving the vulva for more than three months, with no obvious cause. It may be associated with lichen sclerosus. The women experience burning, stinging, and itching irritation. It is localized to a site.
Management:
Avoiding products that may cause irritation is the primary step. A topical anesthetic application can also provide relief. As it is a neural pain, anticonvulsants and antidepressants may be helpful.
Vaginismus:
It is characterized by aversion to vaginal penetration due to painful attempts and associated anticipation anxiety. This ultimately leads to trouble in the relationship.
Management:
Kegel exercises, behavioral therapy, physical therapy to stretch vaginal muscles, releasing pelvic floor tension, use of lubricants, and topical anesthesia are physiological management methods.
Pharmacological methods include anti-anxiety medications and antidepressants. Some may even have relief through botox.
How Are Dermatological Disorders Responsible For Sexual Dysfunction?
The most common dermatological disorder that is linked with sexual dysfunction is psoriasis. Psoriasis negatively affects a person's body image and reduces self-esteem and confidence. These lead to sexual dysfunction. Psoriasis is also strongly associated with diabetes, depression, and hyperlipidemia which are risk factors for erectile dysfunction.
Other dermatological disorders that cause sexual dysfunction include:
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Vitiligo.
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Lichen simplex chronicus.
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Systemic sclerosis.
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Chronic urticaria.
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Lichen sclerosus.
Conclusion
Inherent psychological distress may manifest as sexual dysfunctions and, in worse cases, perversions. Although there may be other causes for sexual dysfunction, skin conditions weaken an individual's confidence, reducing his performance and further worsening his quality of life. Therapy is the mainstay for such psychosexual disorders. Medications to relieve dermatological diseases also help in improving body image. A multidisciplinary approach is needed to treat such conditions.
