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Lack Of Enjoyment During Intercourse

It is characterized by minimal or almost no vaginal lubrication at all during sexual excitation along with absence of feeling of excitation. Women complained ->lack of sexual arousal ->very little or no vaginal lubrication-> no vaginal relaxation -> ultimately lead to painful sexual intercourse. Patient may complaint that there is no excitement or difficulty in getting excited, may also complaint about low or no orgasm. This problem can be from beginning of sexual life or may start later in life. It is also found that in some patients arousal may be absent with one partner whereas it is normal with other partner.

a)Hormones Disorder: Hypogonadotropic hypogonadism (hypothalamic or pituitary deficiencies) Hypogonadisms, Hypothyroidisms, Testosterone deficiency, hyperprolactinemias, Hypogonadotropics states: Hypothalamic – pituitary deficiencies: Idiopathic GnRH deficiency, Kallman syndromes, Prader-Willi syndromes, Laurence-Moon-Biedl syndromes, pituitary hypoplasia, Ovarian Dysfunctions Hypothyroidisms Untreated endocrinopathies & Diabetics Glucorticoids excess, Cushings disease, Addisons disease
b)Excess asthenia i.e. chronic asthenia is a also a significant cause of low sexual excitation and  arousal.
c)Chronic infections like vulvo-vaginitis and chronic urethritis.
d) Alcohol and drug addiction, chain smoking etc
e) Some medications like Sedative, Narcotics, tranquillizers, amphetamine, cocaine, many antidepressant, and anti-psychotics, anti-hypertensives, many other drugs.
f) Some medical or psychiatric disorder, Connective tissue diseases leading to vaginal dryness
g) Sexual dysfunction in man leading to non-enjoyment of sexual act by female may lead to absent arousal & excitement.
i) Any cause of painful sexual intercourse (as due to vaginismus or dyspaerunia) will also lead to secondary loss of excitation in women whether married or unmarried.
j) Various medical conditions can lead to diminish vaginal lubrication due to decreased blood supply to vagina.
k)Hormone deficiency can lead lubrication of vagina
l) Inadequate sexual information, early insecurity in psychosexual role.
m)Obstructive vaginal lesions: Vaginal stenosis, vaginal scarring, post surgical problems, retroverted uterus, organic diseases of uterus, endometriosis, adenomyosis, tubes or ovaries, chronic pelvic inflammatory diseases, urethral diverticulum
n)Idiopathic vulvodynia                                                                                                             o)Disorder of sex brain system: Hippocampus is a part of fore brain, which regulates the desire of sex. Sex center has some well-defined portion, which control different component of normal sexuality. Any disorder of sex center due to various causes can lead to less excitation in response to sexual stimuli. This occurs due to arousal and excitation-controlling portions of sex center does not work properly so that inspite of not having any physical or mental disorders the patient does not gets sexually excited. Beside absent excitation patient may be sexually otherwise be fit or may be suffering with some other sexual disorder.

Diagnosis: To treat patient of this disorder it is mandatory that detailed history of patient and his partner, general physical examination. After that we advice  relevant investigations.

Certain tests are require to confirm the diagnosis of absence of sexual excitation and arousal. Various diagnostic tests that may be requires are:
a)Complete sex hormones profile as Estradiol, SHBG etc.
b)Thyroid function test
c)Serum prolactins
d)Androgen levels
e)Investigation for systemic diseases including liver and renal function tests
f)Other tests which may be required depending on likelihood of the any of above causes.

a) Hormone Therapy:  It is very effective in curing absence of sexual excitation & arousal, when hormone is the cause for absence of sexual excitation and arousal. It is given in the form of oral tablets. Skin cream, local application of gels. These medicines are given in well tested prescribed doses as described in authentic textbooks. Some hormone precursors have also been used for increasing sexual excitation in many patients in whom no hormone disorder is found.
b) Sex therapy: We teach the patient about the various techniques in a way that it increase the enjoyment of body touch better excitation & arousal in female. This leads to good lubrication of vagina thus women enjoys the sex more pleasurable. Due to this more enjoyment of sex leads to women getting orgasm more often. All this improves the desire of sex as well as enjoyment of sex.
c)Treatment of chronic asthenia is done by replacement of antiasthenic drug with good results.
d)Treatment of Urogenital infection balanitis, prostatitis, and epididymitis gives immediate relief & very dramatic increase in absence of sexual excitation & arousal.
e) Treatment for alcohol and drug addiction.
f)Treatment of psychiatric disorder and other systemic disease.
g)Treatment of sex center disorders                                                                                  h)Detailed Sex Counseling: In which our sex counselors meet with respective patient, talking in detail resulting in detection of primary cause leading to absence of sexual excitation & arousal.

With appropriate drug therapy, sex education and sex therapy patient recover in two months time. The sexual excitation and arousal of patient recovers. Once  libido is return to normal her/his family relationship also normalizes.

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