SEXUAL DYSFUNCTION
AS INDICATOR OF AGING PROCESS:
PREVENTION AND MANAGEMENT

Wimpie Pangkahila
Center for Study of Anti-Aging Medicine
Master Degree Postgraduate Program in Anti-Aging Medicine
Department of Andrology and Sexology
Medical Faculty Udayana University

Abstract
    Sexual function consists of 4 components, i.e. sexual desire, sexual arousal, orgasm, and ejaculation in the male. Ejaculation in the male actually is not a component of sexual function, but it is more as a reproductive function.
    Another component that is rarely mentioned is sexual satisfaction. Mostly it is not differentiated with orgasm, even though in fact they are not the same. The sexual satisfaction might improve the quality of life. In contrary, inhibited sexual satisfaction might result in decreased quality of life.  
    There are many factors influencing sexual function which are divided into 2 groups, i.e physical factors and psychological factors. There are 4 groups of physical factors i.e. hormonal, vasculogenic, neurogenic, and iatrogenic factors. The psychological factors can be divided into three groups, i.e. predisposing, precipitating, and maintaining factors.
    Basically the etiologies of sexual dysfunction develop from the two groups of factors influencing the sexual function. Disturbance or disorder of any etiologic factor related to aging process and certain disease may result in sexual dysfunction.
    The etiologies of sexual dysfunction are mostly physical factors rather than psychological factors. However, generally patients with sexual dysfunction will also feel psychological effects of the problem.
    Many patients coming to the clinic with the complaint of sexual dysfunction do not know that they are suffering from certain disorder or disease. Based on the examination, it is found that they have physical disorder or disease as the etiology, especially related to aging process. Therefore sexual dysfunction, either in male or female, may become an indicator of aging process occurred in the patient.      
    One of sexual dysfunction in the male that is oftenly found is erectile dysfunction (ED). Epidemiologic studies mention that ED is found in some condition as highs risk factors, especially that is related to aging process. In another word, ED can become an indicator of some conditions or risk factors including those that are related to aging process. Decreased testosterone level by age also results in ED.  
    To prevent sexual dysfunction, some preventives efforts that is principles of Anti-Aging Medicine should be performed as follows:
1.    Build a harmonious sexual life with the partner
2.    Do not do sexual relationship as a monotonous activity
3.    Do regular exercise
4.    Consume healthy diet
5.    Avoid hazardous substances
6.    Balance the activities and relaxation
7.    Avoid or manage stress
8.    Do regular health check up
9.    Treat any disease that might be the risk factors
10.    Treat any sexual dysfunction soon which occurred in both side
   
    The principle of management of sexual dysfunction is as follows.
1.    Diagnose the sexual dysfunction
2.    Evaluation to find the etiology
3.    Treatment toward the etiology
4.    Treatment to recover the sexual function:
       •    Sexual counseling and sex therapy
       •    Medication
       •    Sexual device
       •    Surgery
    
    In ED, the first choice of medication is the erectogenic agent PDE-5 inhibitor. The first PDE-5 inhibitor is sildenafil citrate (Viagra). Before the presence of sildenafil citrate in 1998, the first choice of ED treatment was intracavernosal injection of vasoactive agents, those were papaverine, alprostadil, and phentolamine. However, since the presence of Viagra, the oral treatment became the first choice.