Medical Disorders

General Comments

Medical conditions in which all sexual dysfunctions occur, and more specifically loss of sexual desire, result from biological, psychological and/or social, or interpersonal factors, and most often from a combination of these elements (40). Examples of biological factors include: direct physiological effects of the illness or its treatment, physical debilitation, and bowel and/or bladder incontinence. Examples of psychological factors include: adopting the "patient role" as an asexual person, altered body image, mood difficulties, and fear of death or rejection by a partner. Examples of social and interpersonal factors include: communication difficulties regarding feelings or sexuality, difficulties initiating a sexual encounter after a period of abstinence, lack of partner, and lack of privacy.

Cardiovascular Diseases (22)

These include disorders of the heart (myocardial infarction, angina pectoris, coronary artery disease, conduction problems), hypertension, and atherosclerosis. Cardiac problems may cause sexual difficulties on their own or as a result of their treatment (see later). Likewise, just experiencing the disorder may cause mood or body image problems. Some cardiovascular diseases may result in avoidance of sexual activity and therefore its limitation. Whenever a sexual dysfunction occurs in the context of a cardiovascular disease, the clinician should attempt to separate the various etiological factors.

Cancers

The "general comments" made earlier are particularly applicable in any discussion of cancer.

Epilepsy

Of all types of epilepsy, that which affects the temporal lobe (TLE) has been the most frequently studied in relation to sexual consequences. TLE is particularly linked with low sexual desire in patients undergoing temporal lobe surgery (an admittedly unrepresentative group afflicted with this disorder) (41). The association between other kinds of epilepsy and low sexual desire is unclear.

Genetic Disorders

Kleinfelter's syndrome (47 XXY).

Testicular Disease

Trauma; mumps orchitis, undescended testes.

Secondary Hypogonadism (Resulting from Hypothalamic-Pituitary Disorders)

Pituitary tumors (especially prolactinoma); and iron overload disorders (e.g., hemochromatosis and thalassemia).

Endocrine Disorders

Cushing's syndrome, diabetes.

Multisystem Disease

Chronic renal failure, chronic liver disease, AIDS.

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