HEALTH AND SEXUALITY  

Health in relation to sexuality issues integrates organic welfare, mental, social and, of course, sexual. They are, therefore, large and everyday issues that affect sexuality, but usually they look sideways and not taken into account. In the usual physician relationships with patients, sexuality is often a taboo subject that is not addressed and who is not normally consulted on its own initiative. However, numerous studies show a clear relationship between quality of life and satisfying sex life. In some, even the latter is associated with increased longevity. Accordingly, it is increasingly common for health personnel are aware of the importance of addressing sexual issues with patients in your practice, given the high frequency of disorders, easily curable, with implications for the quality of life. Quality will improve if it can end with the usual split between gender and health, which leads many people to acknowledge their sexual disorders not related to any illness that may be affected. The person suffering from hypertension or who has diabetes and has chapters of sexual problems may be unaware that they are directly related to their disease, perhaps with the unhealthy diet that bears or that these problems are the result of drugs ingested .

In fact, for the sexual response cycle from developing satisfactorily, both in women as in men, it is essential that adequate blood supply to the genital areas and the organs and systems involved. Any disease that affects vessels also undertake erotic performance.

The mechanisms by which a disease can impair sexual life are numerous and should know. They are recognized as risk factors for diabetes, hypertension, dyslipidemia (elevated blood levels of cholesterol or triglycerides), stress, a sedentary lifestyle, obesity, smoking and taking substances such as alcohol abuse, drugs, etc..

Diabetes is a disorder of the metabolism of carbohydrates, which is characterized by an excessive rise in blood glucose.

There are two types of diabetes, Type I diabetes, which usually occur abruptly in young people and requires treatment with insulin, and Type II diabetes, which begins insidiously with few symptoms, usually in people over 35 years and is usually treated with oral drugs.

Type II diabetes is closely linked to obesity and is more common to cause circulatory disorders, particularly brain and heart. They also tend to associate more closely with other diseases such as hypertension and dyslipidemia (high cholesterol).

Diabetes, in any of the two types occurs within the first 10 years after diagnosis, sexual dysfunction in about half of patients as the disease progresses and the number increases. Sexual disorders mainly affect the excitement phase and cause arousal difficulties and lubrication in women, and erectile dysfunction in men. This impairment of sexual arousal in people with diabetes is more progressive and severe than with other diseases, and throughout its evolution is associated with disorders of desire and also in orgasm. A negative action of diabetes on sexual function is coupled with other diseases that are typically concurrent hypertension, high cholesterol and even taking some medications.
Diabetes, especially Type II, often is associated with sexual problems should be treated by a physician

Erectile dysfunction, impotence misnamed, is the inability to achieve or maintain an adequate erection until the end of sexual activity. In men with diabetes is very common and is caused by circulatory disorders and neuropathic causes the disease, and if not medically, increases with age and years of disease progression. Over time, ED results in lost confidence in your ability to achieve erection, fear of failure and lack of communication with the couple, who may misinterpret behaviors (often thought to have lost its appeal or that someone else in between) and is likely to occur, a serious conflict. This tends to perpetuate erectile dysfunction because it is associated disorders of desire and orgasm if not done an adequate treatment. Diabetes aggravates and accelerates vascular disorders of the male penis typical aging.

In women with diabetes have shown the desire disorders, difficulties with vaginal lubrication and anorgasmia. The decrease or absence of libido or desire can have a psychological origin (unsatisfactory relationships, anxiety, feelings of inferiority, shame, low self esteem) but also is often associated with the disease, because high glucose levels can cause tiredness, leading to decreased desire. The most common sexual problems are difficulties in obtaining adequate lubrication for involvement of the excitement associated with a lack of vaginal expansion, leading to relations irritable and painful intercourse (dyspareunia) and often result in decreased libido and even rejection sex. Anorgasmia or inability to reach orgasm is produced by the lack of lubrication and painful intercourse. An added factor that multiplies the sexual rejection is the frequent occurrence of infections s vagina, fueled by high glucose levels that cause discomfort (odor, itching, sensation of dirt).

Psychological factors about life diabetes and how life adapts to disease significantly affect the sexual relationship. Diabetes can have an impact on self-esteem and personal image, promote negative feelings of insecurity, of being different, having lost its appeal and capacity of seduction and fear of rejection. All this encourages behavior that prevent sexual activity for fear of intimate contact.

In some women the fear of unwanted pregnancy, with all that that entails (fear of possible consequences on the fetus and about your own health) causes anxiety states that foster sexual disinterest and, if carried into effect, to adopt a tense attitude that repels any pleasurable sensation.

In Type I diabetes are referred to sexual disorders so later and are less severe than in Type II diabetes, not least because the Type I is usually associated to a lesser degree to diseases such as hypertension, dyslipidemia and circulatory problems, which also undermined sexual function.

In the treatment of sexual disorders induced by diabetes, proper tracking of the underlying disease plays a role. It is essential to comply adequately with diet, regular intake of drugs that the doctor advised (oral agents or insulin), the practice of regular exercise and correction of other factors that may aggravate the sexual dysfunction (depression, hypertension, high cholesterol, smoking, sedentary lifestyle, alcoholism, ingestion of certain drugs).

Sexual disorders in people with diabetes may need sex therapy. They can be used specific drugs, such as erectile dysfunction or vaginal dryness, have proven effective.

SEXUALITY IN THE PEOPLE WHO SUFFER HIGH BLOOD PRESSURE

It is considered that a person has hypertension when blood pressure is above 140/90 mm / Hg fasting with a proper pressure in making a device approved.

It is a high cause of sexual problems. The suffering one in four patients, with indifference to sex. Affected the excitement phase and there are difficulties in vaginal lubrication and erectile dysfunction. Disorders are also common in orgasm, especially in women. Hypertension damages the circulatory system and also has shown that some medications used for treatment have a negative impact on the erection, this is the case of beta-blockers, sedatives, and diuretics.

The frequency of heart attacks each year in Spain is 100 to 250 cases per hundred thousand inhabitants. To give us an idea of its incidence, this figure represents only 20% of those produced in the U.S.. In absolute terms, the total number of patients with myocardial year ranged between 45,000 and 90,000, of survive between 80% to 90%. In relation to sexual activity of patients who have suffered a stroke, it is estimated that one in four affected not resume, the lower half very intense and only one in four equates to which he was before suffering heart attack. The decrease after infarction in both the frequency and satisfaction levels of sexual activity occurs equally in men than in women.

This is a serious health problem and, although things are changing, both doctors and patients reluctant to talk about sexual life of the affected, which was not done proper health education and appropriate rehabilitation. The low frequency or absence of sexual activity is attributed to medication, to a pre-existing sexual dysfunction (in men often tends to be a history of erectile dysfunction) and, above all, the fear that after having suffered a infarction sexual activity can trigger another.

Contrary to popular belief, the continuity of sexual activity increases very low risk of acute myocardial infarction or death in healthy middle age (it is only responsible for a heart attack for every 10,000 produced) and more among individuals with coronary risk (responsible for a case for every 1,000 heart attacks suffered).

The physical effort required to do the sexual act is, in general, light-moderate intensity and energy expenditure required is similar to walking a mile in 15 minutes (in the pre-orgasm) and then climb quickly to a second flight of stairs (orgasm phase). Comparing's risk sexual activity with other possible situations that can trigger a heart attack, happens to be similar to what is a crisis of rage or anger, and certainly well below that corresponds to intense physical exercise, and this is true both in healthy people and in those with heart problems. It is shown that the most significant factor in preventing coronary accident during sexual activity is the physical shape, which depends on the practice of physical exercise.

If it's been 6 to 8 weeks after infarction have not been complications and can resume sexual activity with prior information provided cardiologist and family doctor, holding a series of basic precautions:

- Educate yourself properly in order to remove the fears and doubts that may have the time to take your sex life naturally after infarction.

- Continue medical surveillance of all factors that increase the risk of another crisis: smoking, hypertension, dyslipidemia (elevated blood levels of cholesterol or triglycerides), overweight, diabetes, etc..

- Conduct a physical exercise program to increase capacity above the minimum required to perform intercourse.

- Practice sexual activity is not strenuous or require intensive effort.

- Avoid sex that generate stress because they pose an additional risk.

- Avoid sexual intercourse practice after a heavy meal, of having drunk alcohol or done a strenuous exercise.

SEXUALITY IN  PEOPLE WHO SUFFER OBESITY

Being overweight is a health risk because it overloads the heart and engages in general throughout the circulatory system. In fact, people who are obese are prone to diseases like diabetes, hypertension, arteriosclerosis and coronary problems.

Although most of the time the excess weight is due to an oversight personnel, both diet and practice exercise, it must be evaluated and ruled out metabolic diseases such as hypothyroidism, which can be the source of trouble.

The morbidly obese (very severe) regardless of its organic disorders, may suffer rejection by their partner and often manifest themselves in low self-esteem, which aggravates any sexual disorder. Sexual disorders are referred by the diseases that complicate obesity, especially by causing physical limitations: easy fatigue, tiredness, difficulty in movement, concealment, and difficult access to the genitals. All these influences and prevents an adequate sexual response.

Conduct a treatment for obesity is not a matter of whim or esthetics. Health is seriously affected when the Body Mass Index (BMI) supports high or very high figures. To find this number is necessary to divide the height in centimeters squared weight: BMI (kg/m2) = Actual Weight / Height x Height. If the resulting number is less than 30 the person will suffer from obesity. If you reach 40 is considered extreme obesity. To define it as morbid data is necessary to accompany the other variants, such as blood pressure or the presence of cholesterol in the blood. Either way, whether mild or severe obesity is a pathology to be addressed. Combat health benefits, and this improvement will allow a return to satisfactory sexual activity.

SEXUALITY IN THE PEOPLE WHO SUFFER DEPRESSION

Mental illnesses are often cause sexual disorders. Depression is among the diseases that most often leads to these problems and, given its high frequency (in Spain affects approximately 10% of adults and 20% of patients who are sick), is a health problem great magnitude.

Depression can have different degrees of severity. It varies from a reactive depression caused by some event that is experienced in a very negative way, as the loss of a loved one, to the extremely serious major depression or bipolar disorder in the alternating phases of depression with others in the the mood is elevated, expansive or irritable.

Most often the depression is present with a range of symptoms among which profound sadness, depressed mood, ideas of ruin and no future ", the easy and constant crying, and inability to enjoy activities before were enjoyable. Are frequent suicide attempts, they consume between 10% and 15% of patients. Often the picture is more subtle and obvious reluctance, discouragement, pessimism, few wanted to get up in the morning, insomnia, appetite, etc.. Sometimes the disease is difficult to recognize because it is masked by other features such as alcoholism, drug addictions, phobias, panic disorders or use of medications such as anxiolytics.

In the current depression is the loss of any type of sexual desire and the ability to enjoy sexual fantasies in men as in women. Only one third of depressed patients produced serious sexual disorders, erectile dysfunction in men and lack of orgasm (anorgasmia) and painful intercourse (dyspareunia) in women.
In patients suffering from depression, the priority is to cure, but treatment can be enhanced by a simultaneous intervention of sexual disorders

Erectile dysfunction occurs between 18% and 35% of depressed patients, but the percentage increases, affecting up to 90% in severe depression, which is not only due to the disease, but also to the inhibition of sexual desire and side effects of psychotropic drugs, which contribute significantly to its occurrence. The most used drugs for treating depression, SSRIs (selective inhibitors of serotonin reuptake), which are ideal antidepressant drugs induce erectile dysfunction on average by almost 30% of patients. Other medications also used, such as clomipramine, cause sexual dysfunction in up to 50% of cases. The velanfaxina does 36% of patients and risperidone in 44%.

In depressed patients who suffer sexual problems, the priority, of course, is to treat depression. However, several studies have shown that treatment outcomes would be enhanced by a comprehensive treatment, with simultaneous intervention on depression and sexual dysfunction. Much of the suffering patients taking antidepressants during treatment, impairment of their sexual ability, that if the patient is identified by (which happens frequently), it is often poorly tolerated and pushes antidepressant drug cessation, as essential to treat your disease. This attitude implies a serious risk to their integrity, given the high incidence of suicide among patients who are not treated properly. Research has confirmed that the simultaneous treatment approach for depression and sexual dysfunction improves quality of life for patients and facilitates a faster recovery from depressive illness because it promotes adherence to treatment.

Of particular interest in patients is the use of anxiolytics such as benzodiazepines, drugs used widely, usually by medication or provided by relatives or neighbors. Although early in the treatment of depression are often referred to, are not in the post and the family doctor or the psychiatrist's usually withdraw quickly (usually start to do so after 3-4 weeks of treatment) because the problems that chronic use entails, among which are: the possible worsening of depression (with increased risk of suicide), its ability to produce addiction or dependence requiring dose increase and induction of memory disorders.

In other mental illnesses such as anxiety and phobias related to sexual matters is also a high incidence of sexual dysfunction. In schizophrenia reach percentages above 50%.