Solutions for Sexual Problems in Thyroid Patients

sexual dysfunction and the thyroid, low sex drive, erectile dysfunction
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According to a study published in the Journal of the American Medical Association (JAMA), about 43 percent of women and 31 percent of men suffer sexual dysfunction. Interestingly, these figures are thought to be low, underestimating the extent of sexual problems in the U.S.

Sexual problems are also a common thyroid symptom, with low libido and erectile dysfunction frequently listed as symptoms of undiagnosed or improperly treated thyroid conditions.

Let's explore the types of sexual dysfunction, the thyroid link, and effective solutions.

The Types of Sexual Dysfunction

There are generally four different types of sexual dysfunction:

  • Lack of desire or interest in sex (low libido)
  • An inability to become aroused
  • An inability to orgasm, or very slow to orgasm
  • Pain during intercourse

The Signs and Symptoms of Sexual Dysfunction

The signs and symptoms of sexual dysfunction in men include:

  • an inability to get an erection
  • difficulty maintaining an erection - known as erectile dysfunction, or ED
  • an inability to ejaculate, or inability to control the timing (premature ejaculation, or delayed ejaculation).

In women, the signs and symptoms of sexual dysfunction include:

  • inadequate lubrication
  • an inability to relax the vaginal muscles
  • an inability to have an orgasm.

Both men and women can experience a lack of interest in sex, an inability to become aroused, or pain during intercourse.

Causes of Sexual Dysfunction

There are a number of possible causes of sexual dysfunction, including:

  • Thyroid dysfunction
  • Other hormone imbalances, most commonly sex hormones such as estrogen and testosterone
  • Hypertension / high blood pressure
  • Diabetes
  • Vascular disease
  • Nerve damage
  • Infection
  • Neurological disorders

It's estimated that these physical factors are a cause of sexual dysfunction in at least a third of the men who have concerns, and more than 10 percent of women with sexual dysfunction issues.

The remainder of people experiencing sexual dysfunction are thought to have issues that are psychological in origin, with specific causes including:

  • stress
  • anxiety
  • concerns about sexual performance
  • relationship issues
  • guilt
  • depression
  • body image issues
  • history of sexual trauma

The Sexual Dysfunction Medical Workup

If you have not been diagnosed with thyroid disease, but are experiencing sexual dysfunction, a complete thyroid evaluation should be performed as part of your medical workup. The tests include TSH, Free T4, Free T3, and thyroid antibodies.

If you have already been diagnosed with thyroid disease and are experiencing sexual dysfunction, your first step should be to ensure that your thyroid treatment is not adequate, but rather, that the treatment is optimized. To understand what optimal treatment means, a good starting point is this article on Optimal Thyroid Treatment.

 

Other elements of your medical workup for sexual dysfunction should typically include:

  • A complete medical history
  • A thorough physical
  • Evaluation of other hormones besides thyroid, including testosterone for both men and women
  • Review of medications and supplements being taken
  • A discussion with the practitioner about possible psychological factors, such as stress, relationship problems, fear, and sexual trauma

Medical Treatments for Sexual Dysfunction

In some cases, men can benefit from drugs such as sildenafil (i.e. Viagra), tadalafil (i.e, Cialis), and vardenafil (i.e., Levitra), which increase blood flow to the penis.

Some men and women who have low testosterone levels benefit from testosterone supplementation.

In women who are perimenopausal, or who have had a surgical menopause, hormone treatment involving estrogen and/or progesterone may be helpful as well.

Some men also benefit from vacuum devices and implants that can help with erectile dysfunction. For women who have pain due to a narrow vagina or tight muscles, known as vaginismus, dilators may be an effective part of treatment.

Other Solutions for Sexual Dysfunction

Research has shown that sexual dysfunction in both men and women can also benefit from weight loss. Losing weight is easier said than done, of course, but excess weight can affect self-image, and make you feel less sexy and less interested in sex. And, medically, being overweight can reduce sex drive. Specifically, losing weight also reduces levels of sex hormone binding globulin (SHBG), which then leaves you with more free circulating estrogen and testosterone, to help with your hormonal balance and sex drive.

Exercise can also be helpful. improves blood flow to all your body parts. Research has found that people who exercise regularly have higher levels of desire, greater sexual confidence and frequency, and an enhanced ability to be aroused and achieve orgasm--no matter what their age. The best type of exercise is aerobic exercise, because it can trigger the release of endorphins, chemicals in the brain that create a feeling of well-being.

Finally, sex therapy and or other forms of therapy with trained counselors may also be useful in dealing with the psychological issues involved

Sexual Dysfunction and the Thyroid

How many people with sexual dysfunction may actually have underlying thyroid disease that has not been diagnosed? It's not a question that has been thoroughly researched, but it's certain that some of the people having a problem could in fact resolve their sexual dysfunction problems simply by having their thyroid function evaluated and properly treated.

Still, many people—women in particular—continue to experience sexual dysfunction even after doctors consider the thyroid problem "treated." Here are some specific steps for thyroid patients:

1. Optimize Your Treatment

Make sure your thyroid drug treatment is optimized. It may not be enough for your levels to be "normal." You may find that sexual dysfunction is resolved when treatment is considered optimal.

Some people do not find their thyroid symptoms—including sexual dysfunction—resolved when taking a levothyroxine/T4 only drug like Synthroid. In some cases, you may find that your sexual dysfunction is resolved or improved when your doctor adds in a synthetic form of the T3 hormone, for example Cytomel, or switches you to a natural thyroid drug like Armour or Nature-throid, that includes natural forms of T4 and T3.

2. Address Your Hormonal Imbalances

Other endocrine and hormone imbalances are more common in thyroid patients. Be sure to have your sex hormones (estrogen, progesterone, and testosterone in women, and testosterone in men) checked.

For men who have thyroid issues, testosterone may be low, and supplementation can be an aid in restoring lost libido. Testosterone is available as a pill form, as a transdermal patch, by injection, and sometimes as transdermal pellets implanted under the skin.

Some women can also benefit from testosterone. Doctors frequently will provide testosterone in pill form to women, or as testosterone propionate cream.

It's also important to have adrenal function evaluated, specifically, cortisol and DHEA, and any imbalances evaluated.

3. Consider Supplements

There are a number of supplements that reportedly may help with sex drive. Be sure to check with your practitioner for guidance on how safely use these supplements.

  • Arginine - An amino acid, for both men and women
  • Asian Ginseng (Panax) - Asian ginseng, also called panax, may help increase sexual energy
  • Avena-Sativa/Oat Extract - This supplement (a popular brand is Vigorex), reportedly helps with sex drive
  • DHEA (dehydroepiandrosterone) - DHEA is a precursor hormone that converts to testosterone by your body, and may be useful to both women and men who have borderline low levels of testosterone 
  • Ginkgo Biloba - Ginkgo biloba is an herb that may improve sexual function in men
  • Horny Goat Weed - Used by Chinese herbalists, it may help improve sexual functions in both men and women
  • Kava Kava - Kava kava is an herb most known for use in relaxation but may be useful as an aphrodisiac for women
  • Zinc - Low levels of zinc have been associated with low sex drive in women and men
  • Royal Maca - Maca is a South American herbal remedy that may help men and women with libido

Dr. Cathy Wong, About.com's Alternative Medicine expert, also has several excellent resources on supplements for sexual health, including:

Note: Always check with your practitioner about herbs and supplements.

Source:

Laumann E, et. al. "Sexual dysfunction in the United States: prevalence and predictors." JAMA. 1999 Feb 10;281(6):537-44.

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