Once a diagnosis of<unk>  dysfunction has been made, treatment is often integrative and individualized.<unk>  experts aim to discover both the physical and psychologic factors that are the cause of an individual's<unk>  dysfunction. Male<unk>  dysfunction The most common male<unk>  dysfunction disorders are erectile dysfunction (ED), low libido, and ejaculatory dysfunction. Once etiology and cardiovascular risk factors for ED have been identified, lifestyle or non-pharmacological therapy can be initiated to mitigate risk factors. As of 2018, the American Urological Association (AUA) ED guidelines recommend shared medical decision-making between patient and provider over first-, second-. and third-line therapies. However, phosphodiesterase-5 (PDE5) inhibitors, such as sildenafil (Viagra) and tadalafil (Cialis), are often recommended due to their favorable efficacy and side effect profile and work by increasing the lifespan of the vasodilator nitric oxide in the corpus cavernosum. Alternative treatments for ED are the use of vacuum-assisted erection devices, intracavernosal injection or intraurethral administration of alprostadil (prostaglandin E1), and surgery if necessary. Treatment for decreased libido is often directed towards the cause of the low libido. Low levels of hormones such as testosterone, serum prolactin, TSH, and estradiol can be associated with low libido, and thus hormone replacement therapy is often used to restore the levels of these hormones in the body. Low libido can also be secondary to use of medications such as selective serotonin reuptake inhibitors (SSRIs), and so reduction of dose of the SSRI is used to improve libido. Additionally, low libido due to psychological causes is often approached with psychotherapy. Similarly, treatment of ejaculatory dysfunction such as premature ejaculation is dependent on the etiology. SSRIs, topical anesthetics, and psychotherapy are commonly used to treat premature ejaculation. Female<unk>  dysfunction Similar to male<unk>  dysfunctions,<unk>  problems in women are also prevalent; however, they differ in the kind of dysfunction. For example, males have more problems related to function of their reproductive organs, where as for women it is more common to experience psychological problems, like lack of a<unk>  desire and more pain related to<unk>  activity. In 2008, 40% of U.S. women reported they were experiencing low<unk>  desire. Treatment approach is dependent on the type of dysfunction the women is experiencing. The treatment of female<unk>  dysfunction is varied as multiple causes are often identified. Following evaluation of symptoms and diagnosis, the woman's goals for treatment are determined and used to track progress. Health professionals are also trained to include the woman's<unk>  partner in the treatment plan, including noting any<unk>  dysfunction of the partner. Referral of the woman or couple to a sex therapist is also common to increase communication and expression of concerns and desires. Finally, conditions associated with the documented<unk>  dysfunction are simultaneously treated and included in the treatment plan. Non-pharmacologic treatment for female<unk>  dysfunction can include lifestyle modifications, biofeedback, and physical therapy. Pharmacologic therapy can include topical treatments, hormone therapy, antidepressants, and muscle relaxants. In fact, low<unk>  desire is the most common<unk>  problem for women at any age. With this,<unk>  ideas and thoughts are also absent. Counseling sessions addressing changes the couple can make can improve a woman's<unk>  desire. Other ways to treat include: trying a new sex position, using a<unk>  toy or device, having sex in an unusual location. Also, a woman enjoying her time with her partner outside of the bedroom, on a "date night", can improve the relationship inside the bedroom.<unk>  pain is another large factor for women, caused by Genitourinary Syndrome of Menopause (GSM), which includes hypoestrogenic vulvovaginal atrophy, provoked pelvic floor hypertonus, and vulvodynia. These can all be treated with lubricants and moisturizers, estrogen, and ospemifene. Psychiatric barriers<unk>  disorders are common in individuals with psychiatric disorders. Depression and anxiety disorders are strongly connected with reduced sex drive and a lack of<unk>  enjoyment. These individuals experience a decreased<unk>  desire and<unk>  aversion. Bipolar disorder, schizophrenia, obsessive–compulsive personality disorder, and eating disorders, are all associated with an increased risk of<unk>  dysfunction and dissatisfaction of<unk>  activity. Many factors can induce<unk>  dysfunction in individuals with psychiatric disorders, such as the effects of antipsychotics and antidepressants. Treatment may include switching medications to one with less<unk>  dysfunction side effects, decreasing the dose of the medication to decrease these side effects, or psychiatric counseling therapy. Lifestyle barriers General health greatly relates to<unk>  health in both males and females.<unk>  specialists take into consideration unhealthy lifestyle habits that may contribute to the<unk>  quality of life of individuals who are experiencing<unk>  dysfunction. Obesity, tobacco smoking, alcohol, substance abuse, and chronic stress are all lifestyle factors that may have negative impacts on<unk>  health and can lead to the development of<unk>  dysfunctions. Both obesity and tobacco smoking have negative impacts on cardiovascular and metabolic function, which contributes to the development of<unk>  dysfunctions. Chronic smoking causes erectile dysfunction in men due to a decrease in vasodilation of vascular endothelial tissue. Alcohol dependence can lead to erectile dysfunction in mend and reduced vaginal lubrication in women. Long term substance abuse of multiple recreational drugs (MDMA, cocaine, heroin, amphetamine), leads to a decrease in<unk>  desire, inability to achieve orgasm, and a reduction of<unk>  satisfaction. Chronic stress may potentially contribute to<unk>  dysfunction, as it can induce high levels of cortisol, which may cause harmful effects in if it remains altered long term. High levels of cortisol have been shown to cause a reduction in gonadic steroids and adrenal androgens. Studies have shown that these steroids and adrenal androgens have effects on genital arousal as well as<unk>  desire.<unk>  experts are responsible for promoting healthy lifestyle habits in order to help prevent<unk>  dissatisfaction. Adoption of healthy lifestyle routines include: avoiding drugs, smoke, and excessive alcohol, as well as incorporating regular physical activity accompanied by a balanced diet and use of stress-management strategies. These habits can be proposed before trying to incorporate pharmacological therapies and/or psychiatric therapies.
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