The impact of physical illness on sexual dysfunction.

Sexuality is the ultimate union of mind and body. Sexual dysfunction is often the first manifestation of physical illness but is often not inquired about on routine review of symptoms. This is, in large part, due to the health care providers' lack of knowledge in diagnosis and treatment of sexual impairment as well as their discomfort with this sensitive topic. However, sexual well-being is an important determinant of quality of life and many medically ill patients find sexual intimacy to be an essential mode of communication with their partners. This chapter attempts to methodically delineate physical illnesses causing sexual dysfunction by organ system. Neurologic, endocrinologic, cardiovascular and pelvic illnesses are discussed as to their impact on sexual health. Diagnostic and established treatment strategies are also reviewed. Breast cancer, rheumatoid arthritis and psoriasis are touched upon. Although not a disease, pregnancy and its unique impact on sexuality is also discussed. Not only the disease itself but the treatment prescribed may also cause sexual impairment. Thus, a separate section on medications that impair sexual functioning is presented. A table of common medications as a quick reference to their effects on each stage of the sexual cycle is also provided.