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Thyroid diseases and sexual dysfunction
Thyroid diseases and their impact on male and female sexual function is an issue that has not historically been given greater importance in sexual medicine, in relation to, for example, the impact of diabetes or high blood pressure. But fortunately the trend is beginning to reverse, since in the last decade we have found an increase in the number of well-designed studies that explore this relationship. Considering that thyroid diseases are quite common in the general population, it is reasonable and desirable that this is happening.
Let's start defining these pathologies. Hypothyroidism is characterized by the fact that the thyroid gland does not produce the amount of thyroid hormones that are needed for normal functioning of the body, while hyperthyroidism is the excess production of these hormones.
In that sense, we found an article published in 2018 in Sexual Medicine Reviews entitled The impact of thyroid disease on sexual dysfunction in men and women. In this work, the thyroid disease, sexual dysfunction, the relationship between the two conditions and their treatments are thoroughly reviewed.
Hypothyroidism and hyperthyroidism are common medical disorders that manifest themselves in a variety of ways that have been well described in the medical literature. Primary hypothyroidism represents 95% of all forms of hypothyroidism. In contrast, hyperthyroidism has a wider and larger number of etiologies.
As for the symptomatology, hypothyroidism manifests itself with symptoms such as weight gain, fatigue, constipation, cold intolerance, cognitive slowness, dry skin, edema, myalgia and also menstrual irregularities. On the other hand, hyperthyroidism occurs in both sexes with a combination of increased appetite and weight loss, heat intolerance, tremors, palpitations, emotional lability and anxiety.
The primary treatment of hypothyroidism is replacement therapy in the form of synthetic T4. The modalities for the treatment of hyperthyroidism include radioactive iodine, various antithyroid medications and thyroidectomy.
Thyroid disorders have been related, as we will see below, with significant disturbances in male and female sexual function.
Hypothyroidism and sexual dysfunction
The limited number of available studies on the prevalence of dysfunction in patients with hypothyroidism has shown that more than 60% of men with this condition experience erectile dysfunction. With regard to female sexual dysfunction, studies show figures ranging from 21% to 46%.
In relation to the mechanisms through which thyroid deficiency can exert direct and indirect effects on sexual function, in the case of men it is the alteration of the regulation of the hypothalamic-pituitary-gonadal axis, which leads to a reduction in the levels of sex hormone in circulation. In women, studies have shown that the low concentration of circulating thyroid hormone is the most important factor that drives sexual dysfunction. Studies have also revealed that prolonged primary hypothyroidism can lead to hyperprolactinemia, which is another potential mechanism for sexual dysfunction that applies to both men and women. On the other hand, hypothyroidism is associated with fatigue, drowsiness and mood disorders - including depression - that undoubtedly contribute to sexual dysfunction in both men and women.
There are several reports that demonstrate an association between sexual dysfunction in male patients with hypothyroidism, especially in the form of erectile dysfunction, ejaculatory dysfunction, low sexual desire and alterations in sperm characteristics and fertility. The relationship between hypothyroidism and erectile dysfunction has been particularly documented, but we also have studies that relate it to the other sexual dysfunctions mentioned.
The association between hypothyroidism and female sexual dysfunction has also been documented, although there are fewer studies available compared to men. Special attention has been given to the link between hypothyroidism and changes in sexual desire, vaginal arousal / lubrication and orgasm. Considering that the incidence of hypothyroidism also peaks at the age of menopause, perimenopausal symptoms may overlap with hypothyroid symptoms and also contribute to sexual dysfunction.
Hyperthyroidism and sexual dysfunction
In men, the prevalence of sexual dysfunction in patients presenting with hyperthyroidism has been estimated between 48% to 77%, and in women from 44% to 60%.
Similar to the mechanisms observed in patients with hypothyroidism, studies have shown that hyperthyroidism can directly and indirectly modulate sexual function. Although the exact mechanism remains a topic of debate, three ways have been involved: sympathetic, endocrine and psychiatric.
The most frequent sexual sequelae of hyperthyroidism in men are erectile dysfunction and premature ejaculation. With respect to women, different studies found significantly lower scores in all domains of the Female Sexual Function Index (FSFI): desire, excitement, lubrication, orgasm, satisfaction and pain, compared to age-matched controls.
In relation to treatment, the correction of hypothyroidism in men and women produced positive effects on sexual function, normalizing the phases of desire, arousal, and increasing levels of sexual satisfaction. Studies also show a significant improvement in sexual function in hyperthyroid patients treated with antithyroid medications.
In conclusion, recent evidence presented in this review suggests that thyroid axis deregulation plays an important role in sexual dysfunction that cannot be overlooked. Correction of thyroid hormone deficiency or excess was associated with an obvious resolution of sexual dysfunction in male and female patients with hypothyroidism or hyperthyroidism.
By deepening the knowledge of the relationship between thyroid disease and sexual dysfunction, doctors working in the field of sexual medicine can more accurately and quickly identify patients with these pathologies, as well as resolve the associated sexual symptoms by the treatment of the underlying thyroid disorder.
Drafted for Boston Medical Group by Ezequiel LГіpez Peralta.
Psychologist. Master in Clinical Sexology and Couples Therapy.
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