Marijuana for posttraumatic stress disorder (PTSD) treatment is a topic on many peoples’ minds as some people are already using marijuana to treat the symptoms of PTSD. In some states, medical marijuana has been approved to treat illnesses like epilepsy, cancer, multiple sclerosis, and, indeed, even PTSD in some cases. But the question is, is this legalization of medical marijuana for the treatment of PTSD actually based on clear science? Is marijuana for PTSD actually helpful or hurtful to the patient?

Marijuana for PTSD – The Science

According to the United States Department of Veteran’s Affairs (VA), there is no evidence to support the treatment of PTSD with marijuana. They note that no controlled studies have been done evaluating its efficacy and, thus, no science stands behind this use. Moreover, some research even suggests that marijuana may be harmful for those with PTSD.

According to Wilkinson et al, authors of the 2015 study Marijuana Use Is Associated with Worse Outcomes in Symptom Severity and violent behavior in Patients with posttraumatic stress disorder:

In this observational study, initiating marijuana use after treatment was associated with worse PTSD symptoms, more violent behavior, and alcohol use. Marijuana may actually worsen PTSD symptoms or nullify the benefits of specialized, intensive treatment. Cessation or prevention of use may be an important goal of treatment.

This study looked at 2,276 veterans with PTSD and assessed them at intake and at four months after discharge. It was found that marijuana use was significantly associated with worse outcomes in PTSD symptom severity, violent behavior and measures of alcohol and drug use. At follow-up, those who had never used marijuana or those that had stopped using marijuana had the lowest levels of PTSD symptoms. Those who started using marijuana after admission had the highest levels of violent behavior.

Other Dangers of Marijuana for PTSD

In addition to specific PTSD and marijuana-related findings, there are dangers that everyone faces if they choose to use marijuana. These dangers are, medical, psychiatric and lifestyle-based in nature.

The medical problems associated with marijuana use include:

• Chronic bronchitis
• Abnormal brain development among early adolescent initiators
• Impairment in short-term memory, motor coordination and the ability to perform complex psychomotor tasks such as driving

Psychiatric problems include the presence of psychosis (hallucinations and/or delusions) and impairment in cognitive ability.

It is noted that quality of life can also be affected by using marijuana through poor life satisfaction, decreased educational attainment and increased sexual risk-taking behavior.

PTSD and Marijuana Addiction

Of course, chronic marijuana use can also lead to marijuana addiction which comes with a significant and recognized withdrawal syndrome ("Is Marijuana Addictive? Can You Develop a Weed Addiction?"). Additionally, it appears that people with PTSD have a particularly difficult time stopping their use of marijuana and responding to treatment for marijuana addiction. People with PTSD have greater cravings and withdrawal after quitting marijuana than those without PTSD. They also have an increased likelihood of usage during the six months after a quit attempt.

That said, people with PTSD and a marijuana addiction can still benefit from evidence-based cessation treatments like cognitive behavioral therapy, motivational enhancement and contingency management.

While the science seems to suggest that, for those with PTSD, never starting to use marijuana is best, it is also clear that quitting is possible and that doing so can improve PTSD treatment outcomes. More positive ways of dealing with PTSD exist that don't include the dangers of smoking marijuana.

article references

Mental wellbeing is an integral part of our overall health. Society often thinks of health as something biological and physical: the condition of our bodies, how healthy we eat, the physical exercise we do. A key component of health is missing from this, though. It’s mental wellbeing, which encompasses our inner workings and the way we describe how we are in our lives.

Mental wellbeing, in general, is the state of thriving in various areas of life, such as in relationships, at work, play, and more, despite ups and downs. It’s the knowledge that we are separate from our problems and the belief that we can handle those problems.

Before examining what mental wellbeing is, it’s important to understand what mental wellbeing is not. It is not

• The absence of mental illness
• The lack of problems, challenges, and adversity

In fact, it is often adversity, including facing mental illness, that shapes and hones mental health and wellbeing. Just as a broken bone is stronger after healing itself, so, too, can be your mental wellbeing each time you face and deal with difficulties.

So what, exactly is this idea of mental wellbeing?

Defining Mental Wellbeing

Mental wellbeing is how we respond to life’s ups and downs. In this simple mental wellbeing definition lies deeper meaning and implication for our lives. It includes how a person thinks, handles emotion (emotional wellness), and acts.

This important part of who we are has multiple meanings. These traits—which are all actually skills we can practice and develop—are all part of mental wellbeing:

• Self-acceptance
• Sense of self as part of something greater
• Sense of self as independent rather than dependent on others for identity or happiness
• Knowing and using our unique character strengths
• Accurate perception of reality, knowing that we can’t mind-read and that our thoughts aren’t always true
• Desire for continued growth
• Thriving in the face of adversity (emotional resilience)
• Having and pursuing interests
• Knowing and remaining true to values
• Maintaining emotionally healthy relationships
• Optimism (hope—the mindset that things can improve)
• Happiness that comes from within rather than being dependent on external conditions
• Determination
• Action (in contrast to a passive mindset and lifestyle, waiting for things to get better)

People who develop and experience wellbeing also have what psychological researcher, Angela Duckworth, calls grit. Grit is comprised of passions and perseverance and means showing up for life. It’s a never-give-up attitude. Grit doesn’t mean never failing, for failure is part of success and life itself. Grit means getting back up when you fall.

Together, all of this defines mental wellbeing. It’s purposely moving ever forward with determination and direction.

Examples of Mental Wellbeing

Wellbeing exists in myriad ways. These mental wellbeing examples are but a handful of ways people can be mentally healthy:

• The man who loses his job and uses his love of learning to take some classes to start a new career path that better matches his passions
• The woman who makes it a point to attend or visit concerts, plays, and museums because she feels joy and inspiration when she does
• The teen athlete who is cut from a team so, with determination and grit, trains hard to make the team next season
• The woman who once experienced a period of homelessness and now gives back by volunteering in the organizations that helped her in the past
• The man whose wife had an affair lets go of bitterness and resentment by forgiving her and divorcing her civilly and then moves on with his life
• The human being with anxiety and depression who gets out of bed every single day, creates a goal for the day, and takes small steps toward it and acknowledging the bravery and progress at the end of the day

The components of mental wellbeing are within reach of everyone, and it has nothing at all to do with the presence or absence of illness.

Someone living with a mental illness can achieve mental wellbeing; likewise, someone who has neither mental nor physical illnesses could have a poor state of mental wellbeing.

Mental wellbeing and all that it encompasses are vital life components in their own right. They’re not something that exists as solely the absence of problems. Happily, they’re also not something that occurs by luck or chance or that we either have or lack and can’t change.

Mental health and wellbeing are traits and skills that we continually develop and hone as we live a tumultuous and quality life.

article references

Eye movement desensitization and reprocessing (EMDR) therapy is a useful trauma therapy and is a psychological treatment designed to alleviate the distress and anxiety that surrounds traumatic memories. In fact, the U.S. Department of Veterans Affairs (VA), who has studied trauma healing extensively, feels that high quality scientific evidence shows that EMDR has “significant benefit” in treating posttraumatic stress disorder (PTSD). EMDR therapy for PTSD has also been shown to be about as useful as exposure therapy, which is more commonly known.

It is believed that EMDR therapy assists trauma survivors to access and process traumatic memories while bringing together a positive resolution. Although EMDR does not appear to be a PTSD cure, the therapy is promising.

What Is EMDR Therapy for PTSD?

In EMDR treatment for PTSD, the therapist collaborates with the patient in order to:

1. Access a disturbing image associated with the trauma
2. Discuss the body sensations that occur for the patient in relation to the disturbing image
3. Identify a negative thought, belief or feeling (known as a “cognition”) that the patient “learned” from the trauma
4. Identify a positive cognition that the patient wants to replace the negative one

The patient is then asked to keep the disturbing image, body sensations and negative cognition in mind while following the therapist’s finger with his or her eyes (known as “tracking”) while the finger moves back and forth in front of the patient. This lasts for about 20 seconds.

A single tracking session is not expected to reprocess a memory. Many tracking sessions may be needed for each component of a memory and several tracking sessions take place during each appointment.

Future tracking sessions have the patient concentrate on whatever changes or new associations with the trauma have occurred and focus on replacing the negative cognitions with the positive ones. Posttraumatic stress disorder EMDR sessions are continued until there are no new associations with the trauma.

Within each session, the patient will use self-rating scales to indicate the intensity of PTSD symptoms as well as the negative cognition and the acceptance of the new, positive cognition. These ratings are taken after each tracking session to show how effective the tracking sessions are.

Between EMDR sessions, the patient keeps a journal of any situations that provokes any PTSD symptoms as well as any related dreams or insights.

Eye Movements as a Part of EMDR Therapy for PTSD

While back and forth eye movement was the traditional way this therapy has been practiced, EMDR protocols also allow for left-right alternating tones or touches.

However, in studies looking at the eye movement component of EMDR therapy, it has not been shown that the alternating movement or focus is needed. These studies seem to indicate that the eye movement is not the critical component of EMDR.

Why Does PTSD Therapy EMDR Work?

Researchers suggest there are several ways that EMDR works to alleviate PTSD symptoms, much of which has to do with desensitization to the trauma as well as anxiety management, specifically, management of the sensations in the body associated with the trauma.

At its most basic level, EMDR:

• Exposes the patient to trauma cues (like in exposure therapy)
• Helps process the emotional responses to trauma
• Creates a corrected and more rational view of the trauma and the effect the trauma has had on the patient’s cognitions
• Encourages self-monitoring of feelings, thoughts and beliefs (like is done in cognitive behavioral therapy)
• Helps to manage the physical response to trauma stimuli

No matter the specifics on how EMDR for PTSD works, what is known through many controlled studies is that it is effective at treating the symptoms that arise after a trauma.

article references

General Description

Our emotional and psychological being is vitally important to our sexual well being. Any kind of psychological or emotional stress can cause sexual dysfunction, even when we do not suffer from a medically diagnosed mental condition. The psychological causes of sexual dysfunction are numerous and diverse. Each of the conditions described below can be a factor in sexual dysfunction.

Depression is a serious disease that affects twice as many women as men, usually between the ages of 18 and 44. It can be caused by a chemical imbalance in the brain, severe stress, grief, family history, emotional conflict or any combination of these factors. Depression often causes a loss of interest in sex as well as function.

Dysthymia is a more common, subtle, lower-grade form of depression that is not easily diagnosed, often because a woman in functioning adequately and doesn't know she has it. A woman with dysthymia may feel sad, isolated, overwhelmed and unappreciated. She has a tendency to feel so unattractive and unloved that she doesn't want to let anyone else in and often withdraws from sex.

Stress: Many women experience far more stress than men particularly when they are full-time working mothers. Stress causes a woman to have far more interest in sleep than in sex and can inhibit her ability to become aroused and reach orgasm. For a woman to feel sexual, she needs some time to nurture and pamper herself, but even chronically exhausted women are much less likely than men to put their own needs first.

Sexual or emotional abuse: Women who have been sexually or emotionally abused in childhood or adolescence often face a range of sexual difficulties. For some women, it is terror whenever they are in a sexual situation. For others it is an inability to stay "present" or connected to their partners while making love. Conversely, some women become overtly promiscuous pursuing multiple, meaningless sexual encounters, trying to replace a lost love object or an unexplainable void inside.

Drug and alcohol abuse tend to have complicated emotional, relational and even sexual pasts. The substance abuse may allow for the numbing of the real pain, but that pain often carries into the sexual relationship. Many women who leave rehabilitation centers not only have to learn how to live sober, but also how to relate sexually to others while sober.

Sexual addiction is a compulsive, driving need for sexual contact that can destroy family life, work life, and a person's ability to function. Among the symptoms is a preoccupation with sex that interferes with normal sexual relations with a loved one and a repeated need for a "high" followed by feelings of guilt, anxiety, or depression. Sexual addiction is similar to addictions to drugs or alcohol, although its classification as an addiction is controversial in the medical community.

Body image and self-esteem problems: Fashion magazines promote such unrealistic images of beauty that we find that even younger women feel they can't live up to them. These are the same women, along with older ones, who turn out the lights during sex, and sometimes even while undressing. Self- esteem plays an important role in a woman's sexual function. If a woman doesn't feel good about her body or herself, or doesn't feel as in control or powerful, it's extremely hard for her to let go and sexually respond to a partner.

Relationship problems: A conflicted relationship with a partner usually means there is a conflicted or nonexistent sex life. Communication problems, anger, a lack of trust, a lack of connection and a lack of intimacy can all adversely affect a woman's sexual response and interest. Couples in marriage and long-term relationships often have unrealistic expectations. They feel that moving from an initial infatuation stage (when a couple can only think of each other and sex is thrilling) to the deeper, more calm stage of attachment (not all-consumed with sex) is somehow wrong. Real love is built on communication and intimacy; sex becomes a part of the whole relationship, not the center of it.

What Can You Do?

First, if you feel your sexual complaints are rooted in emotional or relationship conflicts, don't think that your whole life has to be falling apart before you seek help. The sooner you start to address it, the better your treatment will go.

Regardless, we believe strongly that a therapeutic evaluation with a trained sex therapist should be a first step in treating any sexual function complaint, even when you are also seeking medical treatment for it. Of course, this is not saying it's all in your head. There might be a very real medical cause or factors as well. However, unless you attend to the context in which you experience your sexuality (how you feel about yourself, your body, and the person you're with), no amount of medical intervention will work.

For a general individual or couples therapist, we suggest contacting your local chapter of the American Psychological Association or National Association of Social Work for a trained and board certified therapist. You may want to ask them if they have a listing of marital and family therapists if you have a couples issue you want to discuss. If you are seeking a sex therapist, the American Association of Sex Educators Counselors and Therapists (AASECT) can give you a list of trained sex therapists in your area.

Sexuality for women extends far beyond the release of neurotransmitters, the influence of sex hormones, and vasocongestion of the genitals. A number of psychological and sociological variables may affect female sexual function, as may the aging process, menopause, the presence of diseases, and the use of certain medications.

Effect of Psychosocial Variables on Female Sexual Response

Among the psychosocial variables, perhaps the most important is the relationship with the sexual partner. John Bancroft, MD, and colleagues at the Kinsey Institute for Research in Sex, Gender, and Reproduction suggest that a reduction in libido or sexual response may actually be an adaptive response to a woman's relationship or life problems (rather than a disorder).⁽¹⁾ According to Basson, emotions and thoughts have a stronger impact on a woman's assessment of whether or not she is aroused than does genital congestion. ⁽²⁾

Other emotional factors that may have an impact on female sexual functioning are listed in Table 2.

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TABLE 2. Psychological Factors Affecting Female Sexual Function

• Relationship with sexual partner
• Past negative sexual experiences or sexual abuse
• Low sexual self-image
• Poor body image
• Lack of feeling of safety
• Negative emotions associated with arousal
• Stress
• Fatigue
• Depression or anxiety disorders

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Effects of Aging on Female Sexual Response

Contrary to popular belief, aging does not mean the end of sexual interest, particularly today when many men and women are coupling, uncoupling, and recoupling again, leading to renewed interest in sex due to the novelty of a new sexual partner. Many older women find themselves at a psychologically satisfying sexual peak because of their maturity, knowledge of their body and its workings, ability to ask for and accept pleasure, and their greater comfort with themselves.⁽³⁾

In the past, much of our information about sexuality at perimenopause and beyond has been based on anecdotal complaints from a small, self-selecting group of symptomatic women who presented to providers.^(4,5) Today we have large population-based studies that offer a more accurate picture.^(5,7)

Although many studies do show that there is a normative, gradual decline in sexual desire and activity with age, research also indicates that the majority of men and women who are healthy and have partners will remain interested in sex and engage in sexual activity well into midlife, later life, and until the end of life.⁽⁵⁾ An informal survey conducted by the consumer magazine More of 1,328 readers of the magazine (which is targeted to women over age 40) bears out this new thinking: 53 percent of women in their 50s said their sex life was more satisfying than it was in their 20s; 45 percent said they use vibrators and sex toys; and 45 percent would like a medication for women that enhances sexual desire and activity.⁽⁸⁾

Several factors appear to affect the ability to continue to be sexually active, most notably the availability of a willing sexual partner and a woman's health status (including the presence of a sexual disorder). The Duke Longitudinal Study of 261 white men and 241 white women between the ages of 46 and 71 found that sexual interest declined significantly among men because they were unable to perform (40 percent).^(7,9,10) For women, sexual activity declined because of the death or illness of a spouse (36 percent and 20 percent, respectively), or because the spouse was unable to perform sexually (18 percent). Regression analysis showed that age was the primary factor leading to a reduction in sexual interest, enjoyment, and frequency of intercourse among men, followed by present health. For women, marital status was the primary factor, followed by age and education. Health was not related to sexual functioning in women, and postmenopausal status was identified as a small contributor to lower levels of sexual interest and frequency but not to enjoyment.⁽³⁾

A number of changes that occur with aging have effects on sexual response (see Table 3). Despite these changes, most current studies do not show an appreciable rise in sexual problems as women age.^(1,2,5,11) For instance, baseline data from the Study of Women's Health Across the Nation (SWAN) suggest that sexual function and practices remain unchanged for premenopausal and perimenopausal women.⁽⁶⁾ The study investigated the sexual behavior of 3,262 women without hysterectomy aged 42 to 52 who were not using hormones. Although early perimenopausal women reported more frequent dyspareunia than did premenopausal women, there were no differences between the two groups in regard to sexual desire, satisfaction, arousal, physical pleasure, or the importance of sex. Seventy-nine percent had engaged in sex with a partner within the past 6 months. Seventy-seven percent of the women said that sex was moderately to extremely important to them, although 42 percent reported a desire for sex infrequently (0-2 times per month), prompting the authors to note that a "lack of frequent desire does not appear to preclude emotional satisfaction and physical pleasure with relationships."

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TABLE 3. Effects of Aging on Female Sexual Function^(3,12,13)

• Decreased muscle tension may increase time from arousal to orgasm, lessen intensity of orgasm, and lead to a more rapid resolution
• Distention of the urinary meatus
• Lack of breast-size increase with stimulation
• Clitoral shrinkage, decrease in perfusion, diminished engorgement, and delay in clitoral reaction time
• Decreased vascularization and delayed or absent vaginal lubrication
• Decreased vaginal elasticity
• Decreased congestion in outer third of vagina
• Fewer, occasionally painful, uterine contractions with orgasm
• Genital atrophy
• Thinning of vaginal mucosa
• Increase in vaginal pH
• Decreased sex drive, erotic response, tactile sensation, capacity for orgasm

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John Bancroft, lead author of the 1999-2000 national survey of 987 women that found emotional well-being and the quality of a relationship with a partner had more of an effect on sexuality than aging, suggests that aging affects genital response more in men than women, and sexual interest more in women than men.⁽¹⁾German researcher Uwe Hartmann, PhD, and colleagues support this view but note that: "there is a greater variability of virtually all sexual parameters with higher age, indicating that the sexuality of midlife and older women, in comparison with that of younger women, is more dependent on basic conditions like general well-being, physical and mental health, quality of relationship, or life situation. It is these factors that determine whether the individual woman can retain her sexual interest and pleasure in sexual activity."⁽⁵⁾

Many researchers suggest that the quality and quantity of sexual activity with aging are also dependent on the quality and quantity of sexual activity during earlier years.^(2,5)

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Effects of Perimenopause/Menopause on Female Sexual Response

Although menopause symptoms can indirectly affect sexual responsitivity (see Table 4), as with aging, menopause does not represent an end of sex.⁽⁵⁾ Declining estrogen and testosterone levels may be associated with a flagging sex drive, but in light of Basson's recent model of the sexual response pattern, this may not be as important an occurrence as once thought.⁽¹⁴⁾ If desire is not the motivating force for sexual activity for many women, as Basson contends, then the loss of spontaneous desire may not have very much impact on a woman's sexual life at all if her partner is still interested in engaging in sex.^(2,3)

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TABLE 4.Possible Changes in Sexual Function at Menopause

• Decline in desire
• Diminished sexual response
• Vaginal dryness and dyspareunia
• Decreased sexual activity
• Dysfunctional male partner

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Recent studies suggest that the hormonal changes that occur during menopause have less of an effect on a woman's sexual life and response than do her feelings about her partner, whether her partner has sexual problems, and her overall feelings of well-being.^(4,5)

For instance, analysis of data from 200 premenopausal, perimenopausal, and postmenopausal women with an average age of 54 from the Massachusetts Women's Health Study II (MWHS II) showed that menopause status had less of an impact on sexual functioning than health, marital status, mental health, or smoking.⁽⁴⁾ Satisfaction with their sex life, frequency of sexual intercourse, and pain during intercourse didn't vary by women's menopausal status. Postmenopausal women did self-report significantly less sexual desire than premenopausal women (p<0.05) and were more likely to agree that interest in sexual activity declines with age. Perimenopausal and postmenopausal women also reported feeling less aroused compared with when they were in their 40s than premenopausal women (p<0.05). Interestingly, the presence of vasomotor symptoms was not related to any aspect of sexual functioning.

Declining Estrogen Levels

The loss of ovarian production of estradiol at menopause can result in vaginal dryness and urogenital atrophy, which can affect sexuality.⁽¹⁵⁾ In the MWHS II, vaginal dryness was associated with dyspareunia or pain after intercourse (OR=3.86) and difficulty experiencing orgasm (OR=2.51).⁽⁴⁾ On the other hand, a study by Van Lunsen and Laan found that sexual symptoms after menopause might be related more to psychosocial issues than to age- and menopause-induced changes in the genitals.⁽¹⁶⁾ These authors suggest that some postmenopausal women who complain of vaginal dryness and dyspareunia may be having sexual intercourse while unaroused, perhaps a longstanding practice (linked to their unawareness of genital vasocongestion and lubrication) before menopause. They may not have noticed the dryness and pain because their estrogen production was high enough that it masked a lack of lubrication.

Moodiness or depression associated with the hormonal changes of menopause also can lead to loss of interest in sex, and changes in body configuration can be inhibiting.⁽¹⁵⁾

Declining Testosterone Levels

By age 50, testosterone levels are reduced by half in women compared with age 20.^(16,17) As women enter menopause, the levels remain stable or may even increase slightly.⁽¹⁸⁾ In women undergoing removal of the ovaries (oophorectomy), testosterone levels also drop by 50 percent.⁽¹⁸⁾

Effects of Disease on Female Sexual Response

Although psychosocial factors are the focus of much discussion today in the pathogenesis of sexual disorders, physical factors remain important and cannot be dismissed (see Table 5). A variety of medical conditions can directly or indirectly affect female sexual functioning and satisfaction. For instance, through lack of adequate blood flow, a vascular disease such as hypertension or diabetes might inhibit the ability to become aroused.⁽²¹⁾ Depression, anxiety, and conditions such as cancer, lung disease, and arthritis that cause a lack of physical strength, agility, energy, or chronic pain also can affect sexual functioning and interest.^(3,14)

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TABLE 5. Medical Conditions That Can Affect Female Sexuality^(21,26)

Neurologic Disorders

• Head injury
• Multiple sclerosis
• Psychomotor epilepsy
• Spinal cord injury
• Stroke

Vascular Disorders

• Hypertension and other cardiovascular diseases
• Leukemia
• Sickle-cell disease

Endocrine Disorders

• Diabetes
• Hepatitis
• Kidney disease

Debilitating Diseases

• Cancer
• Degenerative disease
• Lung disease

Psychiatric Disorders

• Anxiety
• Depression

Voiding Disorders

• Overactive bladder
• Stress urinary incontinence

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In the MWHS II, depression was negatively associated with sexual satisfaction and frequency, and psychological symptoms were related to lower libido.⁽⁴⁾ Hartmann et al. also showed that women who suffer from depression are more likely to indicate low sexual desire than those without depression. ⁽⁵⁾

Procedures such as hysterectomy and mastectomy also may have a physical, as well as an emotional, impact on sexuality. Removing or altering female reproductive organs may lead to discomfort during sexual encounters (e.g., dyspareunia) and leave women feeling less feminine, sexual, and desirable.⁽²²⁾ In recent years, however, studies have suggested that elective hysterectomy may actually result in an improvement in rather than a deterioration of sexual functioning.^(23,24) Oophorectomy, on the other hand, leads to a deterioration of functioning, at least initially, because of the sudden cessation of sex hormone production and the onset of premature menopause.⁽²⁵⁾

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Effects of Medications on Female Sexual Responsee

A wide array of pharmaceutical agents may cause sexual difficulties (see Table 6). Perhaps the most commonly acknowledged medications are the selective serotonin reuptake inhibitors (SSRIs) prescribed to treat depression and anxiety disorders, which can diminish sex drive and cause difficulty in experiencing orgasm.^(26,27) Antihypertensive agents are also notorious for causing sexual problems, and antihistamines may reduce vaginal lubrication.^(26,27)

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TABLE 6. Medications That Can Cause Female Sexual Problems⁽²⁸⁾

Medications that cause disorders of desire

Psychoactive Medications

• Antipsychotics
• Barbiturates
• Benzodiazepines
• Lithium
• Selective serotonin reuptake inhibitors
• Tricyclic antidepressants

Cardiovascular and Antihypertensive Medications

• Antilipid medications
• Beta blockers
• Clonidine
• Digoxin
• Spironolactone

Hormonal Preparations

• Danazol
• GnRh agonists
• Oral contraceptives

Other

• Histamine H2-receptor blockers and
• pro-motility agents
• Indomethacin
• Ketoconazole
• Phenytoin sodium

Medications that cause disorders of arousal

• Anticholinergics
• Antihistamines
• Antihypertensives
• Psychoactive medications
  • Benzodiazepines
  • Monoamine oxidase inhibitors
  • Selective serotonin reuptake inhibitors
  • Tricyclic antidepressants

Medications that cause orgasmic disorders

• Amphetamines and related anorexic drugs
• Antipsychotics
• Benzodiazepines
• Methyldopa
• Narcotics
• Selective serotonin reuptake inhibitors
• Trazodone
• Tricyclic antidepressants*

*Also associated with painful orgasm..

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28. Drugs that cause sexual dysfunction: an update. Med Lett Drugs Ther 1992;34:73-78.

Perhaps the most extreme symptoms of female sexual dissatisfaction are those associated with sexual pain disorders. The two most common pain disorders, say Drs. Laura and Jennifer Berman, are:

• Dyspareunia: recurrent or persistent genital pain related to attempted penetration during sex. The pain can be within the vagina or deep in the pelvis. Dyspareunia can emerge following a vaginal infection or vaginal and vulvular surgery, or result from vaginal thinning during menopause. Infections of the vagina, in particular, cause redness, itching, burning or stinging of the vulva - a condition known as vulvitis.

• Vaginismus: recurrent or persistent involuntary contraction of the muscles of the outer one-third of the vagina that interferes with vaginal penetration.

A third subcategory of sexual pain disorder is genital pain caused by any type of sexual stimulation besides intercourse.

Treating Sexual Pain Disorders

"A lot of women experience pain for a variety of different reasons," says Jennifer, a urologist, who adds that - as with most female sexual dissatisfactions - the causes are often a blend of physical and emotional factors. When the problem is medical and can be identified, treatment tends to be fairly straightforward. Among the most common solutions:

Antibiotics for vaginal or urinary tract infections due to yeast, bacteria or parasites. Once the painful symptoms of these conditions clear, dyspareunia goes away. Chronic bladder infections, also a cause of dyspareunia, do not respond to antibiotics.

• Hormone replacement therapy (estrogen + progestin) to alleviate the vaginal dryness, thinning and urinary urgency that may cause dyspareunia. A vaginal estradiol ring (Estring) that delivers low-dose estrogen is an increasingly popular alternative to oral or transdermal estrogen, note the Bermans. If the woman is menopausal, the doctors have found that adding testosterone to the therapy provides additional benefits.

• Dilation Exercises: Commonly prescribed to treat vaginismus, these exercises involve stretching the opening of the vagina. The idea is to help the body accept penetration by conditioning the vagina muscles to relax. The exercise is done with manual objects like a finger, dilator or dildo. Once the woman can accept the object without pain, she can usually handle penile penetration.

Putting Sexual Dissatisfaction in Perspective

Desiring sex less often than your partner, failing to become excited, not achieving orgasm - all of these occurrences are perfectly normal. Daily stressors - financial concerns, demanding jobs, busy parenting schedules - can take a toll on our sex lives.

It's when the lack of or unsatisfying sex becomes the norm that we need to ask whether we could be suffering from one or more of the sexual disorders specific to women. And if we are, the physical or psychological causes or a combination of both can be identified and successfully treated.

General Description

There are quite a few other physical problems women deal with that can cause sexual dysfunction. In this section, we will discuss several conditions generally associated with women's health.

Infections of the vagina caused by yeast, bacteria, or parasites often result in redness, itching, burning, and an unpleasant discharge.

Vulvitis, an inflammation of the vulva, is accompanied by itching, redness and swelling.

Vulvadynia, or chronic vulvar discomfort, is characterized by burning, stinging, irritation, or rawness of the vulva.

Urinary Tract infections, which are usually caused by bacteria that travel from the anal area to the urethra and bladder, result in intense burning upon urination. Sometimes the irritation causes blood in the urine, which is more frightening than dire, although the infections must be treated immediately.

Cystitis is an inflammation of the bladder, which can be due to an infection or medication, although often the cause is unknown. The symptoms are urinary urgency, frequency and burning.

Intersitial cystitis is a chronic inflammatory condition of the bladder with symptoms similar to, but more intense than, ordinary cystitis. There is an urgent need to urinate with accompanying lower abdominal, vaginal and rectal pain. The disease is often confused with other conditions like urethral syndrome, in which women suffer from irritative bladder symptoms without any discernable cause, although it is sometimes associated with lesions in the bladder.

Pelvic floor prolapse refers to relaxation and loosening of the muscles and connective tissue structures that normally hold the uterus, bladder, urethra, vagina and rectum in their correct anatomic positions. Prolapse can develop as a result of aging, menopause, childbirth, prolonged and /or traumatic labor during childbirth, as well as other factors, including prior pelvic surgery (e.g., hysterectomy) as well as neurologic disorders. Women suffering from prolapse experience urinary frequency, urgency and incontinence problems. If severe, prolapse can cause a feeling of pressure, fullness and pain in the vagina and/or rectum. The most common sexual function complaints include vaginal pain during intercourse, loss of sensation in the vagina, and difficulties with arousal and orgasm.

Endometriosis is a condition in which the tissue that normally lines the uterus grows in other areas of the body, causing pain, irregular bleeding and often infertility. The cause is unknown.

Fibroids tumors are benign tumors of muscle and connective tissue that develop within or are attached to the uterine wall. Fibroids can be microscopic, but they can also grow to fill the uterine cavity, causing excessive bleeding and pain.

What Can You Do?

The main solution is often simply treating the medical issue. More often than not, the woman suffering these problems has secondary sexual function complaints. While these may seem to take precedence, unless the medical problems are treated, the sexual ones won't improve. Seek out a specialist who can help you with your specific complaint. Often a simple evaluation and treatment is all that is needed. Occasionally, like in the case of prolapse, more intense treatment is necessary and new operations are available that have a very good prognosis for resolution.

Therapy for PTSD can be an important part of healing for those with posttraumatic stress disorder (PTSD). In fact, the U.S. Department of Veterans Affairs, which has studied PTSD therapy efficacy significantly, “strongly recommends” that anyone diagnosed with PTSD is offered trauma-focused psychotherapy. But what forms of therapy are available for PTSD and what PTSD therapies work best?

Types of PTSD Therapy

There are many types of PTSD therapy that have been tested in trials and there is a wealth of evidence saying that therapy does work in PTSD treatment. The two types of therapy for PTSD with the best evidence are trauma-focused therapy and stress inoculation therapy. Examples of trauma-focused therapy include:

• Exposure-based therapies
• Cognitive-based therapies
• Eye movement desensitization and reprocessing (EMDR)

Other PTSD therapies that may provide some benefit but with a weaker evidence base include:

• Patient education
• Imagery rehearsal therapy
• Psychodynamic therapy (“talk” therapy)
• Hypnosis
• Relaxation techniques
• PTSD support group therapy

There is considerable overlap between therapy types and many specific therapies incorporate portions of several of the above.

Stress Inoculation Therapy for PTSD

Stress inoculation therapy focuses on anxiety and stress management with the use of PTSD coping skills. Stress inoculation therapy combines many therapeutic techniques, such as:

• Deep muscle relaxation training
• Breathing control
• Assertiveness
• Positive thinking and self-talk
• Real life exposure to anxiety-provoking stimuli

Exposure-Based Therapies for PTSD

There are several kinds of exposure-based therapies and examples of this include prolonged exposure therapy for PTSD, brief, eclectic psychotherapy, narrative therapy and written exposure therapies for PTSD.

Exposure-based therapies for PTSD emphasize exposure to the stimuli that remind the person of the trauma and cause anxiety. Exposure may be in person, done through imaginings, written or oral. Very small amounts of exposure are initially done and then, little by little, the exposure gradually increases until the person is able to control their anxiety around that stimuli.

While this therapy can sound scary at first, exposure therapy has been well studied and when done by a qualified practitioner, in a safe and steady way, it has been shown to be very effective.

Cognitive-Based Therapies for PTSD

There are many cognitive-based therapies used to treat PTSD including cognitive behavioral therapy and cognitive processing therapy. In cognitive-based therapies for PTSD, the way a person thinks and feels is challenged and, in the end, modified.

For example, the way a person thinks or feels about his or her own safety may have been directly affected by the trauma. A person may not feel safe in a restaurant, for example. In a cognitive-based therapy, the belief that one is not safe in a restaurant would be challenged in a thought-out and logical way in an attempt to “reality test” (see whether the thought is truly reasonable) the belief.

Relaxation techniques and discussion or narration of the traumatic event are also often included in cognitive-based PTSD therapies.

Eye Movement Desensitization and Reprocessing for PTSD

Eye movement desensitization and reprocessing (EMDR) therapy may seem like quite a mouthful, but this type of PTSD therapy has been extensively studied in controlled trials and has been shown effective. EMDR therapy combines an exposure therapy component along with a cognitive component and relaxation/self-monitoring techniques. EMDR differs in that one of its key components is eye movement, as the name suggests, or other forms of distraction or physical stimulation.

article references

Introduction

At any age, sexual activity has its risks. During the adolescent and young-adult years, the risks are magnified considerably. Still, in spite of the risks, many adolescents choose to engage in sexual activity. Even for the most mature teenager or young adult who takes all the proper precautions, sex still can be a risky business.

Sex during adolescence is risky for several reasons. First, adolescents may have sex because they are pressured into it, either by a partner or by an adult in an abusive relationship. Sex under these circumstances can lead to depression and feelings of low self-esteem. Another major negative consequence of sexual activity among adolescents is pregnancy and all that it implies. Finally, there are sexually transmitted diseases or infections (STDs or STIs), or what used to be called venereal diseases (VD).

Adolescents have the highest rates of sexually transmitted diseases of any age group, and when we calculate the rate of STIs among sexually active teens rather than all teens, the numbers are even higher. Every year, approximately three million adolescents in the United States, about one in four, acquire STIs. In one act of unprotected sexual intercourse, an adolescent woman has a one-percent chance of acquiring HIV, a 30-percent chance of getting genital herpes, and a 50-percent chance of becoming infected with gonorrhea. And when we consider that chlamydia infection occurs about four times more often than gonorrhea, we can see how prevalent this problem is. This is without considering the most common STI, human papilloma virus (HPV) infection, which can be the cause of cancer of a woman's cervix when she gets older.

Teen Risk Factors

Why are teenagers at such great risk for getting these serious infections? There are several reasons. First, adolescents are prone to having more than one sex partner-not at the same time, but sequentially. In other words, kids may have several successive boy- or girlfriends during their teenage and young-adult years. If they have sex with more than one of these partners, they are increasing their chances of coming in contact with germs that cause STIs. Teenagers often have sex without thinking of the consequences. They are less likely to take precautions, such as using condoms, to prevent the spread of disease. Another reason teens are at greater risk is that they may not have learned ways of saying no. They may feel that they have to go along with their partners and have sex, even if they really don't want to. Finally, in teenage girls, the mucous membranes of the vagina may still be immature for three or four years after they start to have periods, and this immaturity can increase their chances of getting STIs.

Varieties of STIs

STIs are infections caused by some type of germ. Some are caused by viruses, some are caused by bacteria, and one is even caused by protozoa, little one-celled animals like amoebas or paramecia. Let's describe the various ones and tell a little about them.

Gonorrhea

One of the most well-known STIs is gonorrhea. It is caused by a bacteria called Neisseria gonorrhea and it is spread almost exclusively by sexual contact. Gonorrhea can cause an infection of the urethra (tube in the penis) in men and of the cervix (the canal leading from the vagina to the uterus) in women. Gonorrhea can be quiet and not produce any symptoms, but frequently it causes pus to come out of the penis or cervix, and it can cause a lot of discomfort. In both boys and girls, gonorrhea can travel up into more internal reproductive organs and cause damage to the tubes in men that transport sperm and the tubes in women that transport the eggs. This means that gonorrhea can really hurt someone's chances of having children later on in life.

Chlamydia trachomatis

Another bacterial infection is caused by Chlamydia trachomatis. This infection is very much like that caused by gonorrhea, but it usually has fewer symptoms, so it may not be treated and it may quietly cause more damage. Both chlamydia and gonorrhea can be prevented by abstinence, of course, and by using condoms every time a teenager or young adult has sex.

Syphilis

Another STI caused by a bacteria is syphilis. Syphilis is a famous disease that is nowhere as near as common as gonorrhea or chlamydia. It can be very serious and damaging, especially to babies who are born to women who have syphilis. Syphilis caused much suffering in the late 19th and early 20th centuries, but it is not that common anymore.

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Human papilloma virus

Human papilloma virus (HPV) is far and away the most common STI. Usually men and women with HPV don't know they have it. When they do know it, it is typically because some types of HPV (there are lots of different types) cause warts to appear on male and female genital organs. The sneaky and dangerous thing about HPV is that it can cause flat warts to appear on a woman's cervix, and she may never know it unless she has a test called a Pap smear each year. All girls who are sexually active should have a yearly Pap smear to see if they have HPV infection. There are some treatments that can help get rid of the flat warts of HPV and the visible ones too, but we don't yet know how to get rid of the virus. Flat warts can lead to cancer of the cervix, so avoiding HPV is very important.

HIV

Probably the most famous STI at the beginning of the 21st century is human immunodeficiency virus (HIV), the cause of the acquired immunodeficiency syndrome or AIDS. AIDS may be the worst STI ever. Although there are drugs that can keep AIDS quiet for a period of time, there are no cures. Globally, AIDS is a catastrophe of the highest order. Millions and millions of people in Africa, Asia, and South America are infected with HIV, and millions of people have died and are dying from AIDS. Because of the death of countless parents in Africa from AIDS, there are now millions of orphans there. AIDS can be prevented by abstinence or by using safe-sex practices, especially using condoms.

Other STIs

There are other diseases that are transmitted by sexual contact. They include the protozoal one, trichomoniasis, and other viral and bacterial diseases such as hepatitis B and ones too rare to mention here. One that should be mentioned is a viral STI called herpes. This STI is caused by a virus just like the one that causes cold sores on the mouth or lips. Herpes infection is often recurrent. Painful ulcers occur on the vagina or penis. This infection can also be transmitted to babies when they're born.

Detection

We are lucky that most STIs can be detected fairly easily. The trouble is that many of them are silent until they have caused a lot of damage. The way to get around this, and to find them before they do much harm, is for girls who are sexually active to get checked each year by having a pelvic examination. STI tests are part of a pelvic exam. Young women who have had sex with drug dealers or users, or bisexuals or gay men ought to be tested for HIV and syphilis, too. These tests are blood tests. Boys can be tested for STIs initially just by having their urine checked. If their urine shows the possibility of an STI, then they should have cultures for the germs done. HPV is not routinely looked for in men because it is almost impossible to treat.

Treatment

The STIs caused by bacteria can frequently be treated with antibiotics, just by one dose by mouth or by a needle. Viral STIs are the tough ones. There aren't any cures, but there are some medicines, especially for HIV and herpes, that can keep the infections from doing much harm, at least for a while.

Prevention

Preventing STIs is easy: Don't have sex, or if you do, use condoms. Also, know the sexual history of the person with whom you are having sex. Learn if they've had sex with other people who might have carried an STI germ. If a teen or young adult plans to have sex, he or she should always have condoms available. Never assume that your partner will have one on hand. And learn how to say no when you don't want to have sex. A big help in avoiding STIs is to avoid using alcohol and drugs. Alcohol and drugs can make someone take bigger risks than if he or she were sober. STIs can be avoided most of the time. But it takes work to do so.

What are some of the sexual problems that arise from childhood sexual abuse? And how does healing begin?

For the last 22 years, Natalie, a survivor of childhood sexual abuse, has been able to climax during sex with her husband. But she has a recurring sexual fantasy that upsets her terribly. In order to orgasm, Natalie must imagine that she's being raped by Nazis; a fantasy that she has never shared with her husband.

Natalie's personal experience is one of many stories that Wendy Maltz, M.S.W., has heard over the last ten years in her work with men and women who have survived sexual abuse. Maltz estimates that "about four out of five survivors experience unwanted sexual fantasies. The content is upsetting, and they feel out of control."

Unfortunately, intrusive and hurtful fantasies make up only a small part of the sexual problems that survivors of sexual abuse may experience. Both therapists and researchers have uncovered many more. What are some of these problems? Why do they occur? And most importantly, how do survivors begin to heal?

What is sexual abuse? How common is it?

Child sexual abuse is any sexual contact or attempt at sexual contact perpetrated against a child by an older person. Psychologists generally consider "older" to be a seniority of five or more years. On average, sexual abuse begins between ages four and 12, and may involve genital fondling or oral-genital contact, and may escalate to intercourse.

Unfortunately, childhood sexual abuse is not uncommon. One San Francisco-based study found that 38% of women had been sexually molested as children. Another study of nearly 800 students at New England colleges revealed that 1% of women were survivors of paternal incest. A national study in the United Kingdom discovered that 12% of women and 8% of men had been sexually molested as children.

Several research studies conducted in the last seven years suggest that people may repress and then recover memories of childhood sexual abuse. But this issue still remains controversial among psychologists.

The after-effects of sexual abuse

Not surprisingly, people who have endured sexual abuse often suffer sexual repercussions later in life. As Maltz emphasizes, "You can't overlook the word 'sex' in sexual abuse. It's no wonder that the repercussions of abuse manifest themselves as issues of sexuality since it was sexuality that was abused in the first place."

But not every person who has experienced sexual abuse experiences sexual problems. In fact, much of the research that has uncovered sexual problems in survivors has been done on people who were seeking therapy for something else.

Still, psychologists agree that sexual abuse can affect a person's sexual health. Touch, in the context of a loving adult relationship, may trigger memories and sensations of the original abuse, causing feelings that seriously interfere with pleasure.

Maltz compares the after effects of abuse to the repercussions of any trauma: "When we experience any kind of trauma in life we associate the emotions with certain sensations and thoughts that were present during the original trauma. Let's say that you were once in an earthquake terrified for your life and it was a hot sunny day. Five years from now, you may encounter a hot sunny day and suddenly be afraid that you're going to die."

Sexual after effects cited by researchers and therapists include unwanted sexual fantasies and flashbacks of the original abuse that regularly occur during sexual activity. According to one study, 80% of incest survivors reported that having sex elicited memories of their original violations.

Like Natalie, some survivors find that their only path to sexual release is fantasizing victimization. When a person's first sexual experience is abuse, that person may later associate sexual arousal with those same feelings of fear and disempowerment. Sexual victimization fantasies are not necessarily psychologically harmful. But it's no surprise that people become very distressed when they can't stop the fantasies, or always need to imagine themselves hurt and victimized in order to climax.

Dissociation and numbness

Survivors of sexual abuse may also experience "dissociation" an impressive defense mechanism formed during ongoing sexual abuse, in which the person being abused "leaves" his body, and watches the abuse from some higher viewpoint. Unfortunately, this defense mechanism may result in a feeling of dissociation during desired sexual activity with a loved one later in life.

Related to dissociation is sexual "numbness," which is the outcome of a child willing her body to numb itself against arousal during unwanted touch. Some adult survivors become so adept at numbing parts of their bodies that they don't feel the pain of appendicitis, or even need Novocaine at the dentist.

According to Maltz, "People who have been sexually abused may also avoid sex or see it as an obligation. Or, at the other end of the spectrum, some people seek sex compulsively," Maltz expresses. "And they often have negative feelings associated with touch, such as fear, guilt, shame and anger."

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How does the healing from childhood sexual abuse start?

Sexual problems sometimes occur later in life, taking people by surprise. According to a fair amount of research, problems may not emerge until people are in their late twenties or thirties and in a stable relationship, or until their children reach the same age as they were when their abuse began.

Many people seek therapy. Therapists have developed exercises to gradually help people reconnect with their bodies after the trauma of sexual abuse. For instance, therapist Yvonne M. Dolan helps her clients reconnect to their bodies by first asking them what activities inspire positive feelings. Bubble baths? Exercise? She then encourages clients to pursue those activities more often.

Maltz has developed a series of "relearning touch" exercises. In one of her exercises, two partners face each other, each putting his or her hand over the other's heart. "You're sending out feelings of appreciation," she says. "I've had survivors tell me that this exercise was their first experience as to what healthy sexuality would feel like. They had never before experienced a sense of sending or receiving love, respect and appreciation through touch."

Why heal? Even in the midst of emotional and psychological turmoil, some survivors might be hesitant to open Pandora's Box and begin the difficult healing process. But Maltz is encouraging. "Healing your sexuality is like shedding layers of shame and self-doubt. Then you can move on to make positive connections with a lover and to express yourself creatively and in strong, powerful ways in the world."

Sex therapist Joy Davidson, Ph.D., who has also worked with people who were sexually abused, offers further inspiration. "The healing is only a first step. The true goal is to thrive and grow as sensual, sexual, erotic, vibrant, wild women, and to recognize that sexual pleasure is a birthright, a natural gift."

Heather Smith is a freelance writer who has written about health, food, and entertainment for online and print publications.