Here's the good news, the bad news, and some more good news about Americans' sexual health: Most (64 percent of Americans, according to one recent study) are satisfied with their sex lives. But many health issues can get in the way of having a good sex life, from prescription medication side effects to depression to sexually transmitted diseases.
In many cases, physicians can work with their patients to improve the situation, whether by changing the dosage of a medication, helping to treat depression or other medical conditions, or by providing sound medical advice for people who have STDs.
"For people who are not satisfied with their sex life, they really should talk to their primary care physician," says Pamela G. Rockwell, D.O., assistant professor of family medicine at the University of Michigan Medical School. "He or she may be able to diagnose something that was previously undiagnosed, change medications, or offer some lifestyle recommendations. In many cases, the patients can improve their sexual satisfaction."
Here, Rockwell explains how nine health issues can affect sexual satisfaction.
1. Prescription medications. Many common drugs can have side effects that impact sexual health, including medications that treat blood pressure, heart conditions and depression.
Diuretics ("water pills") that treat heart and blood pressure conditions can cause erectile dysfunction among men. ACE inhibitors and other calcium channel blockers, which are used to treat some heart-related problems, also have been found to cause erectile problems.
For patients whose depression is being treated with selective serotonin reuptake inhibitors (SSRI) medications - such as Prozac, Paxil, Celexa and other drugs - or other antidepressants, side effects can include a loss of interest in sex and ejaculation problems.
With all of these types of medication and any others that may cause sexual side effects, Rockwell says, patients can talk with their doctors about possibly lowering the dosage, adding a second drug to combat some of the side effects or changing to a different medication.
2. Cardiac health. First, Rockwell would like to dispense with a common misconception. "I think the most common fallacy is that having sex is going to cause a heart attack," she says. "The good news is it really isn't the case."
The majority of people with cardiovascular disease don't need to alter their sex lives, she says. Some people may need to be careful about all physical activity immediately after a heart attack, or after the implantation of a pacemaker or cardioverter defibrillator, but even then, sex generally is safe as soon as the patient's physician gives the go-ahead to resume physical activity.
3. Depression. Untreated depression, Rockwell says, can lead to many sexual difficulties. "People can experience lack of pleasure, lack of desire and lack of ability to perform," she says.
Adding to the challenge is that some people with untreated depression have heard that antidepressants can negatively affect their sex lives. In reality, Rockwell says, most people on antidepressants don't experience these problems. For those who do, doctors often can prescribe different dosages or different drugs to minimize the side effects.
4. Alcohol. As anyone who has ever seen a beer commercial knows, alcohol and sex are linked in the minds of many people. Indeed, Rockwell says, many people believe that alcohol will "get you in the mood."
While a few drinks initially lower one's inhibitions, drinking can lead to risky sexual behavior - not just for people with serious alcohol problems, but also among people who only occasionally have too much to drink. Additionally, Rockwell says, it doesn't really help with one's enjoyment of sex. "Overall, it decreases sexual pleasure because alcohol lowers your sensations," she says.
5. Sexually transmitted diseases. For people with STDs such as HIV, the human papillomavirus (HPV), or hepatitis, sex isn't out of the picture. In fact, Rockwell says, "people with STDs can certainly have healthy, satisfying sex lives."
Protection is a must, she says, and condoms must be used 100 percent of the time. An important caveat is that with HPV, which can cause cervical cancer, condoms do not necessarily protect one's partner against contracting the virus.
6. Stress. Got stress? If so, then you may have more trouble experiencing an enjoyable sex life.
"Stress often has effects on our sex lives. When we are consumed with time management, working, raising children and providing for our families, we often don't leave a lot of time for ourselves," Rockwell notes. "What happens is the libido goes down, and the ability to accept and give pleasure decreases. People who suffer from unsatisfying sex lives may not even realize that it could be caused by stress."
7. Pregnancy. "Physically, there is no barrier to sex during pregnancy," Rockwell says. Intercourse will not harm the fetus or the woman, unless she has a medical problem and has been advised by her physician not to have intercourse. Levels of desire can vary. The use of lubricants and changes in positions as the pregnancy progresses may be necessary.
8. Menopause. Some physical limitations may affect a woman's enjoyment of sex after menopause, but that doesn't mean a woman's sex life is over. "Many women can experience a very healthy sexual life after menopause," Rockwell says. "There is no reason that menopause should mean an end to your sex life." Topical estrogen cream and lubricants may help after the drop in hormone levels that occurs during menopause.
9. Poor body image and self esteem. A woman's self esteem can significantly affect her sexual satisfaction, and low self esteem based on a poor image of her body can detrimentally impact her enjoyment of sex. "Some studies show that as little as five pounds of weight loss can greatly improve a woman's sexual satisfaction," Rockwell notes.