Sexual Arousal

Sexual arousal depends on nitric oxide-mediated genital vasodilation and on central dopaminergic and adrenergic signalling, layered over psychological context. Reduced arousal is often the first sign of endothelial dysfunction, which is why erectile difficulties can precede cardiovascular disease by several years and deserve a cardiovascular workup rather than just a pill. SSRIs are a leading pharmacological cause and warrant a prescriber conversation, not silent discontinuation. Persistent difficulty also merits screening for diabetes, hypogonadism, thyroid disease and depression.

1) Treat cardiovascular risk factors — blood pressure, lipids, glucose and smoking all directly limit genital blood flow. 2) Sleep 7-9 hours; sleep restriction lowers testosterone and dampens arousal in both sexes. 3) Exercise regularly, especially aerobic work, which improves endothelial function measurably within weeks. 4) Review medications with a prescriber — SSRIs, beta blockers, finasteride and some antihistamines are common culprits. 5) Reduce alcohol, which acutely impairs arousal and chronically lowers testosterone. 6) Address relationship context, performance anxiety and stress, which frequently dominate the physiology. 7) Consider psychosexual therapy, which has good evidence for arousal disorders. 8) Supplements are adjuncts: maca and ginseng have modest data, most others do not.

• •Cardiovascular fitness
• •Sleep sufficiency
• •Alcohol reduction
• •Smoking cessation
• •Stress and anxiety management
• •Medication review
• •Relationship communication