Sexual Dysfunction; Treatment

NWHRC Health Center - Sexual Dysfunction, Dec 23, 2005

Treatment for sexual dysfunction depends on the cause of the problem. If the cause is physical, medical treatment will be aimed at correcting the underlying disorder that is contributing to or producing the sexual disorder. If the cause is determined to be psychological, treatment consists of counseling. Treatment also can include a combination of medical and psychological approaches.

Sometimes, treatment may be behavioral. For example, with loss of desire, often, changes in the environment, timing, lovemaking techniques or changes in foreplay will induce desire. With arousal disorder, the use of toys and vibrators will aid circulation. A warm bath and a massage from a partner will promote circulation and relaxation.

Medical Treatment

Lubricating creams, gels or suppositories.

If you are suffering from vaginal dryness caused by medications, a chronic condition or declining estrogen levels resulting from menopause, your health care professional may suggest using water-based over-the counter vaginal lubricants such as Replens, Astroglide or K-Y Jelly, which may make sex more comfortable. Do not use oil-based products, such as petroleum jelly, baby oil or mineral oil, with latex condoms because these can cause a condom to break.

Topical estrogen.

For menopausal women with vaginal thinning, dryness or insensitivity, estrogen creams such as Estrace and Premarin, or vaginal inserts, such as Estring, may be recommended by your health care professional to ease sexual discomfort. A vaginal tablet (Vagifem) containing estradiol, a type of estrogen, is available by prescription for vaginal dryness. Unlike creams, which usually are used at night, Vagifem can be inserted any time of day.

Hormonal therapy.

For menopausal women, menopausal hormone therapy (either a combination of estrogen and progestin known as HT, or estrogen-only therapy known as ERT), can improve clitoral sensitivity, ease discomfort caused by vaginal thinning and dryness, and improve blood flow to the pelvic area. In addition, HRT can help relieve other bothersome menopausal symptoms, including hot flashes, which can interfere with intimacy, but usually end once menopause occurs.

The U.S. Food and Drug Administration (FDA) now advises health care professionals to prescribe postmenopausal hormone therapies at the lowest possible dose and for the shortest possible length of time to achieve treatment goals. This recommendation was made after findings from major studies of postmenopausal women with and without heart disease, conducted as part of the federal Women's Health Initiative, were released in July 2002 and March 2004.

Because every woman's risk profile is different, women who are thinking about taking HRT or are currently taking it for whatever reason, need to review their options and treatment plans with their health care professional in light of the FDA's recent warning.

Ask your health care professional for more information about the latest research on ERT and HT, and how the risks and benefits of using these therapies apply to your personal health needs. Although HT can result in increased sensitivity and decreased discomfort during sex for menopausal women, the therapy may not improve sexual desire. Some health care professionals may recommend adding androgen to stimulate sexual arousal. Androgen is a sex hormone produced by the ovaries, adrenal glands and other tissues that contributes to the rapid growth spurt at puberty, and is thought to regulate a variety of bodily functions.

A type of androgen is testosterone, which may be prescribed in small amounts for women with decreased who have had their ovaries removed, often as part of a hysterectomy. Ovary removal drastically lowers the testosterone level, and younger women who have had their ovaries removed are most likely to benefit from androgen therapy, according to the American College of Obstetricians and Gynecologists.

Whether or not androgen supplementation can improve sexual desire in all menopausal women is controversial. Although a woman's androgen level falls 50 percent during and after menopause, researchers have yet to determine whether the drop weakens sex drive in substantial numbers of women. But, adding androgen to estrogen has been shown in some studies to increase sexual desire in women who reported a decline after menopause.

Androgen supplementation also carries potential risks. It can produce masculinizing effects, such as increased facial hair, and enlargement of the clitoris. The oral form can also produce liver damage, acne and changes in blood cholesterol levels. Be sure to discuss with your health care professional whether androgen supplementation is right for you.

Women with sexual dysfunction caused by androgen deficiency may benefit from treatment with dehydroepiandrosterone (DHEA), according to a presentation reported during the 2001 American Urological Association's annual meeting. DHEA is produced by the adrenal glands, which are located atop the kidneys. In people with underactive adrenal glands, levels of the hormone are low, even in their youth. Researchers gave 32 women with diminished sexual interest, arousal and orgasmic capabilities due to low androgen levels 50 mg DHEA per day for an average of five months. In 80 percent of the women, the hormone treatment returned testosterone and DHEA levels to normal. On the Female Sexual Function Index and the Female Sexual Distress Scale, most of the women reported a significant increase in spontaneity and decreased time to achieve arousal. They also reported having more interest in sex. While the hormone is available over the counter, it should not be taken without medical evaluation. Side effects associated with androgen use can include acne, hair growth, oily skin and a possible increased risk of breast cancer. Medical guidance for using DHEA is highly recommended by health care professionals.