Treatment of Female Sexual Dysfunction
Treatment for sexual dysfunction depends on the cause. If physical, medical treatment may be aimed at correcting the problem or relieving the problem, and if psychological counseling in combination with medical therapies may be necessary.
Subsection of Medical Treatment
Lubricating creams, gels, or suppositories. Vaginal dryness and a lack of arousal, i.e. lubrication caused by medications, chronic medical problems, or declining estrogen levels such as occurs during menopause may be helped by using water-based over-the-counter vaginal lubricants such as Replens, Astroglide, or KY-Jelly. All water-based products should not be used with a condom since this may cause breakage of the condom.
Topical estrogens. For menopausal women with vaginal thinning, dryness, and insensitivity estrogen creams such as Estrace and Premarin or vaginal inserts such as Estring may be helpful. A vaginal tablet (Vagifem) containing estradiol, a type of estrogen, is also available and may not have the messiness of the creams. The creams are usually used at night where as Vagifem can be inserted any time of the day.
Hormonal therapy. For menopausal women hormonal replacement therapy can improve clitoral sensitivity, ease discomfort caused by vaginal thinning and dryness, and improve blood flow to the pelvis area. In addition, hormone replacement therapy (HRT) can relieve bothersome menopausal symptoms including hot flashes, prevent osteoporosis, and possibly prevent other cardiovascular problems although this is quite controversial at this time. Recent studies have indicated that HRT has a higher incidence of cardiovascular problems including phlebothrombosis, pulmonary emboli, and myocardial infarction (heart attack). Two types of HRT are available. HRT usually refers to the combination of estrogen and the synthetic form of the hormone progesterone (progestins) where as ERT refers to estrogen replacement therapy in which estrogen is used alone mostly in women who do not have a uterus. Several large studies have shown that estrogens without progestins have a greater risk of developing endometrial cancer than women who do not use ERT. The risk is ten fold higher, but scientific evidence showed that combining progestins to estrogens reduces the risk to normal levels. Although HRT can increase sensitivity and decrease discomfort or pain associated with sexual activity in menopausal or postmenopausal women improved sexual desire for some women does not occur. Some professionals recommend adding androgens for desire problems. Androgen is the sex hormone produced by the ovaries and the adrenal glands which contributes to the rapid growth spurt at puberty and regulates a variety of bodily functions.
Androgen is testosterone. It can be prescribed in small amounts to reduce sexual desire in women who have had their ovaries moved often as part of a hysterectomy or in women who are postmenopausal with ovarian failure. Androgen supplementation carries some potential risks if the patients are not monitored appropriately and if the doses are not low enough. Masculinization with facial hair and enlargement of the clitoris, lipid abnormalities, acne, polycythemia, agitation, and aggressiveness may occur.
Some women who have sexual desire problems caused by androgen deficiency may benefit from the treatment with dehydroepiandrosterone (DHEA). DHEA is both a precursor to testosterone and estradiol and when given orally at a twice a day dose tends to increase both the estrogen and the testosterone by natural means. At the 2001 American Urologic Association meeting DHEA appeared to return female levels of testosterone to normal in 80 percent of cases. Most of the women reported a significant increase in spontaneity and decreased time to arousal along with an improved interest in sexual activity. DHEA is a health food supplement, however, it should be administered with medical guidance since the side effects of androgen can be induced if not properly monitored and there is an increased risk of breast and endometrial cancer.
Available hormonal therapy that includes androgen are the Androgel 2.5 gram packages applied to the skin daily after showering over a one-week period, i.e. one seventh of the package is used over one week, Depo-Testosterone injections at dosages of 20 mg every three to four weeks where as males use 200 mg every two weeks, and Estratest tablets which include a combination of estrogen and mentholated testosterone in such low doses that liver toxicity and liver cancer is not as significant as one is concerned with in males who need higher dosages that cause higher incidences of chemical hepatitis and cancer of the liver.
Gels in pump bottles are not available for men at this time, but can be used in 2.5 gram doses for females and testosterone subcutaneous pellets and testosterone buccal lozenges may become available for females in the future.
Clitoral therapy devices. The EROS clitoral therapy device is specifically designed to treat female sexual arousal disorders and has been approved by the FDA. It consists of a small soft suction cup attached to a palm-sized battery operated vacuum pump. The cup is placed over the clitoris before having sex and activation of the pump draws blood in to the clitoris expanding and holding the blood within the clitoris and therefore aiding sexual arousal. The device is available by prescription. No adverse effects were noted.
Viagra (sildenafil). Viagra, as you are aware, is used to treat erectile dysfunction in men by increasing blood flow to the genital organs. Unfortunately all the diseases that cause decreased blood flow in men also affect women, and although the drug has not yet been FDA approved for female sexual dysfunction many are using it for increasing pelvic blood flow, i.e. arousal disorders. At this time there is a pivotal international study going on to determine the effectiveness of Viagra in women with arousal disorders. The side effects of Viagra in women is the same as men, i.e. headaches, flushing, rhinitis, GI upset and abnormal vision, and there are several studies indicating improvement in sexual spots and arousal in women using antidepressants, postmenopausal women, and others with sexual arousal disorders. Viagra should not be used in women taking any form of nitrates since this can be lethal with decrease in blood pressure and major cardiovascular collapse. Women who are unable to tolerate sexual activity or have retinitis pigmentosa should also not use the drug. Lastly, if women are on alpha blockers for hypertension the drug should not be used with the alpha blocker within four hours.
In the near future newer more potent and specific PDE-5 inhibitors similar to Viagra will be introduced and may be useful in female sexual arousal disorders. Levitra (vardenafil) and Cialis (tadalafil) are drugs about to be FDA approved for men. Recently research on drugs that specifically affect the subtype-2 dopaminergic centers in the brain (periventricular nuclei) may be helpful for women in the future not only for arousal disorders, but possibly for desire problems as well. Melanocyte agonists may also play a similar role on the central nervous system. (2004)
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