TREATMENT OF SEXUAL PROBLEMS

A number of treatments are available for women with sexual dysfunction. In many cases, a combination of treatments is most effective.

Deal with relationship issues — Difficulties with communication and understanding are a significant cause of decreased sexual desire and response in men and women. Working with a professional counselor or sex therapist can help couples deal with stress, fatigue, lack of privacy, personal values, and religious beliefs, all of which can impact sexuality.

Most couples have better sex while on vacation, demonstrating the importance of reducing stress and fatigue to improve sexual satisfaction. Couples who have more fun together outside of the bedroom typically have more fun in the bedroom, so establishing a regular "date night" and increasing the frequency of special outings and vacations is an effective treatment for many sexual problems.

For premenopausal women, counseling, books, and web sites help couples communicate better about their sexual needs and differences, understand the causes of their difficulties, and provide treatment suggestions. If there are underlying physical problems (eg, pelvic pain), getting these problems under control may also help to improve sexual difficulties.

Treat vaginal dryness — Women with vaginal dryness or discomfort may be advised to use topical (vaginal) estrogen or a non-hormonal vaginal moisturizer. Lubricant use with intercourse also increases comfort and pleasure. Postmenopausal women generally will benefit for use of low dose vaginal estrogen therapy. Treatment of vaginal dryness is discussed in detail in a separate topic.

Deal with sexual side effects of medications — If you have sexual side effects from a medication, speak with your healthcare provider about options for reducing or eliminating this problem.

Options for women who have side effects from an antidepressant medication include trying a reduced dose or change in type of antidepressant medication. Bupropion (Wellbutrin®), Nefazodone (Serzone®), mirtazapine (Remeron®), or duloxetine (Cymbalta®) are antidepressant medications that have few or no sexual side effects, and can sometimes be used in addition to or in place of your current medication. Talk to your healthcare provider before making any changes in your medications.

Carefully consider androgens — Androgens, such as testosterone, are sex hormones that are produced in the testes and adrenal glands in men and the ovaries and adrenal glands in women. In men, androgens are responsible for producing typical male characteristics, such as facial hair, as well as feelings of desire and arousal.

However, the role of androgens in female sexuality is not clear. Androgen levels decline with aging, so all postmenopausal women have low blood levels of androgens. Studies of women who took testosterone treatment have shown that select women have small, but significant improvements in sexual desire and response. Despite these findings, no androgen products are approved for the treatment of women with sexual dysfunction in the United States due to the lack of data regarding long term safety.

Testosterone — Testosterone products are sometimes used "off-label" to treat sexual problems in women. These products include testosterone skin patches, gels, creams or ointments, pills, implants, and injections. Testosterone doses provided by these formulations are often too high for women, increasing the likelihood of side effects. Testosterone is not recommended for premenopausal women.

Testosterone skin patches designed for women are available in Europe for postmenopausal women with decreased sexual desire. Studies of the testosterone patch have been completed in the United States, although further study of long-term safety will be required before these products are approved.

Women who are considering use of testosterone should discuss the possible side effects of this treatment with their healthcare provider.

DHEA — Studies on the use of DHEA (dehydroepiandrosterone), available as a nutritional supplement in the United States, have shown that DHEA can improve sexual interest and satisfaction in some women whose adrenal glands no longer function (adrenal insufficiency).

However, DHEA is not proven to be safe or effective for other women, and it is not generally recommended. In addition, DHEA is produced as a nutritional supplement, and the amount of hormone may vary from one pill or bottle to another.

Androgen side effects — Side effects of testosterone treatment are a concern; androgens can increase body hair growth and cause scalp hair loss, oily skin, acne, irreversible deepening of the voice, liver problems, and high cholesterol levels. In addition, because testosterone is converted to estrogen in a woman's body, there may be an increased risk of breast cancer and coronary heart disease. Women who take androgens should be monitored closely for side effects.

Erectile dysfunction medications — Medications commonly used for men with erectile problems, including sildenafil (Viagra®), tadalafil (Cialis®), or vardenafil (Levitra®), have not been shown to improve sexual function in women and are not usually recommended. The only exception to this is in women who take certain antidepressant medications who have difficulty achieving orgasm and who cannot switch to another antidepressant medication; an erectile dysfunction medication may be recommended in this situation.

Treatments that are unproven

Herbal therapies — Many women are interested in trying over-the-counter herbal supplements, which are advertised to increase sexual desire and pleasure. More studies are needed to ensure herbal therapies are safe and effective. The production of herbs is not regulated by the government, and it is not always possible to know that an herbal product contains the type and quantity of ingredient that the label indicates, or that it is free of potentially dangerous additives. People who wish to use herbal therapies are urged to do so with caution.

Surgical treatments — Surgery is very rarely necessary to make the vagina "better" for sex. Women with abnormalities of the vagina, who have had female circumcision (also known as female genital mutilation), and those with traumatic injuries from childbirth are a few groups that may benefit from careful surgical treatment.

All women should be wary of advertisements for "vaginal rejuvenation surgery"; these procedures can be costly and painful, are permanent, and are unlikely to improve a woman's or her partner's sexual enjoyment.