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TREATMENT
Treatment for sexual dysfunction depends on the cause of the problem. If the cause is physical, medical treatment is aimed at correcting the underlying disorder. If the cause is 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, changes in the environment, timing, lovemaking techniques or foreplay can produce desire. With arousal disorder, the use of toys and vibrators can help with vaginal circulation. A warm bath and a massage from your partner can also help.
Medical Treatment
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Lubricating creams, gels or suppositories.
If you are suffering from vaginal dryness caused by medications, a chronic condition or declining estrogen levels, your health care professional may suggest water-based, over-the counter vaginal lubricants such as Replens, Astroglide or K-Y Jelly to make sex more comfortable. Do not use oil-based products, such as petroleum jelly, baby oil or mineral oil with latex condoms because they can cause a condom to break.
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Topical estrogen.
For menopausal women with vaginal thinning, dryness or insensitivity, your health care professional may recommend estrogen creams such as Estrace and Premarin, or vaginal inserts, such as Estring, 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.
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Hormone therapy.
For menopausal women, hormone therapy (either a combination of estrogen and progestin or estrogen-only therapy) may improve the sensitivity of the clitoris, ease discomfort caused by vaginal thinning and dryness and improve blood flow to the pelvic area. In addition, HT can help relieve other bothersome menopausal symptoms, including hot flashes, which can interfere with intimacy.
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 add testosterone, a hormone produced by the ovaries and adrenal glands that plays a role in sexual desire, to HT to stimulate sexual arousal. Treatment with testosterone is highly controversial, however. Estratest, an estrogen/testosterone combination, is currently the only testosterone treatment available. Studies on other androgen products used to treat sexual dysfunction have had mixed results.
Although there is no FDA-approved form of testosterone available to treat women's sexually dysfunction, many doctors prescribe it "off label" in small amounts, particularly for women whose ovaries have been removed. Removing the ovaries drastically reduces testosterone levels, and some research shows that women who have had their ovaries removed are most likely to benefit from androgen therapy, according to the American College of Obstetricians and Gynecologists (ACOG).
Supplementing with testosterone has potential risks. In too high a dose, testosterone can produce masculinizing effects, such as increased facial hair and enlargement of the clitoris. The oral form can also produce liver damage, acne and a decrease in HDL cholesterol (the "good" cholesterol). The use of testosterone in men and women is highly controversial, so be sure to discuss with your health care professional whether androgen supplementation is right for you.
Clitoral therapy device
The Eros Clitoral Therapy device is an FDA-approved device designed to treat female sexual arousal disorder. It consists of a small, soft suction cup attached to a palm-sized, battery-operated vacuum pump. The suction cup is placed over the clitoris before sex. The gentle vacuum increases genital blood flow, thus increasing sexual arousal and enhancing orgasm.
In one clinical trial, 90 percent of participants reported more sensation after using Eros, 55 percent experienced more orgasms, 80 percent had greater lubrication and 80 percent experienced greater overall satisfaction. No adverse side effects were reported. The device is available by prescription.
Sildenafil (Viagra)
The drug that treats erectile dysfunction in men is also being studied in clinical trials for female sexual arousal disorder, although, to date, it hasn't been approved by the FDA for this purpose. Studies find it may increase blood flow to the female genital area and increase relaxation of clitoral and vaginal muscles. Clinical studies evaluating the safety and efficacy for women with arousal disorder are still underway, and preliminary results show that Viagra may have positive effects in some women with adequate testosterone levels.
Zestra
Introduced in June 2002, Zestra feminine arousal fluid (made of botanical tropical oils) has been shown to increase sexual response in women with arousal disorder or those who have sexual side effects due to antidepressant medications.
Other Medical Approaches
Better control of chronic diseases, switching prescriptions to reduce side effects, and treating vaginal infections by taking antibiotics can eliminate sexual problems related to desire, arousal, orgasm and pain. On very rare occasions, surgery may be needed to remove structural problems, such as cysts, tumors or growths that often produce pain during sex.
Psychological Treatment
Psychological treatment for sexual dysfunction usually involves a series of steps identifying and modifying emotions and behaviors that interfere with sexual response, changing behaviors that act as barriers to sexual responsiveness, and learning new physical and emotional behaviors that encourage sexual responsiveness.
Sex therapy is talk therapy in which you and your counselor, along with your partner, discuss problems, how and why they occur and ways to solve them. You and your partner receive exercises and techniques to try at home, then report on the results at the following session. Depending on your needs, goals and diagnosis, such counseling typically can involve a one-hour session once a week for two- to-six months.
Poor communication between partners is often present with all sexual dysfunction. Learning to communicate, resolving conflict and dealing with negative emotions are the focus of therapy designed to address this issue. Group therapy or support groups also may be recommended.
Behavioral changes may also help. These include: changes in the environment, love making at different times of the day, warm baths, masturbation, massage and the use of sexual toys and vibrators.
Sensate focus exercises are often recommended by therapists to treat sexual arousal disorder and orgasm disorder. These exercises help you and your partner relate to each other physically without any pressure to perform sexually. You begin by touching each other, slowly progressing to genital stimulation and may eventually proceed to intercourse.
Learning the functions of sexual organs and how the body responds sexually, including clitoral and vaginal stimulation, can also help with arousal and orgasm disorders. Kegel exercises can strengthen voluntary control of pelvic muscles, improving the sense of control and quality of orgasms.
Treatment for vaginismus (involuntary spasm of the muscles at the vaginal opening) may focus on techniques to relax the vagina. One option is using dilators in graduated sizes that are placed into the vagina and kept in place for 10 minutes. The woman usually places the dilators herself. Performing Kegel exercises while the dilator is in place helps you learn to control your vaginal muscles. The exercises also can be done with your fingers. Sometimes, waiting for the muscle to relax after penetration may help.
