There’s no quick fix for Female Sexual Dysfunction, but plenty of options remain
While last year’s debut of the so-called “Female Viagra” was a disappointment, women should know it wasn’t their only option. There are still a number of time-tested treatments that can help with some of the gynecological factors behind female sexual dysfunction.
Approximately 40 percent of women in the U.S. are estimated to be suffering from sexual disorders. The problem is more prevalent among women (43%) than men (31%) and can fall into four categories:
- Hypoactive sexual desire disorder (HSDD) - a lack of interest
- Sexual arousal disorder – inability to maintain sexual excitement
- Orgasmic disorder – absence of orgasm after arousal
- Sexual pain disorder – painful intercourse
Because Female Sexual Dysfunction (FSD) can often stem from multiple factors, accurate diagnosis requires careful review of medical and sexual history issues. Women should not assume this is an inevitable part of aging, but should be encouraged to talk with their physicians about available therapies that may improve sexual function. Treatment may include counseling, pharmacotherapy, psychiatric therapy or evaluation for medical conditions.
Just don’t expect the answers to come in one magic pill. The female Viagra buzz for flibanserin (brand name Addyi) turned to disappointment when it didn’t live up to expectations and was found to have more strings attached than Viagra did for men.
Dr. Richard Farnam, director of the Texas Urogynecology and Laser Surgery Center, said many patients who asked about Addyi were surprised to learn the pill has to be taken every day and FDA guidelines say they can’t drink any alcohol while taking the drug. Flibanserin can cause severely low blood pressure and loss of consciousness, which can be more severe in combination with alcohol. It can also cause dangerous side effects when used along with certain antibiotics and heart medications.
“I have yet to write a prescription,” Farnam said.
Finding a solution requires persistence and patience. Women should speak up about their concerns with their physicians or even seek a second opinion from a specialist. The important thing is to not get discouraged because there isn’t one answer that fits everyone. Each case is unique and treatments are individualized based on symptoms, at what stage a woman is in her life and the transition to menopause.
Impact of medication, hormones on desire
A full evaluation checks for physical or psychological factors that may be affecting sexual response. Often external issues such as stress, fatigue, work-life balance and relationship troubles may be involved and call for referral to psychological specialists.
“Desire is directly related to quality and strength of relationships and sometimes if there's discord, it can be remedied through counseling," Farnam said.
But, sometimes desire disorders can also have organic causes. While depression can affect desire, treating just the depression alone may not always be the answer. That’s because many anti-depressant medications can diminish sex drive. Patients who don’t see improvement may want to talk with their physicians about adjusting their medication because some anti-depressants, such as bupropion (Wellbutrin), have been found to raise libido back to or above pre-depression levels.
Desire may also fade due to hormonal changes that start in the pre- and perimenopausal stages of a woman’s life. The endocrine hormones estrogen, progesterone and testosterone (or androgen) are all involved in sexual response and deficiency in the male hormone androgen is linked to diminished drive. There are no medications approved for the issue, but androgen supplementation has been used for decades to treat HSDD in women. Oral and topical treatments are preferred to patches and implants that can cause side effects such as hair growth and acne.
Hot flashes, night sweats and other symptoms of menopause brought on by varying estrogen and progesterone levels also can turn off interest in sex. A full hormonal profile should be done for diagnosing hormonal imbalance and developing an individualized course of treatment.
Common causes of painful sex
The American College of Obstetricians and Gynecologists reports that three out of four women have pain during intercourse at some time in their lives. It can be caused by numerous physical conditions throughout the reproductive system.
Hormones - Falling estrogen levels are a leading cause of vaginal dryness, which can result in itching, burning, discomfort and pain during intercourse. The treatment can be as simple as using a lubricant - either hormonal topical estrogen or non-hormonal products, such as K-Y Jelly. Here again is a situation where women are often too embarrassed to talk with their health care providers about the pain. And many doctors may not think to ask.
“They expect to see dry tissue and they're not going to think too much of it,” Farnam said, explaining that a full assessment by a specialist such as a urogynecologist helps prompt discussion of issues that might otherwise be overlooked.
“If you see that and if you ask, ‘hey this is dry, do you have itching or sexual pain?’ a lot of people are going to say yes. They won't bring it up, but if you ask them about it they'll say yes.”
Endometriosis - One common cause of pain during intercourse is endometriosis, a condition where the tissue that normally lines the uterus grows outside the uterus and into the abdomen and pelvis. Even though the condition is common, it is often misdiagnosed.
Treatment of endometriosis through laparoscopic laser excision can result in a significant improvement or resolution of pain symptoms.
Vulvar skin conditions - The sensitive skin of the vulva is susceptible to a series of conditions that result in dryness, pain and itching. Lichen skin conditions can cause pain during sex and tears in the skin. They usually can be treated simply with a steroid when a diagnosis can be determined.
Vaginal infections -Infections of the vagina, called vaginitis, are frequently misdiagnosed. Vaginitis may be cause by bacteria, yeast, a virus or an STD and each require a different treatment. A full assessment is needed for an accurate diagnosis.
"I've had people who have been treated by other doctors for several years who come in and find out they have chlamydia," Farnam said.
Interstitial cystitis / painful bladder syndrome – Sometimes the only symptom for this condition is painful sex. Other symptoms can include burning, an urgent need to urinate and frequent urination. Patients may become frustrated by how difficult this condition is to diagnose. Women should seek out a specialist who has experience treating these symptoms to do a complete history and advanced diagnostic tests.
“It is often a process of elimination,” Dr. Farnam said.
In many cases surgical management can lead to long-term or permanent resolution of these symptoms.
Pelvic floor myalgia – Caused by involuntary contractions in the muscle of the pelvic floor, this condition can be difficult to treat. It typically not only requires pharmaceutical therapy, but also physical therapy and possibly even psychological counseling.
Fibroids - Uterine Fibroids benign tumors that can range in size from a marble to a grapefruit, but can grow even larger in extreme cases. They can cause abdominal pain and swelling. Fibroids treatment can include hysterectomy, which can be done as a minimally invasive laparoscopic surgery or a Robotic Myomectomy option is also available. This procedure is performed through small incision and involves the removal of fibroids while preserving the uterus and the patient's fertility.
Pelvic Inflammatory Disease – An infection in the pelvic cavity that can cause adhesions where bands of tissue form between internal tissues and organs and keep them from shifting easily as the body moves.
How to get help
See a specialist. The above list contains just some of the more common conditions that may factor into female sexual disorder that many doctors may miss in routine checkups. Discovering and treating the underlying issues can be a complex process more likely to be diagnosed by a physician who has a higher level of experience diagnosing these conditions and greater familiarity with the research in this area.
Be prepared to try different courses of action because there isn’t always just one quick answer for every case, Farnam said.
“This is what I tell every patient that comes in with this type of thing: I’m not going to solve it today. This is going to be a process. I may see you three times, I may see you 12 times, but you'll have to trust the process."