Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Female sexual dysfunction treatment options

Jill of All Trades, MD
Conditions
May 27, 2010
Share
Tweet
Share

Female sexual dysfunction has been reported in up to 40% of women, and described as causing actual distress in approximately 12% of women.

Therefore, it is an important topic to familiarize with and screen for as a primary care physician, as many patients may not report these symptoms unless they are elicited during the history taking process of the patient encounter. Female sexual dysfunction is often multifactorial and complex; it is affected by such factors as depression and anxiety disorders, life stressors, interpersonal conflict between the couple, medication side effects, age, religious concerns, personal health, privacy issues, personal body image, substance and alcohol abuse, and hormonal influences.

In order to understand the necessary treatment options, it is important to understand the normal female sexual cycle. There are four phases:

1. Libido: the desire for sexual intimacy, through images or thoughts.

2. Arousal: the increase in heart rate, blood pressure, and respiratory rate, along with increased genital blood flow.

3. Orgasm: the peak of sexual pleasure, with rhythmic contractions of the pelvic muscles.

4. Resolution: the return to baseline with pelvic muscle relaxation.

However, there may be overlap, they may be out of sequence, absent, or a phase may even be repeated in the normal female sexual cycle. Also, many women with dysfunction are impacted in more than one phase of the cycle. Therefore, the main categories producing female sexual dysfunction consist of the lack of desire, impaired arousal, the inability to achieve orgasm, and sexual pain disorders. However, it is considered a medical disorder only when it is perceived as distressing to the patient.

Treatment is often initiated with non-pharmacologic modalities first. Medications are reserved in those who fail the following:

• Discontinuation of offending medications: Medications such as beta blockers used to treat high blood pressure, or those with depression or anxiety disorders being treated with Selective Serotonin Reuptake Inhibitors (SSRI’s) are two of the most prescribed groups of medications that may contribute to sexual dysfunction. It is important to review and discuss all medications being taken by the patient.

• Lifestyle Changes: Lack of privacy, life stressors, or personal body image may contribute to sexual dysfunction in many women. This can be alleviated by the introduction of regular exercise, relaxation techniques, support groups, yoga, or establishing scheduled “alone time” for the couple away from family and daytime responsibilities.

• Counseling: Consider in those with interpersonal conflict within the relationship, or for those with underlying depression or anxiety disorders.

• Sex Therapy: Many insurance plans cover the visit to the sex therapist, who may be a physician, psychologist, or highly trained social worker. You can find a certified sex therapist through the American Association of Sex Educators, Counselors, and Therapists at: www.aasect.org.

ADVERTISEMENT

• Lubrication: For those experiencing vaginal dryness or pain with intercourse, over the counter lubrication jelly may be of benefit if used during intercourse.

• Devices: There is also a clitoral suction vacuum device, EROS CTDT, that is FDA approved for those with female sexual dysfunction. This is similar to the device designed for males, and allows better genital blood flow. However, it may be no more effective than other less costly devices, such as the vibrator.

If the above treatments do not yield results, and if the dysfunction is found to cause personal distress for the patient, the next step is to consider pharmacologic therapy. However, it is important that patients understand that the data on many of the hormonal treatments are limited, that there is a lack of long-term studies on hormonal methods, and that many are not approved by the United States Food and Drug Administration (FDA):

• Androgens:

1. DHEA: is found over the counter without a prescription. It is found to improve sexual satisfaction in women with adrenal insufficiency, however, no change was found in other women without this diagnosis.
2. Testosterone: Most data is on postmenopausal women, and has not been found effective in pre-menopausal women. There are two preparations that are currently the most affective: one is the topical compounded 1% cream applied at about 0.5 grams daily to the skin of the arms, legs, or abdomen. Then, there is a 300mcg patch that is applied twice a week, yet is only available in Europe at this time.
3. Potential Risks: Oral testosterone is currently limited in use due to its adverse effects on the liver and cholesterol levels. However, topical and transdermal preparations should be used with caution in those with cardiovascular disease, liver disease, a history of endometrial hyperplasia or cancer, and those with breast cancer. Also, the issue of pregnancy prevention should be addressed, as there is a risk to the developing fetus in those with androgen exposure. In addition, androgens may cause hirsutism and acne, yet these effects are mild and usually reversible.

• Estrogen:

1. Vaginal Creams: for those with vaginal dryness or pain with intercourse. However, it is contraindicated in those same patients with contraindications to oral estrogens as well, such as those with a history of breast cancer.
2. Oral Estrogen: The Women’s Health Initiative (WHI) study found that oral estrogen does not improve sexual functioning in postmenopausal women, and may even be harmful.

• Non-Hormonal:

1. Sildenafil (Viagra): For those requiring SSRI’s for depression or anxiety disorders, phosphodiesterase inhibitors (PDE-5) such as Sildenafil have shown to be effective in limited studies. However, they have not been shown to be successful in women not being treated with SSRI’s. Studies are currently limited.
2. Buproprion (Wellbutrin): Has been shown to effectively treat women with sexual dysfunction even without depression.
3. Zestra T Oil: This is an herbal feminine massage oil that may be applied to the female genitals, and reported to improve sexual functioning in a small study.

Please make sure you consult your personal physician prior to initiating any kind of treatment for female sexual dysfunction.

Editor’s note: This is meant to be general information only, and not to be used as medical advice. Please note the disclaimer.

Jill of All Trades is a family physician who blogs at her self-titled site, Jill of All Trades, MD.

Prev

Healthcare needs to be simpler and more like real economics

May 27, 2010 Kevin 13
…
Next

Physician rating sites shouldn't worry doctors

May 28, 2010 Kevin 9
…

Tagged as: Medications, Primary Care

Post navigation

< Previous Post
Healthcare needs to be simpler and more like real economics
Next Post >
Physician rating sites shouldn't worry doctors

ADVERTISEMENT

More by Jill of All Trades, MD

  • a desk with keyboard and ipad with the kevinmd logo

    5 tips to evaluate medical websites

    Jill of All Trades, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Patient tips for your first office visit

    Jill of All Trades, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Be like a circus ring master when seeing a patient in the clinic

    Jill of All Trades, MD

More in Conditions

  • What Elon Musk and Diddy reveal about the price of power

    Osmund Agbo, MD
  • Understanding depression beyond biology: the power of therapy and meaning

    Maire Daugharty, MD
  • Why medicine must stop worshipping burnout and start valuing humanity

    Sarah White, APRN
  • Why perinatal mental health is the top cause of maternal death in the U.S.

    Sheila Noon
  • A world without vaccines: What history teaches us about public health

    Drew Remignanti, MD, MPH
  • Unraveling the mystery behind one of the most dangerous pregnancy complications: preeclampsia

    Thomas McElrath, MD, PhD and Kara Rood, MD
  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • 5 blind spots that stall physician wealth

      Johnny Medina, MSc | Finance
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why flashy AI tools won’t fix health care without real infrastructure

      David Carmouche, MD | Tech
  • Recent Posts

    • Why judgment is hurting doctors—and how mindfulness can heal

      Jessie Mahoney, MD | Physician
    • Why medical schools must ditch lectures and embrace active learning

      Arlen Meyers, MD, MBA | Education
    • Why helping people means more than getting an MD

      Vaishali Jha | Education
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
    • Why evidence-based management may be an effective strategy for stronger health care leadership and equity

      Olumuyiwa Bamgbade, MD | Physician
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 4 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • 5 blind spots that stall physician wealth

      Johnny Medina, MSc | Finance
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why flashy AI tools won’t fix health care without real infrastructure

      David Carmouche, MD | Tech
  • Recent Posts

    • Why judgment is hurting doctors—and how mindfulness can heal

      Jessie Mahoney, MD | Physician
    • Why medical schools must ditch lectures and embrace active learning

      Arlen Meyers, MD, MBA | Education
    • Why helping people means more than getting an MD

      Vaishali Jha | Education
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
    • Why evidence-based management may be an effective strategy for stronger health care leadership and equity

      Olumuyiwa Bamgbade, MD | Physician
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Female sexual dysfunction treatment options
4 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...