Medical Treatment

If the sexual problem is caused by a medical or physical problem, your health care provider or consulting specialist will suggest an appropriate treatment plan. This will vary, of course, depending on the nature of the problem. The plan may include medication, lifestyle changes, or surgery. Your health care provider may recommend counseling even if the problem is physical.

Effective therapies are readily available for some physical problems.

• Vaginal lubricants - These products are highly recommended for women with vaginal dryness. They can be bought in a drugstore without a prescription. They are available as creams, gels, or suppositories. Water-based products are the best choices. Oil-based products such as petroleum jelly, mineral oil, or baby oil can interact with latex condoms and cause them to break.
• Topical estrogen - These products can help make sex more comfortable for menopausal women with vaginal dryness or sensitivity. Estrogen is applied as a cream or vaginal insert. These products are available by prescription and are very effective for some women.
• Clitoral therapy device - The Eros clitoral therapy device has been approved by the U.S. Food and Drug Administration (FDA) to treat women with disorders of sexual arousal. The device consists of a small suction cup, which is placed over the clitoris before sex, and a small, battery-operated vacuum pump. The gentle suction provided by the vacuum pump draws blood into the clitoris, increasing pressure on the clitoral nerve. This device increases lubrication, sensation, and even the number of orgasms in many women who have used it. The device is available by prescription.
• Drugs - Sildenafil (Viagra) is the well-known "erection drug" for men. It is used to treat erectile dysfunction, a common sexual problem among men. No similar drug is yet available for women. The effects of Viagra in women have been studied, but results are not conclusive. In some studies, the drugs helped with arousal problems, but in another important study, they did not. The drug has the same side effects in women as in men, including headache, flushing, nasal congestion and irritation, abnormal vision, and stomach upset. It can worsen retinitis pigmentosa, a hereditary degenerative disease affecting the eye. Most importantly, it can cause dangerously low blood pressure and has been linked to unexplained heart attacks in men. Viagra cannot be taken by people who take a nitrate drug for a heart condition, because the combination can be deadly.

• It comes in 2 forms, estrogen only (ERT) and combination estrogen-progestin, a synthetic form of the hormone progesterone (HRT). ERT generally is used for women who have had a hysterectomy, while HRT is used for women who still have their uterus, because the progestin protects the uterus from the effects of too much estrogen, especially uterine cancer.
• For many years, HRT was believed to have many beneficial effects for menopausal women, continuing the protective effect that estrogen provides naturally before menopause. These benefits were thought to include protecting against heart disease, high cholesterol, colon cancer, Alzheimer disease, and osteoporosis. New research findings published in 2002 called these beliefs into question. Long-term use of HRT or ERT was linked to significantly higher risks of breast cancer, heart attack, stroke, blood clots (from one kind of HRT), and ovarian cancer (from ERT). The research did show that HRT protects against osteoporosis and colon cancer, but the risks are considered to outweigh the benefits.
• HRT can be very effective in some women in relieving vaginal dryness and discomfort during intercourse, as well as "vasoactive" symptoms such as "hot flashes" and sleep problems.
• Most experts believe that short-term use of HRT for treatment of menopausal symptoms is safe.
• The safety of long-term use of HRT is very questionable. Most experts recommend that women who have taken HRT for 5 years or longer stop taking it.
• Each woman's need for HRT and risks in taking HRT are unique to her. These should be discussed in detail with your health care provider.
• Use of HRT in menopausal women is now considered on a case-by-case basis.