Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
If the sexual problem is caused by a medical or physical problem, your health care professional 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 professional 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 other important studies, 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.
Bupropion (Wellbutrin) is an antidepressant drug that has been used to treat certain cases of orgasmic disorders, and preliminary studies have confirmed its effectiveness in some patients. More research is needed to fully clarify the potential therapeutic role of bupropion in the management of female sexual disorders in general.
Hormone therapy (HT), formerly referred to as hormone replacement therapy (HRT): HT has been used to relieve symptoms of menopause for years.
It comes in two forms, estrogen only and combination estrogen-progestin, a synthetic form of the hormone progesterone. Estrogen 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 HT was linked to significantly higher risks of breast cancer, heart attack, stroke, blood clots (from one kind of HT), and ovarian cancer (from estrogen therapy). The research did show that HT 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 HT for treatment of menopausal symptoms is safe; it is recommended that women who choose to take HT do so for the shortest period of time possible and at the lowest effective dose.
Each woman's need for HT and risks in taking HT are unique to her. These should be discussed in detail with your health care professional.
Use of HT in menopausal women is now considered on a case-by-case basis.