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women's sexual problems: FSD treatments

by Janet Casperson, BS, MSN, ANP-C

Treatment of FSD is evolving as more research is being done and evidence-based guidelines are being developed. As with ED, FSD is a couple's problem, not just an individual's problem.

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In our clinical practice, treatment outcomes are most successful when FSD is approached by treating the disorder as a couple's problem and setting realistic goals. Educating the patient and her partner about the causes of female sexual dysfunction, the methods of correct FSD diagnosis and the treatment of FSD is central to achieving positive outcomes in the treatment plan. The education process is ongoing and we frequently recommend that the couple read and investigate on their own. Certainly, it is as important for women to maintain a healthy heart as it is for men.

Estrogen replacement is indicated for FSD associated with menopausal symptoms. Estrogen can relieve hot flashes, improve genital sensation and decrease pain and burning with sexual intercourse. Estrogen can be taken as an oral medication, a topical cream, a patch or a ring that is inserted into the vagina. The lowest dosage needed to achieve symptom control is recommended.

Testosterone Replacement in Women

Testosterone concentrations in women and men decrease with aging but the decrease in testosterone in women is unlike the decrease of estrogen. The decrease in a woman's testosterone is not abrupt but is rather a steady decline with age. Testosterone in women has central and peripheral effects. With testosterone replacement, many women report increased libido, increased feeling of well-being, increased energy, vaginal tissue relaxation and improved lubrication.

Current methods of testosterone replacement in women are in the form of topical gels and oral medications. Testosterone replacement in women is controversial and challenging. One challenge is that lab testing methods for the evaluation of testosterone in women are based upon the much higher concentrations found in men. The guidelines to determine what is "normal" in the pre- and post-menopausal woman are based upon test values of women without FSD.

Side Effects of Testosterone Replacement in Women

A second challenge is the side effects that some women experience with testosterone replacement including acne, oily skin, menstrual irregularities, increased hair growth or enlargement of the clitoris. These potential side effects occur mostly at higher doses, but have been reported at lower doses as well and many women find them unacceptable and discontinue testosterone use.

Other Treatment Methods for FSD

Urinary tract symptoms of overactive bladder, stress urinary incontinence and interstitial cystitis (IC) should be treated and controlled. Overactive bladder is complex and has been reported to cause a significant decrease in quality of life for women. It may be the cause of some FSD but it can be treated successfully with anticholinergic/antimuscarinic medications. Many of the newer medications for overactive bladder do not have the drying effect the older medications had and do not cause decreased lubrication.

Over one-fifth of women with interstitial cystitis report dyspareunia and over one-third completely abstain from sex because of the pain. Controlling the symptoms of interstitial cystitis is helpful to these women.

Stress urinary incontinence impacts physiological well-being. A recent study found that more than 40% of women have some type of sexual dysfunction associated with urinary incontinence. Urinary incontinence can be easily corrected by medication or surgical intervention.

The first treatment approved by the FDA for arousal and orgasmic disorders in women is the Eros-Clitoral Therapy Device. It is a small hand-held device that fits onto the clitoris. The gentle vacuum increases blood flow to the clitoris and surrounding tissue. Clinical studies reported improvement in pre- and post-menopausal women with sexual arousal disorder and/or orgasmic disorder. Vielle is a clitoral stimulator that is used with lubricant to increase blood flow to the clitoris and surrounding tissue. Both devices have been successfully used by patients.

Herbal products such as Zestra have been reported to enhance sexual function in women. Zestra is a natural oil containing botanicals. When it is gently massaged into the female genitalia 3-5 minutes prior to sexual intercourse, it can increase levels of arousal, desire, satisfaction and sexual pleasure.

References: Bibliography

August 2006
Posted August 2008
Updated November 2009

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