Treatments for sexual dysfunction

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Treatments for sexual dysfunction

Tuesday, February 13, 2001

By Christopher Snowbeck, Post-Gazette Staff Writer

A new book by sisters Dr. Jennifer Berman and sex therapist Laura Berman called "For Women Only" offers a summary of available and developing medical treatments for women's sexual dysfunction. The Bermans emphasize that no one therapy will provide all solutions. Psychotherapy continues to be an important part of any treatment.

Viagra -- Also known as sildenafil, Viagra blocks an enzyme that normally prevents erections. For many men, the drug allows blood to flow more freely to the genitals, enabling them to become aroused. Pfizer, the drug maker, is studying whether Viagra will have the same benefit for women. Results so far have been less dramatic. Studies are also under way on two other medicines that affect blood flow in women: prostaglandin E-1 cream and phentolamine (marketed as Vasofem for women).

Hormone replacement therapy -- This treatment, either estrogen or a combination of estrogen and progestin, has been shown to effectively treat symptoms of menopause such as vaginal dryness, which can affect sexual pleasure. But women should talk with their doctors about unresolved questions regarding a possible increased risk of breast cancer and other problems.

Testosterone -- Research is under way on a testosterone skin patch that, according to a study published in the New England Journal of Medicine in September 2000, can help women's sexual response. Testosterone is available through one over-the-counter product as well as EstraTest, a drug that has been approved for treating hot flashes and is being studied for treatment of sexual dysfunction.

Testosterone therapy in high doses can increase hair growth and other masculine characteristics. It also can raise cholesterol levels and risk of liver and heart disease. Pregnant women and women trying to conceive should not take testosterone.

Estrogen and testosterone creams -- Either cream can be effective in women lacking lubrication and sensation.

Two estrogen creams, Estring and Vagifem, can be used by women who only have symptoms of vaginal irritation and/or dryness. Two other estrogen creams, Estrace and Premarin, deliver higher doses that could cause problems for women with histories of blood clots or breast or endometrial cancer.

The Bermans recommend some testosterone creams for increasing genital sensation, but not to treat libido problems.

Apomorphine -- A medicine to be marketed as Uprima, apomorphine works in the brain to stimulate the release of dopamine, a chemical involved in sensations of pleasure and the erection response. The drug awaits FDA approval.

Eros-CTD -- The first FDA-approved treatment for sexual dysfunction, the clitoral therapy device is a small pump with plastic cup attachment that fits over the clitoris and surrounding tissue. It provides suction that simulates the effects of oral sex.

Nerve-sparing surgery -- Surgeons are developing pelvic surgeries for women that spare sexual function, much as doctors at Johns Hopkins University have pioneered nerve-sparing surgeries for removal of the prostate gland.

Changing medicines -- Many medications, particularly antidepressants, can cause sexual dysfunction. Some drugs in the same classes of medicines don't cause as much dysfunction as others.