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Daily Tip:
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Treatment of Sexual Arousal Disorders: Some of the same therapeutic approaches may be recommended for disorders of desire and arousal, and therapy needs to focus on both partners in a couple and not just the patient with the problem. Addressing psychosocial and relationship issues is critical to successful treatment. For example, couples need to be educated that as they age, both men and women require more focused, direct, and lengthy stimulation to become sufficiently aroused. New and stimulating sexual routines may need to be implemented to make sex interesting again to long-standing partners, because repetitive, boring, and short routines may lead to lack of interest and arousal. Anxiety and inhibitions that can affect arousal also may need to be addressed. Your physician should begin by providing education about the disorder and recommending various non-medical treatment strategies. These include: use of erotic materials, such as |
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"Couples need to be educated that as they age, both men and women require more focused, direct, and lengthy stimulation to become sufficiently aroused"
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vibrators, books, magazines and videos; sensual massage, avoiding the genitals; position changes to reduce pain; use of lubricants to moisten the vagina and genital area; kegel exercises to strengthen the vagina and clitoris therapy to overcome any relationship or sexual abuse issues The medical treatments include: Estrogen replacement therapy, which may help with vaginal dryness, pain and arousal; testosterone therapy in women who have low levels of this male hormone (Side effects, however, may include deepening voice, hair growth, and acne); the EROS clitoral therapy device (EROS-CTD), recently approved by the Food and Drug Administration; a small vacuum pump, placed over the clitoris and gently activated to provide a gentle suction designed to increase blood flow to the region, which, in turn, helps with arousal; using the herb yohimbine combined with nitric oxide has been found to increase vaginal blood flow in postmenopausal women and thus help with some forms of FSAD Vaginal lubricants: A variety of lubricants are available over the counter to reduce vaginal irritation during stimulation and intercourse. Regular penetration also appears to increase vaginal lubrication in and of itself. Vaginally administered estrogen: Estrogen |
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therapy can be of benefit to postmenopausal women who experience a lack of lubrication and genital vasocongestion. Treating atrophy with estrogen may increase sensation, but the Women’s Health Initiative findings about the increased risks of cardiovascular events and breast cancer associated with hormone therapy make recommendation of oral estrogen therapy controversial. Estrogen delivered vaginally (in which case it is minimally absorbed systemically) appears to be as effective as oral estrogen therapy to relieve menopause-related vaginal symptoms. Phosphodiesterase inhibitors: Sildenafil (Viagra®) has been investigated for the treatment of female sexual arousal disorders. Although sildenafil increases the vasocongestive response to sexual stimulation, studies have produced inconsistent results in terms of subjective arousal, solidifying the idea that women may demonstrate physical signs of arousal but not feel aroused emotionally. Pfizer Inc. announced in 2004 that it would not pursue Food and Drug Administration (FDA) approval of the drug for use in women. Sildenafil may still have a role in treating selective serotonin reuptake inhibitor-induced sexual problems. Mechanical devices: The EROS™ Clitoral Therapy device is the only FDA-approved device currently available to treat female arousal disorders. The prescription-only device produces clitoral vascular engorgement using a vacuum system and can be used during masturbation and partnered sexual activity. A small trial showed significant improvement in all symptoms of female sexual arousal disorder in women with and without the disorder. Another trial of seven subjects with sexual arousal disorder showed that EROS therapy was associated with significant increases in clitoral engorgement; all subjects also reported either slight-to-moderate pleasure or orgasm. Alternative treatments: Natural estrogens, such as those found in soy products and flax, may be effective. Herbal remedies include belladonna, gingko, and motherwort. However, there is no scientific evidence to prove these herbs actually help. Some women squirt vitamin E in their vagina to increase lubrication. Women may also want to see a sexual therapist for additional help. Zestra™: A botanical feminine massage oil formulated to enhance female sexual pleasure and arousal when applied to the vulva, Zestra was compared in a randomized, double-blind, crossover study with placebo oil in 10 women with and 10 women without female sexual arousal disorder (FSAD). Both women with and without FSAD showed statistically significant improvements compared with placebo in levels of arousal and desire, satisfaction with arousal, genital sensation, the ability to have orgasms, and sexual pleasure. A greater response was found in women with the disorder compared with women who did not complain of arousal problems. ArginMax™: An herbal supplement, ArginMax has been shown in a small study to improve clitoral sensation and other parameters of sexual arousal and well-being. Prevention: Maintaining a close and open relationship with a partner is one way to avoid the emotional pain and isolation that can lead to sexual dysfunction. Additionally, women should learn if any medications they take affect sexual function, and should refrain from alcohol and drugs and quit smoking. Women who have anxieties and fears about sexual intercourse, whether because of earlier abuse, rape, or a prudish upbringing, should deal with those issues through therapy.
Generally, once women seek the appropriate help they are quite likely to find a way to resolve their problems. Often, a holistic approach, using physical as well as emotional therapies, is required for success
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Author: Dr. Rachel
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