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    Understanding Female Sexual Problems -- Diagnosis and Treatment

    What Are the Treatments for Sexual Problems in Women? continued...

    Postmenopausal systemic estrogen therapy should be tried first. Local hormone therapy (vaginal estrogen cream) can reestablish sensitivity and restore the ability to have an orgasm. If improvement does not occur within three to six months, testosterone may be added. Research has not established a relationship between a specific level of testosterone and diminished sexual symptoms. Androgen replacement may be considered if you've entered menopause before age 40.

    Arousal problems may be difficult to resolve if you've never experienced sexual satisfaction. Therapies are designed to help the patient relax, become aware of feelings about sex, and eliminate guilt and fear of rejection.

    Inadequate lubrication in a healthy, premenopausal woman may reflect either a muted sexual response or inadequate arousal by the partner. Explore feelings about sex and seek to eliminate guilt and fear of rejection. Extended foreplay, masturbation, and relaxation techniques may help. Artificial lubricants are available over the counter at any pharmacy.

    For an inability to achieve orgasm, communicating with your partner about your desires for sexual foreplay and intercourse is an essential first step toward satisfaction. Psychotherapy may help improve communication skills and help resolve underlying conflicts about sexuality. With therapy and a supportive partner, the improvement rate is good.

    For pain during intercourse, first make sure there is adequate stimulation and lubrication. A physical exam may reveal a need for medication to treat infection. Or it may be necessary to remove scars around the hymen or gently stretch painful scars at the vaginal opening. Laparoscopic surgery to relieve “deep pain” can often treat endometriosis and pelvic adhesions. Problems related to menopausal change may be relieved with postmenopausal hormone therapy. If pain persists, psychotherapy may help uncover hidden fears about intercourse. Certain exercises -- called sensate focus exercises -- can teach appropriate foreplay and de-emphasize intercourse until both partners are ready. Education can reduce fears of pregnancy or of harm to the fetus.

    Vaginismus is difficult to reverse without professional help. If you have a partner, seek therapy together in a safe and supportive environment. To accustom your body to the feeling of penetration, a therapist may recommend inserting a series of vaginal dilators, each slightly larger than the last. You advance at your own pace until you are comfortable inserting a dilator the size of your partner's erection. Contraction and relaxation exercises can teach control of the vaginal muscles and increase sexual responsiveness.

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