A New Focus on Female Sexuality

From the WebMD Archives

June 9, 2000 -- It made her feel as tingly as a high school girl, says the 44-year-old New York marketing executive.

The executive, who spoke on condition of anonymity, says she tried a topical Viagra cream because she sometimes experiences periods of lower sexual desire. The cream is applied 15 to 20 minutes before intercourse, and the result is "a tingly sensation in the vaginal area," she tells WebMD. "It made me feel like I was back in high school -- very erotic and arousing."

The idea that Viagra might be able to help women, following on the heels of its much-touted success in men, is bringing the topic of female sexual dysfunction out of the closet and into everyday conversation. So is the medical tag team of Laura and Jennifer Berman, PhD and MD respectively, who are helping to shatter the myth that women do not have the same sort of sexual responses, needs, and problems with desire and arousal as men do.

The Berman sisters have made television appearances on Larry King Live and other talk shows, and are often quoted in newspaper and magazine articles about female sexuality. At the annual Congress on Women's Health and Gender-Based Medicine, held recently in Hilton Head, S.C., they spoke about their recent work and women's sexual issues in general.

Laura Berman is a sex therapist who, with her sister, Jennifer, a urologist at the Women's Sexual Health Clinic at Boston University Medical Center in Boston, is exploring both the physical and psychological aspects of low sexual desire.

A recent survey looking at women ages 18 to 59 showed that 43% of women have complaints about sexual function, Laura Berman says. She tells WebMD that women need to tell their physicians when they feel that their sexual functioning is not what it should be.

"[If] it's something that's missing for them, they should ask their physicians about it -- whether it's complaints of lack of interest, whether it's lack of arousal, sensation, not being able to reach an orgasm, or the intensity of the orgasm," she says. This is especially true if the woman's sex life was OK before and suddenly changed.

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Low desire, sometimes called hypoactive sexual desire disorder, is one of women's most common sexual complaints. To be considered a medical problem, according to the American Foundation of Urologic Diseases, this lack of desire must be "persistent and pervasive" and cause a woman personal distress. This last point, Laura Berman says, is most important -- "in other words, one woman's inadequate orgasm is another woman's dream orgasm."

The Bermans have been looking at what they say is a subset of low sexual desire -- low arousal disorder, which they define as an inability to achieve adequate lubrication, swelling, and sensation (separate from orgasm).

One of the biggest problems in treating female sexual dysfunction is the fact that so many factors are involved -- the physical aspect, relationship issues, self-esteem issues. "You can't just send a woman home with medication," Jennifer Berman says.

This may be one reason why Viagra does not seem to hold the same promise for women as it does for men. But in their research, the Bermans say, they have found that Viagra does work well for a certain group of women, especially those who don't suffer from syndromes associated with chronic sexual abuse.

They studied 35 women, 23% of whom had unresolved sexual abuse issues, and assessed them in terms of vaginal lubrication, quality of sensation, ability to reach orgasm, and sexual satisfaction. Viagra appeared to bring about improvements in all areas in 60% of the women who had no unresolved problems related to abuse, and in 29% of those with chronic abuse issues.

Still, the drug is not for everyone. A 48-year-old New York health writer, who spoke to WebMD on condition of anonymity, had a bad experience.

"I have panic disorder, so I take medications for that, and as a side effect of that medication, I experience delayed orgasm," she tells WebMD. Her doctor suggested Viagra in pill form.

"So I tried it," she says. "It was a very unpleasant experience. My blood pressure dropped. I got a killer headache, and my face turned bright red, and I had panic attacks -- all without an orgasm."

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So instead, she reduced the amount of medication she was taking for the panic disorder, and her sexual function has since improved.

Vasoactivate drugs such as Viagra continue to be studied in the U.S. to determine which women will most benefit from them, Jennifer Berman says. Maybe a drug like Viagra is not the same magic bullet for women as it is for some men, but perhaps in combination with other drugs or hormones, it may still have its place in the female sexual pharmacopia. Researchers also are looking at testosterone pills and creams for women.

In their clinic, the Bermans use actual physical measurements to help assess sexual problems. Jennifer Berman measures genital blood flow, vaginal pH (the pH increases with sexual stimulation), inner vaginal pressure changes, and how well the genitals perceive movement. Of the latter, she says that often, women complain of "feeling asleep" in their vaginas or labia.

These measurements are important because assuring a woman there is a physical reason for her lack of arousal or desire takes away the "it's all in your head" aspect.

When taking these measurements, the Bermans go so far as to choose erotic videos that are more appealing to women. Those shown to men usually have little if no effect, they say. The main difference, Laura Berman says, is "they actually have a plot."

The main point for women to take into the bedroom, she tells WebMD, is that they should be advocates for their own sexual needs. If there is a physical problem, it needs to be addressed. But women also need to learn about their bodies and take responsibility for teaching their partners how to sexually satisfy them, she says.

"Some women are under the impression that they will be perceived as some sort of harlot if she shows him, describes to him, or instructs him how to sexually satisfy her," she says. "That's really more of a myth than anything else, and most men really do appreciate it."

Vital Information:

  • A recent survey showed that 43% of women have sexual function complaints, with one of the most common being low desire.
  • Two experts on female sexual dysfunction advise women to go to their physicians with any sexual problems, including lack of interest, arousal or sensation; not being able to reach orgasm; or insufficient intensity of orgasm.
  • Female sexual dysfunction can be treated, although this can be tricky due to the many factors involved -- physical aspects, the nature of the woman's relationship, and her self-esteem.
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