Sept. 6, 2000 -- Sex -- It's everywhere you look: on television, in the movies, magazine ads, and in news articles. But what if you want to jump on the bandwagon, but just can't? Sexual dysfunction among men has begun to get more attention, and the same is becoming true for women. The days of "Honey, I have a headache" may soon only be used by a woman when she really does have a headache.
Sexual dysfunction, especially in women, is little understood. However, it is known that there can be certain physical problems associated with a loss of sexual desire -- menopause for one.
The mechanical problems associated with menopause -- vaginal dryness, loss of elasticity, hot flashes, irritability, and loss of bladder control -- are often thought to be due to the abrupt loss of natural estrogen. For women who can take hormone replacement therapy (HRT), these problems are often easily addressed. Even without HRT, use of an estrogen cream or ring placed in the vagina can help.
However, lack of arousal, desire, and less intense orgasms are often overlooked and not helped by HRT alone. Currently, interest has turned to women's replacing testosterone levels, which is associated with sexual arousal and desire.
Menopause occurs naturally, but it also can be brought on by surgery. Abrupt changes in sexual response often occur after a woman's ovaries are removed, causing profound changes in testosterone and estrogen levels.
A study reported in the Sept. 7 issue of TheNew England Journal of Medicine looked at a group of women who had both ovaries removed and who were on HRT. Their average age was 48, and they all reported a less than satisfying sex life.
The study, which was led by researchers from Massachusetts General Hospital in Boston, tested two testosterone patches against a placebo patch containing no hormones. The researchers found that the low dose and the placebo patch gave about the same results of improved sexual functioning, leading them to conclude that there was a psychological impact of simply giving attention to the women's sexual dysfunction. However, when the women were put on the high-dose patch, there was a twofold to threefold increase in sexual activity, which included desire, arousal, activity, and pleasure.
"The significant finding of the study was that the higher testosterone dose, which importantly was still within the normal range for reproductive-age women, did result in significant increases in frequency of sexual activity and ratings of pleasure," study author Jan Shifren, MD tells WebMD.
Shifren, an assistant professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School in Boston, and a reproductive endocrinologist at the Vincent OB/GYN Service at Massachusetts General Hospital, says an additional highlight of the study was that the women reported a better sense of overall well-being.
Barbara Bartlik, MD, a psychiatrist and sex therapist at New York Weill Cornell Medical Center in New York City, has patients use a testosterone cream applied to the inner thighs or vaginally that she claims is effective.
Testosterone is very important, she says. "You take a woman who is low in testosterone and her orgasms are like a little sneeze, a little blip, and these are women who used to experience all-encompassing, total-body orgasms," Bartlik tells WebMD.
While Bartlik calls it an embarrassment that more study isn't being done on women's sexuality and sexual functioning, she says there are some other advances in female sexual medicine. Among the top 10, she listed:
- oral medications, such as the use of Viagra for women,
- topical medications to enhance stimulation,
- the ERO-CTD -- a flexible cup that stimulates the clitoris and improves arousal,
- erotic and educational videos written, produced, and directed by women, and
- improvements in sexual lubricants and vibrators.
However, testosterone tops Bartlik's list. While stating that it still is not commonly used in clinical practice and has not yet received FDA approval for this purpose, studies such as Shifren's should begin to shed light on this important hormone, she says.
There are questions of using supplemental testosterone akin to those of using estrogen replacement -- will it cause hormone-activated cancers, will it cause women to lose the heart protective aspects of estrogen? Bartlik says there is not enough research to begin to even offer answers. Some research in men suggests that testosterone protects against heart disease in them just as estrogen protects women. It's a new frontier for research.
Bartlik says testosterone replacement makes sense because "if we're losing estrogen and losing testosterone, why are we only replacing estrogen?"
So who would most benefit from this skin patch therapy?
Shifren and other experts agree that if a woman had a very good sexual relationship prior to menopause or a complete hysterectomy and is no longer experiencing those same responses, she would benefit from such therapy.
And none too soon, according to Carole Altman, PhD, a sex therapist who says attention needs to be paid to more than just menopausal women. Addressing female sexual dysfunction is difficult, because often there is not one cause to address. Relationship issues, psychological problems, as well as physical conditions all go hand in hand. But they need to be faced: "There is such a sexual anorexia in this country," Altman tells WebMD.
Altman, the author of You Can Be Your Own Sex Therapist and 101 Ways To make Love Happen, says sex is our built-in health care system. "When you have an orgasm or an ejaculation, your blood pressure improves, your muscles become toned, your immune system increases, your sense of self and well-being increases, and there's a euphoria that comes over the body which is very important."
Altman says there are simple ways to address what she considers as important an aspect of everyday life as eating and breathing. "Touching, fantasizing, sexual games, focusing, bathing together, and brushing each other's hair," are among the various ways Altman says couples can initiate intimacy.
She also tells women to do the Kegel exercise. By learning to control the vaginal muscles through this technique of contracting and relaxing them, women can increase lubrication. "When they feel the lubrication start to come, they'll feel sexual again, and if they don't feel sexual per se, they'll feel female."
"We're really neglecting ourselves, we're body building, popping vitamins, yet we're not doing the one thing God gave us -- man and woman merging with each other," Altman says. "We're neglecting a very important aspect of our health, mental and spiritual well-being, and the ability to feel love."
As for testosterone, it is not yet FDA-approved for use in female sexual dysfunction. Bartlik says
many doctors will not feel comfortable using non-FDA approved therapies, but women can find qualified medical sex therapists by checking with the American Association of Sex Educators, Counselors, and Therapists or the American Board of Sexology, both of whom certify therapists. Also, some gynecologists and urologists have a particular interest in female sexuality and may be amenable to helping with various therapies.
Altman sums it up: "We have to get back to having intercourse, kissing, hugging, and loving each other, she says. Quoting Wilhelm Reich, a pioneer in sexuality and orgasm research, Altman says "[orgasm] is the only singular moment in all of your life where you're totally relaxed."
Shifren and her colleagues currently are doing more study on the testosterone patch. Women who want to take part in the new trial can call (877) 54WOMEN to see if they qualify.