By: Holly L. Thacker, MD
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Some women struggle to enjoy sex. It’s a common issue and also a complicated one because the reasons for these feelings can vary widely from one woman to another. It can be a physical issue, a psychological issue, or both. And it can make women and their partners feel isolated or less connected, so it’s important to address these issues.
What doctors call Female Sexual Dysfunction (FSD) can fall into five types of problems:
- Low libido, or what doctors refer to as Hypoactive Sexual Desire Disorder (HSDD).
- Painful sex. This can include pain during sex due to menopausal vulvo-vaginal atrophy resulting from a lack of hormones as well as a burning pain syndrome of the genitals.
- Difficulty being aroused. Sexual Arousal Disorder can originate in the genital area (comparable to erectile dysfunction in men) or an issue at the brain level (which is more common in women).
- Aversion to sex. Often, this is related to a history of sexual abuse.
- Inability to achieve orgasm. Up to 10-20 percent of women never achieved orgasm and many others have difficulty. But there are treatments available for this.
It’s important to note that if a woman isn’t bothered by low libido or if she likes intimacy with her partner but simply doesn’t seek it, this isn’t considered a problem. It is normal for women to lose some of their sexual drive as they get older, and much depends on whether or not she considers this an issue.
Treatments for sexual dysfunction
There are a variety of treatments for sexual dysfunction, depending on the root cause of the problem. There are a variety of options, including an oral medication and hormones as well as others that are simply creams or devices that help women feel aroused.
Possible treatments include:
- Off-label testosterone – This can effectively treat low libido but requires the help of a hormone expert. Too much testosterone can lead to acne, hair loss, facial hair growth, aggressiveness and permanent voice changes.
- Zestra – Currently, over-the-counter Zestra (a botanical oil to apply to the genitals) is available to enhance a woman’s ability to climax.
- EROS device – The FDA-approved agent, the EROS device, is available by prescription to help women with climax.
- INTONE ™ and Intensity™ – There is a new FDA approved electrical stimulating device called INTONE ™ devised to help treat urinary leakage in women that may also help with orgasmic capacity. In fact, a smaller device, called Intensity™ works on its own to improve and stimulate female orgasms and does not require physician prescription.
- Vaginal estrogen – Available as a cream, a tablet or a vaginal ring, and considered the best treatment for genital arousal problems and pain from vulvovaginal atrophy that occurs in many postmenopausal women.
- Off-Label use of Vaginal DHEA 1 percent suppository – An adrenal precursor that women with vaginal atrophy/thinning/decreased sensation can use as an alternative to vaginal estrogen.
- Osphena – The first, non-estrogen oral therapy for moderate to severe painful sexual activity due to vulvovaginal atrophy.
- Flibanserin (Addyi®) – This drug was recently approved by the FDA to restore female sexual desire in women before menopause. It must be taken orally every day, and it may have side effects, such as severe low blood pressure and fainting.
To find the right treatments, women should talk with their doctors. There is help for female sexual dysfunction — it’s treatable and there are a variety of treatment options.