Female Sexual Dysfunction: A Medical Treatment Era Begins

The modern era of male sexual dysfunction began in 1973 with the advent of the inflatable prosthetic devices by American Medical Systems. Female sexual dysfunction has basically been neglected because no therapy was available. With the advent of Viagra by Pfizer Pharmaceuticals, effective therapy for some forms of female sexual dysfunction may become available to the general public.

Female sexual dysfunction can be classified into five basic areas including:

1. Desire problems
2. Arousal difficulties
3. Lubrication factors
4. Pelvic congestion
5. Orgasmic difficulties

For males, desire problems are minimal and usually related to hormonal difficulties. For females, desire problems occur in more than 33 percent of dysfunction cases. This is probably related to the more complex psychological aspects of female sexuality. On the other hand, many of these patients can be helped. In males, desire problems make up only five percent of all sexual dysfunction. Arousal, lubrication, and pelvic congestion issues together probably represent about half of all female sexual problems and, fortunately, is the area in which pharmacology in the near future appears to offer the greatest hope.

Orgasmic problems make up the significant remainder (17 percent) and are the hardest overall to treat. However, improvement in desire, arousal, pelvic congestion, and lubrication in some cases may lead to satisfactory orgasmic responses.

The issue of pelvic, genital and vaginal discomfort during sexual activity which is extremely complex and can be related to multiple factors including bowel, bladder and local pathology. So what should women do?

A woman--regardless of age -- with a sexual problem should see a qualified doctor and have a good medical and sexual history taken, a general physical exam, with a good genital and pelvic examination, followed by basic blood studies, including CBC and chemical profile. Specific pathology or causes for pelvic or genital pain, or any other pelvic or general pathology, should be treated. But in the end, most women will have function problems --desire, arousal, lubrication, pelvic congestion and orgasm.

Women need to know that some help is here now and that other modalities that are either already accepted or are in the development phase.

APOMORPHINE: An old medication originally used as an emetic. It has a central enhancing effect working on the paraventricular nuclei of the brain stem and allowing sexual stimulation to increase central sexual function. This drug appears in women not to improve sexual desire, but will take stimuli that normally is not effective in producing improved sexual function to more normal sexual capabilities. Research is being done now on this drug and use on women.

Since sexual desire problems represent one-third of all sexual problems in females this drug may play a role in women who have diminished sexual desire since it potentiates central sexual stimulation. Side effects include nausea and vomiting, hypotension, and syncope. It appears that the 2 and 4 mg dosage sublingually (under the tongue) will be available and its effects should be within 10 to 15 minutes of sublingual absorption. This drug will be able to be used in patients who are taking nitrates on a regular basis for angina. This is also big news to men who take nitrates and are warned NOT to take Viagra.

TESTOSTERONE: Testosterone is the most commonly used drug for the treatment of sexual dysfunction in women. It appears best in those women in which desire is diminished. Extremely low doses, one-tenth the dose that males take is all that is necessary for its positive sexual effects on women. Twenty mg subcutaneously (under the skin) every three weeks is a fairly standard dose. Creams, patches, and combinations with estrogen and progestational agents are being developed. Its major side effects include masculinization, but when used properly rarely occurs. The oral forms of testosterone should never be used on a chronic basis due to its high incidence of serious liver toxicity.

VIAGRA (sildenafil citrate): Viagra has revolutionized male sexual dysfunction with approximately 75 percent of men responding. It works by inhibiting the phosphodiesterase inhibiting enzyme that is specifically found in the male and female pelvic area (type V phosphodiesterase inhibitor). By inhibiting this enzyme cyclic GMP is stimulated and with it associated dilation of the pelvic blood vessels, increased blood flow, and pelvic congestion occurs.

Improved vaginal engorgement and lubrication are the major byproducts of this medication. Side effects have been minimal with facial flushing, headaches, stomach upset, and a brightened vision associated with a green-blue halo. This drug should never be taken with nitrates since serious life-threatening complications may occur. Nitroclycerine and nitrate-containing drugs should never be given with 24 hours of Viagra. The drug is absorbed best on an empty stomach and one should wait for at least one hour before sexual stimulation to allow maximal effect. A window of 1 to 4 hours after taking the drug appears to be optimal, however, it is not unheard of for this drug to have sexual potentiating effects for as long as 12 to 14 hours.

VASOMAX: Vasomax is the next male sexual drug to probably be introduced in the United States. It is a rapid-released form of phentolamine, a general alpha I blocking agent that increases blood flow to the organs of the body including the pelvic organs such as the vagina. It will work similarly to Viagra in the sense of improving vaginal engorgement, lubrication, and probably arousal. It can be taken in patients who are using nitroclycerine or nitrate medications for angina. Its major side effects include a transient drop in blood pressure associated with syncope, nausea, and vomiting.

Female sexual dysfunction is beginning to be treated by use of medications that are being developed for male sexual dysfunctions. Apomorphine for male sexual dysfunction will have a role in female sexual dysfunction as well. Viagra and Vasomax will have similar female sexual dysfunction treatment use. Expect newer and more exciting drugs for female sexual dysfunction to grow from the research in male sexual difficulties.