Millions of American women will go to bed tonight unhappy and unsatisfied, with many thinking “What’s wrong with me? Why don’t I enjoy sex?” If this sounds like something you’ve thought about recently, understand that you are not alone. Female sexual dysfunction is a very common disorder. I would say it affects a majority of women, usually beginning in their 30s, yet some women develop symptoms in their 20s. But it certainly becomes more common as women enter perimenopause, which usually begins 15 years before menopause.
Of course, some women are certainly thrown into menopause earlier by surgical menopause, or due to fibroid tumors or ovarian surgery, which can lead to female sexual dysfunction by disrupting arterial blood supply or nerve endings.
Female sexual dysfunction can be broken into three separate types:
1. Decreased libido: This can be further termed hypoactive sexual desire disorder. Many medications, including oral contraceptive pills, synthetic hormones, psychiatric medications (including anti-psychotic, anti-depressants and ADHD drugs), anti-seizure medications, blood pressure medications, sleep medications and cholesterol-lowering medications can all decrease libido and sexual function.
2. Dyspareunia: This has two components, superficial and deep. Superficial dyspareunia can be due to atrophic vaginitis (atrophy of the vaginal tissues) or it may be due to vulvodynia, which can be related to neuropathy or even occur after candida infections. Deeper dyspareunia can be due to vaginismus (involuntary contractions of the vaginal muscles).
3. Emotional factors: The third cause of female sexual dysfunction can be due to emotional factors, including stress, low self-esteem and lifestyle issues.
Treatments are available for all of the aforementioned causes of sexual dysfunction. One common treatment involves bio-identical hormone replacement therapy. In essence, this therapy uses biologically identical hormones to make you feel like you are in your 20s once again. This plays a key role in combatting female sexual dysfunction, in several ways. First, the estrogen, progesterone, and testosterone can improve the tone and integrity of the vaginal tissue. It increases promotion of nitric oxide in the body.
In my office I do hormonal panels and use questionnaires to assess what hormonal deficiencies may be present and I can prescribe a natural hormone supplementation including estrogen, progesterone, DHEA, testosterone, oxytocin, or others if needed. I can also suggest natural agents to replete other brain neurotransmitters if needed. If you would like more information about bioidentical hormones, please refer to the sections on bioidentical hormones on my website homepage.
There are also various neutraceutical and herbal remedies that have been used for centuries to improve libido. These include Horny Goat Weed, which works as a phospho-diesterase inhibitor, in other words, a natural-acting Viagra. There is also L-Arginine, which improves growth hormone levels and relaxes smooth muscle, improving clitoral and vaginal blood flow. Other herbals that have been shown effective for treating female sexual dysfunction include ginseng ginkgo damiana, B complex vitamins, and MACA, or Muira Puama Catuaba.
In general, agents that increase dopamine, or decrease serotonin lead to sexual excitation. For this reason, most of the antidepressants (Prozac Paxil, Zoloft, Celexa) affecting serotonin levels usually cause sexual dysfunction in men and women. From a pharmaceutical standpoint, the FDA rejected Flibanserine as a treatment for female sexual dysfunction. The drug had shown increased dopamine levels in trials and improved libido in laboratory animals.
For general support, most women can benefit from a multivitamin, Omega 3 fatty acids (through fish oil supplements), Vitamin D supplements, thyroid optimization and bio-identical sex hormone balancing.
Beyond the aforementioned therapies to treat the physical symptoms, it’s important for a woman to make lifestyle changes to improve her sexual function. Foremost among these is making dedicated time for intimacy. Set aside time with your partner for two or three date nights a month. If you have kids at home, set up a trade-off with friends where you take turns watching each other’s kids for some alone time on these date nights. In the bedroom, experiment, keep it novel, and have fun.
And as always, if you have any questions or concerns on this or any other health-related issue, please contact my office for a consultation.