Dr. Goldstein describes the available treatments for women with sexual dysfunction.
The treatments for sexual dysfunction when a woman comes to see a sexual medicine physician for a consultation and is found to have a sexual health problem, low interest, poor arousal, can’t orgasm, hurts when having sex, some package of one, two or three or four of these items is based on what is wrong and what is found during the evaluation.
So the evaluation ideally is a psychologic and physiologic one. So during the psychologic one if there are partner issues or depression or anxiety or certain medications that someone is taking where let’s say an SSRI for depression would cause low interest and poor orgasm. Those are recognized side effects.
So if it is a medication issue, we can sort of see if we can switch the medication or there are antidotes that can be provided. During the evaluation, tests are done to see if there is numbness or sensation changes. We can provide therapies that improve sensation. If the tests show that there is testosterone low or estrogen is low or progesterone is low or DHEA is low or thyroid is low or SHBG, this protein made that binds the testosterone, if SHBG is too elevated–those are also strategies that we can employ.
When we get beyond the hormonal package we can move into drugs like Viagra®, what we call the class is phosphodiesterase type 5 inhibitors. We are now appreciating that when a woman is in a normal hormonal state, the use of these drugs that men are using for erections and increased blood flow to their genitals, they will result in increased blood flow to the women’s genitals. So in an appropriate woman who has a problem, let’s say with dryness or poor orgasm, having better blood flow to her genitals would be very helpful to her.
We have drugs that improve the chemical balance of the brain. We talked about this as the balance being here, inhibition to an excitation. If there’s the balance has been shifted because of too much inhibition, we have drugs to reduce the inhibition and improve the excitation.
The chemical dopamine is involved in sexual interest and sexual arousal, sexual orgasm. We have ways to increase dopamine in someone’s central nervous system. We have ways to increase noradrenalin, another drug that’s involved or chemical that’s involved in arousal response. We have ways to disinhibit or get rid of some of the inhibition that’s serotonin brings. Serotonin drugs are used for depression. So we want to switch off some of the serotonin. The treatment is tailored to the individual’s needs basically.
About Dr. Goldstein, M.D.:
Dr. Irwin Goldstein is Director of San Diego Sexual Medicine at Alvarado Hospital, the Secretary of the International Society for the Study of Women’s Sexual Health, a former President of the Sexual Medicine Society of North America and a Clinical Professor of Surgery at University of California at San Diego.
Dr. Goldstein has been involved with sexual dysfunction research since the late 1970s. His specialties include penile microvascular bypass surgery, surgery for dyspareunia, physiologic investigation of sexual function in men and women, and diagnosis and treatment of sexual dysfunction in men and women.