PhytoScience - Article

Sexual disfunction - Females

 

Has your sex life lost some of its spark because your body feels unresponsive or you're just not interested? You might take comfort in knowing that as many as four in 10 women have the same problem at some point in their lives.

If you have persistent or recurrent problems with sexual response {and if these problems are making you distressed or straining your relationship with your partner} what you're experiencing is known medically as female sexual dysfunction.

Female sexual dysfunction has many possible symptoms and causes. Fortunately, they're almost all treatable. Communicating your concerns and understanding your anatomy and your body's normal response to sexual activity are important steps toward gaining sexual satisfaction.

Signs and symptoms

You can develop female sexual dysfunction at any age, but sexual problems are most common when your hormones are in flux; for example, when you've just had a baby or when you're making the transition into menopause. Sexual concerns may also occur with major illness, such as cancer.

Your problems might be classified as female sexual dysfunction if you experience one or more of the following and you're distressed about it:

  • Your desire to have sex is low or absent.
  • You can't maintain arousal during sexual activity, or you don't become aroused despite a desire to have sex.
  • You cannot experience an orgasm.
  • You have pain during sexual contact.

Causes

Several factors may contribute to sexual dissatisfaction or dysfunction. These factors tend to be interrelated.

  • Physical. Physical conditions that may cause or contribute to sexual problems include arthritis, urinary or bowel difficulties, pelvic surgery, fatigue, headaches, other pain problems, and neurological disorders such as multiple sclerosis. Certain medications, including some antidepressants, blood pressure medications, antihistamines and chemotherapy drugs, can decrease your sex drive and your body's ability to achieve orgasm.

  • Hormonal. Lower estrogen levels during the menopausal transition may lead to changes in your genital tissues and your sexual responsiveness. The folds of skin that cover your genital region (labia) become thinner, exposing more of the clitoris. This increased exposure sometimes reduces the sensitivity of the clitoris, or may cause an unpleasant tingling or prickling sensation.
    In addition, the vaginal lining becomes thinner and less elastic, particularly if you're not sexually active. At the same time, the vagina requires more stimulation to relax and lubricate before intercourse. These factors can lead to painful intercourse (dyspareunia), and achieving orgasm may take longer. Your body's hormone levels also shift after giving birth and during breast-feeding, which can lead to vaginal dryness and can affect your desire to have sex.

  • Psychological and social. Untreated anxiety or depression can cause or contribute to sexual dysfunction, as can long-term stress. The worries of pregnancy and demands of being a new mother may have similar effects. Longstanding conflicts with your partner {about sex or any other aspect of your relationship} can diminish your sexual responsiveness as well. Cultural and religious issues and problems with your own body image also may contribute.

    Emotional distress can be both a cause and a result of sexual dysfunction. Regardless of where the cycle began, you usually need to address relationship issues for treatment to be effective.

When to seek medical advice

If sexual problems are undermining your relationship or disrupting your peace of mind, make an appointment with your doctor for evaluation.

Screening and diagnosis

You might be reluctant to consult your doctor about sexual concerns, but your sexuality is integral to your well-being; and it's standard practice during general medical visits for doctors to ask about sexual health. The more forthcoming you can be about your sexual history and current problems, the better your chances of finding an effective approach to treating them.

You may need a pelvic exam, during which your doctor will check for any physical changes that may be diminishing your sexual enjoyment, such as thinning of your genital tissues, decreased skin elasticity, scarring or pain.

Your doctor may also refer you to a counselor or therapist specializing in sexual and relationship problems.

Female sexual dysfunction is generally divided into the following four categories, which are not mutually exclusive:

  • Low sexual desire. You have diminished libido, or lack of sex drive.

  • Sexual arousal disorder. Your desire for sex might be intact, but you have difficulty or are unable to become aroused or maintain arousal during sexual activity.

  • Orgasmic disorder. You have persistent or recurrent difficulty in achieving orgasm after sufficient sexual arousal and ongoing stimulation.

  • Sexual pain disorder. You have pain associated with sexual stimulation or vaginal contact.

Sexual response is a complex interaction of many components, including physiology, emotions, experiences, beliefs, lifestyle and relationships. If any one of these components is disrupted, sexual drive, arousal or satisfaction may be affected.

Treatment

Women with sexual concerns benefit from a combined treatment approach that addresses medical as well as emotional issues. Occasionally, there's a specific medical solution; using vaginal estrogen cream, for example, or switching from one antidepressant medication to another. More often, behavioral treatments {such as couple's therapy and stress management} are needed to address the roots of female sexual dysfunction. And sometimes, a combination approach works best.

Nonmedical treatment for female sexual dysfunction
You can improve your sexual health by enhancing communication with your partner and making healthy lifestyle choices.

  • Talk and listen. Some couples never talk about sex, but open and honest communication with your partner can make a world of difference in your sexual satisfaction. Even if you're not used to communicating about your likes and dislikes, learning to do so and providing feedback in a nonthreatening manner can set the stage for greater sexual intimacy.

  • Practice healthy lifestyle habits. Avoid excessive alcohol. Drinking too much will blunt your sexual responsiveness. Also, stop smoking and start exercising. Cigarette smoking restricts blood flow throughout your body, and less blood reaching your sexual organs means decreased sexual arousal and orgasmic response. Regular aerobic exercise can increase your stamina, improve your body image and elevate your mood, helping you feel more romantic, more often. Finally, don't forget to make time for leisure and relaxation. Learning to relax amid the stresses of your daily life can enhance your ability to focus on the sexual experience and attain better arousal and orgasm.

  • Strengthen pelvic muscles. Pelvic floor exercises can help with some arousal and orgasm problems. Doing Kegel exercises strengthens the muscles involved in pleasurable sexual sensations. To perform these exercises, tighten your pelvic muscles as if you're stopping your stream of urine. Hold for a count of five, relax and repeat. Do these exercises several times a day.

    Your doctor also may recommend exercising with vaginal weights {a series of five weights, each increasingly heavier, that you hold in place in your vagina} to strengthen pelvic floor muscles. You gradually work up to heavier weights as your muscle tone improves.

  • Seek counseling. Talk with a counselor or therapist specializing in sexual and relationship problems. Therapy often includes education about normal sexual response, ways to enhance intimacy with your partner, and recommendations for reading materials or couples exercises. With a therapist's help, you may gain a better understanding of your sexual identity, beliefs and attitudes; relationship factors including intimacy and attachment; communication and coping styles; and your overall emotional health.

Medical treatment for female sexual dysfunction
Effectively treating sexual dysfunction often requires addressing an underlying medical condition or hormonal change that's affecting your sexuality.

Treating female sexual dysfunction tied to an underlying medical condition might include:

  • Adjusting or changing medications that have sexual side effects
  • Treating thyroid problems or other hormonal conditions
  • Optimizing treatment for depression or anxiety
  • Strengthening pelvic floor muscles
  • Trying strategies recommended by your doctor to help with pelvic pain or other pain problems

Treating female sexual dysfunction linked to a hormonal cause might include:

  • Estrogen therapy. Localized estrogen therapy {in the form of a vaginal ring, cream or tablet} can improve sexual function in a number of ways, including improving vaginal tone and elasticity, increasing vaginal blood flow, enhancing lubrication, and having a positive effect on brain function and mood factors that impact sexual response.

  • Progestin therapy. In some research studies, women taking progestins experienced a decrease in sexual desire and vaginal blood flow. However, in other studies, women experienced improvements in desire and arousal when they took progestin in addition to estrogen. More studies are under way to see if different progestin regimens, alone or in combination with estrogen and other hormonal agents, may benefit sexual function. Progestins generally are prescribed to balance estrogen's effect on the uterus and not to treat female sexual dysfunction.

  • Androgen therapy. Androgens include male hormones, such as testosterone. Testosterone is important for sexual function in women as well as men, although testosterone occurs in much lower amounts in a woman. Androgen therapy for sexual dysfunction is controversial. Some studies show a benefit for women who have low testosterone levels and develop sexual dysfunction, other studies show little or no benefit.

    Testosterone may be given as a cream or gel patch applied to your skin. Sometimes, testosterone is given as a pill or injection. Side effects, such as acne, excess body hair (hirsutism), enlargement of the clitoris, and mood or personality changes, are possible. Because long-term effects of testosterone therapy in women aren't known, you should be closely monitored by your doctor.

Hormonal therapies won't resolve sexual problems that have causes unrelated to hormones. Because the issues surrounding female sexual dysfunction are usually complex and multifaceted, even the best medications are unlikely to work if other emotional or social factors remain unresolved.

Emerging treatments
Tibolone is a drug currently used in Europe and Australia for treatment of postmenopausal osteoporosis. In a small study, women taking the drug experienced an increase in vaginal lubrication, arousal and sexual desire. But Tibolone hasn't yet received Food and Drug Administration (FDA) approval for use in the U.S.

Coping skills

At each stage of your life, you may experience changes in sexual desire, arousal and satisfaction. Accepting these changes and exploring new aspects of your sexuality during times of transition contribute to positive sexual experiences.

Understanding your body and what makes for a healthy sexual response can help, too. The more you and your partner know about the physical aspects of your body and how it works, the better able you'll be to find ways to ease sexual difficulties. Ask your doctor about how things like aging, illnesses, pregnancy, menopause and medicines might affect your sex life.

Sexual response often has as much to do with your feelings for your partner as it does with physical sexual stimuli. For women, emotional intimacy tends to be an essential prelude to sexual intimacy. Show affection and communicate openly with your partner about your feelings it can help you reconnect and discover each other again.

Complementary and alternative medicine

Several alternative treatments are being investigated for potential to alleviate erectile dysfunction. They include:

  • Acupuncture
  • DHEA
  • Damiana
  • Ginkgo
  • L-arginine
  • Yohimbe

Like mainstream medications and treatments, these alternative approaches also have risks and side effects; especially for men who have chronic health problems or take other medications.

Some alternative products that claim to work for erectile dysfunction can be dangerous. The Food and Drug Administration (FDA) has issued warnings about several "herbal Viagras" including True Man, Energy Max, Rhino Max, Rhino VMax and Libidus. These contain potentially harmful drugs that aren't listed on the label. These drugs can interact with prescription drugs and cause dangerously low blood pressure. These products are especially dangerous for men who take prescription drugs that contain nitrates.

A range of dietary supplements and herbal medicines claim to offer new ways to prevent or treat diseases in general. Some supplements, like mangosteen juice for example, show promise and are slowly gaining acceptance in mainstream medicine. But the benefits and risks of many products and practices remain unproved in human clinical trials.

Although some complementary treatments can be a good addition to your regular treatment, take some precautions first:

  • Don't stop taking your prescribed medications or skip therapy sessions. Complementary medicine is not a substitute for regular medical care.

  • Be honest with your doctors and health providers. Tell them exactly which complementary treatments you practice or would like to explore. There have been many cases {based on patients test results} where doctors have reduced or stopped medications due to the benificial effects from natural health products.

  • Be aware that some complementary treatments can interfere with your regular treatment. Even over-the-counter or so-called natural supplements may interfere with your prescribed medications. When purchasing a health product; look for information that may be found in small print that would indicate drug interactions or product warnings.

  • DHEA: (dehydroepiandosterone) is a hormone produced naturally by the adrenal glands. It is converted in the body to the hormones estrogen and testosterone. Levels of DHEA decline naturally with age and also with a condition called adrenal insufficiency. Both have been associated with low libido, which is why researchers have examined whether DHEA supplements can boost libido in these groups.

    There is some evidence suggesting that DHEA may help older women. In one study, 280 women and men between 60 and 79 years were given DHEA (50 mg) or placebo daily for a year. There was a slight increase in testosterone and estrogen levels in women, and a significant increase in the libido and sexual satisfaction of women over 70 with DHEA use. No benefits were seen in women between 60 and 70 years. Two additional studies have found that DHEA boosted sexual arousal in older women. Not all studies on DHEA and libido have found a benefit, so more research is needed.

    DHEA should only be taken under the supervision of a qualified healthcare practitioner. People taking DHEA supplements should have blood hormone levels monitored regularly. Side effects that have been reported include acne, male pattern hair growth, weight gain around the waist, high blood pressure, and decreased levels of HDL ("good") cholesterol. High doses of DHEA may be toxic to the liver. There have been no long-term studies on the safety of DHEA.

    DHEA is converted to estrogen and testosterone in the body, so people with hormone-related cancers, such as breast, prostate, ovarian, and endometrial cancer should not take this supplement. DHEA should not be taken by children or pregnant or nursing women.

    Certain drugs should not be taken with DHEA (unless under a doctor's supervision) because DHEA can alter the effects of the medication. These include barbituates, cisplatin, steroids, and estrogen replacement therapy.

  • Damiana: (Turnera diffusa) is a herb used traditionally by the Mayan people of Central America to enhance sexual function in men and women. It is reported to be an aphrodisiac, stimulant, mood enhancer, and a tonic.

    The use of damiana as an aphrodisiac is somewhat controversial because there is no scientific evidence that it works and yet it has been widely promoted as a sexual stimulant.

  • Horny goat weed: According to folklore, horny goat weed's reputed aphrodisiac qualities were discovered when a Chinese goat herder noticed increased sexual activity in his flock after they ingested the weed.

    Animal studies indicate that horny goat weed may work by increasing nitric oxide levels, which relaxes smooth muscle and lets more blood flow to the penis or clitoris. Horny goat weed also appears to act by inhibiting the PDE-5 enzyme, which is the same way that the popular drug Viagra works. Some evidence suggests horny goat weed may modulate levels of the hormones cortisol, testosterone, and thyroid hormone, bringing low levels back to normal.

    There isn't enough information on horny goat weed to safely recommend it for erectile dysfunction or menopause. In one study, epimedium koreanum was found to cause significant inhibition of the cholinesterase enzyme. This can theoretically increase the risk of loss of muscle co-ordination and jerky movements due to acetylcholine buildup in muscles. Animal studies also indicate that high doses of icariin, a compound found in horny goat weed, may be toxic to the kidneys and liver.

  • L-arginine: L-arginine is an amino acid that has numerous functions in the body. It is needed by the body to make nitric oxide, a compound that helps to relax blood vessels and allow blood to flow through arteries.

    Studies on L-arginine for sexual dysfunction in women have used a combination product, which makes it impossible to know if any improvement was due to the L-arginine or other ingredients in the formula.

  • Ginkgo: Ginkgo biloba is a herb used for centuries in traditional Chinese medicine as a remedy for respiratory conditions, cognitive impairment, and circulatory disorders. In North America, it is most commonly used to improve cognitive function and memory in people with age-related cognitive decline and memory loss.

    There has been some preliminary studies suggesting that ginkgo may also help people with sexual dysfunction related to antidepressant use. It was first investigated after an older man with sexual dysfunction due to antidepressant use decided to take ginkgo to improve memory. His sexual function improved noticeably, and his case caught the attention of researchers.

    Studies to date, however, have not confirmed the effectiveness of ginkgo for antidepressant induced sexual dysfunction. For example, one small study examined the use of ginkgo or placebo in 37 people with antidepressant-induced sexual dysfunction. After two months, ginkgo was no more effective than the placebo in relieving symptoms. Larger, longer-term studies are needed.

    Ginkgo should only be used under supervision by a qualified health practitioner.

  • Yohimbe: (Not Recommended) The bark of the herb yohimbe (Pausinystalia yohimbe) was historically used as a folk remedy for sexual dysfunction. The active constituent in the bark is called yohimbine.

    Studies have not found yohimbe to be effective for sexual dysfunction in women. Yohimbe is not recommended and is a potentially dangersous herb with severe side effects.

  • Mangosteen. Mangosteen has been demonstrated to be safe while exhibiting potent anti-inflammatory properties. Natural remedies that lower inflammation can be very beneficial in the prevention or treatment of sexual dysfunction. Mangosteen can be used as an effective adjunct with standard therapies to reduce many of the side effects and helps to speed up recovery time.

    Xanthones, which are unique to the mangosteen, as a class of phytonutrients are polyphenolic bioflavonoids. Over 60 research papers show antitumor, antiproliferative, antimicrobial, antihistamine, antiflammatory, antioxidant and gastrointestinal protective effects. Mangosteen has been used successfully for sexual dysfunction conditions for centuries throughout Southeast Asia.

    In some cases, people using mangosteen for the first time may experience a healing crisis or detoxifying effect {an increase or outbreak of symtoms that may last from 4 to 10 days} typically manifesting as a minor rash, or increased gas in the earliest stages of use. Once the body is cleared of the toxins that exasperate the condition, the healing process can get underway. This is normal and should be expected when using a quality natural product. Results will vary with individuals but the long term benefits are well worth the short term discomfort as mangosteen juice has been effective {alone or used adjuctively with medicationss} in some of the most severe cases of sexual dysfunction.

    Mangosteen juice from the whole fruit puree consumed daily, has successfully been used to treat sexual dysfunction and has demonstrated numerous additional benefits over other natural products. More mangosteen research is needed, but current scientific studies have demonstrated promising results. Mangosteen Science