Facing sexual dysfunction

December 01, 2003|by ANDREA ROWLAND

Lisa Martinez was 44, happily married and unable to have an orgasm.

It was a problem she'd never experienced before her hysterectomy - a problem one doctor labeled "psychological" and another called a "casualty" of her surgery, says Martinez, 48, of Ohio. She and her husband took a European vacation, hoping the escape from life's daily stresses would help her overcome her sexual hurdle.

It didn't.

"I was numb. I thought, 'Oh my God, this is different,'" says Martinez, a health-care attorney with a nursing background. "I was frustrated and devastated. And I didn't want other women to go through what I was going through."

U.S. population census data reveal that 9.7 million American women ages 50 to 74 self-report complaints of diminished vaginal lubrication, pain and discomfort with intercourse, decreased arousal, and difficulty achieving orgasm. And the National Health and Social Life Survey in 1999 found that of the 1,749 women between the ages of 18 to 59 surveyed, 43 percent had experienced a sexual dysfunction at some point in their lives, according to the Network for Excellence in Women's Sexual Health at on the Web.


"I think it's at least that many women," says Dr. Sharon L. Kuebbing, a Frederick, Md.,-based clinical psychologist who specializes in sex therapy.

Female sexual dysfunction (FSD) is a complex, widespread problem that is not well understood, Kuebbing and other experts say.

It is often treatable.

Symptoms can range from lack of sexual desire - the complaint Kuebbing hears most often from her female patients, she says - to pain during intercourse. Related causes can span from childhood trauma to surgery to low sex hormone levels to side effects from certain anti-depressant medications.

Individuals who are depressed, under stress, have low self-esteem, or who have been sexually or emotionally abused face a greater risk for sexual dysfunction. But SSRI drugs - selective serotonin reuptake inhibitors often prescribed for the treatment of depression - such as paroxetine (brand name Paxil), fluoxetine (brand name Prozac) and sertraline (brand name Zoloft) can further hinder sexual functioning, says Dr. David Ferguson, a Minnesota-based physician who works as an independent consultant to the pharmaceutical industry.

And more women than men take SSRI drugs, he says.

As part of the Consensus Panel of the American Foundation of Urologic Disease, Ferguson in 1998 helped redefine the sexual problems that fall under the FSD umbrella - including hypoactive sexual desire disorder, sexual aversion disorder, sexual arousal disorder, orgasmic disorder and sexual pain disorders - in hopes of providing a clearer framework for identifying the problem and its related causes, he says.

Ferguson advocates a two-pronged approach to treating female sexual dysfunction: Talk therapy paired with medical treatment as warranted by hormonal and other tests.

"Women tend to get labeled as hypochondriacs all too readily. I think there's a knee-jerk reflex to send them to a therapist," he says. "The biological and psychological have to work together."

While doctors might prescribe a variety of experimental drug treatments for FSD - usually a combination of different pharmaceuticals used independently to treat different symptoms - there are no drugs designed specifically to treat female sexual dysfunction, says Ferguson, who was involved with bringing Viagra to the U.S. drug market. He also has been a consultant to the World Health Organization with a focus on erectile dysfunction, and was the chairman and founder of the 1st International Advisory Workshop on Clinical Trials in Female Sexual Dysfunction.

Experimental drug therapy approaches for FSD include estrogen replacement therapy, testosterone supplements, Viagra and prostaglandin - a hormone-like substance that is applied locally to increase blood flow and improve nerve conduction, Ferguson says. He adds that Viagra only works for women with normal hormone levels, and even then, not 100 percent of the time.

While pharmaceutical companies are working to develop a Viagra-like drug for women, and combined estrogen-testosterone supplements for post-menopausal women with sexual troubles, effective treatment for FSD must integrate psychological counseling, Ferguson says.

"I think all FSDs certainly need some therapy involved. You cannot treat these problems - that have sometimes taken years to develop -with a pill. I think doing so is tantamount to malpractice," he says. "The impact of (FSD) on the couple and the woman herself creates all kinds of tensions and problems that might be deeply buried. To treat that with a pill would be a disservice to the patient."

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