Dr. Irwin Goldstein, MD, explains what treatments are available for a woman's sexual health.
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I think it’s really important that the woman start off before getting treatment, by undergoing the appropriate diagnostic evaluation we’ve gone over and I will just repeat it very quickly. It’s a very detailed history, physical laboratory test, and psychological evaluation. Having achieved information and the diagnosis can then be established, management happens. So we go through a very important paradigm of management that starts at simple, modify . . . changes that are modifiable. So what does that mean? Sex therapy is an excellent first choice. Certainly talking about the condition is not harmful. Physical therapy for women with vaginal spasm, for women with pain, to learn better control over their pelvic muscles and their pelvic floor, changing medication, if a woman’s on a antidepressant agent, it’s extremely common that antidepressant agents are associated with changes in sexual function. Of course the most common medication that at least pre-menopausal women will use is the birth control pill, very highly and strongly associated with sexual problems. So the initial management should be simple, should be without much risk, with high levels of achieving, changing reversible issues. Another excellent choice is just exercise and diet, yoga, relaxation and feeling better about oneself, counseling, coaching; those kinds of issues are very important. We have data now for the first time in history that diet and exercise can restore sexual function in some women, and that’s very exciting stuff. So it would be those kinds of issues first. Should those persist, should the diagnostic evaluation really identify a really important biologic problem, then attention to the biological problem has to be given. What could those biological problems be? For women, especially in menopause, they can have extremely low values of estradiol. These are the natural hormones made by the ovaries, but in menopause the ovary is just stopping the synthesis of estradiol, and dryness of the vagina, bleeding from the vagina during sexual activity, pain in the vagina, lack of feeling in the vagina, can really be totally related to estrogen. So estrogen therapy becomes a very important part of women’s sexual health. Progesterone is very important sexual hormone and of course, testosterone. Everyone thinks that testosterone is just a male issue, but women make and synthesize testosterone, and it’s extremely important for women and interestingly enough, estradiol, which everyone thinks is a woman’s hormone, is very important for male sexual function. So we’re humans and we have sex steroids and the sex steroids are testosterone, estrogen, progesterone, and they are in all humans. There is a product of testosterone that’s the equivalent FDA approved in Europe, and I just wish it was really available here in the United States, but it's simply not available yet and often it's used off-label, and it would be indicated in those women who have distress from sexual problems, who have definitive lower testosterone values and wish to consider an improvement in their sexual lives.