Improving Women’s Sexual Dysfunction With Medication

Poor sexual function reduces quality of life dramatically. In men, this is called impotence or erectile dysfunction (ED). For women, this is called sexual dysfunction, or female sexual arousal disorder.
This occurs commonly in people with serious chronic illnesses, such as diabetes, high blood pressure and the medicines that treat it, and cardiovascular disease. But both in men and women, other causes of reduced sex drive and poor sexual function include smoking, excess alcohol, reduced body hormones (such as reduced testosterone with age, or reduced hormones in menopause), spinal injury, side effects of medicines, stress, anxiety, depression, and fatigue. In men, excess pelvic or genital pressure, such as long duration bicycle riding, has been reported to cause problems, In women, prior sexual trauma (including rape), dry vagina, reactions to contraceptive devices, vaginal infections, and pregnancy or breastfeeding can produce reduced sexual function or sex drive. So evaluation by the physician is important to determine the cause in an individual.
One of the circumstances in which this becomes most important is when patients are treated with anti-depressant therapy. When this occurs, sexual dysfunction occurs in up to 70% of individuals who have received these medications for serious depression. Because of this, such individuals often stop taking the anti-depressants because sexual dysfunction is so severe. This leads to increased problems with depression, and a further reduction in quality of life. However, even when patients continue to take their anti-depression medications, sexual dysfunction can occur, and it further disrupts their lives.
An important recent study was reported by Dr. H. George Nurnberg of the University of New Mexico and his co-authors (JAMA, Volume 300, page 395, 2008). In this important study, 98 women who were taking anti-depressants for depression and whose depression was improved, but who were also complaining of sexual dysfunction were evaluated, and randomly took either sildenafil (50 mg per day increasing up to 100 mg before sexual activity) or a placebo. The authors used as a clear objective measure of sexual activity, the clinical global impression scale which was rated by clinicians and the patient. This test measured changes in many aspects of sexual function. These scores ranged from 1 which was normal up to 7 which was the most extreme problems in sexual function.
These results were very significant. Women who were treated with sildenafil had an improvement in their clinical global impression sexual function score of 1.9, compared to only 1.1 in patients taking placebo. The difference of 0.8 was highly significant, representing over a 15% improvement in the sexual function score.
The greatest effects of sildenafil were in increased orgasm (over 30% improvement), increased enjoyment (over 20% improvement), and higher overall satisfaction (over 10% improvement). The patients did complain of occasional mild headaches, flushing, or indigestion. Importantly, no patients withdrew because of any serious adverse effects. Patients continued to take the Sildenafil to achieve the improvement in sexual function.
Why is this important to us? Most patients NEVER discuss either depression or sexual function with their physicians. The most critical lesson is that everyone needs to discuss with their physician if they are having any problems with depressed mood, and any difficulties with sexual arousal, sexual satisfaction, or orgasm. Also, it is important to realize that many doctors are not aware of what types of treatment are available to improve sexual dysfunction in patients. Therefore, getting a second opinion from a consultant who specializes in sexual dysfunction may be important so that the newest type of treatments can be used to relieve sexual dysfunction. Your doctor can help find this specialist with you. If you have sexual problems, be certain to ask your doctor if medicines such as sildenafil might help you.
Your physician is your best friend in improving all kinds of problems that you have. Don’t be embarrassed to discuss anything with them.