Do You Want Better Sex?
05 May 2012
“How is your sex life,” I often ask patients. It’s amazing how often I get the reaction, “Finally, someone I can trust will discuss this matter with me”. And often there’s a problem. So what can be done to make the bedroom a happier place for both sexes? It’s an important issue as sex may be only five percent of a relationship. But it’s the first five percent! And it can also affect physical health.
Dr. Leonard DeRogatis, Director of Sexual Medicine at Johns Hopkins University points out a major difference between men and women. He says that men have the desire but as they age can’t get aroused. They’re the lucky sex. Erectile dysfunction (ED) drugs solve the problem in most cases by increasing blood flow to the penis.
Women are less fortunate. Some suffer from what’s called the “hypoactive sexual desire disorder (HSDD)”. In effect, sex may never have been high on their list of priorities and becomes less so later in life. So would ED drugs help to start sexual vibrations for women too?
In one study 202 women were given Viagra. As expected it increased blood flow to the genitals, improved sexual satisfaction for some women who had arousal problems, and provided the stimulus to engage in sex. But it had no effect on those who suffered from HSDD.
So the bedroom discomfort quotient differs between men and women. For males all that’s needed is an engorged penis for a happy bedroom, as their brains are always primed for sex. But for women, ED drugs will not turn those who have HSDD into raving sexual maniacs.
Is there anything that will do it? Many experts believe that the male hormone testosterone also governs a woman’s sexual desire. At 50 years of age women produce 50 percent less testosterone than those in their 20s. That’s one reason why sexual desire gradually diminishes. Boosting their testosterone levels, they say, will also boost their libido.
But does it work? The International Journal of Impotence Research analyzed 12 studies and concluded it does help. The North American Menopausal Society reached the same conclusions and endorsed its use.
Currently there are several drugs available to put a little more zip into the female side of the bedroom scene. Estratest is a combination of estrogen and methyltestosterone (a type of estrogen) which can be taken orally.
Intrinsa is a testosterone skin patch available in Canada and Europe, but has not yet been approved in the U.S. As in any hormonal preparation there is always concern that its use may be associated with problems such as breast cancer. Dr. DeRogatis says he believes this association is highly unlikely and that the greater possibility is growth of facial hair and transient acne.
Non-hormonal treatments are also available. Wellbutrin has been available for many years to treat depressed patients. But it has also been shown to increase sexual desire in women who are not depressed.
But for women there’s more to sex than either hormones or medication. You can’t have happy bedrooms if there’s discontent in a marriage, financial problems, lack of communication or no love.
A woman recently said to me, “I’m bored with my husband and wish I’d never married him.” It would take the second coming of a Messiah to solve this problem. One can only sympathize with such patients.
But not all sexual problems confronting women are in the head. All too often the reason women shy away from sex is obvious. But it’s missed by doctors who neglect the pelvic examination.
Lack of estrogen in menopausal women results in thinning of the vaginal lining. This may cause pain and an inability to have sex or an orgasm. Some women with this condition have been unable to have sex for years. It’s tragic when they could have been cured within a few weeks by Premarin vaginal cream or Vagifem pills.
I remind these patients that if Engelbert Humperdinck is unable to sing with a sore throat neither can they be expected to enjoy sex with an inflamed vagina.
