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A sexual problem, or sexual dysfunction, refers to a problem
during any phase of the
sexual response cycle that prevents the individual or couple from
experiencing satisfaction from the sexual activity. The sexual response cycle
has four phases: excitement, plateau, orgasm, and resolution.

While research suggests that sexual dysfunction is common (43%
of women and 31% of men report some degree of difficulty), it is a topic that
many people are hesitant to discuss. Fortunately, most cases of sexual
dysfunction are treatable, so it is important to share your concerns with your
partner and doctor.

What Causes Sexual Problems?

Sexual dysfunction can be a result of a physical or
psychological problem.

• Physical causes. Many physical and/or medical conditions can cause
  problems with sexual function. These conditions include diabetes, heart
  disease, neurological diseases, hormonal imbalances, menopause, chronic
  diseases such as kidney disease or liver failure, and alcoholism and drug
  abuse. In addition, the side effects of certain medications, including some
  antidepressant drugs, can affect sexual desire and function.
• Psychological causes. These include work-related stress and anxiety,
  concern about sexual performance, marital or relationship problems, depression,
  feelings of guilt, and the effects of a past sexual trauma.

Who Is Affected by Sexual Problems?

Both men and women are affected by sexual problems. Sexual problems occur in
adults of all ages. Among those commonly affected are those in the geriatric
population, which may be related to a decline in health associated with
aging.

How Do Sexual Problems Affect Women?

The most common problems related to sexual dysfunction in women
include:

• Inhibited sexual desire. This involves a lack of sexual desire or
  interest in sex. Many factors can contribute to a lack of desire, including
  hormonal changes, medical conditions and treatments (for example cancer and
  chemotherapy), depression, pregnancy, stress and fatigue. Boredom with regular
  sexual routines also may contribute to a lack of enthusiasm for sex, as can
  lifestyle factors, such as careers and the care of children.
• Inability to become aroused. For women, the inability to become
  physically aroused during sexual activity often involves insufficient vaginal
  lubrication. The inability to become aroused also may be related to anxiety or
  inadequate stimulation. In addition, researchers are investigating how blood
  flow problems affecting the vagina and clitoris may contribute to arousal
  problems.
• Lack of orgasm (anorgasmia). This is the absence of sexual climax
  (orgasm). It can be caused by sexual inhibition, inexperience, lack of
  knowledge and psychological factors such as guilt, anxiety, or a past sexual
  trauma or abuse. Other factors contributing to anorgasmia include insufficient
  stimulation, certain medications, and chronic diseases.
• Painful intercourse. Pain during intercourse can be caused by a
  number of problems, including
  endometriosis, a pelvic mass, ovarian cysts,
  vaginitis, poor lubrication, the presence of scar tissue from surgery, or a

  sexually transmitted disease. A condition called vaginismus is a painful,
  involuntary spasm of the muscles that surround the vaginal entrance. It may
  occur in women who fear that penetration will be painful and also may stem from
  a sexual phobia or from a previous traumatic or painful experience.

How Is a Female Sexual Problem Diagnosed?

The doctor likely will begin with a physical exam and a
thorough evaluation of symptoms and a physical exam. The doctor may perform a

pelvic examination to evaluate the health of the reproductive organs and a

Pap smear to detect changes in the cells of the cervix (to check for cancer
or a pre-cancerous condition). He or she may order other tests to rule out any
medical problems that may be contributing to the problem.

An evaluation of your attitude regarding sex, as well as other
possible contributing factors (fear, anxiety, past sexual trauma/abuse,
relationship problems, alcohol or drug abuse, etc.) will help the doctor
understand the underlying cause of the problem and make appropriate
recommendations for treatment. (more̷

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May 3, 2000 (Washington) — Many women may have yet another reason to rejoice. The FDA said Wednesday that it has approved UroMetrics Inc.’s Eros-CTD, the first treatment for female sexual dysfunction. The announcement follows recent reports from a urology meeting, indicating that the blockbuster male impotence drug Viagra also may perhaps offer some measure of sexual satisfaction for women.

But unlike Viagra, for which physicians already are offering some prescriptions, the Eros Clitoral Therapy Device has no potential side effects. In fact, the FDA approved the device under less stringent requirements than those usually applied to novel devices, because there were no side effects reported in the supporting study or any side effects suspected by the FDA reviewers, Sharon Stone, a FDA spokeswoman, tells WebMD.

The device is a small, soft, plastic cup that with a battery-operated pump increases blood flow to the vaginal area.

The approval was based upon a single study of 25 women, including 15 who had sexual dysfunction and 10 who did not; the 25 women used the device at home during six sexual encounters. The study tested for sensation, ability to achieve orgasm, sexual satisfaction, and lubrication.

According to the FDA analysis, all 15 women with sexual dysfunction experienced more sensation. Of those 15 women, seven also experienced more orgasms, 12 had more satisfaction, and 11 experienced more lubrication. The 10 women with normal sexual function all experienced more sensation; four also had more orgasms, two had more satisfaction, and three had more lubrication.

The concept also has been successfully applied in males, says Irwin Goldstein, MD, professor of urology at Boston University School of Medicine and one of the investigators. But further data are needed to determine its overall value for women, including whether increased blood flow makes a difference and how much vaginal lubrication actually is achieved, he tells WebMD.

In the meantime, Goldstein says, the class of patients most likely to benefit from this device appears to be women with sexual dysfunction who are interested in sex but unable to have orgasm. Pre-menopausal women with normal sexual functions are unlikely to see much of an advantage, he adds.

The device does appear to work much like Viagra, suggesting that it should have perhaps a similar effect, Ira Sharlip, MD, a urologist and partner at Pan Pacific Urology in San Francisco, tells WebMD. Viagra also appears to increase vaginal blood flow. Taken in context, Eros represents another treatment option, Sharlip says. But that is not to say that Eros is for everyone, he adds. Some men are highly resistant to using the penile pump used for impotence, and it is likely that some women also may find the concept disturbing. “I would leave it up to the patient’s discretion,” he tells WebMD.

Women with sexual dysfunction who would like to give it a try will be able to get one immediately, UroMetrics’ spokeswoman Marlene Wesen tells WebMD. The prescription device is already available in Australia, France, and United Kingdom and will be sold in the U.S. for $359, she says. (more̷

male impotency pill, and more another.

Sept. 7, 2006 — The first drug developed specifically for premature
ejaculation performed well in two clinical trials, but the new treatment
probably won’t be available in the U.S any time soon.

Men in the study who took the experimental drug Dapoxetine, developed by
Johnson & Johnson Pharmaceuticals in conjunction with ALZA Corp., were able
to maintain erections longer than men who took placebos.

Dapoxetine is a selective serotonin reuptake inhibitor (SSRI) but is
slightly different from the SSRIs (such as Zoloft, Paxil, and Prozac) widely
prescribed for depression and other
psychiatric disorders.

The drug was designed to be taken as needed, one to three hours before sex,
instead of every day. Also, it is eliminated from the body more quickly than
other SSRIs.

Hopes that Dapoxetine would become the first drug approved for premature
ejaculation dimmed last October, when the FDA sent a “not approvable”
letter to the manufacturer.

The FDA’s concerns about the drug were not made public. In a news release,
ALZA Corp. promised to “address questions raised in the FDA
letter.”

A spokesperson for Johnson & Johnson told WebMD Thursday that the
company “remains committed to the global development” of
Dapoxetine.

A Common Complaint

Although it is rarely talked about, premature ejaculation is a common
problem, affecting as many as a third of men.

Far fewer men seek treatment, however.

Those who do are often advised on practice techniques to help. Some receive
a prescription for a traditional, long-acting SSRI, since delayed ejaculation
is a common side effect among men who take SSRIs for depression.

This use of traditional SSRIs would be considered off-label since the
medications are not specifically indicated for this problem.

Other potential sexual side effects of SSRIs include erectile
dysfunction and loss of libido, however, making the traditional
antidepressants less than ideal for treatment of premature ejaculation, Jon L.
Pryor, MD, tells WebMD. Pryor is a urology professor at the University of
Minnesota.

Longer-Lasting Sex

In the manufacturer-funded study, Pryor and colleagues compared 30-milligram
and 60-milligram doses of Dapoxetine to a placebo in roughly 2,600 men with
moderate to severe premature ejaculation.

Prior to treatment, the men’s average ejaculation time was just under a
minute.

With treatment, the average time to ejaculation was 1.75 minutes in the
placebo-treated men, 2.78 minutes in the men treated with 30 milligrams of
Dapoxetine, and 3.32 minutes in the men treated with 60 milligrams of the drug.
The study lasted three months.

“A couple of minutes may not sound like much but for these guys it was
huge,” Pryor says.

Men who took the short-acting SSRI also reported having more control over
their ejaculations than the placebo-treated men; and they and their female
partners reported improved sexual satisfaction.

The Snicker Factor

Pryor says an effective, specific treatment could do for premature
ejaculation what Viagra did for erectile dysfunction
– taking away the ’snicker’ factor by stimulating open discussion about the
disorder.

“Viagra wasn’t a magic pill, but it did bring ED into the open and men
who had it learned that they were not alone,” he says. “The discussion
that followed stimulated research that led to other treatments.

“Premature ejaculation is more common than ED, but no one talks about
it,” adds Pryor.

Ira Sharlip, MD, a urology professor at the University of California, San
Francisco, tells WebMD there is a definite need for an effective treatment for
premature ejaculation.

“I have patients who are really disturbed by this issue, and so are
their wives,” he says. “The current treatments are far from
perfect.”

Sharlip says traditional SSRIs work best when they are taken every day, and
even then they only work for around two-thirds of patients.

“Premature ejaculation is certainly one of the most common forms of
sexual dysfunction among men,” Sharlip says. “Not everyone who has it
is bothered by it, but for those who are, it can be a very big
problem.” (more̷

June 26, 2003 — It’s looking more and more like the male hormone testosterone may do for women what Viagra did for men.

A newly released study offers some of the best medical evidence yet that the hormone really can help many postmenopausal women with sexual desire problems get in the mood.

Investigators found that boosting testosterone levels was associated with increased sexual desire in women who complained of menopause-related low libido and reduced sexual arousal. Women taking a low-dose estrogen-testosterone combination treatment reported a two-fold improvement in sexual interest, compared with women treated with estrogen alone.

‘Major Advance’

There are currently no medications approved in the United States for the treatment of low libido in women, but many doctors already are prescribing androgens like testosterone or the chemically similar steroid hormone DHEA for this purpose.

“We have known that this works, but we haven’t had the rigorous clinical studies to back that up,” sexual dysfunction specialist Irwin Goldstein, MD, tells WebMD. “This study represents a major advance.”

The Boston University School of Medicine urologist says he has used testosterone or a similar androgen in the treatment of more than 600 women with sexual desire problems over the past five years, with a success rate in the neighborhood of 70%.

“There is no question in my mind that this therapy will do for many women what Viagra has done for men,” he says.

The study included 221 healthy, postmenopausal women who complained of having little or no sexual desire, even though they were already taking estrogen therapy for menopausal symptoms.

Half the women were treated for 16 weeks with the low-dose oral estrogen-testosterone combination drug Estratest HS, and the others took a similar dose of estrogen alone. Testosterone levels were measured at the beginning and end of treatment, and all women completed questionnaires designed to measure their sexual interest.

By week eight, the testosterone-treated patients had measurable improvements in testosterone levels that put them in the upper normal range, and they reported improved interest in sex. They also reported none of the common side effects of treatment with larger doses of testosterone, such as excessive hair growth and acne. The study is published in the June issue of the journal Fertility and Sterility.

But no Cure-all

Columbia University ob-gyn Rogerio A. Lobo, MD, who led the study team, says the results confirm that testosterone is an effective treatment for lack of sexual desire in postmenopausal women who do not respond to estrogen alone and whose libido problems are not caused by depression.

“Certainly testosterone is not the answer for all women with sexual desire problems. It is not a cure-all,” he tells WebMD. “But the results were saw were definitely significant. The improvement in desire seemed to correlate with rising testosterone levels.”

Although this study looked only at postmenopausal women, testosterone is also being used for sexual desire problems in younger women. New research from Australia confirms that testosterone levels drop in women well before they reach menopause.

While he is excited about the potential of testosterone therapy, Goldstein agrees that it is not a cure-all for all women who have no interest in sex.

“The cause of low desire isn’t always medical, but it turns out that a large percentage of women with this problem have blood tests that are consistent with low levels of testosterone and other androgens,” he says. (more̷