women s health issues
Overview of Sexual Function and Dysfunction in Women
Treatment
Treatment of causes of sexual pain Medications, including hormone therapy Pelvic physical therapy Sometimes, personal or couple's psychotherapy or sex therapy Certain treatments depend on the cause of sexual dysfunction. However, some general measures can help regardless of the cause: For both partners, learning about the woman's anatomy and ways to increase libido or arouse her Improving communication, including about sex, between the woman and her partner Encouraging trust, respect, and emotional intimacy between partners: These qualities should be cultivated with or without professional help. Couples may need help learning to resolve conflicts, which can interfere with their relationship. Setting aside time together that does not involve sexual activity: Couples who talk to each other regularly are more likely to want and enjoy sexual activity together. Making time and space for sexual activity: Women may be preoccupied with or distracted by other activities (involving work, household chores, or children). Making sure the place is private can help if the woman is afraid of discovery or interruption. Enough time should be allowed, and a setting that encourages sexual feelings may help. Engaging in many types of sexual activities: For example, stroking and kissing responsive parts of the body and touching each other’s genitals enough before initiating intercourse may enhance intimacy and lessen anxiety. Taking steps to prevent unwanted consequences: Such measures are particularly useful when fear of pregnancy or sexually transmitted infections inhibits desire. Practicing mindfulness: Mindfulness involves learning to focus on what is happening in the moment, without making judgments about or monitoring what is happening. Being mindful helps free women from distractions and enables them to pay attention to sensations during sexual activity by staying in the moment. Resources for learning how to practice mindfulness are available on the Internet. Just becoming aware of what is required for a healthy sexual response may be enough to help women change their thinking and behavior. However, more than one treatment is often required because many women have more than one type of sexual dysfunction. Sometimes a multidisciplinary team, including primary care physicians, gynecologists, pain specialists, psychotherapists, sex therapists, and/or physical therapists, is needed. Hormone Therapy for Menopause can be used to treat sexual dysfunction in women with genitourinary syndrome of menopause. When women have only vaginal and urinary symptoms, doctors usually prescribe forms of estrogen that are inserted into the vagina as a cream (with a plastic applicator), as a tablet, or in a ring. Estrogen cream may also be applied externally to the vulva. These treatments can effectively treat symptoms that affect the vagina (such as dryness and thinning of the vagina, an urgent need to urinate, and frequent urinary tract infections), but they do not help with moodiness, hot flashes, or sleep problems. (a synthetic form of Dehydroepiandrosterone (DHEA) [DHEA]) inserted as a suppository into the vagina, can also relieve vaginal dryness and make sex less painful for postmenopausal women. (a Selective estrogen receptor modulators (SERMs) ) can be used to treat genitourinary syndrome of menopause in women who cannot apply vaginal hormone therapy. Selective serotonin reuptake inhibitors (SSRIs) None , doctors must regularly check for side effects such as acne, excess hair growth ( Hairiness ), and development of masculine characteristics ( Psychological therapies may help women with sexual problems. For example, cognitive-behavioral therapy can help women recognize a negative self-view that results from illness or infertility. Mindfulness-based cognitive therapy combines cognitive-behavioral therapy with the practice of mindfulness. As in cognitive-behavioral therapy, women are encouraged to identify negative thoughts. Women are then encouraged to simply observe these thoughts and to recognize that they are just thoughts and may not reflect reality. This approach can make such thoughts less distracting and disruptive. Mindfulness-based cognitive therapy can be used to treat sexual interest/arousal disorder and pain that occurs whenever pressure is put on the opening to the vagina (called provoked vestibulodynia, a type of Vulvar pain ). More in-depth psychotherapy may be needed when issues from childhood (such as sexual trauma) are interfering with sexual function. Couples therapy may be helpful to improve communication or address relationship issues. Sex therapy often helps women and their partner deal with issues that affect their sexual life, such as specific sexual problems and their relationship with each other. Several types of physical therapy may be useful in women with genito-pelvic pain/penetration disorder. Physical therapists can use several techniques to stretch and relax tight pelvic muscles: Soft-tissue mobilization and myofascial release: Using various movements (such as rhythmic pushing or massage) to apply pressure on and stretch the affected muscles or the tissues that cover muscles (myofasciae) Trigger-point pressure: Applying pressure to very sensitive areas of the affected muscles, which may be where the pain starts (trigger points) Electrical stimulation: Applying gentle electric current through a device positioned at the opening of the vagina General measures and Therapeutic ultrasonography: Applying energy (produced by high-frequency sound waves) to the affected muscles (increasing blood flow to the area, enhancing healing, and relaxing tight muscles) If tight pelvic muscles are making sexual activity painful, women can insert self-dilation devices, available by prescription and over the counter, to stretch and to make the vagina less sensitive. Sexual activity may then be more comfortable. Vaginal lubricants and moisturizers can reduce vaginal dryness, which causes pain during intercourse. These treatments include food-based oils (such as coconut oil), silicone-based lubricants, and water-based products. Water-based lubricants dry out quickly and may have to be reapplied, but they are preferred over petroleum jelly and other oil-based lubricants. Food-based oils can damage latex contraceptive devices such as condoms and diaphragms. They should not be used with condoms. Silicone-based lubricants can be used with condoms and diaphragms, as can water-based lubricants. Women can ask their doctor which type of lubricant would be best for them. Depending on the type of dysfunction, sexual skills training (for example, instruction in masturbation) and exercises to facilitate communication with a partner about sexual needs and preferences can be implemented. Devices such as vibrators or clitoral suction devices may be used by women with sexual interest/arousal or orgasmic disorder, but there is little evidence to support their effectiveness. Many of these products are available over the counter. A major reason older women give up on sex is lack of a sexually functional partner. However, age-related changes, particularly those due to Menopause , can make women more likely to experience sexual dysfunction. Also, medical conditions that can interfere with sexual function, such as In older women as in younger women, the most common problem is lack of interest in sex. After menopause, lessestrogenis produced. The tissues around the vaginal opening (labia) and the walls of the vagina become less elastic and thinner (called vulvovaginal atrophy). Tissues can also become inflamed and irritated because production ofestrogenis decreased (called atrophic vaginitis). Both of these changes can cause pain during sexual activity that involves penetration. Vaginal secretions are reduced, providing less lubrication during sexual intercourse. The acidity of the vagina decreases, making the genitals more likely to become irritated and infected. may contribute to age-related weakening of muscles and other supportive tissues in the pelvis, sometimes allowing a pelvic organ (bladder, intestine, uterus, or rectum) to protrude into the vagina (called Pelvic Organ Prolapse (POP) ). As a result, urine may leak involuntarily, causing embarrassment. With aging, blood flow to the vagina is reduced, causing it to become shorter, narrower, and drier. Blood vessel disorders (such as Atherosclerosis ) can reduce blood flow even more. Less and lesstestosteroneis produced starting when women are in their 30s, andtestosteroneproduction stops by about age 70. Whether this decrease leads to decreased sexual interest and response is unclear. Other problems may interfere with sexual function. For example, older women may be distressed by changes in their body caused by medical conditions, surgery, or aging itself. They may have cultural views that sexual desire and fantasy are improper or shameful at an older age. They may be worried about the general health or sexual function of their partner. Many older women are interested in sex. Older women should not assume that sexual dysfunction is normal for older age. If sexual dysfunction is bothering them, they should talk to their doctor. In many cases, treating a health condition (including depression), stopping or substituting a medication, learning more about sexual function, or talking to a health care professional or counselor can help. Vaginal dryness or painful sex due to menopause can be treated with vaginal hormone therapy, including low-dose estrogen (as a cream, tablet, or ring) or dehydroepiandrosterone (DHEA, as a suppository).Estrogenmay be taken by mouth or applied to the skin in a patch or gel, but these forms ofestrogenaffect the whole body and are usually only used if a woman also has other symptoms of menopause (such as hot flashes) and are usually not given to women older than 60 years.Estrogenhas potential risks (including blood clots and a slightly increased risk of breast cancer) as well as benefits, so women should talk to their doctor about its risks and benefits before starting to take it. Occasionally,testosteroneto be taken by mouth is prescribed in addition to estrogen therapy if all other measures are ineffective, but prescribing this combination is not recommended. It is still considered experimental and long-term safety is unknown. 