Suffering From Sexual Dysfunction?

Options That Are Out There for Men and for Women Live long enough and your sex life is likely to be stalled by some dysfunction, but seek treatment and your odds are good — 70 percent, to put a number on it — to be restored to healthy sexual function, says Irwin Goldstein, M.D., professor of urology and gynecology with Boston University's Institute for Sexual Medicine. "Men and women who have sexual health concerns shouldn't need to live with them," Goldstein says. "If a sexual problem is causing distress, it's time to seek help." Men's Multiple Options The elusive erection is a top sexual trouble point for men. Popular options for impotence include: PDE-5 Inhibitors. Popularly known as Viagra (sildenafil), Levitra (vardenafil) and Cialis (tadalafil), the phosphodiesterase-5 inhibitors are proven effective in promoting erection and restoring satisfactory intercourse. They support an erection by helping the arteries in the penis to dilate and blood flow to increase when a man is sexually stimulated. One of the three might work better for you, so see a doctor to discuss the best choice. (See "The Little Blue Pill ... Plus Other Impotence Options.") Penile Self-Injection. Injection therapy with alprostadil (Caverject), papaverine, or alprostadil with papaverine and phentolamine (Tri-Mix) can take a penis from flaccid to full readiness within a few minutes by engorging the penis with blood. With proper training in use of the injecting syringe, the success rate is relatively high, but pain from the injections causes many men to stop using them. Other side effects are possible, including dangerous prolonged erection, known as priapism. Vacuum-Assisted Erection Devices. The device, which uses vacuum pressure to draw blood to the penis and rings to help keep the blood there, can create erections in most men. Options That Are Out There for Men and for Women Live long enough and your sex life is likely to be stalled by some dysfunction, but seek treatment and your odds are good — 70 percent, to put a number on it — to be restored to healthy sexual function, says Irwin Goldstein, M.D., professor of urology and gynecology with Boston University's Institute for Sexual Medicine. "Men and women who have sexual health concerns shouldn't need to live with them," Goldstein says. "If a sexual problem is causing distress, it's time to seek help." Men's Multiple Options The elusive erection is a top sexual trouble point for men. Popular options for impotence include: PDE-5 Inhibitors. Popularly known as Viagra (sildenafil), Levitra (vardenafil) and Cialis (tadalafil), the phosphodiesterase-5 inhibitors are proven effective in promoting erection and restoring satisfactory intercourse. They support an erection by helping the arteries in the penis to dilate and blood flow to increase when a man is sexually stimulated. One of the three might work better for you, so see a doctor to discuss the best choice. (See "The Little Blue Pill ... Plus Other Impotence Options.") Penile Self-Injection. Injection therapy with alprostadil (Caverject), papaverine, or alprostadil with papaverine and phentolamine (Tri-Mix) can take a penis from flaccid to full readiness within a few minutes by engorging the penis with blood. With proper training in use of the injecting syringe, the success rate is relatively high, but pain from the injections causes many men to stop using them. Other side effects are possible, including dangerous prolonged erection, known as priapism. Vacuum-Assisted Erection Devices. The device, which uses vacuum pressure to draw blood to the penis and rings to help keep the blood there, can create erections in most men. (cont'd) Premature ejaculation (the inability to wait with ejaculation for both partners' enjoyment) is another major troublemaker for men. In addition to the "squeeze technique" — in which pressure is applied to the penis, where the glans meets the shaft, on the brink of ejaculation — some drug therapies have been used successfully, such as: Selective Serotonin Reuptake Inhibitor. This class of antidepressants is blamed for negative sexual side effects, but sometimes the problem can be turned into a positive by delaying ejaculation until it's desired. Tricyclic antidepressant. The drug clomipramine has been shown to be effective in delaying ejaculation, but side effects including dry mouth can occur. Ways to Treat Women's Dysfunction Non-drug treatments are often effective for women suffering from sexual dysfunction. According to Alan Altman, M.D., author of UpToDate.com's "Treatment of Sexual Dysfunction in Women," these steps might return sex that's a pain into a pleasure again: Have More Sex. "Use it or lose it" also applies to sex — with a partner or alone, sexual activity can increase blood flow and improve vaginal health. Communicate Sexual Preferences. Respectfully communicating with your partner about personal sexual turn-ons and turn-offs can work wonders for mutual sexual satisfaction, as can changing up the routine once in awhile in terms of time, location or sexual position. Add More Pre-Sex Stimulation. More stimulation by hand or mouth can help the female's sexual response (as well as helping with the male's erection). Ask your partner honestly if you want a greater fix of foreplay. Make Healthy Lifestyle Adjustments. Stay hydrated, quit smoking, and undertake strength training and aerobic exercise to up stamina and improve sexual satisfaction. Strengthen the Pelvis Floor Muscles. Vaginal weights, inserted and held in the vagina to improve muscle tone, can help some women with orgasmic disorders by helping awareness of sexual response and, in some women, stopping bothersome urine leakage during intercourse. If focusing on psychological, intimacy and relationship issues isn't the hoped-for fix, medical treatment options are available to compensate for hormonal imbalances and increase genital blood flow. These include: Artificial Lubrication. Over-the-counter vaginal lubricating creams, gels or suppositories, such as Replens, Astroglide or K-Y Jelly, may make sex more comfortable and enjoyable. Topical Estrogens. Menopausal women who are uncomfortable during sex might want to try estrogen creams such as Estrace or Premarin or a vaginal insert such as Estring. Another option, the Vagifem vaginal tablet, can combat vaginal dryness. Hormone Therapy. For menopausal women, an estrogen-progestin combination therapy or estrogen alone can improve clitoris sensitivity, ease pain from vaginal thinning and dryness, and improve blood flow. Hormone use should be carefully considered, though, according to the Food and Drug Administration (FDA), because of potentially increased risks for heart disease, stroke and breast cancer. Androgen Therapy. Supplementation with the sex hormone androgen may help with sexual arousal. Testosterone, a type of androgen, is sometimes prescribed to counter reduced desire after hysterectomy, but it is unclear whether androgen supplementation can increase desire in all menopausal women. The risks from this type of therapy include increased facial hair, enlargement of the clitoris, and for the oral form, liver damage, blood cholesterol changes and acne. DHEA. Dehydroepiandrosterone, produced by the adrenal glands, may benefit women with diminished sexual interest and arousal problems caused by low levels of naturally produced DHEA. The supplement form is available over the counter, but medical guidance is suggested based on its risks, such as acne, hair growth and possibly, according to the National Women's Health Resource Center, an increased risk of breast cancer. Clitorial Therapy Device. The FDA-cleared Eros device for female sexual arousal disorder has a suction cup that is placed over the clitoris before sex, and a battery-operated vacuum pump that draws blood into the clitoris. Think About Sex Therapy If a man's impotence could be caused by performance anxiety or a woman's desire has dropped off without a physical explanation, sex therapy can sometimes work wonders. A common technique emphasizes sensate focus exercises — concentrating on the pleasure of touch with your partner without engaging in intercourse. Your sexual relationship with your partner deserves work just like every other aspect of your life, emphasizes Barnaby Barratt, Ph.D., president of the American Association of Sex Educators, Counselors and Therapists. "In this culture, couples often assume that their sexual relationship should run by itself. But every couple needs to work on keeping their sexual life alive and well."