MANAGING LOW SEXUAL DESIRE
There Is a Solution

In 1995, Gail M. had a total hysterectomy for fibroids, including the removal of her cystic ovaries. Recovery was typical and she soon realized that she didn’t feel the same as she had before the surgery. Her whole body felt different and she didn’t feel as passionately about things as she had before the operation. The biggest change was her sexual relationship with her husband. While Gail and her husband had a very active sex life prior to the surgery, after the surgery, sex became a chore.

Her first reaction was to call her gynecologist. Her doctor put her on a combination estrogen/testosterone pill, but Gail did not feel that there was improvement. In fact, with the additional typical responses of aging, her sex life was deteriorating and her orgasms were getting weaker. As a woman who had greatly enjoyed sex before her surgery, Gail felt the need to do something to change things. She continued to contact her gynecologist who tried a variety of testosterone creams and gels. As none of these were effective, Gail’s gynecologist started to believe that there was a psychological basis for her difficulties. She suggested that Gail see a psychotherapist, but Gail believed strongly that there was a physical cause if she could just get to the root of the problem. Her marital relationship with her husband continued to be the strong one she had always experienced and psychotherapy seemed to be an avoidance and denial of what she believed was a physical issue.

Gail attempted to research her issues and discovered that there were physicians who were able to treat problems like the ones she was experiencing. Unfortunately, she was unable to find anyone near where she lived. She even considered relocating temporarily, but that wasn’t feasible.

One day, when reading a magazine, Gail read an article that left her frustrated since it implied that sexual problems for women were psychological and caused by stress. A few days later, she discovered a response to the magazine article. As she read it, she recognized herself in the description. The letter was written by Bat Sheva Marcus, clinical director of The Medical Center for Female Sexuality. Gail contacted the Center and scheduled an appointment.

Gail’s appointment started with an in-depth analysis of her sexual history. After that, she had a full physical exam to ensure a total picture. During her next appointment, Gail was provided with a treatment plan. While she did start feeling better after that first visit, it wasn’t the improvement she was seeking.

Through a series of visits, Gail was able to find a combination of medications that brought her back to her old self. Her current regime includes a combination of estrogen, testosterone and DHEA. Estrogens are steroidal compounds that function as the main female sex hormone; testosterone is a compound that functions as the main male sex hormone; DHEA stands for dehydroepiandrosterone, a steroidal prohormone produced by the adrenal glands. In addition, she occasionally uses a small dose of Viagra to enhance her orgasms.

While it took nearly a year to determine the ultimate mix of medications, Gail is now thrilled with the results. “The professionals at the Center were confident they would be able to optimize a mix of medications and they were correct,” said Gail. “Unlike other physicians I had consulted, they didn’t get frustrated that I was not happy with the results. They kept working at it until they found a combination I felt was successful.”

“Treatment for sexual dysfunction is a combination of science and art,” explains Marcus. “We recognize that there is no single optimal treatment for all patients and we need to customize an individual treatment regime based upon what works with the client. It can often take as much as a year to identify the most effective treatment program.”

The medical treatment of sexual dysfunction is a somewhat new field. For many years, patients were assured that these issues were psychological or just something they had to live with as they aged. Then, with the advent of Viagra, the field changed as experts recognized that sexual dysfunction may have a physical basis.

As pharmaceutical companies research scientific solutions for women’s sexual concerns (often referred to as the “female Viagra”), the media has been covering this search. Many of these stories have vilified everybody’s favorite villain, the pharmaceutical companies, but they often ignore the other side. What about those patients who have found comfort, relief, or solace from these medical treatments?

Since pharmaceutical companies currently do not offer solutions for female patients, some doctors are treating patients with compounded pharmacy remedies or fashioning their own treatments through their expertise and experience using existing medications. This is why The Medical Center for Female Sexuality must craft a unique solution for every patient.

On the other side of this discussion is the argument that sexual problems are all “in her head.” For many years, women who were having sexual issues were sent to therapy, often for years. While this did help some women, there were others who found no relief. Isn’t it possible that the truth lies somewhere in between?

Even the most adamant sexual experts on either side of the discussion will point out that female sexuality is a complicated issue. There are so many sociological, psychological and physical issues that can impact female sexuality, it is often impossible to pinpoint a single cause. Where does this leave the sufferer, the patient who is unhappy with her sex life? She can enter therapy, often for years; she can try to locate one of the clinical trials where pharmaceutical companies are testing these controversial drugs (hoping she gets the drug rather than a placebo); or she can visit one of the few centers in the country that integrate both physical and psychological treatments for sexual dysfunction.

The Medical Center for Female Sexuality treats patients using the modality that female sexual dysfunction is frequently a complicated integration of both physical and psychological causes. Every consultation begins like Gail’s, with an hour-long in-depth sexual history. This allows the professionals to determine what, if any, psychological factors are involved with the sexual dysfunction. Following this is a thorough physical exam, including blood tests to determine what, if any, physical causes are contributing to the patient’s difficulties.

After all the test results are returned, the treatment team meets to develop a treatment plan. This can include anything from treatment with various hormones, treatment with dilators, relaxation exercises or even biofeedback. Every patient’s treatment is different, and is carefully monitored to ensure that the results are as desired.

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