Conditions We Treat
Vulvodynia / Vestibulodynia
Female Sexual Interest / Arousal Disorder (FSAID)
Female sexual arousal interest disorder is a complex and hardly understood condition affecting women of all ages and ethnicities. It may be impacted by biologic, social, psychological, environmental and hormonal factors. Conditions affecting FSIAD may be affected by mood and/or anxiety disorders; panic attacks, depression, phobias or bipolar disorder. Specific knowledge of this is extremely relevant in developing a treatment plan for the disorder; with an expectation of improvement in the enjoyment of sexual activity by the patient. FSIAD may also be impacted by a stored memory or secret can play in inhibiting sexual enjoyment. As well, general sexual dysfunction takes a variety of forms; but Female Sexual Interest/Arousal Disorder is much more specific (American Psychiatric Association, 2013).
DYSPAREUNIA (PAINFUL SEX)
Female sexual pain (dyspareunia) may present in a variety of ways and stems from many causes. Dyspareunia may have substantial impact on a woman’s relationships and quality of life. The estimated prevalence of dyspareunia is approximately one out of every five or six women experiences significant dyspareunia.
Dyspareunia is defined as “pain associated with sexual intercourse which includes pain with attempted or completed vaginal entry”. Although dyspareunia can be caused by a multitude of conditions, the most common cause of dyspareunia in menopausal women is atrophic vaginitis and the most common causes in pre-menopausal women are vestibulodynia, interstitial cystitis, pelvic floor hypertonus, vulvar dermatologic conditions, and endometriosis
Specific Causes Of Dyspareunia
Hypoactive Sexual Desire Disorder (HSDD)
Hypoactive sexual desire disorder (HSDD), is the most common sexual dysfunction in women. It has been associated with negative emotional and psychological states, as well as medical conditions including depression. HSDD is the most common female sexual dysfunction and affects about 1 in 10 women. It can happen at any age. The Mayo Clinic notes that as many as 40% of women have HSDD at some point in their lives, according to some studies. 5% to 15% of women have the problem continuously.
Hypoactive sexual desire disorder (HSDD) refers to a woman’s chronic or ongoing lack of interest in sex, to the point that it causes her personal distress or problems in her relationships.
It’s normal for women to lose interest in sex from time to time. A woman’s libido can change throughout her life. It might be high when she’s feeling good about her relationship or if she’s excited about a new one. It might decline when she’s under emotional stress or dealing with hormonal changes from pregnancy or menopause.
HSDD can be frustrating for a woman and her partner. But it is a treatable condition. Even though it might take some time to discover what’s causing it, a woman with HSDD can return to a satisfying sex life.
There are many ways to treat HSDD. Treatments for the physical causes depend on the individual. For example, changes in medication or diabetes control may be in order. A woman might need to make some lifestyle changes to combat stress and fatigue.
Some women also benefit from counseling or sex therapy. Specialists can help them cope with any past sexual trauma. They can help women improve their self-esteem and understand their relationships with their partners. A sex therapist can help women improve their ability to openly discuss sexual concerns with partners. They might also introduce ways to make intimacy a bigger priority – and more interesting.
Some women find estrogen therapy helpful. Estrogen is sex hormone that affects libido, among other functions. It can be administered in the form of a pill, patch, gel, or injection. This type of therapy, called systemic estrogen therapy, helps the brain make its needed chemical connections to increase desire. Local estrogen therapy can be applied through a vaginal cream or ring. This increases blood flow to the vagina and stimulates arousal.
In some cases, you may require a combination of estrogen and progesterone to treat HSDD.
Testosterone is another hormone that affects the sex drives of both men and women. While the FDA has not approved of the use of testosterone therapy in women, off-label prescribing has shown benefit in the treatment of HSDD. It is critical that you seek treatment with a healthcare provider who is trained in the management of hormone replacement therapy to avoid unthwarted complications.
At Augusta Anti-Aging Medicine, your healthcare provider is trained in the management of hormone replacement therapy and speaks nationally to train other clinicians on the safe use of hormone replacement therapy and the treatment of HSDD.Your healthcare provider will work with you to develop a confidential treatment plan that includes a Bio-Psycho-Social approach to helping you regain optimal sexual health.
Sexuality After Cancer
Many cancer patients face sexual problems from cancer treatment. Diminished libido, arousal difficulties, pain, vaginal dryness, erectile dysfunction (ED), and ejaculation trouble are some of the more common effects.
In some cases, patients can make decisions about sexual function when they plan their treatment with their oncology team.
Some examples include:
Persistent Genital Arousal Disorder (PGAD)
Persistent genital arousal disorder (PGAD) is a chronic sensation of sexual arousal, not related to sexual thoughts or stimulation in any way.
The sensation can last for hours, days, weeks, or months. Unfortunately, the condition is not always taken seriously, and women may feel too embarrassed to discuss it with their doctor. However, women with PGAD do not want to feel sexually aroused. The sensations are not welcome and can be distressing.
PGAD affects women of all ages. This condition is possible, but rare, in men.
Women with PGAD may describe the genital sensations as tingling, burning, throbbing, or itching. There can be genital pressure or pain. Some women become lubricated, as if their body is preparing for sex. Vaginal contractions and spontaneous orgasms may also occur.
Orgasm might relieve symptoms for a little while, but the feelings tend to come back.
The exact causes of PGAD are unknown, but stress and anxiety often trigger symptoms, making PGAD even more distressing. Other common triggers may be movement (such as riding in the car or climbing a ladder), sounds, and urination.
PGAD may be associated with certain medications; other health conditions like Tourette syndrome, epilepsy, and restless leg syndrome; or spinal conditions.
PGAD can be difficult to treat. Some women may find the following strategies helpful:
- Applying an ice pack to the genitals or taking an ice bath
- Topical numbing agents that can be applied directly to the genitals
- Pelvic floor physical therapy
- Antidepressants or anti-seizure medications
- Medication changes (with a healthcare provider’s guidance)
- Electroconvulsive therapy (ECT refers to electrical stimulation of the brain while the patient is under anesthesia. This treatment can be especially helpful for women who struggle with both PGAD and depression.)
- Surgery (if nerve or spinal problems are identified)
Women with PGAD may also benefit from counseling or support groups. For many patients, managing stress and anxiety is a key way to reduce symptoms. Therapy can also address psychological issues that stem from PGAD itself. PGAD symptoms can start at inopportune moments, and learning how to cope with such episodes in important.
If you’re dealing with constant feelings of arousal, even when you don’t want to have sex, call a trained sexual health care provider at Augusta Anti-Aging Medicine for a comprehensive evaluation.
Anorgasmia refers to an inability to reach orgasm within a desired amount of time. Some people with anorgasmia are unable to climax at all. Their bodies become aroused but no orgasm occurs.
Orgasmic disorders can happen to both men and women and can be distressing for both members of a couple. The person with anorgasmia may feel frustrated and sexually dissatisfied. Partners may worry that they are inadequate or not exciting enough which may impact the partner’s performance.
Orgasmic disorders are often caused by psychological factors or social factors, such as:
- performance anxiety
- problems in relationship
- past sexual trauma or abuse
- negative attitudes about sex
- guilt about sex
- sexual inexperience
- inadequate setting (e.g. lack of privacy, inappropriate timing – too late)
Orgasmic disorders can also be the precursors or the results of other sexual dysfunctions, e.g. low sexual desire, arousal problems (erectile dysfunction, lack/low lubrication, or sexual pain).
However, anorgasmia may have physical causes, too.
Here are some examples:
- Excessive drug and alcohol use
- Chronic pain
- Spinal cord injury
- Multiple sclerosis
- Hormonal problems
- Physical disability (motor problems like those in Parkinson’s disease, tremor, rigidity, difficulties in staying in a sexual position)
- Attention problems, hyperactivity (ADD or ADHD)
The first step in treating orgasmic disorders is seek help from a healthcare provider trained in sexual health.