Hormones and Sexual Dysfunction

Column by Linda Long, M.D. – Tidewater Women, August 2009
It is estimated that 50 percent of all women in the United States suffer from some degree of sexual dysfunction during their lifespan. The current medical definition of Hypoactive Sexual Desire Disorder is “deficient sexual fantasies and desire for sexual activity taking into account the age and context of the person’s life.” This deficiency causes distress or interpersonal difficulty.

Frequently in my practice, I see patients who say “I could care less if I ever have sex again” or “I would rather wash dishes than have sex.” Many of them do not care about sex for their own personal gratification but are concerned that the relationship they are in is suffering because of the lack of intimacy. They seek professional help because they feel like they’re missing out on a vital part of life and are afraid they’re losing the connection with their partner.
With men, the cause of sexual dysfunction is primarily physical such as erectile dysfunction. However, in women it is less likely to be so straightforward.

The treatment for sexual dysfunction in women is threefold. Three different areas — mind, body, and relationship — are evaluated to make sure the problem does not stem from more than one.

At the Berman Center where I studied sexual health, each woman was evaluated first by a psychologist to address the mind, then by an M.D. to address the body, followed by a counselor with the woman’s partner to address the relationship.

When I am treating a patient with sexual problems, my first two questions are “Does it hurt? Can you have an orgasm?” Both of these factors are crucial to women enjoying sex and feeling like they are “getting something out of it.” If sex is painful and unsatisfying, women are certainly less likely to have desire and will find reasons to get out of having sex to avoid physical discomfort and frustration.

At age 40, women’s hormone levels begin to decline and desire may wane as a result of declining testosterone. Patients will say to me “but testosterone is male hormone.” Yes it is, but women make it as well — 50 percent from the ovary and 50 percent from the adrenal gland. Ninety-nine percent of women over age 40 whom I test for low testosterone come up deficient.

If you check the testosterone level of a normal 20-year-old woman it will be substantially higher than that of a 50-year-old woman. Maintaining our testosterone level keeps our desire at the level of a younger more vital woman. It also aids in shortening the time to orgasm and enhances orgasmic intensity.

Testosterone is a controlled substance regulated by the FDA, and doctors have used female dose testosterone for years as part of hormone replacement therapy. Women on testosterone notice a slow, gradual increase in libido. Typically the first thing they notice is the return of sexually-oriented thoughts and dreams. Prior to testosterone therapy, they have little or no spontaneous desire, and the thought of sex is something they dread.

It takes about six weeks to notice a difference after starting therapy. I joke with my patients that there is no “Viagra” for women when it comes to desire.

Because there are some rare, potential side effects such as hair growth, acne, and enlargement of the clitoris, blood levels should be monitored at least annually to ensure levels are in the youthful therapeutic range and not high enough to cause androgenic or “male” side effects.

After menopause, many women require estrogen supplementation to achieve intercourse comfortably. Vaginal dryness, burning and occasionally bleeding is a result of falling estrogen levels and can make sex downright excruciating. Lubricants help but seldom are enough to get rid of the symptoms.

Recently I met with a 57-year-old married patient who had been on testosterone for about a year. She said, “Dr. Long, I can’t believe it. Our sex life is better than ever. Now I am chasing my husband around the house instead of the opposite. I never thought that a simple hormone cream could change our lives in such a wonderful way.” Needless to say, her husband is pretty pleased with the change in his wife of 30 years as well.

Sex is something we can enjoy our entire life. Sometimes you just need a little extra help!

Dr. Linda Long, FACOG, is the co-founder of Synergy in Chesapeake, an integrative medicine center for women. She is a board certified gynecologist and an expert in bioidentical hormone replacement and anti-aging medicine. She can be reached at 757-410-5462 or www.synergymedicalcenter.com.