Twelve years ago, the Food and Drug Administration approved Viagra for men with erectile-dysfunction issues.
In April, Stendra (generic
name: avanafil) became the fourth drug to receive FDA approval for the
problem. It is poised to join Viagra, Cialis and Levitra as the latest
in a class of drugs called PDE5 inhibitors. Designed to be taken on an
"as needed basis 30 minutes before sexual activity," according to the
FDA, Stendra has a faster onset than its predecessors.
For women with sexual-dysfunction issues, the wait continues for any FDA-approved drug.
Sexual dysfunction in women is not as cut-and-dried as it is in men.
Low libido -- hypoactive sexual desire disorder in clinical terms, or HSDD -- is the most common sexual disorder in women.
But vulvodynia (chronic pain in the vulva, the area that contains a
woman's outer sexual organs), anorgasmia (inability to reach orgasm),
vaginismus (an involuntary spasm of the muscles surrounding the vagina)
and dyspareunia (persistent or recurring pain in the genital region
before, during or after sex) all fall in the "sexual disorder" category.
Statistics are hard to come by, but HSDD and other sexual disorders
tend to increase in prevalence as a woman ages and reaches menopause.
Published studies put the prevalence of anorgasmia between 10 percent
and 20 percent.
In focusing on treating these disorders, a new division at University
Hospitals MacDonald Women's Hospital is part of a small but growing
trend of care that a generation ago was barely discussed in public.
Sheryl Kingsberg, a women's health psychologist specializing in female sexual dysfunction, and Dr. Roya Rezaee,
an OB-GYN specializing in sexual medicine (she is the designated vulvar
and sexual-dysfunction specialist at UH), are co-directors of the new
Division of Sexual Function and Vulvovaginal Health.
Until the division's creation in late 2011, the sexual-medicine
program at MacDonald Women's Hospital was composed solely of Kingsberg,
who also serves as chief of UH's Behavioral Medicine Program and who
consulted regularly with UH physicians. When Rezaee joined the hospital
in January 2010, the two began collaborating.
"The patients [Kingsberg] sees first are those with emotional
distress and dysfunction that their [physician] doesn't think is an
anatomical issue," Rezaee said. "I get the ones who know they have pain,
who know they have hormonal issues. The physical and emotional go hand
in hand."
The two also will conduct research, she said.
"As diverse women are, so are our expectations of our sexual life and
sexual function," Rezaee said. "Who is it to define what dysfunction
is? What distress does it cause the woman?"
So-called societal norms dictate what's "normal" for people in terms
of the frequency of sex. But not all women can achieve that, because of
physical issues or other factors, she said.
"I think sex for so long was defined by a man's interpretation," she said. "Women saw [sex] in those terms."
That is slowly changing, as women are hearing the topic discussed more in mainstream media.
"I'm seeing women self-refer [themselves for care]," said Rezaee, who
said she also sees a shift in other physicians' willingness to refer
patients more quickly, instead of trying to treat a condition with which
they aren't as familiar.
"The goal of the division is for [physicians] not to feel helpless,"
she said. "Women are more likely to have success with early treatment."
Even now, with the division up and running for several months,
patients continue to be surprised that it exists, Kingsberg said.
"They don't know that sexual health is something that's in their
rights, and that it's part of their health care," she said. "I get the
look of surprise every time [when they find out] there's a program that
really validates their problem."
More hospitals focusing on sexual medicine
Kingsberg and Rezaee team up with physical therapists at UH who work
with patients with pelvic-floor disorders: urinary or anal incontinence,
or pelvic-organ prolapse, in which weakened pelvic muscles can't hold
pelvic organs in place.
There are roughly a dozen programs at public hospitals in North
America devoted to sexual medicine, said Kingsberg, former president of
the International Society for the Study of Women's Sexual Health.
While UH isn't the first public hospital in Northeast Ohio with such a
program, it is the first that is part of an academic medical center, in
an OB-GYN department in a hospital devoted to women's health.
The Cleveland Clinic's Center for Specialized Women's Health includes
specialists in chronic pain, female sexual disorders and vulvar
disorders. At MetroHealth Medical Center, female sexual disorders fall
under the department of family medicine.
At Summa Akron City Hospital, the Vulvar and Vaginal Disorders Center was created five years ago as part of Summa Akron City's Center for Sexual Health in the department of psychiatry.
"Nobody wants to talk about sexual pain," said Dr. Lara Burrows, a
urogynecologist and director of the Vulvar and Vaginal Disorders Center.
"For years, female sexual pain, pelvic pain -- doctors have been giving
the message that 'Lady, it's all in your head.' "
Although more hospitals are beginning to see the value of such
programs, "I don't think the corner clearly has been turned," said Dr.
Andrew Goldstein, director of the Center for Vulvovaginal Disorders in
Washington, D.C., and New York City, and president of the International
Society for the Study of Women's Sexual Health. Training provided by
the society in those specialties has grown in popularity, he said.
"More gynecologists and nurse practitioners are willing to deal with these issues."
To be successful, a sexual-medicine program has to embrace a
multidisciplinary approach that includes a half-dozen or more
specialists, Goldstein said.
An endocrinologist might be called to consult on libido or arousal
issues, for example, whereas a woman with pelvic or other sexual pain
might need to consult with a pelvic-floor physician and psychotherapist,
Goldstein said.
Compiling such a team is easier said than done, he said.
"There are about 20 really well-trained [gynecologists who know how
to treat and evaluate sexual pain] and another 50 who are doing it," he
said.
Rezaee is part of that small group providing that care.
As much as she would love for a "female Viagra" drug to be on the
market, it's not something that would meet every woman's needs, she
said.
"What excites me the most is that women are talking about this, and
health care providers are hearing them," Rezaee said. "Those of us with a
passion [for this specialty] are collaborating and connecting with one
another."
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