When lust is lost: female sexual arousal disorder

by Alice Buckley McCarthy

A medical device recently approved by the Food and Drug Administration may offer help to the millions of women with female sexual arousal disorder.

Paula has been happily married for 17 years, and she and her husband Steven have always enjoyed sex. But since going through menopause, Paula is just not as interested in lovemaking as she used to be. And when she and her husband do make love, it's more difficult for her to achieve orgasm.

"I first thought things would get better after I adjusted to the 'change,'" she says. "But as the months passed and things didn't improve, I really missed the intimacy with Steve."

Paula is just one of the estimated 40 million American women who suffer from a condition called female sexual arousal disorder (FSAD).

A woman's sexual drive and response normally fluctuate throughout her monthly cycle and over the course of her life. So, many women (and men) fail to realize that when a woman is "not in the mood" or persistently can't reach orgasm it may be more than just a moment in time.

While Viagra has grabbed the headlines since its debut in 1998 as a treatment for male impotence (also called "erectile dysfunction"), the topic of female sexual dysfunction, particularly FSAD, is just now coming to light.

Women with FSAD may have no interest in sex (or may enjoy contact only to a certain point), may suffer painful sex because of poor lubrication, or may have difficulty becoming aroused or reaching orgasm.

In March 2000, the International Consensus Development Conference on Female Sexual Dysfunction?a specialized group of experts studying the topic?published a more formal definition of FSAD, describing it as "the persistent or recurrent inability to attain or maintain sufficient sexual excitement, causing personal distress. It may be expressed as lack of subjective excitement or a lack of genital lubrication/swelling."

In other words, any or all of these symptoms suggest more than just the natural fluctuations in sexual drive and satisfaction most women experience to some degree.

One of the factors involved in FSAD is blood flow to the genital organs. Just as a man responds to sexual arousal by more blood flow to his penis, a woman's sexual interest and response is heightened by clitoral stimulation and swelling.

As blood flows to the clitoris, arteries become engorged and the clitoris begins to swell. The swelling puts mild pressure on the clitoral nerves, heightening sensation. Vaginal fluids begin to flow and the vagina expands, which provides a more comfortable sexual experience.

But anything that causes constriction of blood vessels to the vagina and/or clitoris will make arousal, lubrication, and orgasm more difficult. Menopause contributes to FSAD because the reduced estrogen levels that accompany menopause can cause reduced clitoral blood flow and less vaginal lubrication.

Certain medications may also contribute to FSAD, such as hypertension drugs and antidepressants. In addition, women with a history of diabetes or spinal or heart disease may also be at higher risk.

Hormone replacement therapy (HRT) for postmenopausal women is a common, usually highly effective remedy. It can be taken as a pill, cream or patch, and one brand?Estring?is delivered as a vaginal ring to slowly release estrogen directly into the vagina.

Several drug treatments, notably Viagra, are being tested in women to see if they effectively improve blood flow to the genitalia. Unfortunately, the results thus far with Viagra have been disappointing. In the largest study of Viagra in women, there were no differences in sexual response between women with FSAD who took Viagra and those who took a placebo.

In May 2000, the US Food and Drug Administration (FDA) approved a new medical device specifically for women with FSAD called the EROS-CTD (clitoral therapy device), designed to improve blood flow to the clitoris.

A small suction cup is placed over the clitoris and an attached palm-sized device generates a mild suction over the clitoral tissue via a battery-operated vacuum pump (it is similar in principle to the vacuum pumps used for years by men to achieve erections). The intended result is to improve blood flow and, thus, enhance vaginal lubrication and sexual arousal.

The FDA approved the EROS device based on a small research study of 15 women with FSAD, each of whom used the device in her home at least six times. A complete medical history and physical examination was performed on each patient and a brief psychosexual history was taken by a sex therapist to be certain that there was not a primary emotional or relational basis for the woman's complaint (this is because no drug therapy or device will prove useful to a woman whose sexual function symptoms are based on relational or emotional factors). Women who had a history of depression, unresolved sexual abuse, hypoactive sexual desire disorder (not caused by sexual function complaints), diabetes, painful intercourse, or certain other risk factors were excluded from the study

Six of the women in the EROS clinical study were postmenopausal, but the results were encouraging for all of the women. All reported more clitoral sensation, seven of them had increased orgasm, 12 were more satisfied and 11 noted increased lubrication.

In women who had not been having regular intercourse, the therapy took up to about three months of weekly use to reach maximum effectiveness. Women who were already sexually active experienced improvement within a few weeks. No side effects, such as clitoral irritation or abrasion, or any other problems were noted in the study.

Although the clinical findings were positive enough for the FDA to approve the EROS device, studies with more women are still necessary.

Dr. Jennifer Berman, a urologist, and Dr. Laura Berman, a sex therapist?sisters nationally recognized as experts on female sexual dysfunction and researchers involved in the EROS-CTD study?hope to see more clinical studies to assess just how effective the device is among a larger group of women with the symptoms of FSAD. Still, they conclude that "the EROS-CTD device may prove useful in treating sexual arousal complaints including reduced genital sensation, diminished vaginal lubrication, reduced sexual satisfaction, and diminished ability to achieve orgasm."

To obtain the EROS-CTD you'll need a prescription from your doctor. As with Viagra, insurance coverage is likely to vary. The cost without insurance will be about $360. Until the device is available at the local pharmacy, it can be obtained by having your doctor fax a prescription to UroMetrics, the manufacturer.

One last important note: It's important that your doctor knows your full medical and sexual history as your FSAD symptoms occur. Aside from biologic causes, FSAD is sometimes linked to a woman's upbringing, teachings that may result in guilt around sexual pleasure, unresolved anger toward her partner, or a history of emotional or physical sexual abuse. Dr. Jennifer and Dr. Laura Berman comment that, \"if the causes of a woman's sexual problems are entirely emotional or rooted in relational or trauma issues, neither the EROS-CTD device nor any drug treatment will be a cure by itself.\" For women with an emotional cause, professional sexual counseling is a key part of attaining or recovering healthy sexual feelings.