Clinician to Clinician: A 'platform' approach to treating female sexual dysfunction

Since the introduction of Viagra, women have been waiting for their own "little blue pill." It's unlikely to appear, given the complexities of the female sexual response and female sexual dysfunction (FSD). A 'platform' approach is what's critical for treatment of FSD.

Dr. Rosemary Basson describes female sexual response as a dynamic, nonlinear cycle, whereby a woman's inherent need to intimately connect with her partner contributes significantly to her satisfaction.^1,2 FSD is defined as an abnormality in this dynamic cycle that is perceived by a woman and causes her personal distress.³ There are four categories of FSD: hypoactive sexual desire disorder, female arousal disorder, female orgasmic disorder, and sexual pain disorders.³ Low sexual desire is the most common sexual dysfunction in women but it is not unusual for women to suffer from more than one dysfunction.⁴ In addition, the causes of each dysfunction vary significantly from woman to woman.

Given all of this complexity, treatment of FSD is challenging. I recommend a comprehensive treatment platform, which starts with educating the woman on the female sexual response cycle and FSD. Understanding the condition is important because it improves compliance with treatment.

The third component is education on the female anatomy. Many women and many more men do not have a good understanding of the female genitalia. Treatment with medication or physical therapy for specific anatomical locations is bound to fail if a woman has no idea where those areas are.

Fantasy is the fourth platform component. It is human nature to fantasize and most people with normal sexual function report having fantasies.⁵ Fantasy can be stimulated with romantic or sexually charged books and movies. Sexually explicit movies aren't required to promote fantasy but they are acceptable. Using fantasy either alone or during sexual contact allows a woman to maximize eroticism, which can translate into more enjoyable sex.

The fifth component is self-stimulation. Adding self-stimulation allows a woman to enjoy sex with complete control. It affords her the opportunity to appreciate what makes her feel good. Sharing that knowledge with her partner can enhance the relationship.⁵ Prescribing fantasy and self-stimulation can also reduce a woman's inhibitions about masturbation, liberating her from unfair social stigmas. This can "prime" the sexual "pump" and promote sexual health.

The sixth component of the treatment platform is educating a woman on types of and techniques for achieving orgasm. Sixty percent to 80% of women are orgasmic and most orgasms result from clitoral stimulation.⁶ Some women, however, can achieve orgasm through stimulation of the Grafenburg spot, which is located along the urethra on the anterior wall of the vagina. And some women can have both types of orgasm. By understanding this, a woman can maximize her orgasmic potential and physical enjoyment of sex.

Promoting a healthy lifestyle and reducing stress is the final component of the treatment platform. A healthy diet and regular exercise enhance physical fitness and general sense of well-being. A woman who feels and looks healthier will have more self-confidence, which goes hand in hand with sexual confidence and function. Stress plays a role in many medical conditions, including FSD. It increases cortisol levels, which in turn reduce available testosterone, affecting sexual health. Reducing stress will minimize this negative cycle.

Evaluating and treating FSD is challenging and time-consuming and both patient and physician can be frustrated with limited treatment success. In my experience, however, frustration can be reduced by using the multistep process I've outlined here.

REFERENCES

1. Basson R. Human sex-response cycles. J Sex Marital Ther. 2001;27:33-43.

2. Basson R. Using a different model for female sexual response to address women's problematic low sexual desire. J Sex Marital Ther. 2001;27:395-403.