Sex Drive In The Tank? DHEA Is An Option

Women with a decreased sex drive or decreased libido now have treatments that can restore their interest and enthusiasm for sexual intimacy. Options include testosterone, yes the hormone produced in the testicles of men, but also produced in small amounts in women and is responsible for a women’s sex drive. Testosterone is available in pills, lozenges, patches, gels injections, and small rice-sized pellets inserted underneath the skin. Although there are advantages and disadvantages to each, most gynecologists and urologists will not prescribe pills, which can increase the risk of liver toxicity and lower levels of HDL (the “good” cholesterol).

A slightly “milder” alternative to testosterone is DHEA (dehydroepiandrosterone). This steroid hormone is converted to testosterone. Supplementary DHEA, which is available in pill or cream form, increases testosterone levels by one-and-a-half to two times. So it’s not surprising that DHEA provides many of the same therapeutic benefits, including increased sexual interest and enhanced physical and mental satisfaction.

If you think you might be a candidate for testosterone therapy, here’s what to do:
Have your testosterone, DHEA and estrogen levels measured. Normal concentrations of testosterone range from between 25 and 100 nanograms per milliliter of blood.
Eat a well-balanced diet to stabilize your hormones Fiber and foods rich in minerals, such as potassium and magnesium can help balance hormones. Tofu, tempeh and other soy products are excellent sources of phytoestrogens, plant compounds that behave like mild estrogens in the body, helping relieve menopausal symptoms. Other sources of phytoestrogens include apples, alfalfa, cherries, potatoes, rice, wheat and yams. A diet rich in fruits and vegetables will also help maintain optimal health as you transition into menopause.
If you begin androgen therapy, be sure to report any side effects, such as acne, deepening of your voice, go to your doctor so he or she can monitor your progress and decrease your dosage as necessary.

Bottom Line: Although it is not for everyone, emerging research may reveal androgen to be one of the most promising therapies available to menopausal women. Sexuality and vitality need not be passing pleasures of youth.

This was modified from “Testosterone: A Major Breakthrough for Menopausal Women”. This article appeared in Fit & Health and can be accessed at: http://health.howstuffworks.com/wellness/women/menopause/testosterone-major-breakthrough-for-menopausal-women5.htm

Female Sexual Dysfunction-Women, You Can Be Helped

It is of interest that women have just as many sexual problems as men. In the past 15 years, more attention has been given to male sexual problems, mostly erectile dysfunction, as medications have been available for treating this common condition. Now women with decreased desire, decreased lubrication, decrased aroiusal, and lack of orgasm can now be treated.

What Causes Sexual Dysfunction?

Sexual dysfunction in women can be a result of a physical and\or psychological problem.

Physical causes. Many physical and/or medical conditions can cause problems with sexual function. These conditions include diabetes, heart disease, neurological diseases, hormonal imbalances, menopause plus such chronic diseases as kidney disease or liver failure, and alcoholism or drug abuse. In addition, the side effects of certain medications, including some antidepressant drugs, can affect sexual desire and function.
Psychological causes. These include work-related stress and anxiety, concern about sexual performance, marital or relationship problems, depression, feelings of guilt, or the effects of a past sexual trauma.

The most common problems related to sexual dysfunction in women include:

Inhibited sexual desire. This involves a lack of sexual desire or interest in sex. Many factors can contribute to a lack of desire, including hormonal changes associated with menopause, medical conditions and treatments (for example, cancer and chemotherapy), depression, pregnancy, stress, and fatigue. Boredom with regular sexual routines also may contribute to a lack of enthusiasm for sex, as can lifestyle factors, such as careers and the care of children.
Inability to become aroused. For women, the inability to become physically aroused during sexual activity often involves insufficient vaginal lubrication. This inability also may be related to anxiety or inadequate stimulation.
Lack of orgasm. An absence of orgasm can be caused by a woman’s sexual inhibition, inexperience, lack of knowledge, and psychological factors such as guilt, anxiety, or a past sexual trauma or abuse. Other factors contributing to an absent orgasm include insufficient stimulation, certain medications, and chronic diseases.
Painful intercourse. Pain during intercourse can be caused by pelvic organ prolapse, endometriosis, a pelvic mass, ovarian cysts, vaginitis, poor lubrication, the presence of scar tissue from surgery, or a sexually transmitted disease. A condition called vaginismus is a painful, involuntary spasm of the muscles that surround the vaginal entrance. It may occur in women who fear that penetration will be painful and also may stem from a sexual phobia or from a previous traumatic or painful experience.

The diagnosis of female sexual dysfunction begins with a physical exam and a thorough evaluation of symptoms. The doctor performs a pelvic exam to evaluate the health of the reproductive organs and a Pap smear to detect changes in the cells of the cervix (to check for cancer or a pre-cancerous condition).

An evaluation of your attitudes regarding sex, as well as other possible contributing factors (such as fear, anxiety, past sexual trauma/abuse, relationship problems, or alcohol or drug abuse) will help the doctor understand the underlying cause of the problem and make appropriate treatment recommendations.

Treatment of Female Sexual Dysfunction

Most types of sexual problems can be corrected by treating the underlying physical or psychological problems which include:

Providing education. Education about human anatomy, sexual function, and the normal changes associated with aging, as well as sexual behaviors and appropriate responses, may help a woman overcome her anxieties about sexual function and performance.
Enhancing stimulation. This may include the use of erotic materials (videos or books), masturbation, and changes in sexual routines.
Providing distraction techniques. Erotic or non-erotic fantasies; exercises with intercourse; music, videos, or television can be used to increase relaxation and eliminate anxiety.
Encouraging non-coital behaviors. Non-coital behaviors (physically stimulating activity that does not include intercourse), such as sensual massage, can be used to promote comfort and increase communication between partners.
Minimizing pain. Using sexual positions that allow the woman to control the depth of penetration may help relieve some pain. Vaginal lubricants can help reduce pain caused by friction, and a warm bath before intercourse can help increase relaxation.

The success of treatment for female sexual dysfunction depends on the underlying cause of the problem. The outlook is good for dysfunction that is related to a treatable or reversible physical condition. Mild dysfunction that is related to stress, fear, or anxiety often can be successfully treated with counseling, education, and improved communication between partners.

Hormones play an important role in regulating sexual function in women. With the decrease in the female hormone estrogen that is related to aging and menopause, many women experience some changes in sexual function as they age, including poor vaginal lubrication and decreased genital sensation. Low levels of the male hormone testosterone also contribute to a decline in sexual arousal, genital sensation, and orgasm. Women can use a topical gel containing testosterone or receive a small pellet of testosterone, the size of a grain of rice, placed under the skin which can result in enhancement of their libido and sex drive.

Many women experience changes in sexual function after a hysterectomy (surgical removal of the uterus). These changes may include a loss of desire, and decreased vaginal lubrication and genital sensation. These problems may be associated with the hormonal changes that occur with the loss of the uterus. Furthermore, nerves and blood vessels critical to sexual function can be damaged during the surgery.

The loss of estrogen following menopause can lead to changes in a woman’s sexual functioning. Emotional changes that often accompany menopause can add to a woman’s loss of interest in sex and/or ability to become aroused. Hormone replacement therapy (HRT) or vaginal lubricants may improve certain conditions, such as loss of vaginal lubrication and genital sensation, which can create problems with sexual function in women.

I think it is important to mention that some postmenopausal women report an increase in sexual satisfaction. This may be due to decreased anxiety over getting pregnant. In addition, postmenopausal woman often have fewer child-rearing responsibilities, allowing them to relax and enjoy intimacy with their partners.

Bottom Line: Many women experience a problem with sexual function from time to time. However, when the problems are persistent, they can cause distress for the women and her partner, and can have a negative impact on their relationship. If you consistently experience these problems, see your doctor for evaluation and treatment.

For more information on women’s health, I suggest my new book, What’s Going On Down There-Everything You Need To KnowAbout Your Pelvic Health. the book is available from Amazon.com

New book on women’s health

Viagra For Women -A New Drug To Help Women Achieve An Orgasm

It seems a bit unfair that men have access to medications such as Viagra, Levitra, and Cialis to treat erectile dysfunction or impotence. There are also hormones that men can take if they have low testosterone and suffer from a decreased libido. But what about women who have decreased sex desire or decreased lubrication? Now there is a treatment for women who have sexual dysfunction.

There is a the spray that can boost the sex drive of one in three women. Tefina is a testosterone gel that is sprayed up the nose. Researchers say that the testosterone is then absorbed within minutes and will become effective two hours after it is administered for up to six hours.

Researchers said the drug will be taken in the context of sexual activity, but will produce no adverse testosterone-related side effects like bad skin, body or facial hair or a deepened voice.

Researchers say that Tefina will be used as needed and that the drug will be used with the intention that it will increase the occurrence of orgasm for pre-menopausal women with sexual dysfunction or anorgasmia.

I anticipate the treatment will work like Viagra for women. Rather than a long-term, therapy-based approach, this drug can be taken when a woman anticipates sexual activity. For women with low sexual interest, testosterone therapy not only improves sexual desire and arousal, but also enhances a woman’s ability to reach orgasm.

Up to a third of women are affected by life-long problem of difficulty achieving orgasm after ample sexual stimulation, researchers say that until now the only available treatments are psychotherapy and sex therapy.
The new drug would be most helpful for patients who say that sex has become a chore rather than a pleasurable experience.

It has been shown through many documented studies that women who report poor sexual functioning have lower wellbeing, despite not being depressed. Doctors have little to offer women who are experiencing an absence of orgasms, and this could be a breakthrough study for women who currently are frustrated by the lack of any treatment option
.
Clinical trials are taking place in the US and Canada and researchers are currently recruiting participants between the ages of 18 and 49 who experience an absence of orgasm to take part in clinical trials in Australia.

Bottom Line: Men have treatment options for the treatment of erectile dysfunction or impotence. On the horizon is a new treatment for women with sexual problems.

Prescription For Passion-Testosterone Use In Women

Roberta is a middle aged lady who has noted that her sex drive and interest in sex has been reduced to near zero. After watching the movie Hope Springs starring Meryl Streep, Roberta made the decision to go to her doctor and share her situation. She had a blood test that checked her testosterone level and found that she was running on empty. She received a small testosterone pellet under her skin and reports that her “sex light” has been flipped to the on position.
Testosterone is the most celebrated, feared and misunderstood of all human hormones. Our culture lauds this substance’s leading role in male virility and casts it as the villain in acts of violent crime. In truth, testosterone is neither miracle nor monster, but rather, a key player in the complex chemistry of human hormones. When balanced by other hormones, testosterone, also known as androgen, plays a lead role in the health and well-being of both sexes.

Testosterone is known for decades as a male hormone. Testosterone is also made in small amounts by a woman’s ovaries. Just like in a man, a woman’s testosterone is highest around age 20 and slowly declines till it is half as high in her 40s. Women taking testosterone may have more sexual thoughts, fantasies, sexual activity, and satisfaction from sexual intimacy.

At the present time testosterone is not an FDA approved treatment used to raise a woman’s sexual interest, arousal, and satisfaction. Testosterone is available by using a skin patch, gel, cream, or a pellet inserted under the skin as I described for Roberta. Many supplements and herbal medicines, such as DHEA, may interact with testosterone. Be sure to tell your doctor about any nonprescription medicines, supplements, or herbs you are taking before receiving testosterone replacement therapy.
Women with low testosterone levels who might benefit from low-dose testosterone therapy include those who:
▪ Have had their ovaries removed. This causes a sudden drop in testosterone, which may decrease sex drive and satisfaction.
▪ Have a low sex drive that does not seem to be caused by a medicine, nor by relationship or stress-related problems.

Testosterone should be avoided in women who could become pregnant, have or have had breast or uterine cancer, have high cholesterol or heart disease or have liver disease.

Like nearly every medication, testosterone use in women has side effects especially if excessive testosterone is used. You are taking a dose that is too high if you have acne or oily skin, male-pattern hair growth on the face and body, anger and hostility problems, shrinking breast size, hoarseness or a deeper voice, irregular menstrual cycles, if you have been menstruating, or an increase in the size of your clitoris.
Bottom Line: Testosterone is also a necessary hormone for women just as it is for men but at a much lower dosage. Testosterone replacement can be a boon for women with a low sex desire, decrease in fantasies, and decrease enjoyment from sexual intimacy. See you doctor, get your testosterone level checked and if it is decreased, talk to your doctor about receiving testosterone replacement.
For those who want even more information I suggest Dr. Susan Rako’s book, “The Hormone of Desire: The Truth About Sexuality, Menopause and Testosterone.”

Ladies, Another Reason To Work on Your Abs

It’s a fact that some women experience sexual pleasure by working out-and this can be accomplished without toys or even a partner! The secret is to workout from the core abdominal muscles. The University of Indiana discovered this phenomenon by surveying hundreds of women who reported sexual pleasure during exercise,. Most of the women reported that the sexual pleasure including orgasm occurred during an abs workout. The lead investigator, Debbie Herbenick, has coined the pleasure experience while working out the abdominal core, coregasm.

Bottom Line: There are plenty of reasons to work out and especially paying attention to your core group of muscles. You may not get a six pack but you can have a lot of fun trying!

Important Discovery-The Elusive G- Spot Has Been Found

I attended a urology\gynecology convention in Las Vegas and I saw an exhibit by Intimina. They have a number of products but the one that caught my eye was a personal massager. There are three sizes of these hand-held massagers. One is palm-sized to a medium sized and finally a larger one with a gentle curve and flat tip that is targeted to the top of the vagina which is the vicinity of elusive G-spot.

These vibrators have multiple control buttons which allow you to switch between 6 levels of vibration patterns and 16 different speeds. The power is supplied by AAA batteries.

These massagers are made of non-irritating silicone and are waterproof which can be washed after use with gentle soap and water. Each massager includes a hygienic storage pouch with a one-year warranty.

For more information on the Intimina personal massager go to their website, http://www.intimina.com

Don’t Let Anti-Depressants Rain on Your Love Life

B.B., a 52-year old lady, had a history of depression, which has been controlled with Prozac. She noted a waning of her libido or sexual desire. She consulted with her doctor who prescribed the Prozac and he changed her medication to Wellbutrin, which allowed her libido to return to normal, and controlled her depression as well.
Sexual dysfunction, which includes loss of libido, decrease in arousal or vaginal dryness for women and decreased libido, and erectile dysfunction in men, is common in both men and women with depression. If that wasn’t bad enough, the treatment for depression with the antidepressant medication can cause sexual dysfunction. It is estimated that 30-70% of men and women who use antidepressant medication, such as Celexa, Prozac, Effexor, Zoloft and Remeron, experience a sexual dysfunction. The lowest rate of sexual side effects occurred in patients taking Wellbutrin.
Many men and women who experience these side effects of the medication may try to resolve the problem by stopping the use of their antidepressant medication. This should be avoided, as restoring sexual intimacy is not a good trade off if the depression returns. Fortunately, there’s a solution to this dilemma for those who suffer from depression or for those who require the use of antidepressant medications.
How do you know if your antidepressant is causing sexual problems? Experts say that the trouble is probably the result of the medication if a person who did not previously have sexual dysfunction experiences problems within two to three months of beginning antidepressant treatment.
What To Do

First and most importantly, do not make any changes in your treatment regimen without first consulting your physician. Here are some suggestions which you might discuss with your physician:

1. If you are experiencing sexual side effects from your antidepressant medication, your doctor may consider switching you to Wellbutrin, which has a low rate of sexual side effects. Wait to see if sexual side effects abate.
2. Consider taking your medication after you have engaged in sexual intimacy.
3. With your doctor’s permission you may consider a drug holiday. A drug holiday involves taking a short break from your antidepressant. By taking periodic two-day breaks from antidepressant treatment can lower the rate of sexual side effects during the drug holiday without increasing the risk of a relapse or recurrence of depressive symptoms.

Bottom Line: Sexual side effects are common in men and women with depression. Most men and women can be restored to a meaningful sexual function by sharing with your doctor your concern and having him\her making changes and adjustments in your medication or changing to another drug as described in my patient B.B.

Testosterone Is For Women, Too!

If you are a middle aged woman who is post menopause, you may find that your sex drive or libido has decreased to the point of no interest in sexual intimacy. It doesn’t have to be this way.

When we think of testosterone we usually think of this hormone as only existing in men. However, testosterone is also produced by the female reproductive organs.
A special menopause supplement in the March 1999 issue of the “American Journal of Obstetrics and Gynecology” recommends the addition of androgen (testosterone) to estrogen for all women undergoing surgical menopause. The use of androgen therapy may also be beneficial to women who experience loss of libido and other symptoms of testosterone deficiency during natural menopause.

Medical science now knows that testosterone is produced naturally by the ovaries and smaller amounts by the adrenal glands. Testosterone is an important factor in women’s health before and after menopause. Testosterone provides several benefits to women:
• improves relief of vasomotor symptoms of menopause 

• increases energy levels

• enhances of feelings of well-being

• decreases breast tenderness

• improves sexual desire

• increases sexual sensitivity

• increases the frequency of coitus

• enhances orgasm

Androgen therapy has been around since 1936, however the myths often associated with testosterone therapy in women have placed fear in many women and resulted in few women considering this therapy. Rare, but possible side effects of testosterone therapy include hoarseness or other voice changes, development of facial hair, acne, and over-sexuality. These side effects rarely occur at the low doses most often in use today; when side effects do occur relief is usually achieved by reducing the dose of testosterone.

The Symptoms of Testosterone Deficiency?
• diminished sexual pleasure

• decreased sensitivity of breast and genital tissues

• decreased orgasmic response

• decreased libido

• low energy

• depression
If you are experiencing any of these symptoms, talk with your doctor. Several forms of testosterone replacement are available including oral estrogen-androgen combinations such as Estratest, injections of testosterone, topical gels containing testosterone and, recently, there is an implantable forms of testosterone, Testopel.
Bottom Line: Testosterone is not just for men. If you are a woman and suffer from a significant decrease in your sex drive or libido, check with your doctor. You may be a candidate for testosterone replacement therapy.

This blog was excerpted from an article, Menopause and Testosterone, by Tracee Cornforth.

http://womenshealth.about.com/cs/menopaus1/a/menotestosteron.htm

When Sex Is No Longer Fun For Women

Women have sex drive and libido just like men. Although the sex drive of women is hormonally based and when the hormones are not aligned properly, havoc takes place. There are also a dozen other physical causes that can affect a women’s interest in sex. However, help is available and most women with decrease or loss of libido can be helped.
A woman’s desire for sex is based on a complex interaction of many components affecting intimacy, including physical well-being, emotional well-being, experiences, beliefs, lifestyle and current relationship. If you’re experiencing problems in any of these areas, it can affect your sexual desire.
Physical causes
Numerous nonsexual diseases can also affect desire for sex, including arthritis, cancer, diabetes, high blood pressure, coronary artery disease and neurological diseases. Infertility also can contribute to low sex drive, even after infertility treatments are over.
Many prescription medications — including antidepressants, blood pressure medications and chemotherapy drugs — are notorious libido killers. Antihistamines also can diminish your sex drive.
A glass of wine may make you feel amorous, but too much alcohol can spoil your sex drive; the same is true of street drugs.
Any surgery related to your breasts or your genital tract can affect your body image, function and desire for sex. Also, surgery in the pelvis on the uterus or ovaries can affect a woman’s sex desire and interest.
Finally, changes in your hormone levels may change your desire for sex: Estrogen helps maintain the health of your vaginal tissues and your interest in sex. But estrogen levels drop during the transition to menopause, which can cause a double whammy — decreased interest in sex and dryer vaginal tissues, resulting in painful or uncomfortable sex. At the same time, women may also experience a decrease in the hormone testosterone, which boosts sex drive in men and women alike. Although many women continue to have satisfying sex during menopause and beyond, some women experience a lagging libido during this hormonal change.
Treatments for low sex desire
Unfortunately, there is no simple pill or potion to increase sex drive in women. In fact, most women benefit from a multifaceted treatment approach aimed at the many causes behind this condition. This may include sex education, counseling, lifestyle changes and sometimes medication.
Healthy lifestyle changes can make a big difference in your desire for sex: Regular aerobic exercise and strength training can increase your stamina, improve your body image, elevate your mood and enhance your libido. Finding a better way to cope with work stress, financial stress and daily hassles can enhance your sex drive. Pelvic floor exercises (Kegel exercises) can improve your awareness of the muscles involved in pleasurable sexual sensations and increase your libido. To perform these exercises, tighten your pelvic muscles as if you’re stopping a stream of urine. Hold for a count of five, relax and repeat. Do these exercises several times a day. Remember a Kegel a day keeps the sex drive up so you can have a great time in the hay!
Systemic estrogen therapy — by pill, patch or gel — can have a positive effect on brain function and mood factors that affect sexual response. Local estrogen therapy — in the form of a vaginal cream or a slow-releasing suppository or ring that you place in your vagina — can increase blood flow to the vagina and help improve desire. In some cases, your doctor may prescribe a combination of estrogen and progesterone.
Male hormones, such as testosterone, play an important role in female sexual function, even though testosterone occurs in much lower amounts in women. However, replacing testosterone in women is controversial and it’s not approved by the Food and Drug Administration (FDA) for sexual dysfunction in women. Plus, it can cause negative side effects, including acne, excess body hair (hirsutism), and mood or personality changes. Testosterone seems most effective for women with low testosterone levels as a result of surgery to remove the ovaries (oophorectomy). If you choose to use this therapy, your doctor will closely monitor your symptoms to make sure you’re not experiencing negative side effects. I have had several dozen patients who have used testosterone replacement therapy for decreased libido with amazing results.

Bottom Line: Sex is not over when a women enters middle age. There are many treatment options that can help her get back in the saddle. Contact your doctor for more information.

This article has been excerpted from the May Clinic Newsletter: http://www.mayoclinic.com/health/low-sex-drive-in-women/DS01043/DSECTION=causes

New YouTube video on female sexual dysfunction-When It’s No Longer Fun “Down There”

Dr. Neil Baum, urologist Please see my video on “female sexual dysfunction” on YouTube. To see video go to: http://bit.ly/hfZafP