Last month we talked about treatment for low or absent sexual desire in broad, general terms. This month we will talk about treatments for Female Hypoactive Sexual Desire Disorder (FHSDD) associated with specific medical conditions.
Medical problems such as cancer, heart disease, obesity, arthritis, neurological conditions, and aging, just to name a few, are commonly associated with physical discomfort and insufficient stamina necessary for satisfying sexual activity. Soon, the desire to even attempt sex diminishes and disappears.
When your body and mind are consuming so much energy in minimizing pain and keeping the underlying illness under control, sexual desire takes a back seat.
When your body and mind are consuming so much energy in minimizing pain and keeping the underlying illness under control, sexual desire takes a back seat. Though you may no longer have the desire to have sex, your memories of younger and healthier times remain, and you still have an emotional desire to be intimate with your partner.
Fortunately, these situations are generally manageable by focusing on the intimacy associated with sexual activity rather than performance. Finding sexual activities or positions that cause the least amount of fatigue and discomfort will also allow you and your partner you to relax and comfortably enjoy the activity.
On the surface it seems like an obvious solution, but with an emotionally-charged issue like sexuality, your brain sometimes just can’t process it. Breast cancer is a particularly complex condition because issues of body image and loss of femininity frequently coexist with the physical aspects of sexual dysfunction. Is those situations, the addition of counseling alone and with your partner to reinforce and reassure you that you are still sexually attractive and desirable are critical.
When decreased or absent sexual desire is associated with medications such as sedatives, antidepressants, or blood pressure medications, working with your medical provider to find alternative treatments is important. The class of antidepressants known as SSRIs, which includes Prozac, Zoloft, Paxil, and Lexapro, are common offenders. Switching to Wellbutrin or a similar class of medication can be helpful.
Finally, medical conditions which cause sex to be painful are common causes of FHSDD, because most people don’t desire things that cause pain. It is important to have a thorough gynecologic evaluation and discuss treatment.
- Conditions such as uterine fibroids, endometriosis, pelvic adhesions, and genital prolapse, among others, generally respond to appropriate medical and surgical treatment.
- Vaginal atrophy (an inflammation of the vagina due to thinning tissue) caused by menopause in most cases can be safely and successfully treated by your gynecologist with vaginal estrogen or similar medications.
- A condition called Vulvodynia, which is unexplained pain near the opening of the vagina during sex, is felt to be similar to other chronic pain conditions such as fibromyalgia, and frequently responds to similar treatments. Topical local anesthetic creams have been shown to be successful as well.
- Vaginismus is an involuntary spasm of the vaginal muscles precluding intercourse. This can be a particularly challenging problem for you and your provider since it is usually associated with an underlying medical, emotional, relational disorder. Counseling and the use of vaginal dilators and lots of patience are generally successful.
Next month, we’ll continue our discussion on treatment for FHSDD in the absence of coexisting medical conditions. As always, feel free to leave your questions and feedback in the comments below.
Luigi D’Amato, MD, is a sexuality counselor who completed extensive training in sexuality counseling at the University of Michigan. A former obstetrician/gynecologist, he has more than 35 years of experience practicing medicine. Dr. D’Amato is available for sexuality counseling at the ProMedica Health and Wellness Center at 5700 Monroe St., Sylvania.