Pharmacological and non-pharmacological treatments for patients with sexual dysfunction

Posted by Specialist I To Thi Thanh Huong - Obstetrician and Gynecologist - Women's Health Center - Vinmec Times City International Hospital

Impaired sexual function not only affects health but also seriously affects the quality of life and marital life of anyone. Therefore, after being diagnosed with the disease, you need to strictly follow the treatment instructions of your doctor. In some cases, the doctor will appoint the patient to take medicine, while in some cases, the patient will be treated with psychological therapy, physical activity, ... to improve this condition.

1.1. Estrogen Vaginal estrogen can be used to treat postmenopausal mucosal atrophy. This results in improved pain during intercourse, less vaginal dryness, improved vaginal discharge, and lower vaginal pH. The secretion of estradiol varies during the perimenopausal years and declines to very low levels after menopause. The destruction of estrogen weakens vaginal tissues, increases the frequency of vaginal and urinary tract infections, irritation, dryness, urogenital pain, and vaginal tissue injury.
Oral estrogens may not alleviate vulvovaginal atrophy, requiring topical estrogen. For vulvar-vaginal atrophy resulting in decreased sexual function, topical estrogen is more effective. Tablets, gels, creams, and vaginal rings are equally effective and the choice of estrogen form should be the patient's choice. The lowest effective dose should be used for the shortest time to help improve symptoms.
The duration of treatment is not fixed, but experts advocate daily treatment over a period of several weeks, reducing the dose after this period based on symptoms. Non-estrogenic lubricants may also be helpful for women who cannot or choose not to take estrogen. Water-based or silicone-based lubricants and moisturizers do not address the underlying causes of sexual dysfunction, but can be helpful in alleviating and alleviating painful intercourse. .
Systemic estrogen: indicated only if loss of sexual stimulation is determined to be due to atrophy of the vaginal mucosa and there is another health problem related to decreased estrogen in postmenopausal women. The meta-analysis suggests that estrogen alone or in combination with progesterone may permit improvement of sexual function, but mainly pain perception.
Vaginal dehydroepiandrosterone (DHEA): preliminary evidence suggests that vaginal DHEA is beneficial for both atrophy (dryness and painful intercourse) and sexual response (orgasm intensity and desire/arousal). DHEA is approved by the U.S. Food and Drug Administration for painful intercourse related to menopause.
1.2. Vaginal Device A battery-powered device used to insert the clitoris has received approval from the US Food and Drug Administration (FDA). This device precisely attaches to the clitoris to create a vacuum to increase blood flow and increase blood stasis.
A few studies have evaluated its effectiveness in improving pleasure, vaginal smoothness, sexual sensation and sexual satisfaction. This device is best suited for women who have difficulty arousal. No adverse effects have been reported from the use of this device.

1.3. Transdermal testosterone has been shown to be effective in the short-term treatment of hypogonadism in women. Prolonged use (more than 6 months) has little evidence of usefulness. Transdermal testosterone via patch is most commonly used.
A clinical study of the use of this patch in nearly 3,000 postmenopausal women (naturally occurring or surgical menopause) with hypogonadism demonstrated dose-related efficacy use. Also, there was an improvement in libido in the testosterone patch compared with placebo when the dose was maintained at 300 micrograms a day or more.
All studies using the patch showed that testosterone doses were variable (150 micrograms, 300 micrograms or 450 micrograms a day depending on clinical signs). The doses studied were approximately larger and higher than the levels of testosterone produced in premenopausal women.
1.4. Vasodilators Vasoactive drugs (such as Sildenafil citrate) are believed to increase pelvic blood flow to the clitoris and vagina as in men used to treat erectile dysfunction. In randomized clinical trials in women treated for sexual dysfunction, the results were mixed.
The use of Sildenafil increases blood flow to the vagina and clitoris but does not actually improve sexual arousal. Therefore, more studies are needed before recommendations can be made regarding the use of sildenafil for the treatment of women with hypogonadism.

Non-drug treatment for sexual dysfunction should be the first choice, specifically:
Psychotherapy to find out the psychological problems that scare the patient, reduce vaginal discharge, Decreased libido or failure to orgasm during intercourse. Contracting the muscles of the vagina tightly (Kegel exercises) and then relaxing can also increase arousal. Try sexual activity other than intercourse, such as massage, oral sex, or masturbation. Talking to your partner about your likes and dislikes or what you would like to try can help improve the sexual relationship. There are many causes of low sex drive, depending on the cause, there are different treatments. In addition to medication, doctors can prescribe patients non-drug treatments. Therefore, when there are signs of sexual dysfunction, patients should go to medical centers to check and get the best advice from doctors.
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