Is Testosterone the End All-Be All for Sexual Dysfunction?

Whether it be for our skin, our hair, or our vaginas, we are always in search of the Fountain of Youth. You know, that product or device that will keep everything looking and feeling young. In the land of sexual dysfunction, testosterone was thought to be just that. The magic medication that would keep us like our 20-year-old self—need we say more? And while it certainly can do the trick for some women, it has probably gotten much more press than it deserved. Let us explain…

As women age, androgen levels decrease. As androgen levels decrease, so does sexual desire. This connection led scientists to study the impact of androgen replacement treatment on sexual dysfunction, specifically hypoactive sexual desire disorder (Sexual Dysfunction). And like all good competitions, the results were split. Some studies showed improvements in sexual functioning, and others showed no change. And because there was no good tiebreaker for the long-term use of testosterone to treat sexual dysfunction (a.k.a. a prospective randomized controlled study), doctors were hesitant to prescribe it.

Furthermore, due to the limited data, the FDA was not willing to put their stamp of approval on testosterone treatment. For this reason, transdermal testosterone is only used to treat hypoactive sexual disorder in the short term, that is, no greater than six months. Long-term use is not recommended, no matter how hypoactive your sexual desire is.

We tread lightly when using testosterone because it is teeming with negative side effects. Think acne, facial hair growth, deepening of your voice, and cardiovascular complications. Not fun. Additionally, some researchers have noted an association between testosterone use and breast cancer. While the link is loose, it is another reason to opt for the short-term rather than long-term use of testosterone.

When it comes to hormones, testosterone is not the only game in town. While testosterone has gotten a lot of attention, it seems to work best on hypoactive sexual disorder (a.k.a. I am just not that interested).

When the desire is there but vaginal dryness is holding you back, cue estrogen. Low estrogen (think menopause and breastfeeding) leads to a loss of vaginal lubrication. Vaginal dryness equals vaginal discomfort, and collectively, these symptoms are a common culprit in sexual dysfunction. Vaginal estrogen (tablets, gels, creams, and rings) can be particularly helpful in alleviating vaginal dryness (picture a hose in a desert).

Oral estrogen can also add some water to the well but is generally not as effective as vaginal estrogen for the treatment of vaginal dryness. Going straight to the source is way more effective! Last, adding vaginal lubricants or moisturizers (Astroglide, Replens, etc.) will help to turn up the power on that hose and further reduce the dryness.

Hormones are certainly helpful in hampering sexual dysfunction. However, they are only the half of it. Treatment will generally take on many other forms, such as the addition or subtraction of other medications, counseling, and physical therapy. So, while our Fountain of Youth remains dry (no pun intended), the combination of treatments may just do the trick. It may not fill up that well, but it’s worth a shot!

When Having Sex Is More of a Chore Than a Choice: Sexual Dysfunction

Talking about sex is not always easy. Although it is plastered on magazine covers and frequently a hot topic on “The View,” opening up to others about your sex life (or lack thereof) can be difficult. In fact, dishing about how much you are “doing it,” whether you’re talking with your friends, your sister, or even your GYN, can make even the most open amongst us close up. Bottom line, it’s not an easy conversation to have. And the topic can become particularly taboo when we aren’t having it or aren’t even wanting to have it. Your lack of desire and/or pleasure from what is supposed to be one of the most pleasurable acts can make you feel alone. But we are here to tell you that you are most certainly not alone. Millions of women, particularly during the post-partum period plus, shudder at the thought of sex. So, in the words of our favorite ‘90s hip-hop artists Salt-N-Pepa, “Let’s talk about sex…”

Starting with the basics: sexual dysfunction actually comes in a few different flavors. And while most suffer from a lack of sexual desire, there are actually three other types that may be forcing you to choose sleep, shopping, and even sorting laundry over sex: impaired arousal, inability to achieve an orgasm, and sexual pain.

We learned a lot about sex and sexual response from the Kinsey, Masters, and Johnson sex studies. In fact, the sexual response is pretty intense (no pun intended). There are four phases (excitement, plateau, orgasm, and resolution), and in sexual dysfunction, any or all can be off. It goes something like this:

  1. Sexual Desire Disorders
    Those who fall into this category are basically suffering from “hypoactive sexual desire disorder” or “sexual aversion disorder.” The former is the most common in women of all ages. And while it seems to get us all equally (no matter how old or young we are), it gets us in different age groups for different reasons. For our seasoned women, it usually has to do with things like atrophic vaginitis (a.k.a. dry vagina from hormonal shifts), chronic disease, medication use, and even mental health issues. In our mommying group, we are more commonly looking at situational circumstances. Think of things such as newborn babies, terrible twos, crazy fatigue, and even dysfunctional relationships. The treatment for sexual desire disorders usually consists of counseling plus or minus medications (including creams/lubricants/ moisturizers that can help with vaginal dryness).
  2. Sexual Arousal Disorder
    Women in this category are generally unable to go the distance (a.k.a. complete sexual activity) due to inadequate lubrication. It is usually linked to a chronic medical condition or medication use. It usually exits stage left once the condition is treated or the medication is stopped. Additionally, lubricants and/or moisturizers can also be particularly helpful.
  3. Orgasmic Disorder
    When all seems to be going just right (normal excitement phase) but you can’t get to that place (achieve an orgasm), you have female orgasmic disorder. In most cases, orgasmic disorder does not stand alone. It is generally linked to hypoactive sexual desire, and therefore, the treatment is fairly the same. The one exception are women who have never achieved an orgasm (medically termed, primary orgasmic disorder). We usually prescribe masturbation, education, communication exercises, and body awareness.
  4. Sexual Pain Disorders
    Dyspareunia and vaginismus are the two culprits when it comes to sexual pain. While dyspareunia is pain with sex not caused by a lack of lubrication and vaginismus is an involuntary spasm of the outer vaginal muscles that make sex and any vaginal penetration nearly impossible, they are both a pretty big pain (no pun intended). They are frequently linked to some of the above diagnoses. In most cases, CBT as well as physical therapy and some at- home dilator use are key to quelling this problem.

Finding a doctor who not only gets you but also gets the difference between the various types of sexual dysfunction is key. The only way to get to the bottom of what’s bothering you is to lay it all out there. If the person across the table doesn’t evoke that vibe, then you need to evict yourself from their office, ASAP. Everything you take (particularly medications like anti-depressants and anti-hypertensives), everything you feel, and everything you don’t feel should be shared. No judgment here.

If you feel more like lying on the couch than lying in bed with your partner, you are not weird, you are not atypical, and you are certainly not alone. Many of us have also gone through this (especially when you have little ones at home). Major life events can take a major toll on your body and your psyche. And while we certainly don’t expect you to post hypoactive sexual disorder on your Facebook page, we do suggest you share it with you GYN. They will have ways to help you work through this time and get you back to your home base. If we don’t know the answers, we have colleagues (a.k.a. sex therapists) who have seen it all, heard it all, and have all the tricks to treating this issue. So, as our girls Salt-N-Pepa liked to say… “Let’s talk about sex.”