Treatment of sexual disorders in women
Treatment is carried out in accordance with the type of disorders and their causes. With a combination of symptoms, complex therapy is prescribed. Empathy and understanding of the patient's problems, patient attitude and careful examination can become an independent therapeutic effect. Since the appointment of selective serotonin inhibitors can lead to the development of some forms of sexual disorders, they can be replaced with antidepressants that have less adverse effects on sexual function. You can recommend the following drugs: bupropion, moclobemide, mirtazapine, venlafaxine. For empirical use, phosphodiesterase inhibitors can be recommended: sildenafil, tadalafil, vardenafil, but the efficacy of these drugs has not been proven.
Sexual desire (interest) and subjective general disorders of sexual arousal
If there are factors in the relations between partners that limit trust, respect, attractiveness and violate emotional intimacy, then such a pair recommends a survey of specialists. Emotional proximity is the main condition for the emergence of sexual reaction in women, and therefore it must be developed with professional help or without it. Patients can be helped by information on sufficient and adequate incentives; women should remind their partners about the need for emotional, physical, sexual and genital stimulation. Recommendations for the use of stronger erotic stimuli and fantasies can help to eliminate attention disturbance; practical recommendations for the preservation of secrecy and a sense of security can help with fear of unwanted pregnancy or sexually transmitted diseases, i.e. Of what are inhibitors of sexual arousal. If patients have psychological factors of sexual abuse, psychotherapy may be required, although a simple understanding of the importance of these factors may be sufficient for women to change their attitudes and behavior. Hormonal disorders require treatment. For example, active estrogens are used to treat atrophic vulvovaginitis and bromocriptine for the treatment of hyperprolactinaemia. The benefits and risk of additional treatment with testosterone are in the research stage. In the absence of interpersonal, contextual and deeply personal factors, additional examinations (for example, with oral methyltestosterone 1.5 mg once daily or transdermal testosterone 300 μg daily) by some clinical physicians of a group of patients with both sexual disorders and endocrine pathology . Patients with the following endocrine pathology leading to sexual disorders are subject to examination: women in the postmenopausal period who undergo estrogen replacement therapy; women 40-50 years old, who have a decrease in the level of androgens in the adrenal glands; women in whom sexual dysfunction is associated with surgical or medicamentally induced menopause; patients with impaired adrenal and pituitary functions. Careful continuation of the examination is of great importance. In Europe, the synthetic steroid tibolone is widely used. It has a specific effect on the receptors of estrogens, progestogen, shows androgenic activity and increases sexual excitability and vaginal secretion. In low doses, it does not stimulate the endometrium, increase the mass of bone tissue and does not have an estrogenic effect on lipids and lipoproteins. The risk of developing breast cancer when taking tibolone in the US is being studied.
It may be recommended to replace the drug (eg, transdermal estrogen for oral or oral contraceptives or oral contraceptives for barrier methods).
Sexual arousal disorders
With estrogen deficiency, local estrogens are prescribed at the beginning of treatment (or systemic estrogens are prescribed if there are other symptoms of the perimenopausal period). In the absence of effect in the treatment with estrogens, phosphodiesterase inhibitors are used, but this only helps patients with reduced vaginal secretion. Another method of treatment is the appointment of clitoral applications with a 2% ointment of testosterone (0.2 ml of solution on vaseline, prepared in a pharmacy).
Violation of orgasm
Self-excitation techniques are recommended. A vibrator placed in the clitoris area is used, if necessary, a combination of stimuli (mental, visual, tactile, auditory, written) can be used simultaneously. Psychotherapy can help patients to recognize and cope with situations in cases of reduced control over the situation, in the presence of low self-esteem, with a decrease in confidence in the partner. Phosphodiesterase inhibitors can be used empirically in cases of acquired disturbances of orgasm with damage to bundles of autonomic nerve fibers.