PRESCRIPTIONS
Help prevalent for sexual problems
By Landis Lum
Difficulties in the sexual realm are both common and distressing — doubly so because many people are ashamed to bring this issue up not only with their partners, but their physicians. But don't let the silence drag into years. The topic is worth talking about because there are effective treatments for men and women with sexual dysfunction.
Before starting any treatment, see your physician first, as diabetes, drug problems, hormonal diseases and other causes of dysfunction should be detected and treated first.
Here's the lowdown on some popular treatments.
Men's concerns
- Viagra is a pill that helps men obtain better erections. Erectile dysfunction afflicts more than 20 million men in the United States. Viagra is taken anywhere from half an hour to four hours before sex, and works 60 percent to 80 percent of the time. Possible side effects include headache, dizziness and upset stomach. Never take Viagra and nitrate drugs such as nitroglycerin or Isordil (isosorbide) within 24 hours of each other, as this can cause a fatal drop in blood pressure.
- Yohimbine also works for erectile dysfunction, randomized studies show, though Viagra seems better. Mild blood pressure increases, anxiety and increased urination are possible side effects.
- Caverject and Edex are injections into the penis that men can do at home using tiny needles, and these work 80 percent of the time. Patient satisfaction is relatively high, and side effects are few.
- Vacuum devices usually involve using a tension ring applied to the base of the penis after erection is achieved, but this is not a normal erection, as the penis can pivot at its base.
- For premature ejaculation problems, books such as "Sexual Solutions" by Michael Castleman may help as well as for impotence. The drug Paxil 20 mg taken several hours before sex may be effective for premature ejaculation.
Women's concerns
- Treatments for vaginismus — an involuntary, painful contraction of the vagina that prevents intercourse — are wide-ranging. Cognitive- and sex-therapies include systematic desensitization (sometimes using imagery), which involves education, relaxation exercises, and inserting lubricated dilators of gradually increasing size.
- Use of estrogens and testosterone-like drugs for certain cases of female sexual dysfunction are attracting interest. In the September 2000 New England Journal of Medicine, women who had their tubes and ovaries removed and had reduced sexual function were randomly given either a testosterone skin patch or a placebo. Both groups also received Premarin. Those on 300 micrograms a day of testosterone reported not only improved sexual activity but a better sense of well-being. But the approach requires more study.
- "Our Bodies, Ourselves for the New Century: A Book by and for Women" is a great book. It delves into nutrition, mood-altering drugs, relationships, emotional well-being and biology.
For all types of sexual dysfunction, psychological counseling is recommended, because problems can stem from other areas of a couple's relationship. Sex therapy is also useful. The initial focus is not on intercourse, but rather on sensual massage with no involvement of sexual areas before progressing. Fantasy, pelvic muscle contraction and relaxation (such as kegel exercises), and background music or videos also may be used. Workshops, retreats and videos on better sex or techniques also have helped many couples.
Dr. Landis Lum is a family practice physician with Kaiser Permanente, and an associate clinical professor of family and community medicine at the University of Hawai'i's John A. Burns School of Medicine.
Write: Prescriptions, 'Ohana Section, The Honolulu Advertiser, P.O. Box 3110, Honolulu, HI 96802; e-mail ohana@honoluluadvertiser.com; fax 535-8170. This column provides opinions and information, and is not intended to provide medical advice; you should consult your doctor.
Correction: In the treatment of sexual dysfunction, the drug Paxil may be effective for premature ejaculation, and vacuum devices may cause the penis to be able to pivot at its base. A previous version of this column contained incorrect information. Other paragraphs of this column were also reedited for clarity.
