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What are the most commonly seen sexual problems in women?

A recent survey (conducted by Laumann and colleagues at the University of Chicago) of American women (ages 18-59) found that the most common sexual problem in women is hypoactive sexual desire disorder (HSDD), more commonly referred to as low sex drive or libido (33.4%), followed by difficulty with orgasm (24.1%). Pain during intercourse–which occurs in 14.4% of women–was the only condition to show a relationship to age — it decreases as women get older.

HSDD is a deficiency or absence of sexual fantasies and desire for sexual activity, as defined by the American Psychiatric Association (APA). The definition is vague because the APA acknowledges that there can be significant differences in sexual interest levels among women. According to the survey mentioned above, 37% of women think about sex a few times a month and only 33% think about sex 2-3 times a week or more. Happier women seem to think about sex more often than unhappy women.

Difficulty with orgasm, or female orgasmic disorder, is a persistent delay or absence of orgasm. This definition is also from the APA and it again attempts to allow for individual variation by not giving a specific number or percentage to define a “normal” amount of orgasms. The survey states that 29% of women say they always have orgasms during sex and 40% say they are physically satisfied with their partners.

There are wide variations in sexual functioning, and there is no gold-standard that women should feel they must meet for their sexual functioning to be considered ‘normal.’ If a woman experiences a sexual problem that troubles her, then it is a problem that needs to be addressed and she should be encouraged to talk to her doctor about it to see how it can be improved.

What causes decreased sexual desire in women?

Low sex drive can be caused by a range of factors, which vary from one individual to the next. Fatigue, the daily responsibilities and multiple roles women often assume, and many possible psychological causes can impact a woman’s sexual appetite. It is also known that certain health conditions and medications can affect a woman’s sexual desire. Depression and anxiety disorders can interfere with sexual desire, but so can some of the drugs used to treat these conditions. Many antidepressants, in particular Selective Serotonin Reuptake Inhibitors, also called SSRIs (e.g., Prozac, Paxil, Zoloft), have side effects that have a negative impact on women’s libidos. Wellbutrin SR is a possible alternative, as it does not seem to cause sexual problems. Serzone, Remeron and Luvox may not cause problems with sexual desire either.

In addition, birth control pills, mood stabilizers, tranquilizers and other medications have been shown to decrease libido. If you notice a drop in your sexual desire around the time you start a new medication, talk to you doctor to see if there is a connection. Do not stop taking any medication without talking to your doctor first.

What is the difference between sexual arousal and sexual desire?

In most women who are not experiencing sexual problems, libido and arousal are closely related and difficult to separate. Libido refers to a baseline interest in sex and might be redefined as sexual appetite. Arousal refers to the physiological response to sexual stimuli. Women with higher libidos generally have a greater response to sexual stimuli, or greater arousal. Physical manifestations of sexual arousal include vaginal lubrication and increased blood flow to the labia, clitoris and vagina.

Do all men really go through this, as similar to mid-life crisis in women -“menopause”?

There is great variability in testosterone levels among healthy men so not all will experience the same changes. It is estimated that 30% of men in their 50s will have testosterone levels low enough to be causing symptoms. These symptoms can impact their quality of life and may expose them to other, longer-term risks of low testosterone, like effect on bone, sexual drive and heart.

What can increase sexual arousal in women?

One of the symptoms of decreased sexual arousal in women is a reduced amount of vaginal lubrication. Over-the-counter vaginal lubricants can augment lubrication.

If a decrease in vaginal lubrication has been caused by menopause, hormone replacement therapy can help. This is the only approved drug therapy for this disorder.

Viagra (sildenafil) and a class of medications called alpha-adrenergic blockers, such as Regitine (phentolamine), can also increase the vaginal lubrication response to sexual stimulation. However, it should be mentioned that study after study of Viagra for various female sexual problems have not shown an increase in sexual pleasure in women.

Aside from pharmacologic solutions, women can also choose behavioral therapy to help increase sexual arousal. Such therapy is aimed at enhancing sexual fantasies and focusing one’s attention on sexual stimuli. For women in on-going relationships, the therapist would also look into the possibility of communication problems in the relationship, or lack of sexual stimulation by the woman’s partner.

What can increase sexual desire in women?

At this time, there are no approved drug treatments for low sexual desire. However, a recent study of 66 women, ages 23 to 65, with HSDD for an average of six years, found that Wellbutrin SR may be an effective treatment. Approximately one third of women experienced doubled interest in sexual activity, sexual arousal and sexual fantasies. Although Wellbutrin SR is an antidepressant, the women in this study did not suffer from depression and they did not have relationship difficulties. More studies are needed to support this preliminary data.

There have also been studies that indicate that testosterone can increase sexual desire in women who’s low sex drive is a result of the surgical removal of their ovaries. Continual treatment with testosterone does have side effects and may lead to “masculine” side effects in some women (i.e., lower voice, hair loss, enlarged clitoris).

Another factor to consider is that for some women, feelings of guilt and shame learned in early childhood may interfere with adult sexual function and may affect one or more phases of the sexual response cycle. In these instances, as well as in cases of sexual abuse, psychotherapy may be beneficial. Marriage counseling or couples therapy can also be of value.

What can cause lack of orgasm?

The inability to achieve orgasm (anorgasmia) can be caused by a number of factors, both physical and psychological in nature. Lack of adequate stimulation, acute stress, anxiety, as well as depression and relationship problems can all interfere with the ability to experience orgasm. Other health conditions, such as incontinence, can cause problems too.

Everyday stress and the many roles and responsibilities women deal with can result in distractions, making orgasms more difficult to achieve. In addition, cultural and religious prohibitions may result in anorgasmia (possibly related to a heightened sense of guilt).

Fortunately, there are very good self-help books available to assist women in developing skills that will improve their ability to reach orgasm.

Medications can also interfere with the ability to experience orgasm. Many antidepressants, including Prozac, Zoloft and Paxil have a high propensity to cause such problems. In addition, antipsychotic drugs such as Haldol, Thorazine and Mellaril can cause inability to reach orgasm and Valium may delay orgasm. Fortunately there are other antidepressants (Wellbutrin SR) and antipsychotic drugs (Zyprexa and Seroquel), which don’t seem to cause inability to experience orgasm. Antihypertensive drugs may also interfere with orgasm.

Any disease, such as multiple sclerosis, that interrupts the nerve supply to the genitals may cause lack of orgasm.

How is pain during sex treated?

In postmenopausal women who experience diminished vaginal lubrication, hormone replacement therapy is often recommended. Vaginal creams containing estrogen may also help.

Even women who are not postmenopausal experience problems with vaginal lubrication which can create friction during sex, and ultimately cause pain. In this case, use of over-the-counter vaginal lubricants before intercourse is a possible remedy.

If the woman experiencing pain is in a relationship, she should communicate with her partner. Together they can work to find a position that is more comfortable. Sometimes a change in the time of day when you are more rested may help.

If pain is persistent, see your doctor. The pain could be a symptom of another medical condition. In fact, most physicians view dyspareunia (pain with intercourse) as a pain disorder and treat accordingly (anagesics/creams, etc.).

There are many treatments available. Your doctor will work with you to find a solution to your problem.

Will hormones help women with decreased sexual desire? Which hormones? Testosterone? Estrogen? Progesterone? What about DHEA?

In postmenopausal or peri-menopausal women, estrogen replacement can decrease pain during intercourse and facilitate vaginal lubrication.

Studies have also shown that testosterone increases libido in women, so if someone’s decreased desire is due to a drop in hormones, it can very likely be resolved with testosterone. However, to date, these studies have used high doses of testosterone, which might lead to masculinization if taken for long periods of time.

Although DHEA is also a male hormone, there have been very few studies of its affect on women and none have shown that it improves a woman’s libido.

control used in our facility help us provide our patients the comfort, treatment and care they deserve.

How to over come recurrent pregnancy loss?

Pregnancy loss is a distressful experience. It is especially devastating when the losses are repetitive. Loss of pregnancy is physically and emotionally challenging ordeal. Until recently there was little a couple could do if they suffered from so called unexplained recurrent pregnancy loss.

Research however provided information on the causes of the hereto fore unexplained pregnancy losses resulting in availability of treatment that enables women to carry their pregnancies to term.

What are causes of implantation failure?

An embryo may not implant because there is something wrong with the embryo itself that it cannot implant, or there is something in the uterine environment that does not allow a normal embryo to implant or a combination of these factors.

How can we determine the problems with the egg?

Problems with in the egg can manifest clinically as diminished ovarian reserve or premature ovarian failure. Diagnostic tests useful for identifying individuals at greater risk for diminished ovarian reserve or premature ovarian failure include:

Hormonal analysis for Follicle Stimulating Hormone [FSH], Estradiol and Inhibin

Antiovarian antibodies [AOA]

How can we determine the problems within sperms?

Problems within the sperm not diagnosed by the standard parameters of semen analysis can be detected by:- Sperm function tests, sperm DNA integrity assay [SDla], Y chromosome microdeletion assay

How can we determine the anatomic problems within the uterus?

Problems with the uterine environment Problems within the environment in which the embryo implants and foetus grows have been classified as anatomic, hormonal and immunologic.

Anatomic abnormalities of the uterus can be diagnosed by:

Hysterosonography [ultrasound evaluation of the uterus after fluid is injected] or

Hysterosalpingography [X-ray with instillation of dye into the uterus and fallopian tubes]

Hysteroscopy [telescopic evaluation of the uterine cavity]

How can we determine problems of hormonal response of uterus?

Hormonal response of the uterus can be diagnosed with the aid of:

Transvaginal ultrasound examination of the lining of the uterus around the time of ovulation.

Color Doppler flow studies to evaluate blood flow to the lining of the uterus.

How can the immunologic factors causing implantation failure be diagnosed?

Antiphospholipid Antibody [APA] Panel Antiphospholipid antibodies have shown to kill pre-implantation embryos. They also interfere with angiogenesis

Antinuclear antibody [ANA] panel Antinuclear antibodies have also been shown to be embryotoxic.

Antithyoid Antibody [ATA] Panel – Antithyroid antibodies have no direct effect on preimplantation embryos, but are a marker of activated T cells in the lining of the uterus.

Reproductive Immunophenotype [RIP] measures circulating levels of NK cells. Elevated NK killing activity [greater than 10%] has been associated with implantation failure.

Natural Killer Cell Activity [NKa] Assay measures killing activity with NK cells. Elevated NK killing activity [greater than 10%] has been associated with implantation failure.

Embryotoxicity Assay [ ETA] measures circulating substances that kill preimplantation embryo.

Immunoglobulin [Ig] panel Elevated levels of immunoglobulin particularly immunoglobulin M, have been associated with implantation failure. Also the immunoglobulin panel will detect deficiencies in IgA which can be a contra indication to the use of IVIg if anti IgA antibodies are present.

Thrombophilila Panel – Included in the thrombophilia panel is the gene for Plasminogen Activator Inhibitor[PAI] which can detect the most common cause of defective fibrinolysis contributed by an increase in plasminogen activator inhibitor [PAI 1] concentrations.

Cytokine Panel – Proteins or cytokines that are produced by immunologic cells within the lining of the uterus.

What do you mean by urodynamics?

1Urodynamics are special outpatient tests to assess the normal and abnormal function of the urinary passages.

It is always the male who needs to be evaluated FIRST, as the basic test is very simple and easy in the male. Although the semen analysis is not an absolute proof of fertility, yet it is the most important single indicator of the functional status in the male reproductive tract.

Who needs urodynamics?

Those who have difficulty passing urine

Those with troublesome urinary leak.

Those who leak urine on coughing, straining and laughing.

Those with persistent urine passing problems.

Those who complain of bladder problems after previous gynecological surgery.

Those who have had previous failed incontinence surgery.

Are Urodynamics necessary?

Urodynamics will help your doctor make an accurate diagnosis, which may be absolutely essential to treat you successfully, especially, if surgery is required.

Is urodynamics painful?

It is generally not painful, as we will use a lubricating gel to diminish your discomfort.

Are there any preparations required, e.g. fasting, before urodynamics?

No. However you should try to pass stools that day morning and you should not have had urinary infection recently.

A male fertility test can reveal whether the sperms are of normal shape and size. Some of the common sperm abnormalities are:

What are the symptoms of PCOS?

The symptoms of PCOS can vary from woman to woman and may include excessive weight gain, irregular or completely absent periods, ovarian cysts, excessive facial or body hair known as hirsutism, male pattern hair loss, obesity, acne, skin tags, high cholesterol levels, exhaustion or lack of mental alertness, depression, anxiety, decreased sex drive, excess male hormones and infertility

What tests do I have to do to determine PCOS?

The diagnostic criteria are not definitive for PCOS. There are a few tests that help confirm insulin resistance. A fasting insulin blood test and cholesterol panels [specifically triglycerides]. Testosterone, cortisol and DHEA should also be tested.

A pelvic scan of ovaries should be done for knowing the number of visible cysts. No cysts does not confirm that one does not have PCOS. Treatment is usually ineffective pharmaceutically and is usually more effective if strategies are arrived at life style and reducing insulin.

Can surgery treat PCOS?

The removal of ovarian cysts is not an effective way to treat PCOS. Cysts on the ovaries are the result of hormone imbalance that begin with the production of too much insulin. This over abundance of insulin causes an increase in male hormones, which eventually create the cysts. As a result, removing the cyst does not remove the problem, just a symptom.

How is polycystic ovarian syndrome treated?

Because there is no cure for PCOS, it needs to be managed to prevent problems. Treatment goals are based on your symptoms, whether or not you want to become pregnant and lowering your chances of getting heart disease and diabetes. Many women will need a combination of treatments to meet these goals.

Birth Control Pills: For women who do not want to be pregnant and still control menstrual cycles, reduce male hormone levels and help clear acne. However symptoms return once the pill is stopped.

Diabetes medications: Metformin [Glucophage] helps women with PCOS symptoms, it lowers testosterone production, controls blood glucose, abnormal hair growth will slow down, ovulation may return after a few months use, it will also decrease body mass index [BMI] and improve cholesterol levels.

Fertility medications: Lack of ovulation is usually seen in PCOS. This can be treated with the use of clomiphene citrate. Clomiphene citrate + Metformin is also used for ovulation stimulation. Another option is IVF with Gonadotropins treatment.

Surgery: Ovarian drilling is a surgery that brings on ovulation. It is used on some women who do not respond to fertility medicines. Laparoscopy is also another option.

Life style modifications: Many women with PCOS are overweight or obese. Keeping a healthy weight by eating healthy foods and exercising is another way woman can manage PCOS. Even a 10 percent loss in body weight can restore a normal period and make a women’s cycle more regular

Does PCOS put women at risk for other health problems?

Women with PCOS have greater chances of developing several serious, life threatening diseases, including type 2 diabetes, cardiovascular disease [CVD] and cancer. Getting your symptoms under control at an earlier age can help reduce the above complications.

How is PCOS and infertility related?

PCOS is some times associated with infertility. In PCOS there is elevated LH and reversal of the LH/FSH ratio as LH becomes higher than FSH. The low levels of FSH allow many follicles to develop but without ever maturing even one follicle. Thus numerous follicles are present in ovaries and once they become ataractic they form cysts, hence the ovaries appear as polycystic. Since the follicles do not mature, they do not release the egg, hence, lack of ovulation is seen. The most likely cause of infertility is anovulation or lack of ovulation. Ovulation can be induced with ovulation drugs [clomid & metformin], by gonadotropins or correction of insulin resistance. The final option for achieving pregnancy in patients with PCOS related infertility is IVF i.e Invitro Fertilization with Gonadotropins.



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