(c) 2011 L.Romanzi
Does she or does she not; is the epidemic of “female sexual dysfunction” (FSD) fact or fiction? If fact, what’s to be done about it? Is it hormonal, vascular (clogged arteries – think “atherosclerosis of the vulva and clitoris”), muscular, psychological, or some labyrinthine combination of contributors? Or should we say, detractors? The bad news – we’re not really sure. The good news – smart, skilled & talented people on both sides of the debate care deeply, all carefully plumbing the depths of truth and possibility to sort it all out – to whit:
Apr 2011 Journal of Sexual Medicine Literature Review
NB: Dypareunia = painful sex Vaginismus = vaginal muscle spasm often preventing sexual intercourse and always painful
HSDD = Hypoactive Sexual Desire Disorder
Sandhu KS, Melman A, Mikhail MS. Impact of Hormones on Female Sexual Function and Dysfunction. Female Pelvic Med Reconstr Surg 2011;17:8-16.
This review article provides a comprehensive overview of current literature, including areas of controversy, with regard to hormone levels and female sexuality. The authors review the available prevalence data, stating that 43% is the number obtained by the original U. S. National Health and Social Life Survey published in JAMA in 1999 that included women who were, per that author, not necessarily outside of normal range, as the “sexual dysfunctions” included things like fatigue from childcare and housework leading to diminished interest in sex that was not necessarily considered pathological, abnormal or bothersome by the participant women. Nonetheless, that 43% prevalence rate sparked an avalanche of interest in the possibility that lots of women were suffering sexually without access to evaluation and therapy aside from interactive verbal counseling. These authors respond to the rapid evolution of data sets, therapies and claims by carefully reviewing the formal definitions for the DSM-IV diagnoses of HSDD, categories of female sexual arousal disorders, female orgasmic disorders, dyspareunia and vaginismus, followed by a balanced review of the literature on central and peripheral hormone physiology in menstrual and menopausal women, individual reviews of the roles of estrogen and androgens, the current consensus on normal and abnormal hormone values, the impact of hormone therapies with estrogens and androgens, the impact of natural vs surgical menopause, the controversy regarding androgen insufficiency in pre-menopausal women, and a summary table of Conclusions and Recommendations generated by the Female Sexual Dysfunction Committee in 2004. The authors finish by reviewing practical aspects of current therapies for female sexual dysfunction including phosphodiesterase inhibitors, Tibolone, DHEA, mechanical devices and electric stimulation, both vaginal electric stimulation for vaginismus and the more controversial sacral neuro-modulation implant with its dearth of data. The authors of this comprehensive review article state that while classification systems and therapeutic options continue to evolve, much is lacking with regard to understanding, defining, evaluating and treating female sexual dysfunction. This is a meaningful review for all clinicians, be they specialists in treating female sexual disorders or general primary care clinicians interested in knowing more about a subject affecting more than ½ of their patient population.