Major Breakthrough in Treating Female Sexual Dysfunction

Major Breakthrough in Treating Female Sexual Dysfunction.

Testosterone for the Lady.

Dr Andrew Rynne.

People naturally associate the hormone testosterone, also called androgen, with men. It’s what makes us so nasty, so aggressive, so driven, so bald, so hairy and so sex mad. Isn’t that so? What very few people don’t realise though is that testosterone also plays a vital role in female sexual functioning. To be healthy, a woman needs to have androgen levels of approximately one tenth of that of young men. This they produce in their ovaries and adrenal glands. It plays a part in many things of which sex drive or libido is but one.

It may go against the grain to associate testosterone with femininity. After all, in the main when compared to men, women are gentler, better at empathising, more intuitive and more patient than men with their raging testosterone. So how could they possible need this stuff that enjoys such bad press? Recent studies have shown that post menopausal women not only lack oestrogen and progesterone but testosterone as well.

This low level of male hormone in post-menopausal women can give rise to many undesirable consequences. Indeed it is now suggested that testosterone may be the “missing link” in the management of menopausal symptoms not otherwise responding to standard HRT. To date this in the main consisted of oestrogen and progesterone. Included here are hot flushes, depression, osteoporosis and the sexual dysfunctions of vaginal dryness, dyspareunia, anorgasmia and low or no libido.

So how much testosterone replacement do ladies need? The quick answer is not a lot. At most her optimum levels of androgen will be from one seventh to one tenth of that of men. So, if a man requires on average 50mg of testosterone delivered daily via a gel call Testogel, then a woman’s requirement will be one tenth of this or 5mg of testosterone daily. A handy way to think of this is that if a man uses one tube of Testogel every day then the same tube of gel should last a woman one week. A little “toothpaste” sized smear on the inside of her forearm every day should do the job nicely.

Doctors who “approve” of testosterone replacement therapy for women are still thin on the ground and some of those like to try and make things complicated. Blood tests, for example, to measure the levels of testosterone that a post-menopausal woman might have, are largely a waste of time and money. They contribute not a jot to the diagnosis. Likewise, expensive specially compounded “female” testosterone replacement therapy will do a lot more for the doctor’s bank account than it will for client’s wellbeing. There is nothing wrong with existing pharmaceutically manufactured androgen gels as given to men.

It is in practise quite simple. All you need do is ask yourself some simple questions: Do you have post-menopausal symptoms not relieved with standard HRT? In particular, do you have sexual dysfunctions like vaginal dryness and loss of libido? If the answer to this is “yes” then try some testosterone replacement therapy at a does of about one tenth of that for a man? Did that improve things for you? If yes then continue if no then discontinue. Now, isn’t that nice and simple? Why complicate things?

To find out more about Testosterone treatments available for women please visit www.doctorrynne.com

Loss of Libido in Young Woman.

Loss of Libido in Young Woman.

What do you make of this? How would you advise? About a week ago, in my Allexpert.com slot, a young woman from South Africa wrote to me as follows:

“I have been thinking of asking for professional help for a while, because there seems to be a serious problem that I just can’t ignore. I am 32 years old, married for 7 years to a man two years my junior. Together we have four lovely children.

The problem started to appear after I started my third pregnancy and lately I just can’t handle it anymore. I do not want to have sex. I do not feel the need to. If I do it does not happen more than 2 or 3 times a month. Yesterday I realized that the mere thought of having sex disgusts me! I feel ashamed and insufficient to satisfy my husband who has been complaining about it recently. What’s the matter with me? I am a young vibrant woman. I take care of my appearance and I know that men like me, but something has stopped working properly. Please, please help me!”

First of all what sticks you about this questioner as odd, or as possibly the root cause of her problem? And secondly, what further information would you like to have before reaching a conclusion and offering some sound advice? Let’s deal with the second question first. When I hear of loss of libido in a woman the first thing I think of is clarity – what exactly does the questioner mean by loss of libido. The second thing that I think of is could some medications be causing this. I wrote to her therefore as follows seeking some clarity:

“Hi there Ruth, thanks for your question. When you say loss of libido do you mean loss of interest in all things sexual – no desire, no urge, on sex drive? Or is it a case that you do have these things but that you are not responding – you have so-called Female Sexual Arousal Defect?

I also need to know if you are on any form of birth control including the IUCD and if you were ever on any antidepressants?”

Her answers to these questions were revealing in their own way. No she was not on any form of BC, not now or ever and she was never on any antidepressants. As to the first part of my question; her problem was indeed a pure loss of libido and had nothing to do with response. While answering this Ruth also let it slip that she had a full time job!

This of course underlined and re-enforced my first impressions as to what exactly was going on here. Now we have a young woman aged 32 with four young children, obviously talented and well educated and holding down a full time job and not on any form of birth control! And she wonders where her libido has gone to! When I was first reading through her question I was thinking of all sorts of fancy footwork like hormone assay and possibly testosterone replacement therapy for women. But on more sober reflection the answer was far more pedestrian.

Four small children, under the age of seven, no matter how lovely they may be, is draining enough God knows. Now add onto that a full time, and I would guess a fairly onerous job and you are approaching human limitations. On top of that we have a young woman not on any form of family planning such that any sexual activity with her husband exposes her to the risk of further pregnancy and she is wondering where her libido has gone to!

Moral considerations aside, I think Ruth is going to have to give some serious consideration to possible a permanent form of family planning – vasectomy or tubal ligation or, less satisfactory, Marina Coil or implant. Once she has her fertility under some kind of control she should consider taking a break from her work and/or from her parenting duties. What Ruth may desperately need is a quiet week in the country somewhere. Then perhaps she will discover where her libido had vanished to. 

What do you think? Please leave a comment. 

Dr Andrew Rynne. http://www.doctorrynne.com 

Hormonal Replacement Therapy for Women - Do women need testosterone

Hormonal Replacement Therapy for Women.

 Do women need testosterone?

Dr Andrew Rynne.

Up to the year 2002 hormone replacement therapy or HRT was almost standard treatment for all post-menopausal women suffering from symptoms of falling female sex hormone levels. Up to then, testosterone was not considered a female sex hormone of any significance. In the past ten years there have been some quite dramatic developments.

What are the most frequent symptoms of Menopause?

(1)   Frequent hot flushes.

(2)   Night sweats.

(3)   Vaginal dryness making sexual activity difficult or impossible.

(4)   Loss of libido and mild depression.

(5)   Hair and skin dryness.

(6)   Weight gain unrelated to over-eating.

(7)   Slowing down and eventual cessation of menstruation. Erratic menstrual periods.

What hormone levels fall at time of menopause?   

All female hormonal levels, including testosterone, fall around the time of menopause but the ones that cause the most symptoms are oestrogen, progesterone and testosterone. Testosterone is a steroid androgen hormone produced by the ovaries and adrenal glands. During early adulthood women produce testosterone at about 10% the rate that men do. As with men also, their levels of testosterone fall as they get older such that by menopause, or shortly thereafter, their testosterone levels fall to zero or near zero.

Testosterone levels in women.

Testosterone is now thought to play an important role in female libido and sexual response. Not all women, by any means, will experience a fall in their sex drive or function as a result of declining testosterone levels. Some however will and it is important to know that these women can be helped and need to be helped.  

Can these be replaced?

Yes, all three hormones can be replaced. In the case of post hysterectomy, oestrogen can be given alone since endometrial cancer is no longer a possible side effect. Otherwise a combination of oestrogen and progesterone are usually chosen since oestrogen given alone carries a greater risk of endometrial cancer. Testosterone, so often forgotten, can now be given alone or in combination with either of the other hormones.

What are the treatments for menopause?

The most effective treatment for menopausal symptoms remains hormone replacement therapy. If you have not had a hysterectomy this will involve a combination of oestrogen and progesterone and perhaps testosterone. If you have had a hysterectomy, because that removes the danger of endometrial cancer, the estrogens alone or in combination with testosterone, will be your treatment of choice.

In 2002 the preliminary findings of the Women’s Health Initiative study were reported to a fanfare of alarming publicity. The bottom line was often misinterpreted in attention grabbing headlines like: HRT CAUSES BREAST CANCER.   However, it might be useful to understand exactly what the study did in fact report:

Among 10,000 women taking oestrogen/ progesterone combination HRT for one year there were eight extra cases of breast cancers when compared to a similar group of women not receiving HRT over one year. The initial study did not show any extra deaths among the HRT taking women.

Other facts that sometimes hysterical reports on this study failed to mention was that there was a decreased incidence of bone fracture and of bowel cancer among the HRT group. And also there was a 15% reduction in the incidence of breast cancer among women who were on oestrogen only HRT – that is, post-hysterectomy women.  

There were 38 cases of breast cancers among the HRT group compared to just 30 cases among the non HRT group. The question then that a woman needs to ask herself is this. Are the benefits of my taking HRT such that they outweigh the increase in the risk of developing breast cancer? This question needs to be answered in the calm light of day and not be unduly influenced by devotees on either side. Is the risk versus benefit ratio correct? Are my menopausal symptoms such that to be rid of them would be well worth the risk of being one of those 8 in 10,000 women for whom this treatment might cause breast cancer?

To add even more worry to this vexed question The Women’s Health Institute study also showed an increased risk of developing heart attach and stroke among the HRT group of approximately the same increased rate of some 10 extra women per 10,000 on treatment. Again this figure needs to be looked at in a balanced fashion for what it is and risk/benefit ratio needs to be weighed up.  

What about Natural or Bioidentical HRT.

Much play has been made in recent years about the virtues of naturally occurring hormones as distinct from the synthetic ones. Indeed a major industry has grown up around this very topic. Some very fashionable and famous women have thrown themselves behind the argument in favour of “naturally occurring” HRT. Unfortunately though, this is invariably accompanies by far more hyperbolae than clinically proven fact, anecdote rather than study.  The problem is, search as you may, there are no published studies that I am aware of, that actually prove that naturally occurring hormones impart any benefit over the synthetic ones and may do not carry the same efficacy.

Summary.

Hormone replacement therapy (HRT) for women today remains every bit as valid and as useful as it always has been. It has now been extended to considering the addition of testosterone to oestrogen and progesterone. As always, care must be exercised and this therapy should only be embarked upon under medical supervision and advice. In our present knowledge so called “Bioidentical” HRT offers no advantage over their synthetic equivalents and indeed may not be as effective.   

Article by Doctor Rynne: http://www.doctorrynne.com/

Treatment for Vaginismus

Vaginismus or vaginal muscle spasm on penetration makes sex impossible. You may have noticed that I have not used the term "fidget" to describe any female sexual dysfunction. I have not because I consider such a term to be a judgemental pejorative belonging to an earlier era of sexual repression. It may have been applied however to, among other things, muscular spasm to the vaginal entrance preventing intercourse. Today this is called 'vaginismus' and it can put a real strain on your daily life, as well as your sex life. Indeed it can spiral into a major problem you feel you'll never find a cure for. It can make a woman feel utterly inadequate and miserable. Her sex partner also will often incorrectly blame himself and this can make matters even worse.
If that happens to you, it is very easy to feel that no one fully understands what you are going through, or is prepared to take your vaginismus seriously. Searching for a quick fix for your problem, it is likely you will consider the many pills, exercises and vaginal dilators available both online, and in some cases, as a prescription via your GP.
Vaginismus is defined as the involuntary contractions or spasm of the muscles surrounding the vaginal opening causing pain and preventing penetration. In its more severe forms, the tensing may also extend to muscles of the inner thigh and abdomen.
Vaginismus may be either primary or secondary. Primary vaginismus is where the woman has had the problem from the very first attempt at intercourse. In this case there is often a background of strict religious orthodoxy where sex is depicted as 'dirty' or sinful or simply as painful and as something that has to be endured to please men.
Secondary vaginismus on the other hand is the situation where the woman once enjoyed sex to the full but, because of some traumatic experience like a rape or very difficult childbirth, developed vaginismus as a result of that assault.
Treatment consists of (a) relaxing the muscles of the pelvic floor and vaginal opening through specific relaxation exercised and (b) gentle and graded dilatation of the vagina using finger(s) and specially graded vaginal dilators known as boogies. Remember that practically all vaginismus is curable but it does take time and some effort. There is no quick fix.
Attending a skilled sex councilor is often the best way forwards.

Dr Andrew Rynne.
http://www.doctorrynne.com
 
Dr Andrew Rynne is a medical practitioner and writer. He has thirty years experience in treating Sexual Dysfunction in men and women

Female Anorgasmia - Understanding and Treatment

Female Anorgasmia - Can not Orgasm through intercourse.

It is estimated that as many as one in four women suffer from this sexual difficulty. Not being able to orgasm during intercourse can put a real strain on your daily life, as well as your sex life. Before too long your inability can spiral into a major problem that you feel you'll never find a cure for. It can make a woman feel utterly inadequate and miserable. Her sex partner also will often incorrectly blame himself and this can make matters even worse.

Like so many sexual dysfunctions, Anorgasmia often elicits very little understanding and even less sympathy. So what if you can't have an orgasm during intercourse? Therefore it must it is very easy to feel that no one fully understands what you are going through, or is prepared to take your problem seriously. Searching for a quick fix it is likely that you will have considered the many pills, exercises and devices available both online, and in some cases, as a prescription via your GP.

Anorgasmia is defined as the sustained inability to reach orgasm through sexual intercourse while not having any trouble when alone through masturbation. It is a complex multifaceted problem involving all aspects of a relationship both physical and emotional. In may be caused by something as simple as depression or stress or a lack of physical fitness. Or it can be caused by something more complex like premature ejaculation in the man, distrust, anger or inadequate sexual stimulation.

Lack of communication and faking orgasms are other major issues often found in conjunction with Anorgasmia. Women may find it easier to lie and to pretend to have had an orgasm rather than run the risk of hurting his fragile ego or of having him, perhaps unfairly, blame himself. A history of sexual abuse or exploitation or one of a repressive upbringing are other areas that need enquiring into.

Finding that solution, tailor-made to address your specific needs, can be a challenge. Too many people think that by just throwing tablets at it, female Anorgasmia can be cured. If you are already taking SSRI antidepressants then these need to be discontinued before any progress can be made.

Dr Andrew Rynne.

http://www.doctorrynne.com

Dr Andrew Rynne is a medical practitioner and writer. He has thirty years experience in treating Sexual Dysfunction in men and women.

Improving your Sexual Performance

Well, that's a slightly loaded question because it's only natural for you to think that you would benefit from improved sexual function. And, just as you might reasonably expect to benefit from improved eyesight, improved memory, improved dexterity or improved anything else to do with your body, surely you would benefit also from improved sexual function.
However, you need to be extremely careful here. Sexual function, quite simply, is not like your eyesight or your memory or your dexterity. It is, in many ways, more delicate and sensitive than any of these things and, in fact, sexual function can actually be damaged by inappropriate attempts to improve it.
In addition, whilst you may well benefit from improved sexual function, you would need to have some degree of dysfunction first in order for this to happen.
How will I know if I have a genuine case of Erectile Dysfunction?
If, over a period of time, you are unable to achieve an erection of sufficient quality or hold it long enough to satisfy your needs or those of your partner and you are finding this an ongoing, frustrating and even stressful situation, then you have genuine Erectile Dysfunction.
You will notice also that your partner is not happy either with the situation and that your Erectile Dysfunction is now beginning to threaten your relationship with her. On the other hand, it may even be that the problem has already ended an otherwise happy relationship.
If this happens, you may find yourself avoiding new relationships altogether fearing, or indeed knowing, that your Erectile Dysfunction will make it impossible to sustain that new relationship.
This situation, avoiding getting into new sexual relationships for fear of failure, is sometimes confused with loss of libido.
And, in certain cases men with Erectile Dysfunction sometimes seek libido-boosting treatments, like testosterone replacement therapy, when in fact what they actually need is to have their condition properly diagnosed and managed by a specialist.
New relationship avoidance and confusing this with lack of libido are both hallmark signs of genuine Erectile Dysfunction.
However, the good news is that specialist advice, guidance and treatment is available to help you find a cure, giving you back your love life and your confidence.

Dr Andrew Rynne.
http://www.doctorrynne.com

Dr Andrew Rynne is a medical practitioner and writer. He has thirty years experience in treating Sexual Dysfunction but most particularly Erectile Dysfunction and Premature Ejaculation.

Treating Vaginismus

Vaginismus or vaginal muscle spasm on penetration makes sex impossible. You may have noticed that I have not used the term "fidget" to describe any female sexual dysfunction. I have not because I consider such a term to be a judgemental pejorative belonging to an earlier era of sexual repression. It may have been applied however to, among other things, muscular spasm to the vaginal entrance preventing intercourse. Today this is called 'vaginismus' and it can put a real strain on your daily life, as well as your sex life. Indeed it can spiral into a major problem you feel you'll never find a cure for. It can make a woman feel utterly inadequate and miserable. Her sex partner also will often incorrectly blame himself and this can make matters even worse.
If that happens to you, it is very easy to feel that no one fully understands what you are going through, or is prepared to take your vaginismus seriously. Searching for a quick fix for your problem, it is likely you will consider the many pills, exercises and vaginal dilators available both online, and in some cases, as a prescription via your GP.
Vaginismus is defined as the involuntary contractions or spasm of the muscles surrounding the vaginal opening causing pain and preventing penetration. In its more severe forms, the tensing may also extend to muscles of the inner thigh and abdomen.
Vaginismus may be either primary or secondary. Primary vaginismus is where the woman has had the problem from the very first attempt at intercourse. In this case there is often a background of strict religious orthodoxy where sex is depicted as 'dirty' or sinful or simply as painful and as something that has to be endured to please men.
Secondary vaginismus on the other hand is the situation where the woman once enjoyed sex to the full but, because of some traumatic experience like a rape or very difficult childbirth, developed vaginismus as a result of that assault.
Treatment consists of (a) relaxing the muscles of the pelvic floor and vaginal opening through specific relaxation exercised and (b) gentle and graded dilatation of the vagina using finger(s) and specially graded vaginal dilators known as boogies. Remember that practically all vaginismus is curable but it does take time and some effort. There is no quick fix.
Attending a skilled sex councilor is often the best way forwards.

Dr Andrew Rynne. http://www.doctorrynne.com   Dr Andrew Rynne is a medical practitioner and writer. He has thirty years experience in treating Sexual Dysfunction in men and women

Pain During Intercourse. Painful Sex. Dyspareunia.

Pain During Intercourse. Painful Sex. Dyspareunia.

Not being able to enjoy intercourse due to pain can put a real strain on your daily life, as well as your sex life, and before too long this can spiral into a major problem. Indeed you may well feel that you'll never find a cure for this. It can make a woman feel utterly inadequate and miserable. Her sex partner also will often incorrectly blame himself and this can make matters even worse.
Dyspareunia takes a great deal of patient analysis. It is very important that the doctor or therapist is clear in their mind as to when and where the woman experiences pain during intercourse. It is easy to feel that no one fully understands what you are going through, or is prepared to take your dyspareunia seriously. There usually is no quick fix for your problem but with proper history taking and careful consideration a solution can be found.
The key to fixing dyspareunia is making the correct diagnosis. Dyspareunia, or pain during intercourse can be caused by either something inside the vagina or outside in the pelvic organs. Inside the vagina some common causes are:
Vaginismus or painful spasm of the vaginal muscles.
Female Sexual Arousal Deficit.
Vaginitis or infection.
Perineal tear.
Vulvar trauma from childbirth.
Outside the vagina some common causes are:
Endometriosis.
Ovarian Cyst.
Uterine fibroids.
Diverticular disease.
Pelvic Inflammatory Disease'
Each of these problems has additional symptoms other than dyspareunia and their presence can often be elicited through careful history taking. Finding that solution, tailor-made to address your specific needs, can be a challenge. Too many people think that by just throwing tablets at it, female dyspareunia can be cured. It does not work that way however.
Just one final note. Pain felt around or inside your vagina may not be arising from there at all. Referred pain, arising from some source distant from the vagina but felt there is not uncommon. Damage to the Iliolumbar ligament or endometriosis are good examples.

Dr Andrew Rynne. http://www.doctorrynne.com Dr Andrew Rynne is a medical practitioner and writer. He has thirty years experience in treating Sexual Dysfunction in men and women.

Female Sexual Arousal Disorder

Female Sexual Arousal Disorder

Because they are often confused, it is important from the beginning to distinguish between sexual desire or libido and arousal. Desire comes first arousal second. Here we are considering a woman's inability to experience arousal in spite of strong desire or libido. Not being able to enjoy intercourse due to an inability to become aroused can put a real strain on your daily life, as well as your sex life. It can spiral into a major problem you feel you'll never find a cure for. It can make a woman feel utterly inadequate and miserable. Her sex partner also will often incorrectly blame himself and this can make matters even worse.
If that happens to you, it is very easy to feel that no one fully understands what you are going through, or is prepared to take your lack of genital arousal seriously. Searching for a quick fix for your problem on the internet can make matters even worse. It is tempting for you to consider the many pills, potions, lubricants and gels available both online, and in some cases, as a prescription via your GP who may also not understand this problem.
Female Sexual Arousal Disorder (FSAD) is a major component of female sexual dysfunction. It may be defined as the persistent or recurring inability of a woman to achieve or maintain an adequate lubrication/swelling response during sexual activity. This occurs in spite of strong desire (libido) and sexual stimulation. Lack of desire or libido is a separate problem and it is important not to confuse the two issues.
The causes may be either physiological or psychological. The effects may be either lifelong or acquired, generalised or situational. The consequences are the same however--- pain and discomfort during intercourse, sexual avoidance and sexual tensions in a relationship. Treatments are as many and as variable as are the causes and ramifications of this common sexual dysfunction.

 

Dr Andrew Rynne.

For more information please visit: http://www.doctorrynne.com