Primary care physicians, as well as obstetrician-gynecologists (ObGyns), are often trained in the diagnosis and treatment of female sexual dysfunction (FSD). However, not all sexual problems are dysfunctions such as inadequate stimulation. Once the underlying reason is uncovered, many cases of sexual dysfunction can be treated.

A physician will most likely diagnose sexual dysfunction based on the patient’s symptoms. In addition, the patient’s medical history, sexual history, a physical examination including a gynecologic examination will help determine the underlying cause. Patient education and reassurance, combined with early diagnosis and treatment, are the keys to effective treatment of FSD.

Although it may be difficult to speak with a physician about intimate relationships, it is best to be candid. Sexual function is an important part of a woman’s life. It is important for women to realize that sexual dysfunction may be treated. Perhaps the most important step in treating sexual dysfunction is keeping communication open between a woman and her partner.

Basic treatment strategies for FSD may include:

• Medical treatment including management of chronic illnesses (e.g., diabetes). If the underlying cause of the sexual dysfunction is medical, then effective treatment must first address the condition or disease (e.g., surgery for endometriosis).
  
  
• Education. This includes providing information and education about the body, sexual signals and receptors, sexuality changes during and after pregnancy and during menopause.
  
  
• Psychological therapy (e.g., psychotherapy, counseling).
  
  
• Sex therapy from a licensed sex therapist or counselor.

At times, a woman’s physician may prescribe testosterone, which is a male hormone. In many cases this will increase sexual desire, but there are side effects that a woman may find intolerable, such as growth of facial hair, weight gain or acne.

The Food and Drug Administration (FDA) approved a medical device for the treatment of female sexual arousal disorder in 2000. It is a clitoral engorgement device, called Eros-CTD, used to stimulate the clitoris and increase blood flow to the area. It is the only FDA-approved device for female sexual dysfunction.

Women who felt comfortable with and enjoyed their sexuality prior to being diagnosed with chronic disease or breast cancer are likely to maintain or preserve a healthy sexual self-image despite changes brought about by the disease and its treatments. For many who undergo changes or stresses that affect sexuality because of disease, it is common for sexuality to take a back seat to fatigue, pain and a fight for survival.

Once the immediate crisis has passed, however, anxiety over resuming sexual activity is normal and natural. The following suggestions may offer relief for specific concerns:

• Give it time. Many patients experiencing FSD from a medical condition may have unrealistic expectations of how soon normal sexual relations will resume. It is important to realize that an interruption in the patient’s usual ability to experience sexual pleasure is perfectly normal. After treatment for cancer for example, it may be best for a patient and her partner to schedule quiet time together and start slowly.
  
  
• Keep communication open. It is helpful for a woman to communicate her feelings about any physical changes (e.g., loss of a breast due to breast cancer) with her partner. It is best for the couple to be open about how they may work though any anxiety about loss of a body part or gynecologic changes and the remaining scars together. Open communication means letting a partner know what type of physical touching the patient is ready to explore. Remember that poor communication often results in feelings of rejection for the woman and frustration and confusion for her partner. Continuous sharing offers an atmosphere of acceptance and understanding that will help to slowly eliminate any “off-limit” zone. For example, some women may enjoy a partner’s touch at the site of a mastectomy scar, but others will not and may even dislike being touched on the remaining breast and nipple. Experimenting with different visual types of exposure, such as wearing a camisole or even a bra during sex may also help.
  
  
• Try over-the-counter (OTC) remedies for painful intercourse (dyspareunia). To alleviate painful intercourse, many women choose hormone replacement therapy (HRT) or estrogen creams. However, HRT and estrogen-based creams can have serious side effects and health risks and may not be recommended for breast cancer patients as they could lead to a recurrence. There are many OTC creams, gels and lubricants that work well to alleviate vaginal dryness.
  
  
• Reduce medication side effects. Many medications that are commonly prescribed for patients can have sexual side effects, including antidepressants. However, some of the newer antidepressants have fewer sexual side effects. Generic brands that offer fewer sexual side affects include venlafaxine, citalopram and bupropion.
  
  
• Make healthy lifestyle changes. This includes quitting smoking, avoiding or reducing alcohol consumption, exercising regularly and getting plenty of rest and relaxation. Smoking or drinking alcohol can affect not only the prognosis or treatment of a medical condition, but also the patient’s sexual function. The serious side effects of tobacco and alcohol apply to prescribed and OTC medications. Health experts recommend regular aerobic exercise for increasing stamina, improving body image and elevating mood. Getting proper relaxation and rest also can enhance a woman’s ability to focus on the sexual experience and achieve better arousal and orgasm.
  
  
• Strengthen pelvic muscles. Pelvic floor exercises (e.g., Kegel exercises) can help with some arousal and orgasm problems. Kegel exercises can help strengthen the muscles involved in pleasurable sexual sensations. A physician also may recommend using vaginal weights to strengthen the pelvic muscles.
  
  
• Seek professional help. At times, focusing on the positives are not enough, and the problems that affect sex and intimacy in a relationship require the assistance of a professional. Patients and their partners may find help and the needed support from a sex therapist or counselor who has experience counseling patients with chronic illnesses or gynecologic cancers.