On the Beach—Mature Women, Sexual Dysfuction, and All That Jazz

South Beach is one of our favorite beaches in Martha’s Vineyard.  The sound of waves crashing to shore makes great background noise to drown out conversations that hold the shared secrets of friendship.  That is why some of my best conversations have taken place on South Beach.

Yesterday I had one of those special times.  For the last several years, my friend Wendy Rotstein (or Wendy Wolfman, MD, if you happen to be a mature woman in need of a great gynecologist in Toronto) and her family have joined me for an afternoon on the beach.  We first met in 1983, during the first week we were in Buffalo.  And although they moved back to their native land more than 18 years age, for a quarter century we have remained friends. 

During my conversations about my thoughts on the gender gap in healthcare with my MV tennis friends, many interesting subjects were discussed.   After listening to these women with whom I played with for years, I was eager to tap into Wendy’s enormous knowledge base about some of their women’s healthcare issues.  Wendy knows simply everything about such varied subjects such as menopause, hormone replacement therapy (HRT), gynecologic cancers and sexual dysfunction in the mature woman.  (She also knows a lot about obstetrics, but had to give up that part of her practice up 10 years ago for a variety of external reasons, much to the detriment of women’s health in Canada, in my opinion).

With her grown children and hubby seated far enough away that the sounds of our voices could not be heard over the wild sea and the cries of the hungry gulls, we launched into a spirited discussion about the search for a female Viagra equivalent.  Wendy re-educated me about male and female hormones, and then went to talk about the major causes of depressed libido in women.  That was when I really was happy to hear the waves get more fearsome as the tide rose and they crashed closer to shore, closer to where we sat.  I really didn’t know that there were 5 major factors that were associated with sexual dysfunction in women over 40 years of age.  These things just don’t get discussed in everyday conversation.

31% of men have sexual dysfunction, and 43% of women are reported to be similarly affected.  So why have women been pharmacologically neglected in this area?  With such a large market for the drug companies, you would think that a pharmacologic solution would have by now become available.

After talking with Wendy and through further research on the internet (which we doctors are quick to point out is less accurate than the knowledge base of a real expert, i.e. your doctor) I learned that there are at least three, as yet non-scientifically proven options.  L-arginine amino acid cream, used by atheletes to increase blood flow to muscles, has been shown “in informal studies to improve sexual function in 70% of women who applied this to the clitoris before intercourse.”  What is an informal study?  Is there IRB oversight of such research?  Were these women given medications and even suggested to “try something” without an informed consent?

Another possibility is DHEA, a male hormone that converts to testosterone and estrogen.   It is the testosterone which increases the sexual drive. This is sold over the counter with a suggested dosage of 25 mg /day.  A 1999 New England Journal of Medicine study, women who took 50 mg/day experienced an increase in sexual interest.  The results were described as “encouraging” despite the rather serious side effects of increased risk of breast cancer, heart attacks and masculinization, particularly increased bodily hair.  Hmmm, ten years later, I guess that therapy has bit the dust.  The question remains is how many women have also bitten the dust because they used this promising but unproven therapy?

Other studies that have looked at testosterone itself as a treatment have cited unacceptable masculinizing effects of facial hair and irreversible voice change.  Natural extracts of testosterone like substances have been shown to increase libido in women when combined with erotic films as compared to those who received placebo (and possibly no erotic films?)

And at least for now, in the US and Canada, there is no FDA approved, safe and effective way to enhance female sexual function.  Nor is there likely to be anything on the horizon soon.  But take heart.  I have been told that minimizing our “risk factors for dysfunction” by having a satisfying relationship, being in good health (no diabetes, high blood pressure, thyroid problems, stress, etc), experiencing no pain during intercourse, having a previous history of good sexual function, and living a life without antidepressants (or other psychotropic drugs which are known to interfere with libido and normal sexual function), we will have a better chance of enjoying sex and might not need this pill.

Staying healthy and enjoying life is sometimes hard work.  But enhancing our living a better life through chemistry should be available to all.  Just haven’t figured out why the pharmaceutical companies have not jumped into this potentially huge market. Are women really so much more complex?  Or is it that they are afraid to advocate for their own sexual needs?  Or is it that the people making the decisions on what research is important and what research is not, have a uniquely male point of view? I don’t really know.  Do you have any ideas?

Whatever the case may be, my afternoon at the beach was more informative than even I could have ever hoped! Thank you, Wendy Wolfman, MD, gynecologist and women’s advocate extraordinaire.