MEN AND WOMEN: MEDICATION AND THERAPY, AN OVERVIEW
Author: Dr. Jaqueline Brendler
Sexual dysfunctions and problems are common both in men and women. Contemporary sexual therapy, which allows the association of distinct approaches and uses at least the behavioural cognitive one in order to formulate sexual complaints, might be useful. The therapist should see the person as a whole being including affective, sexual, family, work, and social aspects.
Pharmacological science has advanced more on solutions for male sexual problems than for female ones. For women, who are subjected to a much more repressive education since childhood than men are, therapy is the best solution for cases of sexual desire disorder, when it is hypoactive (HSDD), of orgasmic dysfunction, of sexual excitement dysfunction, and vaginismus. In situations of dyspareunia (coital pain), a differential diagnosis with sexual excitement dysfunction is needed. However, having done that, the arsenal of gynaecology will be used, from medication to surgery. The most common type of sexual dysfunction in women is currently the hypoactive sexual desire disorder, after the woman's lack of identification with the 'sexed woman' or secondary to other sexual dysfunction (absence of orgasm or sexual excitement). Therapy is essential in those situations. For women who need hormone replacement for hot flushes or osteoporosis during climacteric, the best choice would be transdermal oestrogen, with another option being tibolone. For ooforectomized women, methyltestosterone associated to estradiol might be an option. Those medications will not solve longstanding sexual problems common to most patients, but they have a healthier sexual profile if there is clinical indication other than the in sexual domain.
For men and women, medication that might be negatively interfering on sexuality should be replaced. If an antidepressant is needed, one that does not have as much interference with dopamine, such as bupropion and trazodone is preferable.
As allies to therapy in the treatment of erectile dysfunction (ED), sildenafil, apomorphine, tadalafil, vardenafil might be used to fight 'performance fear' (negative thoughts about the impossibility to have an erection). If the organic factor is more important, injectable E1 prostaglandin might be used or, as a last resort, a penile prosthesis. In all situations, therapy will help not only in re-establishing erection but also in improving self-esteem.
If the diagnosis is quick, or premature ejaculation (PE), medication that can be current used as temporary aides include sertraline, paroxetine, and fluoxetine. However, they will not solve the PE situation without therapy.
It is important that the therapist make a correct diagnosis and have a whole view of the human person, of the situation of the couple, and of the treatments possibilities offered by science.
Annals of the 7th Rio Grande do Sul State Meeting on Human Sexuality, May 13-15, 2004, Porto Alegre, Brazil, page 22.