Female sexual dysfunction affects 41% of reproductive women world wide, with the peak age consisting of women aged 51-59 years old. 75% of all menopausal women will experience sexual dysfunction. The incidence of this problem varies greatly throughout the world and depends on how the questions concerning this disorder are asked.
The definition was recently redefined and includes;
- Female Orgasmic Disorder
- Female Sexual Interest/Arousal Disorder
- Genito-pelvic Pain/Penetration Disorder
To be considered dysfunctional, these problems must occur 75% of the time over a 6 month period of time.
Causes of female sexual dysfunction
Diverse and usually multiple factors overlap
- Hormonal
- Metabolic
- Vascular
- Neurologic
- Relationship issues
- Psychosocial Issues
- Stressors
- Mood
- History of sexual abuse
- Psychiatric Issues
- Medications
- Substance abuse
History of the disorder
Sexual interest /arousal disorder
- Does the patient state she has “low sex drive”
- When did the feelings of “low sex drive start”?
- Does she have sexual thoughts?
- Did she initiate sex in the past?
Sexual Pain
- Does it cause pain?
- Do certain positions cause pain?
- Have you had to stop due to pain?
- When did the pain start?
Orgasmic disorder
- Have you reached orgasm in the past?
- When did your orgasms stop?
- Do you reach orgasm with vibration or penetration?
These issues are important to address to diagnose the underlying nature of the problem. Patients can have problems with sexual desire, arousal, orgasm, sexual pain or many emotional problems.
PHYSICAL EXAMINATION
Helpful in women complaining of pain with sex.
Common gynecologic conditions include;
- Sexually transmitted diseases
- Endometriosis
- Masses
- Dermatosis
- Prolapse of uterus
- Intra -peritoneal masses
- Uterine fibroids
FEMALE ORGASMIC DYSFUNCTION
May experience decreased intensity or lack thereof. May be related to lack of stimulation.
Causes
- Lack of education concerning the anatomy
- Lack of stimulation
- Medications
- Relationship issues
- Medical issues such as Diabetes and autonomic neuropathy
FEMALE SEXUAL INTEREST? AROUSAL DISORDER
- Relationship Issues
- Depression
- Thyroid Disease
- Hormone Deficiency
- Vascular Disease
- Survivor of Abuse
GENITO-PELVIC/PENETRATION DISORDER
Penetration is painful due to a combination of many problems both physical and emotional.
LAB TESTING
Rarely helpful but is nearing menopause and in doubt testing may enlighten the diagnosis especially if prior hysterectomy.
The literature does not support a direct relationship between levels of androgens and estrogens and the capacity for sexual arousal or desire.
Thyroid testing is helpful and should be done.
Irregular menses should have testing done.
IMAGING
Trans-vaginal ultrasound is helpful in patients with sexual pain to rule/out cervical, bladder or uterine masses.
TREATMENT
Treatment of female sexual dysfunction depends on the underlying disorder. Correctable disorders or issues may be addressed with education, counseling and reassurance. However, if correctable causes have been ruled out, medical intervention should be considered. Medical intervention can be individualized to the category of female sexual disorder.
Treatment of Female Sexual Interest/ Arousal Disorder:
- Medicines used for other disorders should be addressed and modified if possible
- Medicines such as beta blockers, antihistamines, diuretics and hormonal contraceptives have been implicated in reduction of sexual desire
- Most common culprits are drugs used for mental health such as selective reuptake inhibitors (Prozac and others) These drugs have been implicated in 56% of women and the sexual desire side effect can cause women to discontinue them 70% of the time
- Anti-depressant drugs should NEVER be abruptly discontinued and should be reduced or discontinued with the aid of the mental healthcare provider
FDA approved medicine to treat Female Sexual Interest/Arousal Disorder is Fibanserin (Addyi) It is indicated only for premenopausal women with low sexual desire. Significant side effects include low blood pressure, dizziness and syncope. There are multiple drug interaction and cannot operate machinery of any type within 6 hours of ingestion. Alcohol must be avoided. It works by changing the activity of serotonin and other substances in the brain.
FDA approved Bremelanotide (Vyleesi) for hypoactive sexual desire in premenopausal women. This drug is injected 45 minutes before sexual activity. Usage is limited to 8 times a month. This drug can cause nausea which can be severe. It cannot be used with any heart disease or high blood pressure. Bremelanotide injections are in a class of medications called melanocortin receptor agonists. It works by activating certain substances in the brain that control mood and thinking.
Supplemental androgens have not been approved for use in the US for sexual dysfunction. However, testosterone preparations are used for post- menopausal women. Side effects are virilizing for women therefore cannot be used long term.
Genito-pelvic Pain/Penetration Disorder:
Lubricants and moisturizers are the primary treatment options. Women with vaginal dryness due to menopause can use topical estrogen products that improve vaginal integrity and improves the elasticity of the vaginal tissues. Ospemifene is a estrogen receptor modulator used to treat vaginal dryness and dyspareunia (painful intercourse due to vaginal dryness) It works by acting like estrogen in some parts of the body.
With other restrictive disease conditions, causing narrowing of the introitus, pelvic floor therapy may be needed. Surgery may be appropriate in patients with adhesions due to pelvic floor diseases or prior radiation therapy.
Female Orgasmic Disorder:
Education and counseling should be the initial therapy especially discussion of the female anatomy. Drawing attention to stimulation is important. Viagra has been used in women especially those treated with anti-depressant medicines. Anti-depressants especially the class of SSRI (Prozac like medicines) are a primary cause of female orgasmic disorder.
Platelet Rich Plasma
Platelet Rich Plasma is an autologous blood derived product that contains super physiologic concentrations of growth factors and cytokines that repair and rejuvenate damaged tissues in the body. When used in the areas of the vagina for the purpose of treating female sexual dysfunction, PRP will cause the differentiation of stem cells mediated by the cytokines and growth factors resulting in angiogenesis, fibroblast growth, glandular growth and new neuronal growth resulting in improved physiologic response.
After blood is taken from the arm, the PRP is then processed. The PRP shot is inserted into the vagina and clitoris while the patient is under local anesthesia. The process is simple and relatively painless.
Patients have reported the following after the procedure;
- Enhancement in libido and sexual desire
- Stronger orgasms
- Improved vaginal lubrication
- Improved atrophy in the vaginal tissues
- Pain reduction during intercourse
- Reduction in urinary stress incontinence
All without significant side effects. Sexual function improvements have been reported in an estimated 70-95% of women post procedure.
STUDIES
- A Pilot Study of the Effect of Localized Injections of Autologous Platelet Rich Plasma for the Treatment of Female Sexual Dysfunction Women’s Health Care 3:169. Doi 10.4172/2167-0420.1000169
Discussion- Women who presented with complains of dyspareunia or other symptoms related to sexual dysfunction were offered PRP injections into the periurethral area of the Skene’s glands and the clitoris and were observed for their responses to this treatment.
Conclusion- The results of this study suggest that specifically placed intravaginal and intraclitoral PRP injections could be an effective treatment for certain types of female sexual dysfunction especially in the areas of desire, arousal, lubrication and orgasm
- The Emerging Role on the Use of Platelet-Rich-Plasma Products in the Management of Urogynaecological Disorders Surg Innov.2021 Apr 28; DOI 10.1177/15533506211014848 PMID 33909538
A meticulous search of the currently available literature on the use of PRP for the management of pelvic disorders
Conclusion- Platelet-Rich-Plasma appears to be a promising, easy to apply, cost effective treatment modality for the treatment of various urogynaecological disorders
- Platelet-Rich-Plasma and Genital Rejuvenation, Skinmed 2019 Jul1;17(4)272-274 PMID 31627791
Lipofilling with the additional injection of PRP has been used to successfully treat vaginal laxity and vaginal atrophy; the unexpected resolution of lichen sclerosis In one of the women treated prompts consideration to initially use PRP of this condition. Additional evaluation of the potential efficacy of PRP for vaginal rejuvenation is warranted.
Juventix Regenerative Medical manufactures FDA approved Platelet Rich Plasma Kits that are easy to use, cost effective, safe and will provide scientifically proven PRP concentrations when taken from the same source.
Juventix Regenerative Medical provides a patent pending LED activator for increased efficacy stimulating the platelets to release higher concentrations of growth factors and cytokines without the addition of other substances such as Calcium Chloride or Thrombin
Juventix Regenerative Medical provides an innovative Bio-Incubator to transition the PRP into and injectable Platelet Rich Fibrin for a wide variety of clinical applications utilizing the anti-inflammatory properties of this second-generation matrix
RESTORE, REVIVE, REGENERATE- JUVENTIX REGENERATIVE MEDICAL.
Regenerative Regards,
Dr. Robert McGrath
