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Treatment Plan
Men's treatments
The nature of your problem dictates your treatment. Here are some common therapies for men.
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Drug therapy: Viagra® (sildenafil) was approved by the U.S. Food and Drug Administration in 1998. Taken an hour or so before sexual activity, it increases the concentration of a natural chemical in the penis that causes the blood vessels to dilate, which increases blood flow to the penis. It works in response to sexual stimulation. However, sildenafil isn't right for everyone. Men who have heart problems and take medications that help widen the coronary arteries are not good candidates because the drug combination can lower blood pressure dangerously. In 2003, the FDA approved Levitra® (vardenafil) for the treatment of erectile dysfunction (ED). The way it works is similar to sildenafil. Cialis® (tadalafil) is the first oral ED treatment that works up to 36 hours. Some men with hormonal imbalances may be helped by testosterone shots or skin patches.
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Vacuum constriction device: This involves placing a plastic tube over the penis and pumping the air out of the tube, drawing blood into the penis and making it erect. An elastic band is placed around the base of the penis to maintain the erection.
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Penile injection therapy: Medication injected directly into the side of the penis causes the blood vessels to widen and erection to occur.
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Intraurethral therapy: A soft pellet of medication is inserted into the urethra. Its absorption produces an erection.
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Surgery: Surgery may involve one of three procedures: implanting a device (prosthesis) that can cause the penis to become erect, reconstructing arteries to increase blood flow to the penis, or repairing the veins within the penis that are failing to keep sufficient blood within the organ.
 Risk of blindness
In 2005, the Food and Drug Administration (FDA) approved updated labeling for Cialis, Levitra and Viagra to reflect a small number of reports of sudden vision loss, attributed to NAION (non arteritic ischemic optic neuropathy), a condition where blood flow is blocked to the optic nerve. The FDA advises patients to stop taking these medicines, and call a doctor or health care provider right away if they have sudden or decreased vision loss in one or both eyes. Further, patients taking or considering taking these products should inform their health care professionals if they have ever had severe loss of vision, which might they had an earlier episode of NAION. Such patients are at higher risk of developing NAION.
At this time, it is not possible to determine whether these oral medicines for erectile dysfunction were the cause of the loss of sight or whether the problem is related to other factors such as high blood pressure or diabetes, or to a combination of these problems.
Peyronie's disease
In many cases, the condition clears up on its own, but the doctor continues to monitor the man for many years, watching the plaque development and checking erectile function. Medications that might help to alleviate plaque buildup include topical vitamin A, collagenase ointment, B-complex vitamins or calcium channel blockers. These treatments are still unproven.
Some researchers have given vitamin E orally to men with Peyronie's disease in small studies and have reported improvements. Yet, no controlled studies have established the effectiveness of vitamin E therapy. Similar inconclusive success has been attributed to oral application of para-aminobenzoate, a substance belonging to the family of B-complex molecules. Researchers have injected chemical agents such as verapamil, collagenase, steroids, calcium channel blockers, and interferon alpha-2b directly into the plaques. These interventions are still considered unproven because studies included small numbers of patients and lacked adequate control groups.
If treatment doesn't work and the condition doesn't go away on its own, surgery may be necessary. Surgeons have developed techniques for removing the plaque without affecting the proper functioning of the penis.
Women's treatments
FSAD: Counseling can help unless there is a physical problem causing the sexual dysfunction. Treatment with the hormones estrogen and testosterone works for some women. Testosterone creams and patches are becoming more widely available but need more testing before they can be considered effective. Other agents that work to increase blood flow to the genitals, such as a gel called prostaglandin E-1 and even Viagra -- both approved for men -- are being studied for women.
Dyspareunia: A doctor needs to determine the underlying cause before treating you. For women who have passed menopause, estrogen replacement therapy may help. A water-soluble lubricant just before intercourse may also relieve pain. Lubricants include Astroglide®, Lubrin® and K-Y Jelly® and are placed into the vagina before sex. Moisturizers such as Replens® and K-Y Long Lasting® decrease dryness for more than a day with a single application.
Vaginismus: The problem is treated with educational counseling and, sometimes, progressive vaginal dilation, which helps to relax the muscle spasm. This therapy involves the use of vaginal inserts, each progressively larger than the last, which help condition the vaginal opening. As one becomes comfortable, the next larger size is inserted in the vagina. This process continues until the vagina has been dilated sufficiently for intercourse to take place painlessly.
Vaginitis: This can be cured through prescription medications and antibiotics.
Men and women
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Psychotherapy: Some people feel guilty having sex. Some are afraid of getting pregnant or a sexually transmitted disease. Sometimes, a past bad sexual experience, such as rape or abuse, may be the cause. Psychotherapy can also help with depression. Marriage counseling can aid a couple with re-establishing their bonds and attraction.
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Antidepressants drugs: Getting drug treatment for depression might help fuel interest in sex by improving self esteem and relieving a depressed mood. However, some antidepressants known as selective serotonin reuptake inhibitors (SSRI) may themselves cause sexual problems as a side effect. In some cases, premature ejaculation can be treated with small doses of an SSRI such as Prozac®, Paxil® or Zoloft®, taken either daily or one to two hours before sex.
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Sex therapy: A licensed counselor specializing in sex therapy can help a couple learn how to become more intimate.
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Exercise: Exercise does wonders for your self-esteem, body image and energy levels. Try to exercise 30 minutes most days of the week.
Children, teens and adults being treated with antidepressants, particularly people being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior. Close watching may be especially important early in treatment, or when the dose is changed, either increased or decreased. Bring up your concerns immediately with a doctor.
The FDA is also warning people about Paxil, which may increase the risk for birth defects, particularly heart defects, when women take it during the first three months of pregnancy. The FDA is waiting for the results of recent studies to better understand the higher risk. Discuss with your doctor about the health risks of Paxil if you plan to become pregnant or are in the first three months of pregnancy. You may want to consider taking a different antidepressant. Do not stop taking the drug without first talking to your doctor.
More on Sexual Problems
In the Encyclopedia:
This article was reviewed and updated June 2007.
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