Nice girls do talk about it… and not just on the silver screen. Female sexual issues—especially sexual dysfunctions—are a real health issue. In fact, one-third of all women, regardless of age, experience diminished sexual interest.
"Many women do not get aroused, cannot experience orgasm or suffer from sexual pain disorders,” according to Irwin Goldstein, MD, medical director of the Alvarado Hospital Sexual Medicine Program. "These health issues can negatively impact relationships and quality of life.”
Sheila*, who lives in Coronado, underwent hormone treatment to improve her life. Widowed after more than 40 years of marriage, Sheila, 77, didn’t realize she had a problem until recently, when a partner commented on her slow response and difficulty achieving orgasm. An evaluation at the sexual medicine program at Alvarado Hospital, found Sheila’s hormone levels were lower than normal. After she started hormone therapy last fall to restore her hormone levels to normal, Sheila began feeling much better.
"I feel so much more alive,” she said. "I have more energy, sleep better and I feel more ‘female.’ I had been feeling rundown and thought I was getting old. Now, I feel like I am 40.” In April, Sheila had a face lift so she would look the way she feels inside. She continues to see Dr. Goldstein and have blood tests to check her hormone levels regularly.
For Amy, of Del Mar, low hormone levels are only part of the story. Amy, 44, has experienced sexual dysfunction as a result of surgery, chemotherapy and radiation treatment for vaginal cancer.
Sex has become difficult and extremely painful for several reasons. Therapy caused Amy’s ovaries to stop functioning, which put her immediately into menopause. As a result, she has lost muscle tone in her legs, hips and abdomen. Amy also has lymphedema in her abdomen, which makes her appear pregnant. Radiation injured healthy tissue and left scar tissues on her vaginal walls.
Sexual dysfunction after cancer treatment is common. Still, Amy’s radiation oncologist told her she must have sex in order to prevent the collapse of her vaginal walls. Otherwise, even a pap smear would be painfully difficult.
Working with Amy’s oncologist, Dr. Goldstein has developed a treatment protocol that includes, in part, hormone therapy, as well as physical therapy, and sex therapy for her and her husband.
A Nationwide Issue
Sheila and Amy illustrate two of the diverse sexual disorders affecting women of all ages. In fact, one-third of all women—regardless of age—experience diminished sexual interest. For example, many women do not get aroused, cannot experience orgasm or suffer from sexual pain disorders. These health issues can negatively impact relationships and quality of life.
According to Irwin Goldstein, MD, these problems usually manifest in the following ways:
From Boston to San Diego
Dr. Goldstein has studied sexual medicine since the late 1970s and written more than 325 publications about sexual function and dysfunction. Prior to opening the Alvarado Hospital Sexual Medicine Program in 2007, he spent 25 years on the faculty of Boston University School of Medicine, where he created the university’s Institute for Sexual Medicine. Dr. Goldstein said sexual dysfunction impacts relationships, and how a woman feels about herself.
"For many women, sexuality defines who they are,” he said. If they lose it, they feel like a different person. The partner interprets this is as lack of emotion or love. It can be a common cause of divorce or affairs. This can be a driving force in seeking help.”
Dr. Goldstein said traditional treatment for sexual dysfunction focused on psychological counseling. However, many disorders are now known to have a biological component. The current treatment model is a biological-psychosocial approach that evaluates the many factors that may cause sexual dysfunction:
- Pelvic floor disorders
- Obesity, diabetes
- Infertility treatments
- Birth control pills
- Panic disorders
- Bicycle riding
- Thyroid problems
- Cancer treatment
- Sexual abuse
Although Dr. Goldstein treats patients of all ages, many of his patients are women at mid-life seeking help after failed relationships and other problems resulting from an inability to enjoy sex.
Julia, who is only 26, is determined that won’t happen to her. For her, seeking treatment is about more than enhancing her quality of life; it’s an investment in her marriage.
"My concern was because of the importance of sex to the relationship,” said Julie, who was married in May. "A couple of previous relationships ended because of the sex.”
Prior to treatment, Julia had never enjoyed sex. She started suspecting something was wrong years ago when matters did not improve with her boyfriend. Julia’s history included some incidents of sexual abuse. At the time she was advised to undergo psychological counseling. Although she did this for years, things never improved.
"I wasn’t getting help from therapy, so I went to a regular doctor and a gynecologist,” Julia said. "The gynecologist said my hormone levels were normal, and the other doctor put me on antidepressants. I saw an acupuncturist, tried physical therapy and all kinds of things. No one had any idea how to help me.”
She didn’t know help was available until she came across "When Sex Isn’t Good,” a book co-written by Dr. Goldstein’s wife, Sue, with medical reference sections authored by Dr. Goldstein. "I read it and thought, ‘finally, these people understand,’” she recalled. Julie decided to travel from her home in Northern California to San Diego for treatment.
The results of a comprehensive evaluation confirmed that Julia’s hormones were indeed low. Within a week of beginning hormone therapy, Julia started noticing a difference. "I thought I was hopeless and that I would never like sex,” she said. "But after taking the hormone, I started wanting to have sex and stopped crying every time, which was a big deal before. I think that my first orgasm is right around the corner, which I am really happy about because I just got married.”
Julia still shakes her head when she recalls how other doctors said her hormone levels were normal. She goes to San Diego two to three times a year for follow-up.
"It took me so long to find out, and it wasn’t complicated,” she said. "People just don’t know anything about sexual dysfunction, and I don’t want other people to have to go through the same thing.”
For more information, call (800) ALVARADO (258-2723).
*Most of the women interviewed for this story requested that only first names be used.