Couples' treatment for sexual problems and other innovative approaches to improving sexual health for men and women are on the agenda of sexual medicine experts.
"This is a fun time to be involved in this," says Dr. Ronald Lewis, impotence expert, chief of the Section of Urology at the Medical College of Georgia School of Medicine and newly elected president-elect of the 300-member Sexual Medicine Society of North America.
"We are gaining a more comprehensive perspective on the causes, effects and potential treatment of sexual dysfunction," says Dr. Lewis who is organizing the society's spring scientific meeting.
Evidence is mounting, for example, that if one partner has problems, it's likely the other does as well. However Dr. Lewis says treatments focused mostly on men, and rarely on women or couples, hinders effectiveness.
Couples' treatment is a win-win, he says, because it explores problems that may exist in the relationship beyond the man's physical ability to have an erection, such as whether there is adequate foreplay to create a more satisfying experience, or whether pushback from partners is impacting their desire and, ultimately, ability to have sex, Dr. Lewis says.
Such problems create a classic cause-and-effect scenario. "The man says, 'I can't please her, I am not a man anymore.' The woman says, 'He doesn't love me any more because he is not paying attention to me.' It gets to be a real bad situation."
The reality could be low estrogen levels are causing her vaginal dryness and painful intercourse and lower testosterone levels are decreasing the firmness of his erection, hurting his confidence, even before she pushes away. Not unlike the old adage, 'use it or lose it,' chemicals that are supposed to cause the erection can retool, so the man begins to have less sexual thought and erectile activity, "essentially a situational cause for real end-organ disease," Dr. Lewis says.
The focus on treating the disease - regional sexual medicine society's across the world use to be dubbed erectile dysfunction societies - actually helped illustrate the need for a broader perspective. Erection treatments - first shots, then pills - made men instantly technically ready for sex but did nothing for their partners' issues, Dr. Lewis says. "A lot of women would say, 'You may be fixed but it has not fixed our relationship.'"
A good place for partners to initiate a fix is talking about sex - with each other and their doctor, he says.
Many problems, such as vaginal dryness, already are treatable, and new options such as pills that turn on sexual centers in the brain and Viagra-like drugs for women are on the horizon. In fact, an MCG research team led by Dr. R. Clinton Webb recently showed these phosphodiesterase Type 5 inhibitors, which block an enzyme responsible for breaking down an erection, show promise in female rats at least, although they work differently than they do in the males. The MCG scientists and Dr. Lewis agree that is more evidence as well that sex for females is different and likely more complex.
While scientists explore new options for women, they also are taking a closer look at how low testosterone levels affect men. Testosterone therapy already is used to improve libido and erection but physicians likely need to put an emphasis on keeping tabs on testosterone levels to ensure bone health as well.
"In treating prostate cancer, for example, we actually have made a group of men more likely to have bone problems because we give them medication to block testosterone because prostate cancer depends on it," says Dr. Lewis.
Now urologists and others are "waking up" to the fact that low levels, natural or otherwise, contribute to osteoporosis and that hormone replacement therapy can even be given safely to a select number of men who have recovered from their cancer, as measured by a prostate specific antigen level of zero.