Overview | Sexual Health | Survivorship Medicine

Sexual Health

Sexual Dysfunction affects nearly half of all post-pubertal women in the U.S. as well as the vast majority of peri- and post-menopausal women. Women often experience symptoms that can greatly reduce their desire for intimacy as well as impair their quality of life.

For instance, such chronic illnesses as hypertension, cardiovascular disease, diabetes, and neurological disorders may impact a woman’s sexual function. Additionally, many drug classes used to treat these conditions can affect the sexual response cycle and cause sexual dysfunction. Hormones also play a significant role in regulating sexual function. Loss of estrogen and androgen affects both the central nervous system and the sensory organs that determine the quality of sexual response; therefore, peri- and post-menopausal women often experience sexual problems, especially dysparenia and vaginal atrophy.

Sexual dysfunction is also a common consequence of cancer therapy that may persist after treatment is completed. It is reported that 90% of female cancer survivors have some form of long-lasting sexual complaint. Chemotherapy and radiation (especially to the pelvic area) can result in a sudden loss of estrogen production in the ovaries causing a woman to experience symptoms of menopause including vaginal dryness, vaginal atrophy and dysparenia. Hormonal manipulation, specifically anti-estrogens and aromatase inhibitors, can also exacerbate menopausal symptoms.

Additionally, women undergoing a radical hysterectomy, cystectomy, abdominal-lperineal resection and vulvectomy to remove cancer in the reproductive organs will also experience menopause and the symptoms previously discussed. Furthermore, these operative procedures can change the structural anatomy and compromise the neurovascular integrity to organ systems that are critical to sexual responsiveness.

Common Sexual Complaints and Etiologies

Some of the more common sexual complaints and etiologies include:

Inhibited sexual desire – due to hormonal changes, medical conditions and treatments, depression, stress and fatigue.
Inability to become aroused – due to insufficient vaginal lubrication, inadequate stimulation and blood flow disorders.
Lack of orgasm – due to insufficient stimulation, certain chronic illnesses and medications.
Painful intercourse/dysparenia – due to vaginitis, poor lubrication, presence of scar tissue and endometriosis.
Vulvodynia and Vulvar Vestibulitis – due to infections, allergic reactions or unknown causes.
Sexual complaints as a result of medications.

Women who are referred to Hoag’s Sexual Health and Survivorship Medicine program undergo a comprehensive assessment of medical illnesses, a medical and gynecologic examination, a sexual functioning assessment, and a complete psychosexual evaluation. Environmental sexuality is also analyzed, exploring how a woman’s work, home life and stresses impact her intimacy. Once the cause of a woman’s sexual dysfunction is determined, a therapeutic management scheme is formulated.

A variety of treatments are provided based on the sexual complaint. Forms of therapeutic treatment can include sensate focusing, guided imagery, relaxation techniques, and an exploration of sexual expression. Patients are also given structured exercises to help with specific issues. For patients with chronic disease, Hoag specialists often work with the patient’s referring physician to modify medication regimens. Hoag’s program also offers physical therapy, pain management and access to mental health professionals.

Sexual Health Program Areas of Specialty

Hoag’s Sexual Health program specializes in the following areas:

Vaginal atrophy/vaginal dryness
Painful intercourse/dysparenia
Problems with sexual arousal
Problems with orgasm
Low sex drive
Vaginal spasms
Problems with body image
Condom sensitivity and allergy

An extensive range of therapies for female sexual dysfunction are also offered, including:

Hormonal replacements
Non-hormonal methods to manage menopausal symptoms
Local vaginal therapy with or without hormones
Vaginal lubricants/moisturizers
Treatment for arousal difficulties
Vaginal dilators and vacuum devices
Testosterone supplementation
Complementary/alternative techniques
Physical therapy
Nerve block
Surgical intervention
Nutritional counseling
Stress reduction

Counseling

The counseling component of the program involves highly trained mental health professionals who specialize in the care of the following disorders:

Adjustment disorder secondary to medical conditions
Body image concerns
Low mood or depression
Marital discord

Some of the psychosocial therapies available to patients include:

Individual counseling
Marital counseling
Cognitive behavioral counseling
Behavior modification
Sexual counseling
Group therapy
Stress Management

Couples Program

Hoag’s Sexual Health and Survivorship Medicine program also seeks to enhance the sexual lives of women and their partners through specifically designed couple’s programs. Treating the patient alone, without addressing the effects on the partner, may make it more difficult to accomplish the goal of resuming satisfactory sexual relations for the patient and partner. All men and women who attend the program are encouraged to receive both a medical and psychological evaluation.

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