madman
Super Moderator
BACKGROUND TO A NEW ERA
To discuss “a new era” in the management of sexual dysfunction implies progress from a previous norm, so that discussion must begin with an understanding of the historical foundations and associated assumptions undergirding that progress. This is particularly true of the diagnosis of female sexual dysfunction (FSD), which is a prerequisite to application of the novel and experimental therapeutic interventions that are the focus of this article. FSD is a category of diagnoses infamous for its changeability and its constancy over time: in the past three decades, its nomenclature and classification have gone through multiple iterations by various national and international organizations1; at the same time, historical and now medically anachronistic terms, such as “frigidity,” continue to be used in the context of doctor-patient encounters and popular discourse about female sexuality.
Despite incontrovertible progress in medical science and the evolution of social norms since the early modern period, medical historians describe remarkable continuity in the terms of debate about FSD. These have included arguments over whether sexual problems in women deserve significant medical attention (given that they do not necessarily preclude successful reproduction, in contrast with male erectile dysfunction [ED]) and the extent to which they signify a moral or psychological disorder versus a problem of anatomy or physiology.2 The residue of these debates persists today, in the inequitable distribution of research funding and clinical attention to male sexual dysfunction and FSD, and in the tension between different classification systems used to define and diagnose these diseases.
*NAVIGATING NOMENCLATURE
*CRITIQUING FEMALE SEXUAL DYSFUNCTION
*PHARMACEUTICAL MANAGEMENT
-Phosphodiesterase-5 Inhibitors
-Psychoactive Medications
-Flibanserin
-Bremelanotide
-Hormonal Medications: a Blast From the Past
*ENERGY-BASED MANAGEMENT
-Vaginal Lasers
-Radiofrequency
-Low-Intensity Extracorporeal Shockwave Therapy
-Neuromodulation: Sacral and Percutaneous Tibial Nerve Stimulation
-Neuromodulation: Vagal Nerve Stimulation
SUMMARY
The enthusiasm with which energy-based treatments for sexual dysfunction have been adopted for sale in the medical marketplace is disproportionate to the amount of data that are currently available to support their clinical use. Neuromodulation and focal induction of a healing response hold promise for the improvement of tissue quality, genital arousal response, and related FSD symptoms. Caution and further study are required to determine whether this promise will be fulfilled and if indeed fulfillment will lead to relief of sexual problems. Given the limited scope of action for most of these devices, the widely ranging biopsychosocial factors that are implicated in the manifestation of FSD, and the characteristic discordance of female arousal, it is likely that their helpfulness will be specific to defined FSD symptomatology and/or specific populations of women with relevant comorbidities.
Pharmacotherapy for FSD (Table 3) has considerably more research evidence to justify its use and the potential to promote sexual desire, cognitive and genital arousal, and orgasmic response. The functional improvements that are produced by these medications are generally small, and their benefits may not outweigh the bother of taking medications and hazarding their potential AEs. There is sufficient demand for medical treatment of sexual dysfunction that studies continue in an effort to expand the demographic for whom the drugs are FDA-approved to include older women and possibly men. It is essential that patients in all of these groups be empowered to make an informed, autonomous determination as to whether the ratio of risk to reward favors the use of pharmacotherapy, energy-based therapy, or some other treatment intervention.
To discuss “a new era” in the management of sexual dysfunction implies progress from a previous norm, so that discussion must begin with an understanding of the historical foundations and associated assumptions undergirding that progress. This is particularly true of the diagnosis of female sexual dysfunction (FSD), which is a prerequisite to application of the novel and experimental therapeutic interventions that are the focus of this article. FSD is a category of diagnoses infamous for its changeability and its constancy over time: in the past three decades, its nomenclature and classification have gone through multiple iterations by various national and international organizations1; at the same time, historical and now medically anachronistic terms, such as “frigidity,” continue to be used in the context of doctor-patient encounters and popular discourse about female sexuality.
Despite incontrovertible progress in medical science and the evolution of social norms since the early modern period, medical historians describe remarkable continuity in the terms of debate about FSD. These have included arguments over whether sexual problems in women deserve significant medical attention (given that they do not necessarily preclude successful reproduction, in contrast with male erectile dysfunction [ED]) and the extent to which they signify a moral or psychological disorder versus a problem of anatomy or physiology.2 The residue of these debates persists today, in the inequitable distribution of research funding and clinical attention to male sexual dysfunction and FSD, and in the tension between different classification systems used to define and diagnose these diseases.
*NAVIGATING NOMENCLATURE
*CRITIQUING FEMALE SEXUAL DYSFUNCTION
*PHARMACEUTICAL MANAGEMENT
-Phosphodiesterase-5 Inhibitors
-Psychoactive Medications
-Flibanserin
-Bremelanotide
-Hormonal Medications: a Blast From the Past
*ENERGY-BASED MANAGEMENT
-Vaginal Lasers
-Radiofrequency
-Low-Intensity Extracorporeal Shockwave Therapy
-Neuromodulation: Sacral and Percutaneous Tibial Nerve Stimulation
-Neuromodulation: Vagal Nerve Stimulation
SUMMARY
The enthusiasm with which energy-based treatments for sexual dysfunction have been adopted for sale in the medical marketplace is disproportionate to the amount of data that are currently available to support their clinical use. Neuromodulation and focal induction of a healing response hold promise for the improvement of tissue quality, genital arousal response, and related FSD symptoms. Caution and further study are required to determine whether this promise will be fulfilled and if indeed fulfillment will lead to relief of sexual problems. Given the limited scope of action for most of these devices, the widely ranging biopsychosocial factors that are implicated in the manifestation of FSD, and the characteristic discordance of female arousal, it is likely that their helpfulness will be specific to defined FSD symptomatology and/or specific populations of women with relevant comorbidities.
Pharmacotherapy for FSD (Table 3) has considerably more research evidence to justify its use and the potential to promote sexual desire, cognitive and genital arousal, and orgasmic response. The functional improvements that are produced by these medications are generally small, and their benefits may not outweigh the bother of taking medications and hazarding their potential AEs. There is sufficient demand for medical treatment of sexual dysfunction that studies continue in an effort to expand the demographic for whom the drugs are FDA-approved to include older women and possibly men. It is essential that patients in all of these groups be empowered to make an informed, autonomous determination as to whether the ratio of risk to reward favors the use of pharmacotherapy, energy-based therapy, or some other treatment intervention.
