As they learn about the body, scientists are rethinking the types and roots of sexual dysfunction in women. Part 1 (March 2001) explained findings about sexual desire. Part 2 discusses difficulty becoming aroused, inability to reach orgasm, and painful intercourse.



Arousal

Problems with arousal are difficult to diagnose because of the variable physiological impairments. Most women with SCI experience some difficulties with lubrication that are often related directly to their disability. Usually the injury's level and completeness will have a direct relationship to whether the woman is capable of lubrication and physiological arousal. Scientists have great hope that the "female pill" will improve dilation of blood vessels to the vagina and clitoris and thus improve circulation and physical arousal.



Inability to Reach Orgasm

Although previously believed impossible for women with complete lesions, according to new studies orgasm is possible for all levels of injury. This is true regardless of the completeness of the spinal lesion. Although orgasm's incidence in this population is lower than in non-SCI women, studies show that a satisfying orgasm is frequently possible with increased time and stimulation.

For women with SCI, painful intercourse that is not the result of insufficient lubrication is unlikely if the lesion is above the sacral area. In these cases, the absence of sensation in the genitals tends to preclude pain at the time of penetration. When sensation is intact, pain or increased spasticity may be possible.

Although somewhat rare, autonomic dysreflexia (AD) may be a concern during penetration or intercourse itself.



Treatments

Although the female-sexuality field has blossomed in the last three years, many of the treatment methods are still under investigation, and actual solutions to these problems are difficult to find. This is especially true outside large urban medical centers where much of today's research takes place.

Today, no equivalent of Viagra for females exists, but new drugs are under development. Although disappointing results have been obtained with Viagra, clinical trials have yet to be performed on women with SCI. Many people expect a large-scale international trial with women with SCI will begin in 2001. This study will look at Viagra's effects on arousal and lubrication. There is good reason to expect positive results from Viagra on young women with SCI. These women still have good circulation without the deterioration in blood flow caused by the aging process.

A new drug, apomorphime (sold as Uprima) was recently approved for men and now is being used for erectile dysfunction (ED). Tests have not yet been conducted on Uprima's effectiveness for people with SCI. Unlike Viagra, this medication affects the brain's sexual mechanisms located in the hypothalamus and triggers increases in blood flow to the genitals. In addition, various creams designed to increase blood flow to the genitals are still in early development, and clinical trials are just beginning.

Another area of intense investigation is the role of testosterone in women. Patches seem to have a major effect on sexual desire and, when combined with medications like Viagra, appear to offer significant changes in sexual desire and arousal.

Although still under investigation, natural substances such as Yohimbe and DHEA do not require FDA approval and seem to improve sexual desire. These agents signal the body to increase testosterone production.

Medications are not the only approach studied in the field of female sexuality. The FDA recently approved a small suction device known as EROS-CTD [clitoral therapy device]. Produced by the U.S. company Urometrics and available by prescription, the EROS-CTD is designed to fit over the clitoris and provides a gentle suction that improves sensation and increases blood flow to this area. It is unclear as to how EROS-CTD may alter arousal levels in women with disabilities such as SCI.



Conclusion

The interest in female sexuality and the rush to find effective treatments are clearly here to stay. The professional community is finally addressing female sexual functioning. At the very least, women are beginning to realize that, like men, they are entitled to a positive sexual response and a healthy sexual life. Hopefully the double standard between men and women will begin to disappear.

For women with SCI, progress in this area is slow, but many reasons exist to be enthusiastic as this new field unfolds. There are great expectations that many of these newer developments will have a positive effect on the sexuality of women with SCI.

There has never been more reason to feel optimistic about maintaining positive sexual health. Finally, driven by the stampede of the pharmaceutical companies, this area of rehabilitation is attracting the attention it deserves.



Dr. Stanley Ducharme is a clinical psychologist in the Departments of Rehabilitation Medicine and Urology at Boston University Medical Center. For several years, PN has included his quarterly column Sexuality & SCI.