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In the past, women who complained of sexual function issues were often told they had an aging problem or a mental problem. Unlike male sexual dysfunction, we now know that female sexual dysfunction can occur at any age and is often the result of multiple issues. And, more often than not, female dysfunction is treatable.

However, nurses should know that treating sexual dysfunction is not simple, says Peggy Francis, RN, MSN, CS, FNP-C, codirector at the Center for Female Sexual Medicine, Urology San Antonio.

"It's not as simple as erectile dysfunction. It's complicated because you have to look at all aspects of the person, and any of those can interfere with their sexual health," Francis says.

Female sexual dysfunction

Sexual dysfunction is by no means a man's problem — studies are showing that it is also rampant among women.

A 1999 study published in the Journal of the American Medical Association revealed that 43% of the women and 31% of the men participants had sexual dysfunction.

The American Urologic Association defines sexual dysfunction as "a persistent impairment of a couple's normal or usual patterns of sexual interest." The definition lists four classifications of female sexual dysfunction:

• Desire disorder — characterized by decreased libido.

• Sexual arousal disorder — an inability to become aroused.

• Orgasmic disorder — includes women who have never been able to orgasm and women who can no longer have an orgasm.

• Sexual pain disorder — characterized by pain caused by sexual relations.

Causes

The causes, experts agree, can rarely be limited to one simple problem. Women tend to have complicated cases and have one or many psychological and physiological conditions.

Some common causes include: hormonal imbalances, specifically involving testosterone; medications, such as antidepressants; and diseases including cancer and those that affect the cardiovascular system, such as high blood pressure, diabetes or hypolipidemia.

Francis says she is seeing more perimenopausal and menopausal women whose arousal levels have plummeted along with their hormone levels. Many of these women quit taking hormone replacement medications after reports of the drugs' potential to cause cancer.

"Now we're beginning to see the result of that as they come in with female sexual medicine and incontinence issues," Francis says.

Pain associated with sexual activity is usually related to a few things, says Christopher J. Jayne, MD, FACOG, an obstetrician and director of the Center for Women's Sexual Health at The Woman's Hospital in Houston.

"The primary cause of pain might be a lack of hormones or estrogen, scar tissue or a bladder condition called interstitial cystitis .... The secondary pain component usually involves the pelvic floor muscles," Jayne says. "When you talk about sexual desire disorders, you have to rule out medical conditions that are known to cause sexual desire issues — specifically, depression."

Diagnosis and treatment

There is no one pill or cream that completely can revolutionize a woman's sex life, nor is talk therapy alone sufficient, says Susan Kellogg, PhD, CRNP, director of sexual medicine at the Pelvic and Sexual Health Institute of Philadelphia.

Every case is different and can be complex, requiring the expertise of a multidisciplinary team.

"One [development] that is relatively new is our appreciation of the role of the pelvic floor musculature of women," Kellogg says. "Spastic or high-tone pelvic floors can cause problems in sexual performance, arousal, and orgasm, as can low tone or laxity of the pelvic floor."

Many experts work with physical therapists who are trained in pelvic floor dysfunction. The PTs perform pelvic stabilization exercises and direct internal massage to the muscles to relax them.

When it comes to prescribing medications, Kellogg says, everything is off label.

"There is no FDA-approved pro-sexual medicine that is specifically for women," Kellogg says.

While most over-the-counter remedies have not been adequately tested, two botanicals have been evaluated by the FDA and have shown promise, according to Kellogg. Zestra, a botanical oil and arousal enhancer, and Arginmax for Women, an oral medication, are both available at health food stores.

The only FDA-approved treatment for female sexual dysfunction is Eros, a clitoral therapy device.

Nurses at the helm

Jeffrey Albaugh, MS, APRN, who works at Northwestern Memorial Hospital's nurse-run Sexual Dysfunction Clinic, says advanced-practice nurses often run sexual dysfunction clinics. And, nurses in general, he says, are ideal to provide the key components of care. Treating sexual dysfunction requires time, multidisciplinary collaboration, and a great deal of education.

"I think primarily the reasons that nurse practitioners are getting involved is that nurse practitioners have a rapport with their patients," Francis says.

Getting involved also means being highly trained in sexual medicine, Jayne says.

"Certainly anybody who wants to involve themselves in this area of medicine needs the training. I would strongly recommend that they belong to the American Association of Sex Educators, Counselors and Therapists and become certified," he says.

Today, more than ever, researchers, the media and consumers are wanting to know more about potential causes of dysfunciton and how to cure them. Still, the field is in its infancy, experts say, and nurses can work on the front lines to get patients the help they need.

"Sexual dysfunction is a common disorder and probably many more patients are suffering than we know," Albaugh says. "They might not bring it up because they might not know it's OK to ask you. But, as nurses — to treat the patients holistically — we have to ask them even just the one simple question: 'Are you having any problems with sexuality and intimacy?'" Albaugh says.

"Who is better for patients to come to with these personal, intimate questions? Who is better to educate the patient than the nurse?" he says.

Lisette Hilton is a NurseWeek freelance writer. To comment, e-mail editors@nurseweek.com.