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Special to msnbc.com
updated 12/14/2003 8:56:18 AM ET 2003-12-14T13:56:18

Can having a hysterectomy impact a woman’s sexual function? What about going through menopause? Urologist Dr. Jennifer Berman and sex therapist Laura Berman, a sister team at the University of California at Los Angeles, answer these questions and more.

Q: What are the causes of female sexual dysfunction?

A: The same diseases that cause erectile dysfunction in men can lead to sexual dysfunction in women. These include diabetes, heart disease, high cholesterol, spinal cord injury, hormonal disorders and smoking. And just as prostate-removal surgery can lead to impotence, pelvic surgery may lead to nerve or blood-vessel damage that causes sexual problems. These physical conditions may or may not interact with emotional issues that contribute to sexual dysfunction, such as relationship problems, low self-esteem, poor body image or a history of sexual trauma or abuse. In addition, certain drugs can impair sexual function.

Q:What effect do antidepressants have on women’s sexual function?

A: Antidepressants can impact both sexual function and libido. Women taking these drugs may report decreased arousal, increased vaginal dryness and increased difficulty reaching orgasm. Women who notice such side effects should speak to their physician about switching medications or decreasing the dose.

Q:Can a hysterectomy impact a woman’s sexual function?

A: Yes. We have seen a large number of women who noted that their sexual response dramatically changed following hysterectomy. They report a loss of sexual desire, decreased vaginal lubrication and a loss of genital sensation. Even if the ovaries are preserved, women still often experience these symptoms.

We are currently working to identify the specific nerves and blood vessels that are vital to female sexual function, and to develop ways to perform “nerve-sparing” hysterectomies, similar to the nerve-sparing prostatectomies in men.

Q:What happens to women sexually as they go through menopause?

A: Many women experience a change in their sexual function during the years immediately before and after menopause. This is primarily a result of a decrease in estrogen and testosterone levels. As women age, they also experience decreased blood flow to their genitals. Common complaints include a loss of desire, diminished responsiveness and low sexual arousal. Vaginal atrophy, which involves thinning, drying and irritation of the vaginal lining, causes significant distress for the menopausal woman.

In addition, the interplay of psychological, cultural and interpersonal factors all contribute to the aging woman’s sexual experience. Unfortunately, our culture does not encourage or acknowledge sexuality in the older woman.

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But sex later in life has its benefits. A woman no longer has to worry about becoming pregnant. She can enjoy her partner and the empty nest — often for the first time.

Q:What is the role of hormone replacement therapy (HRT) in women’s sexual function?

A: Given to menopausal and postmenopausal women, HRT helps to prevent osteoporosis and cardiovascular disease as well as vaginal atrophy, sexual dysfunction and incontinence. We are evaluating the effect of the combination of HRT with other medications such as Viagra on female sexual function, and have found dramatic improvement in sexual responsiveness.

Q:How important is sexual function for women’s general health?

A: Due to subtle social taboos that still exist today, many women are uncomfortable reporting sexual dysfunction. They often feel that they are not entitled to sexual satisfaction and are uncomfortable talking about it, even with their partners.

But sexuality is a basic part of women’s general wellness. Experiencing a positive and functional sex life enhances feelings of self-esteem and positive body image. A satisfying sexual relationship also helps to build an emotional connection with one’s partner and higher levels of intimacy.

Q:What treatments are available for women with sexual function complaints?

A: Historically, the only treatment option for women suffering from sexual dysfunction was sex therapy, lubricating gels and hormone replacement therapy (both estrogen and testosterone for menopausal women). These treatments can be effective for some women, and are often most helpful when used in combination.

But women now also have available to them the first medical device to be approved by the Food and Drug Administration for treating female sexual dysfunction. The device, called Eros, is a vacuum pump that helps promote blood flow to the clitoris.

In addition, other promising treatments are on the horizon, including Viagra for women and other drugs like apomorphine, phentolamine and prostaglandin. They focus primarily on enhancing genital blood flow and smooth muscle relaxation.

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