By: Barbara Bartlik, MD
We need more solutions for the sexual problems of men and women. Viagra-like medications are not always the answer. Half of the prescriptions written are not refilled. Pre-menopausal women now have two prescription medication therapies for low sexual desire: bremelanotide and flibanserin. But they are not gaining acceptance and are not covered by insurance for post-menopausal women. Evidence-based integrative medicine solutions are available as stand-alone or adjunctive therapies. Due to time limitations, I will briefly run through some of these.
Most sexual problems are caused by a combination of psychological and physical issues. So, treating one without the other is not as effective as it could be. Nutritional deficiencies, inflammation, medication side effects, toxicity, and an unhealthy diet and lifestyle could contribute to or even cause sexual problems. Clients could be seen as treatment-resistant and unresponsive to sex therapy and mental health treatment when an undetected physiological problem is the primary cause. Clients feel cared for when you help them find new ways to improve their health. Integrative medicine counselling is perceived as psychologically supportive and may improve anxiety and mood. When clients improve their lifestyles, they lose weight and need less medication for psychiatric and medical conditions. These medications often harm sexual functioning, so it is essential to reduce them when possible. We need to think outside the box.
Adequate sleep is essential to sex hormone production and sexual function. It also improves energy and mood and helps prevent weight gain.
Ancient traditional therapies such as Ayurveda, acupuncture, aromatherapy, botanical medicine, European hydrotherapy, Traditional Chinese medicine, and others can help sexual problems. There is some scientific evidence that these can be beneficial.
Exercise benefits mood, fitness, weight control, well-being, and sexuality. Anaerobic exercise of large muscle groups, such as doing squats, increases testosterone in men and possibly in women, which can improve desire and arousal. Yoga can increase flexibility and sexual performance. Other exercises can enhance the strength of the pelvic floor.
Micronutrients are necessary for hormone production and metabolism, and for endothelial and neurotransmitter function. Many common medications deplete micronutrients, which can cause sexual dysfunction. Supplementing with the following micronutrients when they are deficient can improve sexual functioning: Vitamins C, D, B6, B12, Boron, Folate, Iron, Magnesium, Sodium, Zinc.
Amino acids L-arginine and L-citrulline, precursors to nitric oxide, support vasodilatation and sexual function.
Omega-3 fatty acids support hormone metabolism, cardiovascular health, and neurological function.
Botanical medicines can benefit sexual function; Ashwagandha, damiana, horny goat weed, maca, ginseng, shilajit, and Tribulus are used traditionally for sexuality and most are backed up byresearch.
Off-label compounded penile and vulvar creams are mostly not evidence-based but are available through compounding pharmacies. They contain combinations of ingredients such as alprostadil, DHEA, L-arginine, PDE-5 inhibitors, pentoxifylline, phentolamine, testosterone, and theophylline. To learn more about these, ask a compounding pharmacist which preparations are most popular.
Oral troches and nasal sprays contain Oxytocin.
CBD is available over-the-counter, orally and in lotions and lubricants
DHEA may be taken orally or vaginally.
Vaginal moisturizers contain hyaluronic acid, vitamin E, and coconut oil
Case: Vaginismus successfully treated with Viagra
A 38-year-old married mother was the victim of sexual abuse by an older sibling when she was a child. She struggled with vaginismus from the time she was sexually active in her late teens until she was in her early thirties. After several years with her husband and treatment with vaginal dilators, she could finally have sexual intercourse comfortably. However, after the birth of her child, the vaginismus returned. She could not have intercourse for two years, but she and her husband engaged in other forms of sexual activity once or twice a week. She started on sildenafil 50 mg of sildenafil, which was very effective. She noted that her vagina felt more open, relaxed, and lubricated, and, after a few times, she had no pain on penetration.
The research on PDE-5 inhibitors, the Viagra-like medications, in women is mixed, with some studies reporting that they are effective and others finding no efficacy. There is a study showing that sildenafil is helpful for unconsumated marriage.
Strengthening the pelvic floor muscles improves bladder control and sexual function in men and women. Women who do Kegel exercises experience enhanced sexual desire, arousal, lubrication, and orgasm. Men experience improved erections, ejaculatory control, and orgasm. However, people find doing Kegel exercises tedious and challenging to do consistently. 70% of women have some degree of incontinence at some point in their lives. The solutions for female incontinence include medications with unwanted side effects and surgeries that can have serious consequences. Both can interfere with sexual life. Several new electrical or energy devices can help strengthen the pelvic floor and provide sexual benefits. I mention them briefly here because you might be able to help your clients by recommending them.
Why are these devices considered integrative? For several reasons: (1) primarily, practitioners with an integrative orientation are using them; (2) they are not yet standard of care; they may have been FDA-approved for other indications but are considered experimental for sexual problems and are used off-label for sexual dysfunction. The devices may be safe, but questions of efficacy and safety remain about many of them, and most are expensive and not covered by insurance.
Emsella Pelvic Floor Treatment uses high-intensity focused electromagnetic technology to strengthen and tone the pelvic floor muscles. It is designed to improve urinary incontinence, pelvic organ prolapse, and vaginal laxity. It also improves sexual function in men and women. The client sits on a chair that emits electromagnetic pulses that stimulate the pelvic floor muscles, causing them to contract repeatedly, the equivalent of doing thousands of Kegel exercises in 30 minutes.
Neuromuscular Electrical Stimulation devices are similar to TENS units. They use electrodes to deliver an electrical current, which causes pelvic floor muscles to contract rhythmically. The electrodes can be applied externally to the vulva or intravaginally through a probe.
Pulsed Electromagnetic Frequency (PEMF) Treatment creates a magnetic field by pulsing an electric current through a coil. It increases nitric oxide production in the endothelial cells lining the blood vessels, causing them to relax. This improves circulation and oxygenation, reduces blood pressure, promotes healing, and increases genital engorgement. Studies show that nitric oxide levels in plasma increase after PEMF application (Kim, 2019). PEMF stimulates cell growth and repair and may improve vulvovaginal atrophy, erectile disorder, and orgasmic difficulties.
Radiofrequency Thermal Treatment is usually performed by gynecologists and involves inserting a probe in the vagina that delivers painless heat to the vaginal canal and external clitoral and labial tissues. The claim is that it improves circulation and blood flow, stimulates new collagen production, and regenerates nerves. Women have reported improvements in their ability to orgasm, postpartum healing, sexual pleasure, vaginal intercourse satisfaction, vaginal laxity, vaginal moisture during sexual activity, mild bladder prolapse and urinary leakage.
Red Light Therapy uses red or near-infrared light to stimulate the mitochondria and enhance ATP production. This promotes circulation, collagen formation, and healing and reduces inflammation. The light is directed toward the genitals using a wrap, a seat, or other methods. Studies have shown that red light therapy can improve penile blood flow and erectile dysfunction and increase testosterone levels, sperm volume, and sexual satisfaction.
Consider including Integrative/Functional principles to your psychotherapy practice. You will learn how to improve your health and that of your clients by helping them adopt a healthier lifestyle. They will then respond better to therapy for mental health issues and sexual problems.
You can obtain integrative medicine training and become an integrative health coach at the following:
* Institute of Integrative Nutrition (IIN), NYC, https://www.integrativenutrition.com/
* Andrew Weil Center for Integrative Medicine (AWCIM), University of Arizona, https://awcim.arizona.edu
* Institute for Functional Medicine (IFM), https://www.ifm.org
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