Sexual dysfunction was once taboo, but now there's a name for every problem - and a treatment, too. Roger Dobson reports

Great - even earth-moving - things are expected from a little pill being taken by women at a clinic in Ohio. If all goes well, it could revolutionise treatment of a chronic health problem affecting as many as one in four women in Britain.

The pill, being used by 80 women on a clinical trial, is designed to help women achieve a fulfilling orgasm.

The drug is being tested for women aged up to 50 suffering with female or global orgasmic disorder, estimated to affect 24 per cent or more of women, and it's one of a growing number of drug treatments for sexual dysfunction.

According to research based on a survey of more than 60,000 men and women, sexual dysfunction is a growing problem; 43 per cent of women and 21 per cent of men have at least one syndrome. Of those, 71 per cent had not consulted a doctor about it, even though a number of treatments are available.

Until recently, the mainstay of treatments for sexual dysfunction were behavioural therapies designed to tackle relationship problems, infidelity, depression, performance anxiety, fear of failure, and loss of attraction. But increasing numbers of drugs are being used to treat a range of syndromes, many of which have only been defined in the past few years.

More than 30 clinical trials are underway, but the drugs' development has been attacked by groups opposed to what they see as medicalisation of unsatisfying sexual performance into a disease in need of a treatment.

"The creation and promotion of female sexual dysfunction is a textbook case of disease-mongering," says Dr Leonore Tiefer, associate professor of psychiatry at New York University school of medicine, and convenor of the Campaign for a New View of Women's Sexual Problems. "[It is] a process that encourages the conversion of socially created anxiety into medical diagnoses suitable for drug treatment. People fed a myth that sex is natural, at the same time as expecting high levels of performance and enduring pleasure, are likely to look for simple solutions.

"The pharmaceutical industry has taken an aggressive interest in sex to create a sense of sexual inadequacy and interest in drug treatments. The public finds medicalisation attractive because the notion of simple scientific solutions fits in with a general over-investment in biological explanations."

Critics of increasing use of drug therapies suggest the media have raised sexual expectations so high that dissatisfaction rates have rocketed. "Media promotion, advertising and a pipeline of drugs will create continuing hope for the next new drug, along with a neglect of other ways to deal with sexual discontent,'' says Tiefer.

LOW SEX DRIVE

What it is Hypoactive sexual desire disorder is defined as a deficiency or absence of sexual fantasies, thoughts and desire for sexual activity, which causes distress. It's estimated to affect up to 30 per cent of women and 10 per cent of men.

What causes it It can occur at all ages and last a lifetime, although it often follows in the wake of stress. Causes range from partnership problems and depression, to hormonal changes and menopause.

How to treat it Testosterone supplements, in the form of patches, pills, creams or injections, can work for some men, while psychological therapies, including relationship counselling, can work for both sexes.

The drug bupropion may also be an option. Trial results on women aged over 23 showed that nearly 40 per cent were satisfied with their sexual desire, compared with zero levels of satisfaction before the start of treatment. How it works is not clear, but it is thought to have an effect on anxiety.

FEMALE SEXUAL AROUSAL DISORDER

What it is Formally defined as the inability to attain or maintain sufficient sexual excitement, its symptoms include lack of libido, decreased sensation and reduced arousal and excitement. Around one in five women suffers it, and about two-thirds of them are menopausal. In about 15 per cent of postmenopausal women, sexual desire decreases significantly.

What causes it Anything from partnership problems and depression, to the drop in oestrogen levels at menopause. Some medication, including oral contraceptives, antihypertensives and antidepressants, can have an impact on libido, too.

How to treat it Therapists can help with relationship problems are involved, and some research shows that HRT can improve sensitivity, and increase libido. There is evidence that vitamin E can help, and a number of drugs and creams, including a nasal spray, are on trial as possible treatments. According to the Association of Reproductive Health Professionals, Sildenafil or Viagra has been investigated for the treatment of female sexual arousal disorders, but the results have been inconsistent.

FEMALE ORGASMIC DISORDER

What it is Also known as global orgasmic disorder, it is described as a delay or absence of attaining orgasm following sufficient sexual stimulation and arousal. It can be lifelong or acquired, and around 10 per cent of women never attain orgasm regardless of stimulation. Only about 50 per cent of women regularly attain orgasm.

What causes it It has been associated with illness, low levels of oestrogen and side effects from medication. Possible psychological explanations include guilt, hostility and anxiety.

How to treat it Counselling and psychotherapy are among possible therapies, along with relaxation techniques and lubricants.

The new pill trial at the MetroHealth Medical Center in Cleveland, Ohio, is being used for women with female or global orgasmic disorder whose frequency of orgasm during sexual activity is less than 50 per cent, and who have had the problem for at least six months. "It is hypothesised that the drug will increase orgasm completion. The primary objective is to evaluate its effect on the ease and frequency of achieving orgasm in sexual activity,'' say the researchers.

PREMATURE EJACULATION

What it is One of the most widespread sexual problems for men, this is when ejaculation occurs before or early into coitus. Just how quickly may be a matter of opinion. According to research at Columbia University, it has to occur within the first minute to quality for a diagnosis.

What causes it It's estimated that 25 to 40 per cent of men will have a problem with this at some time, and it can be due to a range of factors, including anxiety and partnership problems. It may also have a physical component: some work suggests differences in hormone levels and sensitivity among men with and without premature ejaculation.

How to treat it A large number of treatments is available, including sexual behaviour modification and anti-depressants. A number of new drugs are in development. Rub-on anaesthetic creams that help to reduce sensation have been used.

ERECTILE DYSFUNCTION

What it is Once known as impotence, it's the inability to have or maintain an erection sufficient for satisfactory sexual functioning. One of the biggest studies, carried out in Boston on men aged 40 to 70, found that complete erectile dysfunction occurred in five to 15 per cent of those surveyed.

What causes it A wide range of causes are involved, including stress, anxiety, fatigue, ageing, side effects of medication and partnership difficulties. Physical causes can include nerve damage from ldiabetes, heart problems and hormonal disorders.

How to treat it Treatments include testosterone patches and pills, vacuum constriction devices, rub-on creams, and drugs, including sildenafil (Viagra), which boost the effects of nitric oxide, a chemical messenger that relaxes the smooth muscles in the penis.

Some lesser-known difficulties

Dyspareunia

One of the pain syndromes associated with sex, its symptoms are persistent genital pain during intercourse. Causes may be physical or psychological. Some research suggests that women with the condition may experience negative attitudes about sex, and low levels of marital satisfaction. Relaxation exercises may help a woman regain control over vaginal muscles.

Sexual aversion

A phobia of sexual contact with a partner, this is generally a psychologically- or emotionally-based problem that can result from a number of factors, including childhood trauma. Just how many men and women are affected is not clear, but some estimates put it at fewer than 4 per cent.

Persistent Sexual Arousal Disorder

Defined as spontaneous genital arousal in the absence of sexual desire, its symptoms can sometimes last for days. According to the Association of Reproductive Health Professionals, it may not be as rare as previously believed.

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