Have More Sex – It May Help Prevent Breast Cancer
What is testosterone replacement, and how is it linked with women’s sexuality?
Testosterone is also a hormone that remains controversial for women with breast cancer. Many researchers are still unconvinced of any direct link between testosterone and female sexual health. The data are confusing and conflicting.
Female androgen insufficiency syndrome is characterized by blunted or decreased motivation, persistent fatigue, and a decreased sense of personal well-being that is identified by insufficient plasma estrogen, low circulating bioavailability of testosterone, and low sexual desire (libido). Other potential symptoms include bone loss, decreased muscle strength, and changes in cognition or memory. Bone density may also be affected.
In September 2005, the North American Menopause Society published a comprehensive position statement on its inclusive review of testosterone use, which included monitoring, safety, and replacement guidelines and doses for postmenopausal women. Currently, no U.S. FDA approved androgen product is available for women. The use of male products or bio identical products should be used with caution, as more long-term safety data are warranted. In Europe, the testosterone patch Intrinsa has been recently approved and will be released shortly. Very high levels of testosterone may have several potentially serious side effects, including increased facial and body hair growth, weight gain, abnormal enlargement of the clitoris, hair loss, changes in lipid profiles, and liver or hematological changes. Women who have taken testosterone supplements have also reported emotional changes. The safety of androgen in the cancer population has not been adequately studied. Testosterone can be converted to estrogen, which may reactivate, promote, or stimulate tumor growth. Intrinsa may be promising for libido issues; however, further randomized controlled trials that examine long-term safety data are warranted.
Some of the testosterones successfully used in women include oral methyl testosterone, transdermal testosterone, topical testosterone propionate cream 2%, testosterone gel, and oral dehydroepiandrosterone. A woman who is taking testosterone off-label in an effort to increase desire or for libido issues should be under the care of a sexual medicine specialist and should have her blood lipids and liver monitored; any side effects should be immediately reported to the clinician. The authors who conducted a recent study concluded that testosterone replacement in breast cancer patients who are suffering from lowered libido was ineffective. This finding also reiterates that sexual libido is a multivariate problem that involves a complexity of issues, including sexual medicine and sexual psychology. Women are not ruled by hormones alone. There are women with low or no hormones whose sexual function is excellent and those with hormones that are within the normal range who are sexually dysfunctional.
How can phosphodiesterase inhibitors be helpful to women? I thought they were only for men.
Phosphodiesterase inhibitors (medications such as Sildenafil [Viagra], Tadalafil [Cialis], and Vardenafil [Levitra]) are medications that have been used traditionally for the treatment of erectile dysfunction in men. Numerous attempts have been made to show an efficacy in women, but most fail to show any significant benefit. The medication is supposed to relax the clitoral and vaginal smooth muscle. Some potential side effects of this class of medications include headache, uterine contractions, dizziness, hypotension, myocardial infarction (heart attack), stroke, and sudden death.
New and exciting emerging data may support their use in women who suffer from sexual complaints because of selective serotonin reuptake inhibitor (SSRI) use. Recent data suggest that men who use phosphodiesterase inhibitors may actually be helping their spouses achieve sexual satisfaction. In an article titled “Through the Eyes of Women: The Partners’ Perspective on Tadalafil,” which was published in the Journal of Urology in September 2006, Althof and associates attempted to evaluate patient and partner responses to the efficacy and overall satisfaction with use of tadalafil to treat erectile dysfunction. This was a double-blinded, placebo-controlled, 12-week trial of approximately 746 couples who received either placebo or 10 or 20 mg of tadalafil. Female partners of men who were taking the medication reported significantly improved overall sexual satisfaction and corroborated the men’s report of erectile improvement and penetration ability. The men were understandably happy, and many reported improved erection, penetration, and overall satisfaction with the sexual experience while taking the medication. Sexual complaints do not exist in an individual vacuum but rather are intricately involve the partner and his or her reaction to treatment. Some women who have changes in orgasm (it takes too long to achieve an orgasm and the intensity and frequency of orgasm have diminished) may benefit from the use of a phosphodiesterase inhibiting medication. Ask your sexual healthcare provider if this medication may be helpful for you.
What is Alprostadil cream?
Alprostadil cream is a prostaglandin E1 cream. It is not FDA approved for the treatment of female sexual dysfunction but has been used in men for the treatment of erectile dysfunction; however, according to preliminary clinical trials, this topical medication (a compounded cream) can be applied to the pelvic genital area in women and may act to relax arterial smooth blood vessels, causing vasodilation and increased sensitivity and sexual arousal. NexMed pharmaceutical company is conducting advanced randomized clinical trials with this cream with the intention of making it widely available in the United States under the brand name Femprox. A similar product, Alista, is under investigation by Vivus. In a double-blind trial, 400 women with female sexual arousal disorder aged 21 to 65 years were randomized to receive a 10-dose at-home treatment of 500, 700, or 900 μg of Alprostadil cream or a placebo cream. They were instructed to apply the cream to their clitoris and G-spot. More than 370 patients completed the study, and many showed significant improvement in sexual arousal. Possible side effects include pain to the genitals (decreased as the cream was washed away), lowered blood pressure, and possible temporary fainting. Alprostadil cream should be topically applied approximately 15 minutes before engaging in intercourse.
Terms:
Androgen insufficiency syndrome – A constellation of symptoms attributed to low testosterone levels in women. Some of the symptoms include fatigue, decreased well-being, a lack of energy or motivation, and decreased or absent sexual interest or desire.
Erectile dysfunction – A persistent or recurrent inability to achieve or maintain an erection sufficient enough to accomplish a desired sexual behavior such as intercourse or coitus.
G-spot – An area of increased erotic sensitivity on or deep inside the front of the vagina. It is located on the anterior surface of the vaginal vault. Stimulation in some women provides intense sexual pleasure.
