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Women's health program tackles female sexual issues

17-Apr-2008: Women's sexual dysfunctions are getting their day in the sun, thanks to the newly developed Female Sexual Medicine Program at Stanford Hospital & Clinics.

"It's such a needed area that had been ignored for so long," said Leah Millheiser, M.D., an instructor in obstetrics and gynecology at the School of Medicine, the founder and director of the program.

About 43 percent of women aged 18 to 49 suffer from sexual dysfunction, according to Millheiser. In women, sexual dysfunction is classified by four disorders: lack of sexual desire or low libido, the inability to become aroused, inability to achieve orgasm and painful intercourse. Her patients are referred from other physicians or come to the Female Sexual Medicine Program after learning about it on their own. The clinic welcomes patients of all ages.

"I see women as young as 16 to 17, and I even had a woman in her 90s come to see me," Millheiser said. She said she also sees many college-aged women.

"The majority of complaints I see in the younger women are low desire and sexual pain," Millheiser explained.

She said low desire is often due to work stress, school stress or relationship issues. Sexual pain has many causes, including vaginal irritation and dryness some women experience while taking the birth control pill. Millheiser said another problem young women can experience is vaginismus, which is an involuntary spasm of a woman's pelvic floor muscles that makes it very difficult and painful to achieve vaginal penetration.

Millheiser stressed that there is help for women with sexual dysfunctions.

"If women have one, they think, 'Oh, I'll just suffer through it.'" she said. "But they don't need to."

In addition to affecting a person's relationships and quality of life, sexual dysfunction can signal a serious underlying disease.

"Neurological disorders, diabetes and heart disease can all have their first manifestation as a sexual symptom," Millheiser said. "It's very important [for doctors] to always ask patients about it."

Millheiser said that studying female sexual dysfunction from a biological perspective had a surprising start: the erectile dysfunction drug Sildenafil citrate.

"It was Viagra in men that opened the door for us to learn more about the way women work sexually," she said. "Up until 1998, we were looking at female sexual dysfunction as a psychological problem. But if there's a physical problem in men, why wouldn't the same go for women?"

The discovery resulted in a major shift in thinking for medical professionals, according to Millheiser.

"Everybody was like, 'Wait a minute, we've got this all wrong,'" she said.

The ensuing flurry of research brought many new discoveries about women's sexual response. The human sexual response cycle, as medical textbooks describe it, is a four-stage model that includes excitement, plateau, orgasm and resolution. Millheiser said some medical professionals recommend making a new sexual response model for women, in which the orgasmic phase is removed altogether.

"Men looked shocked when we say this, but women don't necessarily need an orgasm to be sexually satisfied," Millheiser said.

While women can be frustrated if they want to have an orgasm but are unable to, many women can enjoy themselves just as much in a sexual situation without having an orgasm.

Their partners may not understand this, and "women end up faking a lot more orgasms than they need to," according to Millheiser.

Another difference between men and women manifests itself in their reasons for having sex.

Men are often motivated by a spontaneous desire for sex, or thoughts and fantasies about sex, but women are more complicated, said Millheiser.

"Women have many reasons for initiating or agreeing to sex with their partners," she said. For example, a woman may want to please her partner, or she may know that even if she's not in the mood for sex at the time, she'll begin to enjoy herself as the act progresses.

Millheiser said it took effort on her part to get Stanford's medical center to recognize sexual medicine as an important part of women's health. She said she was never trained in sexual medicine during medical school, and the training she did get was mostly about male sexuality. When she began her residency, she was unprepared to deal with women's questions about their sexual health.

"I felt like I didn't have the training to help them," she said.

Millheiser got a National Institutes of Health (NIH) grant to study female sexual dysfunction, and she began researching the subject. She hasn't looked back since.

"This was my calling," she said. "It's overwhelming the positive response and feedback we've received from the community and other medical practitioners in the area. I think the patients really appreciate it."

Source: Stanford Daily

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