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Week of 7 November 2003· Vol. VII, No. 11

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MED center copes with demand to treat female sexual dysfunction equally

By David J. Craig

Irwin Goldstein directs BU’s Institute for Sexual Medicine and its clinical practice arm, the 25-year-old Center for Sexual Medicine, which recently has made important strides in understanding and treating female sexual dysfunction. His wife, Sue Goldstein, coordinates the center’s education outreach efforts. Photo by Kalman Zabarsky


Irwin Goldstein directs BU’s Institute for Sexual Medicine and its clinical practice arm, the 25-year-old Center for Sexual Medicine, which recently has made important strides in understanding and treating female sexual dysfunction. His wife, Sue Goldstein, coordinates the center’s education outreach efforts. Photo by Kalman Zabarsky


Clinicians at BU’s Center for Sexual Medicine braced for a wave of new patients following the release of the impotency drug Viagra in 1998. The facility had conducted key studies involved in the drug’s development and had attracted extensive media attention.

But no one predicted what came next: for the first time, women began calling to seek treatment for their sexual health problems. Because the center addressed sexual dysfunction in men only, its staff reluctantly referred the women to other clinicians. But they kept calling back.

“ The women would say, ‘I’ve been to my family doctor, my gynecologist, and a psychologist, and I’m still having problems with desire or arousal or orgasm or pain during penetration, so please help me,’” says Irwin Goldstein, a MED professor of urology and gynecology. He directs the center, which was founded in 1978 and now is the clinical practice arm of BU’s multidisciplinary Institute for Sexual Medicine, also directed by him.

“ All of a sudden, between a third and half of the phone calls we were receiving were from women. That showed us that people will come forward to discuss their sexual dysfunction only if they believe reasonable treatment options are available,” Goldstein continues. “Penile implants had existed for years, but for women there were no physiologic treatment options. When Viagra appeared, everybody assumed that it might work for women too.”

Responding to the demand, the center in 1998 became the first site in the world to offer a comprehensive diagnosis and treatment program for women’s sexual health. Today, it treats about 50 women every week, in addition to 75 men, and conducts clinical research on treatments for both female and male sexual dysfunction. The Institute for Sexual Medicine, meanwhile, conducts basic science research on a wide variety of physiologic aspects of women’s and men’s sexual arousal.

A man’s world

Originally called the New England Male Reproductive Center, the Center for Sexual Medicine was launched at a time when the medical establishment assumed that female sexual dysfunction was purely a psychological issue and disregarded it as a possibility for scientific inquiry. In the 1970s, in fact, researchers showed little interest in the physiologic causes of sexual dysfunction in men. Investigation in that area was jump-started somewhat accidentally in 1973 when Baylor University urologist Brantley Scott discovered that a technology he had developed as part of an artificial urinary sphincter could be used to create penile implants for treating impotence. The late Robert Krane, a former chairman of the MED urology department, learned the novel procedure and brought it to BU in the mid-1970s.

“ The unusual aspect of penile implants,” says Goldstein, who came to BU in 1976 and worked with Krane, “was that while the surgery worked, no one really understood how erections happen physiologically.”

Goldstein received his first NIH grant to study the physiologic processes involved in male sexual arousal in 1980, and his research team has been at the forefront of the field ever since. By studying tissue from the penises of men who received penile implants at the Center for Sexual Medicine, for instance, Goldstein contributed to the development in 1983 of the first impotency drugs that could be injected into the penis. And in the late 1980s, his laboratory identified the neurotransmitter that causes the penis to become erect, which was instrumental in the development of Viagra.

But until recently, female sexual dysfunction continued to be neglected by researchers. “In terms of what’s understood about women’s sexual response, it’s the 1970s,” says Goldstein. “We still don’t know what is the neurotransmitter that relaxes the vagina and how the vaginal canal widens and lengthens during sexual activity. Our basic research group is asking those questions, as well as what is the physiology of clitoral engorgement, labia engorgement, the g-spot, the cervix, and vaginal engorgement, relaxation, and lubrication.”

Catch up

Despite the unknowns, researchers have developed reliable and safe treatments for female sexual dysfunction. The Center for Sexual Medicine has treated about 2,500 women since 1998, Goldstein says, and about 70 percent of female patients now report improvement in sexual function after one year of treatment. That’s approximately the same success rate as the center has with men.

About 75 percent of female patients have a hormonal imbalance that can be corrected with hormone therapy, Goldstein says. In addition, after receiving physical and psychological examinations and discussing with practitioners their sexual experiences, men and women who visit the center are counseled, with their sexual partners, on potential behavioral factors that could contribute to their problem. These include alcohol or recreational drug use and bicycle riding, which can harm men’s and women’s genitals. Medical treatments available to men include penile implants and the injection of drugs into the penis, as well as oral medications like Viagra.

While scientists have not yet determined if Viagra is effective for women (preliminary results show the drug helps improve blood flow to the genitals in some women), Goldstein is optimistic that researchers will develop a drug counterpart for women. He says the common assertion that female sexuality is more complex and more psychologically based than male sexuality, and therefore more difficult to treat, is misguided. “The sexual function of each gender is dictated by the triad of mind, body, and interpersonal relationships,” he says. “We happen to know less about female sexual response, but the genders are equally complicated.”

Reaching out

Because a lack of knowledge among physicians remains an obstacle to providing treatment to the estimated 31 percent of men and 43 percent of women in the United States who experience sexual dysfunction, the Institute for Sexual Medicine also offers a wide range of training and education programs to health-care providers and the public.

“ Many people who call the center are absolutely desperate because they’ve been told over and over by their doctors that their problem is in their head, or that there can’t be anything wrong with them because they’re generally healthy,” says Sue Goldstein, coordinator of education and development for the institute and Irwin’s wife. “In addition to referring them to clinicians, we ask them to tell their doctors about our Web site, because half of the site is designed for health-care providers and includes PDF files of questionnaires that can be used for diagnosing sexual dysfunction.

“ We live in the 21st century and women are empowered to have as much sexual fulfillment as men, but you can’t do that if you’re not physiologically able to,” she continues. “Part of what we do in our outreach is help women determine if there might be something wrong with them, and then encourage them to explore what the treatment options are. Whether a woman is 28 years old and doesn’t understand why she’s not interested in sex with her really cute boyfriend, or has gone through menopause, it may not dawn on her that what she is experiencing might be sexual dysfunction.”

Irwin Goldstein will speak at an Institute for Sexual Medicine symposium on female sexual dysfunction, held on Sunday, November 23, from 1 to 5 p.m., at the Holiday Inn, 399 Grove St., Newton Lower Falls, Mass. For more information about the event, which is free and open to the public, visit http://www.bumc.bu.edu/Departments/PageMain.asp?Page

For more information about the Institute for Sexual Medicine, visit www.bumc.bu.edu/Departments/HomeMain.asp?DepartmentID=371.


7 November 2003
Boston University
Office of University Relations