 |
 |
|
|
|
|||
|
|||
 |
|||
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 |
|
|
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
=8350&DepartmentID=371.
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