Hope for Women with Sexual Dysfunction

Female sexual dysfunction is a prevalent but often-undertreated phenomenon, especially among cancer survivors. The problems, which include low sexual desire, difficulty reaching orgasm or pain on intercourse, among others, can be devastating to women and their partners.

Compounding these issues, physicians often feel unprepared to deal with them, reports Pelin Batur, MD, Ob/Gyn & Women’s Health Institute. “Physicians may not have time to address these complex issues, or feel they don’t have many options to offer patients. If the woman is shy about discussing the issue, physicians may underestimate the impact of the problem in the patient’s life.”

Luckily, multiple treatments are available to help such women. Treatments include detailed sexual education, mindfulness therapies, counseling, pelvic floor physical therapy, systemic and vaginal hormonal treatments (both estrogen and nonestrogen), as well as nonhormonal medications. Sometimes, just spending the time to discuss simple options, such as using the right type of lubricant, can make all of the difference in a woman’s life.

Partnership with Cleveland Clinic Cancer Center

To help manage this unmet need, Dr. Batur and the Ob/Gyn & Women’s Health Institute have partnered with Cleveland Clinic Cancer Center to develop the health system’s first comprehensive Female Sexual Dysfunction Program. Services are provided at three Cleveland Clinic locations — Center for Specialized Women’s Health at Main Campus, Beachwood Family Health and Surgery Center, and Strongsville Family Health and Surgery Center. Dr. Batur directs the program.

Open to all women

The program is open to all patients, but will be working particularly closely with cancer patients since survivors have more complex sexual complications than the general population while also having more limited treatment options, Dr. Batur explains.

“For instance, patients who have had breast cancer may be hesitant to use hormonal therapies that alleviate painful intercourse,” she says. “We often can offer them nonhormonal treatments instead, or try approaches that use the least amount of hormones possible.”

Other conditions that contribute

Other conditions that can contribute to sexual dysfunction include kidney, liver and heart disease, diabetes, anxiety/depression/stress and drug or alcohol abuse. It can also be a side effect of certain medications or a lingering effect after pregnancy and childbirth, Dr. Batur notes.

The Female Sexual Dysfunction Program also cares for women who have concerns about issues related to hormonal changes, such as genitourinary syndrome of menopause, which leaves more than half of all postmenopausal women with symptoms such as vulvovaginal dryness or atrophy, burning, irritation, dyspareunia, urinary urgency, dysuria and urinary tract infections. These problems affect cancer patients at higher rates than the general population.

At times, incontinence concerns affect sexuality. Patients can be offered pelvic stimulation therapies that they perform at home, Dr. Batur says. Pelvic stimulation devices are approved for the treatment of all types of stress urinary incontinence as well as fecal incontinence, and may also help improve orgasm.

A comprehensive approach

The clinic utilizes a comprehensive team-based approach, incorporating breast health experts, pelvic floor physical therapists, medical and gynecological staff, sex therapists and others. A full range of evidence-based treatment options will be available, including:

• Flibanserin.
• Systemic hormone therapy.
• Testosterone
• Lidocaine.
• Ospemifene.
• Vaginal DHEA.
• Vaginal estrogen.
• Nonpharmacological therapies (such as lubricants, dilators, vibrators, pelvic physical therapy/stimulation therapy).

“We spend a good deal of time getting to the core of each patient’s problem,” Dr. Batur emphasizes. “For some, medical treatments will be warranted; for others, counseling may be the right path to help them overcome psychological barriers that are preventing them from enjoying sexual intercourse. Those barriers can stem from many sources, such as social or religious beliefs, relationship difficulties, poor body image or a history of sexual abuse.”

Dr. Batur and her colleagues have been collaborating with other noted sexual health centers nationally to compare best practices and make joint presentations.

Virtual visits available

The new clinic offers virtual visits for patients who cannot travel to Cleveland, after an initial face-to-face visit that includes a history and physical examination. Patients can schedule an introductory virtual visit to get the conversation started (via Cleveland Clinic Express Care® Online).