Articles

Sexual Health for Men and Women

By Pete Hueseman, R.Ph.

Effectively treating sexual dysfunction often requires addressing an underlying medical condition or hormonal change that is affecting your sexuality. Medical conditions that can contribute to sexual dysfunction include depression or anxiety, diabetes, cardiovascular and neurological diseases, pelvic or abdominal surgery, and cancers.

Vulnerable hormonal times in a woman's life occure during pregnancy and the postpartum period, while using hormonal birth control methods, and during perimenopause and menopause. Men are vulnerable during andropause when testosterone levels decrease and estradiol levels increase.

Five major areas involved in male and female libido:

1. Psychological/Mental- There are numerous causes of psychological sexual dysfunction and loss of libido. Most often low libido is related to stress, lack of adequate sleep, depression, anxiety, marital or relationship problems, life crisis, financial difficulties, problems at work, religious repression, or some forms of mental illness. Getting a deep sleep at night can do wonders for a healthy libido.

   
   

2. Hormonal- Androgens including testosterone are major components of libido. Testosterone levels decline about one percent each year in men, and may contribute to lower male libido with aging. Testosterone declines with age in women and may lead to a decrease in libido with menopause. Women who have experienced surgical removal of the ovaries notice a drop in sexual interest. Replacement of androgens can be helpful in those with age related sexual dysfunction. Testosterone is available by prescription only. An over-the-counter hormone, such as DHEA, converts into testosterone and thus has a positive influence on libido.

   
   

3. Vascular- Alterations in the flow of blood to and from the penis are thought to be a commone cause of male erectile dysfunction. Conditions such as atherosclerosis, high cholesterol, hypertension, or diabetes all reduce blood flow to the penis and genital organs and may lead to difficulty with erection or genital swelling. Additional factors that can impede blood flow include penile injury, surgery in the pelvic or abdominal area—and even sitting on a bicycle too long.

4. Neural- Nerve damage from disorders such as diabetes, multiple sclerosis, Parkinson's disease, and stroke affect the brain's ability to respond to sexual stimulation. In women, abdominal or pelvic operations can occasionally lead to nerve damage. Sexual dysfunction is common in men undergoing surgical treatment for prostate enlargement or cancer.

   
   

5. Chemical- Some chemical involved in the human sexual response and libido include dopamine, acetylcholine, and nitric oxide.

   Special Formulations to help enhance Sexual Response, Especially for Women:

   When the time is right, choose a formula just right for you
   Many women commonly complain of vaginal dryness, low sensation, and low libido. Bellevue Pharmacy offers several formulations commonly prescribed for these conditions. These unique, prescription-only formulas are available in 40 gram tubes.

   Our exclusive formula contain ingredients for vasodilation and amino acids to increase blood flow. Increasing L-Arginine concentration is a necessary substrate for nitric oxide synathase (NOS). NOS is a crucial enzyme for vaginal lubrication and genital sensation.

   Sildenafil, a phosphodiespherase type 5 inhibitor, is thought to enhance sexual responsivity when used in a topical cream for female patients through genital vasodilation, just as it does in male patients. Sildenafil and the amino acid, L-Arginine, combine to further promote vasodilation which enhances sexual function.

   Our Most Popular Formulations include:
   Aminophylline + L-Arginine + Sildenafil in our special gel base.

   Aminophylline + L-Arginine + Testosterone + Sildenafil in our special gel base
   (Strengths can be discussed during a consultation with one of our consultant Pharmacists)
   Suggested use:
   Insert 1 gram of the formula vaginally about 30 minutes before intercourse or as directed.
   Other formulations available by prescription only include:
   

   
   
   • Testosterone 2% thick gel
     
   • Sidenafil + L-Arginine in the gel base
     
   • Apomorphine in a nasal spray
     
   • Tadalafil sublingual tablets
     
   • Sildenafil sublingual tablets
     
   • Oxytocin nasal spray
     
   
   Non-Prescription products:
   Alura- Formulated as a natural, topical cream, applied to a tiny portion of the genital area. Acts as a stimulant to the soft tissue and creates a "cool tingling" sensation.

   Zestra- Bioactive botanical ingredients work upon topical application to increase female pleasure in women. Zestra contains no hormones, drugs, glycerin, preservatives, or irritants such as cinnamon and peppermint, which are common in other intimacy enhancers.

   According to the Nation Helath and Social Life Survey, approximately 20% of women reported a lack of vaginal lubrication during sexual stimulation.₁ Women often require more time and stimulation to become aroused as they age.₂ Menopause associated vulvar atrophy can also lead to decreased sensation with decreased arousal, while medical conditions can lessen sensation.₂

   
   Special Formulation to Help Enhance Sexual Response Especially for Men
   
   Erectile Dysfunction (ED) Formulations

   Erectile dysfunction, sometimes called "impotence", is the repeated inability to achieve or maintain an erection firm enough for sexual intercourse.

   The word "impotence" may also be used to describe other problems that interfere with sexual intercourse and reproduction, such as lack of sexual desire and problems with ejaculation or orgasm. Using the term erectile dysfunction makes it clear that those other problems are not involved.

   In older men, ED usually has a physical cause, such as disease, injury, or side effects of drugs. Any disorder that causes injury to the nerves or impairs blood flow in the penis has the potential to cause ED. Incidence increases with age: About 5% of 40 year old men and between 15 and 25% of 65 year-old men experience ED. But it is not an inevitable part of aging.

   ED is treatable at any age, and awareness of this fact has been growing. More men have been seeking help and returning to normal sexual activity because of improved, successful treatments for ED.

   Our most popular formulations include:
   Trimix: which is different strengths in combination of Papaverine, Phentolamine, and PGE-1.
   Intraurethral Trimix gel: contains the following- Alprostadil, prazosin, and Papaverine. In either 0.02ml or 0.04ml syringes
   Other Formulations available by prescription only:
   

   
   
   • Quadmix-Papaverine, phentolamine,PGE-1, and Atropine
     
   • BiMix- Papaverine and Phentolaine
     
   • Erectile Cream- Aminophylline, ergoloid mesylate, Isosorbide dinitrate in a cream.
     
   • Testosterone pellets implants- for subcutaneous implantation by a physician.
     
   • Apomorphine nasal Spray
     
   • Sildenafil sublingual tabs
     
   • Tadalafil sublingual tabs
     
   
   The first step begins with a consultation, from one of our consulting Pharmacists. We then make an assessment and write a clinical consult note that you can provide to your physician.

   To learn more about this process and how we work with you and your physician to choose the best option, click here: Patient Empowerment Program
   

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   References:
   

   
   
   1. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA 1999; 281:537-544
      
   2. Bachmann GA, Leiblum SR. The impact of hormones on menopausal sexuality: a literature review. Menopause 2004; 11:120-130.
      
   
   
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