The first thing to do: consult your doctor

It is always necessary to start with a medical check-up as well as a review of the drugs taken. This may be enough to find the cause of a sexual difficulty. Note that the contraceptive pill or antidepressants are regularly involved in disorders of sexual desire.

Physiotherapy: rehabilitation of the pelvic muscles

Le physiotherapist or the midwife qualified in perineal rehabilitation can be of help for certain sexual difficulties.

In case of difficulty reaching orgasm, perineal strength training can help to regain orgasms, particularly in women who have had children, but also in older women, even without children.

If you have a coital pain or vaginismus, work on the muscles of the pelvic floor (the perineum) is often useful. But it can only be done after or in parallel with psychotherapy work in the case of vaginismus.

pharmaceuticals

Treat the diseases involved:

When the malfunction is attributable to a health problem that affects the genitals (vaginitis, urinary tract infection, sexually transmitted infection, etc.), appropriate treatment is possible and usually contributes to the return of a fulfilling sex life. Consult the sheets corresponding to these conditions to learn more about their treatment.

Medicines to treat desire disorder

There is currently a drug, flibanserin, which has been marketed since 2015 under the name Addyi® in the United States to treat acquired and generalized hypoactive sexual desire disorders in premenopausal women. However, it is very controversial: in the study that allowed it to be marketed, women taking placebo had 3,7 intercourse per month and women taking Flibanserin 4,4, i.e. 0,7 more intercourse per month. On the other hand, side effects are common (36% of women in the study reported) with drops in blood pressure, drowsiness, syncope, dizziness, nausea or fatigue. (This medication is originally from the antidepressant family).

Discover hormone therapy

Women who, in agreement with their doctor, choose the hormonal treatment menopause  when they experience the first symptoms of menopause may decrease or even disappear their symptoms of dryness of the vaginal mucous membranes. But this treatment is not effective in all women.

Women suffering from decreased libido linked to a hormonal insufficiency, the doctor may also prescribe Testosterone, but little is known about the long-term effects of this type of hormone therapy and its use remains marginal and controversial. A testosterone patch (Intrinsa®) was marketed, but it was withdrawn from the market in 2012. It was authorized for women with reduced sexual desire and whose ovaries had been removed by surgery.

New treatments for female sexual dysfunctions

– The fractional laser. It is used to treat vaginal dryness in women who cannot or do not want to benefit from estrogen-like hormones. A thin probe is inserted into the vagina and sends out painless laser pulses. This causes micro burns which, by healing, will stimulate the vaginal hydration capacities (we speak of vaginal revitalization). In three sessions spaced about a month apart, women regain comfortable lubrication. This method is also used at the vulvar level. It allows women who have undergone treatment for breast or uterine cancer to regain a comfortable sexuality. The fractional vaginal laser is unfortunately not supported by Health Insurance in France and the price of a session is around € 400

– Radio frequency. A thin probe inserted into the vagina sends out pulses of radiofrequency waves that cause gentle warmth in the depths. The woman feels a local warmth. This has the effect of tightening the tissues and reviving the vaginal lubricating capacities. In 3 sessions about 1 month apart, women find good lubrication, and also more sensations of pleasure and stronger and easier orgasms (thanks to the tightening of the tissues), and very often see their small urinary problems disappear. (tingling, small drop that bothers …). The radiofrequency is not supported by the Health Insurance and it is still at a high price (around 850 € per session).

Why not make an appointment with a sex therapist?

Sometimes a multidisciplinary approach, which gives way to the intervention of a sexologist, makes it possible to treat dysfunctions sex^5-7 . In Quebec, most sex therapists work in private practice. It can be individual or couple sessions. These sessions can help calm the frustration and the tensions or marital conflicts caused by the difficulties experienced in sexual life. They will also help increase self-esteem, which is often abused in such cases. 

The 6 approaches to sex therapy:

• La cognitive-behavioral therapy  aims in particular to break the vicious circle of negative thoughts about sexuality (and the behaviors that result from it) by identifying these thoughts and trying to defuse them; it also consists in prescribing communication exercises or physical exercises for the couple. This individual psychotherapy approach helps to explore and understand the issue by analyzing the person’s thoughts, expectations and beliefs about sexuality. These will depend on lived experiences, family history, social conventions, etc. As examples of compelling beliefs: “the only true orgasm is vaginal” or “by focusing on my desire to cum, I will achieve orgasm”. This creates internal tensions which, on the contrary, decrease sexual satisfaction. In the event of decreased libido or inability to reach orgasm, this is the preferred approach. It can also be useful in case of coital pain, in addition to physiotherapy. Consult a psychologist or sex therapist familiar with this approach.
• Trauma therapies. When a woman has suffered violence (intra-family violence in her childhood, sexual violence, verbal violence), methods currently exist to heal the psychological damage caused by these traumas: EMDR, life cycle integration (ICV), Brainspotting, EFT … are very active therapies.
• L’systematic approach, which looks at the interaction of spouses and their effect on their sex life;
• THEanalytical approach, who tries to resolve internal conflicts at the origin of sexual problems by analyzing the imagination and erotic fantasies;
• L’existential approach, where the person is encouraged to discover their perceptions of their sexual difficulties and to get to know themselves better;
• thesex-bodily approach, which takes into account the inseparable links body – emotions – intellect, and which aims for a satisfying sexuality both individually and relational.

Surgeries

Surgery has hardly any place in the treatment of sexual dysfunctions.

It can be done in women with endometriosis and pain on penetration to remove the cysts involved.

In some cases of vestibulitis (intense pain between the two labia minora at the slightest contact), some surgeons have performed vestibulectomies. These surgeries are only performed when all other possible approaches have been exhausted without obtaining a satisfactory result.