Effective Non-Drug Treatment for Women's Desire and Arousal Problems

Drugs don't work for women. But something else does.

Posted Jan 02, 2011

It may sound odd, but drug companies were loath to pursue medications to treat sex problems--until 1998 when Viagra took the world by storm. After its stunning launch, the most successful in drug history, you could almost hear pharmaceutical executives licking their lips in anticipation of the real money-maker, a drug to treat low libido and arousal difficulties in women.

Compared with men, women are more willing take medication, in fact, women take an estimated two-thirds of all drugs. Meanwhile, women's sex problems, variously known as female sexual dysfunction (FSD) and women's hypoactive sexual desire disorder (HSDD), are at least as prevalent as erectile dysfunction, and they affect women of all ages. If Viagra could rack up sales of $2 billion a year, drug pundits predicted that a drug for women would make even more, and labs went into frenzied overdrive to develop it.

But a funny thing happened on the way to winning this huge jackpot. Nothing worked. Pfizer spent eight years and tens of millions trying to show that Viagra could also help women, but the studies produced very mixed results, from no effect at all to modest insufficient to win FDA approval. In 2006, Pfizer gave up on Viagra for women.

Then the huge German drug maker, Boehringer Ingelheim, thought it had a winner with a pill called flibanserin. In one study, women taking it reported that "satisfying sexual events" increased from 2.8 times a month to 4.5 times. But women taking the placebo reported almost as much improvement, from 2.7 times a month to 3.7 times. Meanwhile, flibanserin had no effect on the problems the drug was developed to address, low libido and arousal difficulties. In June 2010 an FDA advisory panel voted unanimously against approving flibanserin. Soon after, Boehringer Ingelheim announced that it was giving up on flibanserin.

While drugs have so far done nothing to help women with low libido and arousal problems, researchers at the University of British Columbia have come up with a non-drug approach that appears to offer significant benefits, a combination of (1) relationship counseling, (2) education about how women become aroused, (3) progressive muscle relaxation exercises that involve consciously releasing tension around the body, (4) the self-exploration and masturbation exercises in Becoming Orgasmic, a classic self-help guide for women, and (5) mindfulness, a form of Buddhist meditation that produces "relaxed wakefulness" and has been used successfully in treatment of depression, chronic pain, substance abuse, eating disorders, and couple distress.

The researchers recruited 26 women who'd sought treatment for low libido and/or arousal problems at the British Columbia Center for Sexual Medicine. After taking standard tests of sexual function, in groups of four to six, they participated in three 90-minute education-counseling-meditation sessions spaced two weeks apart and led by a psychotherapist and a gynecologist trained in sexual medicine. Between sessions, they did homework involving mindfulness meditation. After the third session, the participants retook the sexual function tests.

The program increased the women's desire, arousal, lubrication, and sexual satisfaction. The increase in self-reported arousal was highly significant (P<0.001). In post-program feedback, the women rated the mindfulness exercises as most helpful.

Why would a mindfulness meditation program boost libido and arousal? Because it promotes deep relaxation and focuses attention on the present moment. Deep relaxation and present-moment focus are fundamental to sexual arousal and satisfying lovemaking, and dovetail neatly with the sensuality exercises that are a pillar of sex therapy. Mindfulness and other meditative practices carve a time-out from the stresses of daily living, and foster deep relaxation and a focus on the moment. Lovemaking involves the same things: a time-out from daily routines, deep relaxation, and a focus on the immediate experience of lovemaking.

I hasten to add that this report--and another similar study by the same researchers--are small pilot projects that must be replicated in larger trials before the results can be considered valid. However, I believe these researchers are on to something. Women's desire and arousal difficulties are not about quick fixes with drugs, but rather about women's ability to relax deeply, their comfort with sex and their bodies, and how they manage the stresses in their lives.

Brotto, L.A. et al. "A Psychoeducational Intervention for Sexual Dysfunction in Women with Gynecologic Cancer," Archives of Sexual Behavior (2008) 37:317.

Brotto, L.A. et al. "A Mindfulness-Based Group Psychoeducation Intervention Targeting Sexual Arousal Disorder in Women," Journal of Sexual Medicine (2008) 5:1646.

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