Women have Erectile Dysfunction Too

If the title didn’t warn you ahead of time, I’m going to issue a content warning up top: in this edition of Off The Record, I’m going to venture into the mind and body of women for this post. I’m going to use intimidating words like WOMAN, CLITORIS, and VAGINA so men, consider yourself warned.

One Disclaimer: I am a woman. You’ve been with me while I write about men’s health, so stay with me (and bring your lady friends/partners/etc.) while we journey to the other side.

BECAUSE WOMEN HAVE ERECTILE DYSFUNCTION TOO!

Might seem a bit of overkill to write that in all caps because have you ever seen a commercial for women’s sexual issues? Every time I’m scrolling through a streaming service or social media, I constantly see ads for men’s sexual issues, but I have never seen a single ad for a woman.

At least 40% of women report issues with sexual dysfunction in their lifetime. We (Urologists) all believe that this number is falsely low because women don’t talk about it. So let’s start the conversation and make this an acceptable topic!

Why? Well, that’s not my place to answer (though I do have plenty of thoughts). Instead,

In medical school, one of the first core topics to understand is anatomy. So let’s go.

Anatomy 101

Female anatomy is actually not that much different than that of males, but the major difference is most of it is below the surface. Did you know that women have two erectile chambers? Women have two corpora cavernosa that fill with blood and engorge with stimulation just like a male erection. The part of the clitoris that is visible is actually called the glans – just like the head of a penis.

I love drawing a picture of female anatomy in my office for my patients, and reminding my men who pride themselves in their knowledge of female anatomy about just how little they actually know. And you know what – it isn’t your fault!

Women’s sexual health has been traditionally ignored or not discussed, but thanks to recent studies and movers and shakers in the Urology world (Dr. and Mrs. Goldstein, Dr. Rubin, Dr. Casperson,etc.), women are getting their overdue attention. The first step is understanding anatomy.

Hormones 101

Now that you understand more what the female sexual anatomy looks like, let’s discuss how it functions, so we can better understand how it dysfunctions. Similar to men, women respond to sexual stimulation. With stimulation there is increased blood flow, engorgement of the clitoral cavernosal bodies, release of lubrication, and orgasm.

The woman’s sexual cycle is very similar to a man’s. However, our major difference anatomically is the vaginal canal. Women have natural lubrication and tissue expansion
here, but this is reliant on estrogen. Women who are around menopause, are post menopause, or have had chemical/surgical menopause (ie hysterectomies, breast cancer treatment, etc) lose this natural ability. When this happens, sex HURTS. If sex hurts, no one is interested, period. This is when hormones come in to play.

Just like men need testosterone, women need testosterone AND estrogen. Testosterone for libido, estrogen for everything else. Let me side bar here.

Women need estrogen systemically (ie that gets to their whole body/into their blood stream) AND locally to the vagina/vestibule. And if a woman can’t have estrogen replacement because of breast cancer, she can still have estrogen cream vaginally. There are dozens of studies documenting its safety – and its success! It is a miracle cream and I prescribe it to every woman that will accept the prescription.

Pelvic Floor Physical Therapy 101

There is a reason why pelvic floor physical therapy is the #1 recommended treatment for many gynecologic/urologic/pelvic diagnoses in women. It’s because IT WORKS. I will warn you, as I warn my patients, that it is…well a bit weird. Things are inserted into your vagina. Exams are done internally and externally. It takes a specially trained physical therapist to have this skill set (make sure you find a good one!). But it is so worth it!

With a combination of physical therapy and hormone replacement, I have been able to cure 99% of my female patients with sexual dysfunction.

My practice started as men coming to see me, and then sending their wives once they were ready to perform, but now it is shifting to the women coming in first and sending their partners next. And I love it. Urology and Sexual Medicine isn’t a man’s world.

If it was, you wouldn’t be reading my blog posts.

We all know that you can’t say happiness without saying penis, but you also can’t say pleasure without saying her so take care of the women in your lives. And ladies – take care of yourselves. Don’t think that hope is lost. You have treatment options that work. We also have newer medications (the little pink pill) and I will tap into those in a future post.

What’s Off The Record?