It isn't unusual for doctors to hear from grateful patients -- to get cards or flowers after treating someone for cancer or saving someone in surgery.But one thank-you in particular stands out for Dr. Leah Millheiser."I got a beautiful card in the mail from this woman. After three years of treatment, she was so excited because she'd finally had an orgasm," said Millheiser, director of the Stanford Female Sexual Medicine Program.Millheiser founded the program three years ago when she noticed an increase in female patients seeking help for sexual disorders. Women's new interest in sexual health, she said, was an unexpected side effect of a major medical breakthrough for men: the availability of Viagra in the United States, beginning a decade ago this March.Women who were too embarrassed to talk about sex became bolder after Viagra was introduced. They started looking up information on the Internet or approaching their gynecologists with questions. Sometimes it was just a matter of postmenopausal women trying to keep up with their newly aroused husbands, but for millions of women, Viagra raised a fundamental issue of fairness, Millheiser said."Viagra came out and all of a sudden sex was everywhere, but no one was addressing the female issues," Millheiser said. "Women wanted to know, 'If my husband or my partner has a pill, why can't I?' "It's only been in the past decade or so that researchers have come to understand how widespread sexual dysfunction is in the United States. One study of more than 3,000 men and women found that 43 percent of women and 31 percent of men reported sexual dysfunction, which is defined as a persistent problem with sex that causes distress.In men, the most common sexual problem is erectile dysfunction, which studies show afflicts roughly a third of males over 40. In women, the problems are more varied, but are generally divided among four categories: lack of desire, difficulty with arousal, pain during sex and inability to achieve orgasm.At the Stanford center, researchers are studying drugs that could one day be the Viagra equivalent for women. At the same time, physicians offer medication and therapy treatments that are already available.One patient, Maria, 35, said she never particularly enjoyed sex, and for most of her life she assumed she just "wasn't a sexual person.""If I did it, it was for my husband," said Maria, who asked that her last name not be used. "I wasn't enjoying it."Her lack of sexual enjoyment was compounded after childbirth when she began experiencing pain during intercourse. Still, she let it go on for three years before she brought it up with her gynecologist, who referred her to Millheiser. Within a few months, Maria was seeing a physical therapist who specializes in treating pelvic-floor disorders and painful intercourse.Just hearing that there was a treatment was a relief, Maria said. She wasn't expecting miracles. Then, after five or six months, she tried having sex again."I'd never had great sex. And suddenly it was like, 'OK, wow, yes,' " Maria said, laughing.The challenge of getting treated for sexual dysfunction starts in the exam room, doctors say: The vast majority of physicians aren't trained to treat sexual disorders, and so they never ask women about their sex lives."It's like a lot of other medical conditions. If you don't ask about it, you won't hear about it," said Tracy Flanagan, director of women's health for Kaiser Permanente's Northern California region.There aren't many mainstream, easily accessible treatments available and there are no drugs in the United States for treating women's sexual dysfunctions, although there are off-label treatments doctors can use, including hormones and topical anesthetics to dull pain. The Food and Drug Administration in 2004 rejected a testosterone patch called Intrinsa that is designed to increase libido in postmenopausal women.Without the equivalent of Viagra for women, doctors rely heavily on physical and behavioral therapy to treat sexual dysfunctions. Physical therapy usually involves easing tight muscles around the vagina. Behavioral therapy addresses psychological blocks.Among the most common sources of sexual dysfunction is menopause, when a loss of hormones can lead to a drop in libido, problems becoming sexually aroused and vaginal dryness that makes intercourse painful.The problem can be compounded when women are in their 50s and 60s, or older, and their husbands start taking Viagra. A couple that may have adapted to changes in their sex lives as they've matured are suddenly faced with an abrupt and sometimes hurtful shift in interests, said Dr. Louann Brizendine, director of the University of California-San Francisco Women's Mood and Hormone Clinic and author of "The Female Brain.""His problem is fixed, and all of a sudden he's saying, 'OK, honey, I'm ready, let's go,' " Brizendine said. "He's expecting her to return to her 35-year-old sexual self. And it's not that she doesn't want to feel sexual again. It's just such a pressure."(Distributed by Scripps Howard News Service, www.scrippsnews.com.)
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