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Treatments for sexual problems can be simple and effective. Often treatments have few side effects.

Female Hormone Replacement

Women can have pain during sex because the inner lining of the vagina becomes dry and thin after menopause. Note that regular sexual intercourse can help maintain the health of the vagina.

If women need treatment, effective and easy remedies exist. They involve:

  • Vaginal creams or tablets that contain low doses of estrogen. 
  • An “estrogen ring,” which gradually releases estrogen into the vagina. The ring gets replaced every few months.

Side effects of vaginal estrogen are generally rare and mild. Since the estrogen stays in the vaginal area, the hormone doesn’t affect the entire body.

Considerations of Estrogen Treatment

  • While vaginal estrogen can treat sexual pain, the hormone doesn’t increase sexual desire.
  • Topical estrogens and prasterone may harm women with estrogen-sensitive cancers.
  • Women who don’t want to use vaginal estrogen can get some relief with vaginal moisturizers or by using lubricants during intercourse. However, these products don’t reverse vaginal thinning.  

Topical prasterone is another way to treat vaginal pain due to thinning of the vaginal walls. This drug is a human-made version of dehydroepiandrosterone (DHEA).

Drug Treatments that Affect a Woman’s Health

Several treatments could create problems:

  • Oral estrogen replacement therapy after menopause. This can cause stroke, blood clots, and cancer.
  • Ospemifene. This can treat pain during intercourse caused by vaginal changes.  Negative side effects include hot flashes and increased risk of blood clots.
  • Testosterone is primarily a male sex hormone. It can help women who have less sexual desire. Little information exists on the long-term safety of women taking this hormone.

Male Hormone Replacement

Men who have naturally low levels of testosterone in the body and bothersome symptoms as a result, including tiredness, loss of interest in sex etc, can get help by taking testosterone. However, this hormone doesn’t improve sexual activity in men with normal levels of testosterone. And, the hormone can cause liver and prostate problems, sleep apnea, or high red blood cell counts. Also testosterone treatment is avoided in people with known history of breast or prostate cancer due to concern for causing spread of these cancers.

Men who take testosterone need tests including:

  • Baseline and regular blood tests.
  • Prostate exams.
  • Monitoring of water retention.

Treatments for Erectile Dysfunction (Impotence)

Several good medication and non-medication treatments are available for impotence. 

Pills

Men can take pills of the class Phosphodiesterase-5 inhibitors that can help with erection. An erection may usually come within one hour. Men who may take the medication will still need sexual stimulation to get an erection.

These medications can interact with other medications e.g., nitrates where there is a risk of causing low blood pressure that can cause death. Other side effects may include headache, short-term color blindness, or upset stomach. 

If a man doesn’t have an erection with these drugs, he may have a blood vessel problem (vascular disease) and should see their healthcare provider for further evaluation.

These medications have an uncommon but dangerous side effect called priapism. Priapism is an erection that lasts for more than four hours. This is a medical emergency. Seek help quickly if this happens. 

Injections Into the Penis

There is one injectable drug available in the United States. Alprostadil goes into the penis with a very fine needle. Erection after receiving this injection will last up to an hour. This is an option for men who can’t take the pills.

The injections may cause side effects such as bruises, local pain, or scarring from repeated administration. This treatment may also cause priapism in rare cases.

Vacuum Pumps for Erectile Dysfunction

Vacuum-pump devices can treat impotence (difficulty having an erection). The penis goes into a plastic cylinder that causes the penis to become rigid. A ring around the penis traps the blood to maintain the erection. It lasts about half an hour. The ring has to be removed after 30 minutes.

Side effects include pain, swelling, bruising, and painful ejaculation. Men who take blood thinners or who have a history of bleeding disorders should not use this pump.

Medication Changes

Your healthcare provider should review your medications to identify any drugs that can cause sexual problems. Such medications may include antidepressants, antipsychotics, antihistamines, antihypertensive agents, and antacids. Reducing doses or using other medications can help.

Treatment of Underlying Medical Conditions

Treatment of many health problems can help reduce sexual problems. For example, treatment of diabetes can improve blood flow to sex organs. Treating pain can help too. 

Vaginal Lubricants

Many non-drug vaginal lubricants are at local pharmacies. They can help reduce or stop pain resulting from vaginal dryness. Do not use lubricants after their expiration date. Their chemicals break down and can cause an allergic skin reaction.

Talk Therapy or Counseling

A primary healthcare provider may be able to help a person with sexual concerns. If some situations, seeing a trained counselor can help.

Simple behavioral changes may make a difference. For example:

    • Longer foreplay may be necessary with advancing age.
    • Direct gentle stimulation of the genitals can also improve response.
    • Regular sex can help maintain vaginal tissues and improve lubrication.
    • Hugging and kissing, caressing, and manual or oral stimulation are sexual activities that may satisfy both partners.
    • Masturbation can help someone with an active sex drive.
    • Modification of sexual positions to reduce physical exertion or stress on certain parts of the body.

 

Last Updated May 2023

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