Clinical Application for the Female Patient

Copyright ©2006 Winnifred B. Cutler, PhD and Athena Institute for Women's Wellness

Dr. Winnifred Cutler's invited article on pheromones and clinical applications for the female patient.

The quality of marital sex tends to decline with the duration of the relationship according to recent studies in diverse age groups. In 2003, Liu analyzed data from the University of Chicago’s probability sample of more than 3000 non institutionalized US residents 18 to 59 years old. The quality of marital sex declined with the marital duration and married women are less satisfied with sex and marriage than married men are. Postmenopausal and perimenopausal Australian women also reported significant declines in sexual responsivity, frequency of sexual activity, libido, and the relationship with the partner as they moved through the menopausal transition into the postmenopausal phase.* Moreover, the man’s ability to perform sexually is adversely affected by the menopausal transition.* Marital status significantly predicts both less desire and less enjoyment in North American midlife women’s sexuality as well.* While sexual intercourse and arousal declined in midlife women, more non-genital touching from their partners was wanted.

Sexual motivation and the duration of the partnership were also studied in German college students in “long term” (90 month) relationships. Although when relationships began both partners wanted sex as often, a steady decline in interest occurred with time in women but not in the men. By the 90th month less than 20% of the women wanted to have sex as often as their men.

Disease exacerbates these effects. Breast cancer survivors have dramatic declines in sexual function (Greendale et al 2001) and low confidence in their sexual attractiveness. Similar effects have been reported for women with urinary incontinence, pelvic organ prolapse, those scheduled for hysterectomy,* and those undergoing tedious intrusive and uncomfortable infertility treatments. Sexual function was not improved by the surgery to correct the prolapse or the randomized varied treatments to correct the severity of incontinence in one study searching for positive outcomes.

Because an increase in sexual attractiveness and sociosexual behavior has been recently demonstrated by the three recently published investigations, it makes sense to address possible uses and benefits for patients who seek help to improve their own romantic contact with a partner. This frontier of therapeutic applications involving the use of cosmetics has exciting potential. Because there are no drug side effects associated with them, they are nontoxic and may help up to 75% of those who try them after 6 weeks of steady use.

Promoting sexual attractiveness in the patient


Drs. Berman and Berman and colleagues have recently reported on a web-based survey instrument that 3807 women completed addressing their experience of seeking help for sexual function complaints from their physicians. Physicians were frequently not delivering satisfactory help to patients who seek it and data suggested that more than 50% of physicians who were approached by these women did not appear to want to hear about the problem, did not appreciate its significance to the patient, and expressed reluctance to either treat or assess the problem. A startling 76% of the physicians in this study did not thoroughly examine the patient in reference to her complaint or make an actual diagnosis, or perform any test to evaluate the problem. The highest figure 88%, was reported by the women on the question of “did not develop the specific treatment plan with the patients consent.” The authors suggested that medical school health educators as well a physicians who deliver services to women should vastly improve what they are offering. And that they should recognize patient needs in this area are going to increase. *

Dr. Rosemary Basson has been articulating the inadequate role of drugs in the management of most sexual dysfunction that women seek help for. She notes that a large component of women’s sexual desire is responsive rather than spontaneous and points out that the old Masters and Johnson and Helen Singer Kaplan models of the sex response cycles have proved inadequate for the treatment of most women presenting for sex complaints. Unless there is a specific absence of genital congestion when there is mental arousal, she opines that drugs to promote genital congestion will be ineffective.

In fact Cynthia Meston, to this point, recently demonstrated that post-hysterectomized women who watch erotic films with vaginal photoplethesmography in place, are not experiencing blood flow to the genitals and that this absence is irrelevant because they are also not considering it relevant

Winnifred Cutler, Ph.D.