Augusta, GA, USA. The field of sexual medicine has been hobbled by values-driven views of morality and culture that precluded closer examination of physical causes. Also, Dr. Ronald Lewis says treatments focused mostly on men, and rarely on women or couples, hinders effectiveness.

However, the field has undergone a renewal in recent years, with measureable benefits, especially for female-male couples. Lewis, an impotence expert, is chief of the urology section at the Medical College of Georgia (MCG) School of Medicine.

Lewis says "This is a fun time to be involved in this ... we are gaining a more comprehensive perspective on the causes, effects and potential treatment of sexual dysfunction." Dr. Lewis is the newly elected president-elect of the Sexual Medicine Society of North America (SMSNA) and busy organizing the society's spring scientific meeting. He says there is mounting evidence that if one partner in a couple has problems, the other likely does as well.

Many problems, such as vaginal dryness, already are treatable, and new options such as pills that turn on sexual centers in the brain and Viagra-like drugs for women are on the horizon. Such problems create a classic cause-and-effect scenario.

"The man says, 'I can’t please her, I am not a man anymore.'

The woman says, 'He doesn't love me any more because he is not paying attention to me.'"

The reality could be low estrogen levels are causing her vaginal dryness and painful intercourse and lower testosterone levels are decreasing the firmness of his erection, hurting his confidence, even before she pushes away. Not unlike the old adage, use it or lose it, chemicals that are supposed to cause the erection can retool, so the man begins to have less sexual thought and erectile activity, "essentially a situational cause for real end-organ disease," Dr. Lewis says.

The focus on treating the disease – regional sexual medicine societies around the world used to be called erectile dysfunction societies — actually helped illustrate the need for a broader perspective.

Prior attention was focused on quick and easy erection treatments — first shots, then pills — that made men instantly technically ready for sex but did nothing for their partners' issues, Dr. Lewis says.

"A lot of women would say, 'You may be fixed but it has not fixed our relationship.'" A good place for partners to initiate a fix is talking about sex — with each other and their doctor, he says.

Many problems, such as vaginal dryness, already are treatable, and new options such as pills that turn on sexual centers in the brain and Viagra-like drugs for women are on the horizon. In fact, an MCG research team led by Dr. R. Clinton Webb recently showed these phosphodiesterase Type 5 inhibitors, which block an enzyme responsible for breaking down an erection, show promise in female rats at least, although they work differently than they do in the males. The MCG scientists and Dr. Lewis agree that is more evidence as well that sex for females is different and likely more complex.

While scientists explore new options for women, they also are taking a closer look at how low testosterone levels affect men. Testosterone therapy already is used to improve libido and erection but physicians likely need to put an emphasis on keeping tabs on testosterone levels to ensure bone health as well.

"In treating prostate cancer, for example, we actually have made a group of men more likely to have bone problems because we give them medication to block testosterone because prostate cancer depends on it," says Dr. Lewis.

Now urologists and others are learning that low levels, natural or otherwise, contribute to osteoporosis and that hormone replacement therapy can even be given safely to a select number of men who have recovered from their cancer, as measured by a prostate specific antigen level of zero.

In fact, the thrust of last year's SMSNA research meeting focused on how there is little evidence to indict testosterone as an instigator of prostate cancer although patients with untreated prostate cancer shouldn't take it because the prostate cancer cells have receptors that feed off the hormone. Dr. Lewis has hand picked a number of recovered prostate cancer patients in his practice for testosterone therapy along with extremely close follow up.

As the need for hormone replacement therapy in men appears to be expanding, so are the delivery options. Near term, shots that last three months and pellets placed under the arm or in the abdomen that deliver six months of therapy likely will prove better options than older approaches such as a topical cream that is effective to the point that men have to wait until it dries to have casual contact with a woman and are advised to wear a shirt during sex even after it dries.

The increasing obesity epidemic is affecting sexual health as well. In men, for example, fat converts testosterone to estrogen. It's also becoming clear that the inability to get an erection can be one of the most visible signs of cardiovascular disease. "We tell people who see us for erectile dysfunction it's probably a good idea to get your heart vessels checked," Dr. Lewis says.

While sexual problems may not be lethal, they can be very impactful on general well being, Dr. Lewis notes. "If there is something breaking down between you and your partner of 20 years, you take it to work with you. It probably produces more absenteeism. It probably has more impact on us and our environment than we think."

FYI: SMSNA Established in 1994 as an independent organization of health care professionals concerned with the science of human sexual function and dysfunction, the Sexual Medicine Society of North America (SMSNA) strives to:

• Promote, encourage, and support the highest standards of practice, research, education, and ethics in the study of the anatomy, physiology, pathology, diagnosis, and treatment of human sexual function and dysfunction and

• Provide a forum for the free exchange and discussion of new ideas, thoughts, and concepts in this field.

The SMS seeks to identify existing and emerging issues in the field of human sexual function and dysfunction, provide accurate and credible information to medical professionals, develop standards and guidelines for impotence research and practice, and produce educational program that bring leading-edge concepts of research, clinical practice, ethics, and politics to health care professionals interested in impotence and related matters.

The TS-Si News Service is a collaborative effort by TS-Si.org editors, contributors, and corresponding institutions. Sources can include the cited individuals and organizations, as well as TS-Si.org staff contributions. Articles and news reports do not necessarily convey official positions of TS-Si, its partners, or affiliates. We welcome your comments. Use the form below to leave a public comment or send private correspondence via the TS-Si Contact Page. We will not divulge any personal details or place you on a mailing list without your permission.


TS-Si is dedicated to the acceptance, medical treatment, and legal protection of individuals correcting the misalignment of their brains and their anatomical sex, while supporting their transition into society as hormonally reconstituted and surgically corrected citizens.

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