Maria Sophocles, MD: Why Female Sexual Dysfunction Therapy is Lacking

The differences between the US Food and Drug Administration (FDA) market for male and female sexual dysfunction therapies are severe, and Maria Sophocles, MD, doesn’t foresee the inequality lessening anytime soon.

The medical director of Women's Healthcare of Princeton told MD Magazine® that a proven and profitable field of male sexual therapies has resulted in its continued funding and research, while a severely limited field for female sexual therapies leaves patients at the hands of a network of clinicians.

Sophocles explained the makeup of that treatment team, and what different specialists may bring to the table in female sexual dysfunction care.

What is the current standard of therapy for sexual dysfunction?

Well, female sexual dysfunction has been woefully underserved in the biopharma community and in society as a whole. I was just discussing last night what I call an androgenic model of sexuality in human culture for 4 centuries—which is that male sexual pleasure is sort of the ultimate goal of sexual interaction between men and women, and that female sexual pleasure has not really been prioritized.

This is reflected in the biopharmaceutical industry, if you look at Viagra and its overwhelming success and the numerous other drugs for male erection that have been marketed successfully. There is only one FDA approved medication that relates to or whose purpose is to enhance the female sexual experience.

And it's also about money. When you have tried-and-true money makers that work to enhance the male sexual response, it's cheaper for a pharmaceutical company to build another one like that than it is to sort of start from scratch and address female sexual dysfunction. It's also, frankly, just more poorly understood by clinicians as a whole, by the lay public. As we said before, it's not talked about. So, those are some of the problems.

The standard of care is really a multi-modal approach, a team-approach, behavioral therapy. Many therapists will address this, but there is a subset of therapists, psychologists, social workers who are certified by AASECT (American Association of Sexuality Educators, Counselors, and Therapists). Clinicians and lay public can go on the AASECT website and find therapists who are certified in sex education and counseling, which is really beneficial, because the busy clinician just doesn't always have time or expertise to sit and discuss sexual dysfunctions.

So, an AASECT-certified counselor is an excellent person to help a clinician address sexual dysfunction. Certainly if a clinician is comfortable taking a sexual history and addressing and treating sexual dysfunction, they should, but many are not. It's a very poorly covered part of most medical training. So most clinicians, even if they have the time, lack the expertise or the comfort.

So, a sexual counselor or clinician to address for clinically treatable issues like vaginal dryness, and then sometimes a pelvic floor physical therapist. This is a physical therapist who has specialized training in treating the female pelvic floor, because some sexual dysfunction relates to problems with the pelvic floor muscles and nerves.