June 22, 2009

(McClatchy-Tribune Information Services) -- Ronald W. Lewis dreams of a day when couples would be treated for sexual dysfunction together and therapists would be able to offer more to women with sexual problems.

As president-elect of the Sexual Medicine Society of North America, he is in a position to help lead the way. Dr. Lewis, the chief of urology at Medical College of Georgia, has been involved with sexual medicine associations since they began as informal groups of researchers and therapists meeting during the annual American Urological Association meeting 30 years ago. Back then, the focus was on "male impotence," a phrase that has now been largely discarded in favor of erectile dysfunction.

And while Viagra and similar drugs have revolutionized the treatment of that disorder, basic research into female sexual dysfunction has lagged behind. Until about five years ago, female sexual dysfunction was thought to be largely psychological, Dr. Lewis said.

"Now, over the last five years, there's really been some significant basic research going on in female sexual medicine," he said. "There are some things happening at the biological level that really need to be addressed."

Just as understanding the molecular biology of erectile dysfunction led to a pill to help overcome it, the hope is something similar can be done for women, Dr. Lewis said.

"Probably what we're going to see, as the physiology and molecular biology is better understood, then the chemicals that are really necessary for the female sexual process, we'll identify them, become so specific that we'll then probably be able to address that therapeutically," he said. "Because right now, we're at the level where we don't even really know what those are."

Women could be more complicated to address because it is thought that female sexual response is more dependent on the sexual centers in the brain. Complicating that is the sexual centers are close to the area of the brain controlling nausea, and stimulating one could activate the other, Dr. Lewis said.

"That kind of detracts from what you're trying to do," he said.

Treating both sexual dysfunctions, particularly as a couple, would be ideal because they tend to be connected, Dr. Lewis said.

"There's really good research out there that shows that if a man has erectile dysfunction, the woman is going to have some sexual problems and vice versa," Dr. Lewis said. "Sexuality really is a couple thing and if we can learn to evaluate the couple and properly treat both of them at the same time, that's the place we need to go."

Research shows sexual dysfunction should be taken seriously, he said.

"It turned out to be that often erectile dysfunction was a harbinger and a predictor of coronary artery disease five years later," Dr. Lewis said. Sexual dysfunction has also been associated with diabetes and could be the first sign that serious problems are developing, he said.

"Therefore, if we detect it earlier, we will probably save some lives," Dr. Lewis said.