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CNN Saturday Morning News

Weekend House Call

Aired August 30, 2003 - 08:29   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


HEIDI COLLINS, CNN ANCHOR: Weekend House Call with CNN's Elizabeth Cohen begins right now.
ELIZABETH COHEN, CNN CORRESPONDENT: Today on Weekend House Call, female sexual dysfunction. Last weekend, we focused on male sexual dysfunction and the new anti-impotence drug Levitra. Well, we got so many phone calls and e-mails from women saying do a show for us. Well, we heard you, so this one's for you.

Female sexual dysfunction is a general term that's used for anything that's wrong with a woman's sex life.

(BEGIN VIDEOTAPE)

COHEN (voice-over): Ever since Viagra came out in 1998, women have been asking, what about us? The problem is a simple pill might not cure sexual dysfunction in women. Men's sexual problems are more mechanical and so more easily fixed with a pill. But for women, it appears to be much more complicated.

Sexual dysfunction can be a number of things -- lack of sex drive or a loss of desire, difficulty being aroused or lack of lubrication, lack of orgasms, pain with intercourse, depression or problems with the relationship.

Some treatments have worked for some women. Joanne Dorman (ph) didn't enjoy sex, but after taking Viagra, sex got a whole lot better.

JOANNE DORMAN: It's fabulous. It's an enjoyable moment of our life.

COHEN: But studies show Viagra does not work for most women. Another treatment that's had some success is the over the counter supplement DHEA. In the body, it converts to testosterone, which women need to have a sex drive. This woman said she had no sex drive, but then she took DHEA.

UNIDENTIFIED FEMALE: And suddenly when I would look at someone that was attractive or something that was sexually stimulating, I started feeling things that I'd never felt before.

COHEN: Before taking DHEA, doctors had told her the problem was all in her head. That's the old way of thinking. The new way of thinking is that female sexual dysfunction is a real medical problem that needs real medical attention.

(END VIDEOTAPE) COHEN: Studies show that women actually have more problems with sex than men do. About 40 percent of women said they had one or more sexual problems in the past year, but only 10 percent of those women ever saw a doctor about it. For women, sexual dysfunction is a combination of physical and psychological elements.

Most difficulties can be broken into four disorders -- problems with sexual desire, orgasms, sexual arousal and sexual pain.

Sexual desire disorder is the most common problem for women across-the-board. It occurs when there's a persistent lack of desire or absence of sexual fantasies. In other words, you're rarely in the mood. You neither initiate sex nor seek stimulation. It can be caused by the use of -- by the overuse, sometimes, of prescribed drugs, like anti-depressants, birth control pills or high blood pressure medicine. Menopause, stress, depression and relationship problems can lessen sexual desire, as well.

We'll talk about the other disorders throughout this program, but we want to hear your questions now. Call us at 1-800-807-2620 or send us an e-mail at housecall@cnn.com.

Dr. Irwin Goldstein is making a return engagement this weekend to answer your questions. He's doing research on the front lines of women's sexuality at the Boston University Medical Center for Sexual Medicine.

Thanks for joining us, Dr. Goldstein.

DR. IRWIN GOLDSTEIN, DIRECTOR, INSTITUTE FOR SEXUAL MEDICINE: Hi, Elizabeth.

How are you this morning?

COHEN: We're doing fine.

We're very interested in hearing from all these people who've called us. This is a special program asked for by our viewers, so let's get straight to one of our viewers, Michelle from Wisconsin.

Welcome to House Call.

What's your question for Dr. Goldstein?

MICHELLE: Well, good morning.

GOLDSTEIN: Good morning, Michelle.

How are you?

MICHELLE: I'm doing pretty good.

My question is what help is there for sexual dysfunction due to medication?

GOLDSTEIN: Which medication are we talking about, Michelle? MICHELLE: Anti-depressants.

GOLDSTEIN: Anti-depressants are very commonly used and are very needed in many situations, but have a major problem on desire and orgasmic response. So there are different anti-depressants you can use. Wellbutrin is a depressant, anti-depressant that has limited adverse effects on sexual function. But in all cases of sexual dysfunction, Michelle, you need to see a psychologist, you need to see a physician, you need to have blood tests, you need to have sensory testing of the genitals, you need to maybe have blood flow testing, you need at least at a minimum a history and a physical examination.

The entire evaluation is needed to better understand the effects of your anti-depressants on your sexual response.

COHEN: Well, we're glad to hear that men also care about female sexual problems. We have this e-mail from a concerned husband in Chicago. He writes, "My wife experienced a significant decrease in sexual desire two to three years into our relationship. We first suspected this might have coincided with her regular use of oral birth control, but she's been moved to a few different varieties with no change. Could you please discuss the possible reasons why a woman would see a significant decreases in libido at the age of 25?"

GOLDSTEIN: Elizabeth, this is a huge problem. I'm so glad you have this e-mail. I really believe birth control pills have a lot of issues with sexual problems. The birth control pill turns off the ovary and that's its desired function. It stops the brain's messages to the ovary, so it stops making the eggs.

One of the synthetic functions of the ovary, however, is to make testosterone, which is an absolute requirement for sexual function. A second issue is that there's a binding protein called sex hormone binding protein, otherwise called sex SHBG. Elevations in SHBG bind the testosterone, rendering the free or unbound component very low, and that's the basis for sexual response.

So, birth control pills really do cause a lot of sexual problems. So we see so much of this and we need to change and readdress our very frequent use of birth control pills in young women.

COHEN: Do you think maybe some women see a sexual, a decrease in sexual appetite with birth control pills but not even notice it?

GOLDSTEIN: Well, they do notice it. They, very often women see diminished desire and diminished lubrication on the birth control pill, and when they get off it, that returns. Unfortunately, what we're finding is X percent of women, almost even up to a third, when they stop the birth control pill, their sexual dysfunction remains as a permanent problem in their lives.

COHEN: We have a phone call now from Rosie in Tennessee.

Rosie, go ahead with your question for Dr. Goldstein.

ROSIE: Yes, doctor, I have RSD and I take a lot of medication. And I'm wondering if you're ever going to come out with anything for us women. My husband sometimes thinks I don't love him, but I do. It's just I don't desire, you know?

GOLDSTEIN: Did you say you have I.C., like interstitial cystitis?

ROSIE: RSD, reflex sympathetic dystrophy.

GOLDSTEIN: Oh, OK. Well, I would love to have the opportunity to examine you. I think the, as we said to the first individual who called, sexual dysfunctions require a detailed evaluation. You need to see a psychologist. You need to see a physician. You need a sexual history, a medical history. You need a detailed physical examination of the vestibule and vulva. You need blood tests. You need sensory testing.

Once women get into this concept that, you know, like you have a broken bone and a broken leg or a heart problem, you see a physician, a plan is created, we can get on to management. We have a 70 percent restoration of function rate in women with whom we have this integrated biology and psychology approach.

So I would encourage you to get that evaluation.

COHEN: Another e-mail now from a concerned husband. Zack from Wisconsin writes, "My wife started taking Avlimil. I was wondering if it really works. Do you know of any studies on these pills? Are we just wasting our money?"

Dr. Goldstein, can you start out by saying exactly what Avlimil is.

GOLDSTEIN: Well, it's a collection of about a dozen or so herbs and spices. Unfortunately, there really is not good science behind some of these new products that display or mention the fact that we are now the treatment for sexual dysfunction.

I encourage women who have sexual problems to really get an appropriate evaluation. Go see the psychologist. Go see the physician. Get the blood tests and identify what is the plan by finding out what the issues are.

I think the hope is that you take a pill and this thing will go away, and I think Avlimil tries to address those issues. But that is really not the issue here. These are mind/body and relationship issues, they're relatively complicated, they require sex therapy, physical therapy, sometimes medical therapies, hormonal therapies, to really get at the entire problem.

COHEN: We have some Avlimil right here and certainly this is -- it looks like a medicine. When you open it up it's sort of in a way that you often see medicines being presented. And...

GOLDSTEIN: It's very slick marketing, Elizabeth.

COHEN: The makers of Avlimil say that they have done studies showing that it works and they say that most women who take it do, indeed, see an improvement in their sex life.

We've got to take a break now.

When we come back, we'll take a look at what childbirth can do to your sex life. Beyond the obvious lack of time alone with our spouse, there are some other physical effects that can dampen your sexual desire.

Call us with your questions. Our number is 1-800-807-2620. Or e-mail us at housecall@cnn.com.

COMMERCIAL BREAK

COHEN: Did you know that the smell of licorice candy is the most arousing scent for women? Who knew? That's according to a study by the Smell and Taste Treatment And Research Foundation in Chicago. Men's after shave actually, it turns out, is a turnoff for women, decreasing blood flow to the genitalia. And maybe we all spend too much money on perfume. It turns out that men are most aroused by the smell of cinnamon buns. I guess preferably smothered all over the body. Pumpkin pie came in a close second, so start baking.

This is Weekend House Call and we're talking about female sexual dysfunction. If you're having issues in the bedroom, this is the place for answers. Call us with your questions about 1-800-807-2620, or e-mail us at housecall@cnn.com.

While we're getting your phone calls and e-mails lined up, let's check our daily dose health quiz.

Which hormone holds the most promise for women with sexual dysfunction, estrogen, progesterone or testosterone?

We'll have that answer in 30 seconds.

Stay with us.

COMMERCIAL BREAK

COHEN: Checking the daily dose quiz, we asked which hormone holds the most promise for women with sexual dysfunction, estrogen, progesterone or testosterone?

The answer is testosterone. It's called the hormone of desire and it's the focus of new research by several pharmaceutical companies, as the next best libido prescription.

This is Weekend House Call and we're talking about female sexual dysfunction. Another disorder many women struggle with is sexual arousal. This is when you're interested in sex but your body just isn't cooperating. You're not able to get excited. You lack natural genital lubrication and you have no nipple sensitivity or swelling. Lubrication is dependent on the swelling of blood vessels in the vaginal area, so any impediment to blood flow could be the cause of the problem. Hysterectomies can cause loss of feeling. So can vaginal tearing at childbirth or blood flow diseases like high blood pressure, diabetes or high cholesterol. Hormonal changes from menopause, childbirth or medications can lessen your arousal, as well.

We're joined by Dr. Irwin Goldstein in Boston.

Dr. Goldstein, we have a caller on the phone.

Go ahead with your question.

It's Betty in California.

BETTY: Good morning.

GOLDSTEIN: Hi, Betty.

My sister's name is Betty. I like that name.

BETTY: Oh, good. It's a good name.

I have had a total hysterectomy 11 years ago and I've gone through the testosterone and estrogen...

GOLDSTEIN: How old were you when you had the hysterectomy?

BETTY: Eleven years ago.

GOLDSTEIN: How old was that?

BETTY: Well, I'm 68 now, so I guess I was 57.

GOLDSTEIN: OK.

BETTY: But right now...

COHEN: Betty, go right ahead.

BETTY: Hello?

COHEN: Betty, are you still there? Go ahead with your question.

BETTY: Yes. Well, I was just curious because I've been through the hmm therapies and the testosterone, you know, had the side effects of the facial hair and so forth. And it really wasn't all that effective. Where can I go now?

GOLDSTEIN: Betty, you can supplement -- first of all, you need to have normal hormones. So I would continue and maintain the hormones correctly. We, of course, we need to do an appropriate history and see if you're on anti-depressants or any other medications. Women in their 60s are often on blood pressure medicines or cholesterol medicines. The drugs, the PD5 inhibitors that increase blood flow to men are actually very effective, if the hormones are normal, in women in your age group. So the new Levitra drug or Viagra drug can be used. There's also a vacuum therapy device from Eros which, if you do this exercise, say, 10 minutes three times a week, will increase sensitivity to your clitoris and frenular area, and increase sensitivity and increase lubrication response.

So there are things we can do and you should seek medical help and don't give up, Betty.

COHEN: We have an e-mail question now from Vantrese in Texas. She wants to know, "Since I gave birth two years ago, my libido has decreased significantly. My husband's getting frustrated because I really have no desire to have sex these days. Before the baby, we had the same sexual appetite. Who should I talk to about this problem?"

And Dr. Goldstein, I think there's sort of two parts here. One, there's loss of desire after childbirth, and, two, who do you go to? What kind of doctor do you go to?

GOLDSTEIN: Oh, a sexual medicine doctor and integrate the biology with the psychology. There are, American Association of Sexual Educators, Counselors and Therapists, certified sex therapists and sexual medicine doctors to take care of this problem.

The leading reason we see women -- in our clinic we've seen 2,000 women now -- is sexual dysfunction after childbirth. One of the most amazing things that we're seeing is that women go from their pubertal like hmm values back to the same values of hormones they've had prior to their puberty. And really our therapy is to reintroduce puberty back into their lives by giving them agents like DHEA and testosterone, which you used as your quiz, Elizabeth.

The other issue is once the hormones are normal, we can do what we did for Betty. If lubrication is required, we can add drugs that increase blood flow. Because there's lots we can do for women, and they're usually younger, who have changes in sexual problems, sexual function after their childbirth times.

COHEN: We have a caller now, Susan from Florida.

Susan, welcome to Weekend House Call.

Why do you go ahead with your question.

SUSAN: Good morning, Dr. Goldstein.

GOLDSTEIN: Hey, Susan, how are you doing?

SUSAN: I have always been a highly sexual person.

GOLDSTEIN: God bless you, Susan.

SUSAN: Yes, and I always loved it. But suddenly I experienced an atrophied clitoris.

GOLDSTEIN: An...

SUSAN: I have very, very little sensation in the clitoris area.

GOLDSTEIN: OK.

SUSAN: What can be done?

GOLDSTEIN: Well, we need to document and verify that. A physical examination would be very important. There's a hood that overlies the clitoris that sometimes closes down and encroaches. We call that fimosis (ph) of the clitoris. There's testing we can do called quantitative sensory testing. We have examinations that measure the sensation of the clitoris.

I must say that the Eros may be a useful product to improve sensation and I'll say again that we've talked about hormones throughout the morning here. Hormones can increase sensitivity. We have animal studies where the nerve to the clitoris, if you remove the hormonal support, deteriorates. And when you reapply hormones systematically, we can get better function in the sensation to the genital area.

So, again, as I've tried to say over and over today, please see a sex therapist and a medical doctor, get a full evaluation. All these issues can be resolved with this new medical therapy.

COHEN: Dr. Goldstein mentioned the Eros device. I have one right here. This is the only FDA approved device that's actually on the market for female sexual dysfunction. It is a clitoral vacuum and it works like this. If I just use it on my hand here, you can see it creates a bit of suction. So these are available if you take a look on their Web site. Again, Eros.

We're going to be back soon with more questions. The elusive orgasm -- if you've never had one, is it a problem? We'll talk about it when Weekend House Call continues.

COMMERCIAL BREAK

COHEN: Welcome back to Weekend House Call.

We're talking about female sexual problems and the ability, or lack thereof, to have an orgasm. Not having an orgasm usually has a psychological cause. It can be due to a relationship problem, anxiety, past sexual trauma, negative feelings about sex or inadequate stimulation. There are two types of orgasmic disorders, primary, meaning you've never had an orgasm before, and secondary, meaning you used to be able to, but can't anymore.

We have an e-mail question on this topic from Trina in Virginia. She writes, "I've been married to the same man for 30 years and I've never, ever had a climax. I never feel satisfied. My husband knows sometimes that I don't have a climax, but I've never shared with him that I have never had one. We try all kinds of things, but nothing seems to work. Sometimes I get a good sensation, but never to the point that I hear others speaking of. Is there something wrong with me or is my husband not doing something right? Please help."

Dr. Irwin Goldstein is here with us from Boston University.

Dr. Goldstein, do you think you can help Trina?

GOLDSTEIN: God bless Trina.

Please come and get an evaluation. There are so many things that it could be. But I'll tell you, in the end, Elizabeth and Trina, an orgasm is a neurologic reflex. You have to provide sufficient stimulation to the spinal cord and then it activates a reflex, which is ultimately an orgasmic response.

Many, many women have diminished sensation in their genitals for reasons that we don't know. They could be horseback riders, they could be spinners, they could be bicyclists, where the nerve to the genital area gets locally damaged. They could have diabetes or systematic disorders were there's neurologic intervention. You've mentioned the relationship issues. Hormonal problems, interestingly enough -- I brought it up before -- they cause, for some reason, diminished sensation to the genitals.

For women who have difficulty with orgasm, vibrators and vibrator like mechanical devices are excellent tools. You know, if you can't hear, you sort of turn up the volume. If you can't have an orgasm, the equivalent of turning up the volume is to use a vibrator.

But please get an evaluation. These treatments are very successful in women with orgasmic problems.

COHEN: We have a phone call now from Jim from Missouri.

Jim, welcome to our show.

Go ahead with your question.

JIM: Thank you.

I'm 47. My wife is 48. We're in a long -- we've been in a long- term marriage for a lot of years. And it's a monogamous marriage with a lot of trust, so it's not a relationship issue. My wife has given birth to three children. At the -- 14 years ago, when she gave birth to our last child, she had a tubal ligation. In the past two to three years, she seems to have lost the desire and she's suffering from vaginal dryness.

She is multi-orgasmic when we do have sex, but she's afraid of any repercussions or health issues with hormones.

COHEN: Dr. Goldstein, dryness, pain, are these common things someone in this age, in their 40s, after giving birth to three children?

GOLDSTEIN: Yes, absolutely. And I'm so excited that Jim is on to talk about women's sexual health issues. This just goes to show you what a couple's issue this is. This is such a dramatic conversation we're having on national and international TV. Listen, Jim, it's the same issue. Your wife desperately needs to get an evaluation. Of most interest, she needs her hormones measured. There are 10 to 12 hormones that really need to be measured. Check them out on our Web site. There's the list of which ones are needed. Go to your doctor and get them done and get them evaluated.

For women of her age group, hormones are very important. Orgasms, if she maintains her orgasms and the problem is desire, hormones are really very, an important item here. In particular, DHEA and testosterone gel have been found to be helpful.

COHEN: When we come back, Dr. Goldstein -- we're running out of time right now -- but when we come back, we'll have some final thoughts on female sexual dysfunction.

COMMERCIAL BREAK

COHEN: Welcome back to Weekend House Call.

We've been talking to Dr. Irwin Goldstein, who helps women with female sexual dysfunction.

Dr. Goldstein, tell us your bottom line for women with female sexual dysfunction.

GOLDSTEIN: Become empowered. Go, you have a right to sexual health. If you're distressed with your sexual problem, become empowered and seek medical help. Be optimistic, but be realistic. These are complicated issues that take time to develop.

I want to say one thing, Elizabeth. 8/30/03, remember this date. This is an historic time. We have done medical and psychological discussion on an international news broadcast system. This is an historic moment. This is a great moment in sexual medicine, really.

Thank you very much.

COHEN: Well, thank you, Dr. Goldstein, for joining us.

CNN SATURDAY MORNING continues now.

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Aired August 30, 2003 - 08:29   ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
HEIDI COLLINS, CNN ANCHOR: Weekend House Call with CNN's Elizabeth Cohen begins right now.
ELIZABETH COHEN, CNN CORRESPONDENT: Today on Weekend House Call, female sexual dysfunction. Last weekend, we focused on male sexual dysfunction and the new anti-impotence drug Levitra. Well, we got so many phone calls and e-mails from women saying do a show for us. Well, we heard you, so this one's for you.

Female sexual dysfunction is a general term that's used for anything that's wrong with a woman's sex life.

(BEGIN VIDEOTAPE)

COHEN (voice-over): Ever since Viagra came out in 1998, women have been asking, what about us? The problem is a simple pill might not cure sexual dysfunction in women. Men's sexual problems are more mechanical and so more easily fixed with a pill. But for women, it appears to be much more complicated.

Sexual dysfunction can be a number of things -- lack of sex drive or a loss of desire, difficulty being aroused or lack of lubrication, lack of orgasms, pain with intercourse, depression or problems with the relationship.

Some treatments have worked for some women. Joanne Dorman (ph) didn't enjoy sex, but after taking Viagra, sex got a whole lot better.

JOANNE DORMAN: It's fabulous. It's an enjoyable moment of our life.

COHEN: But studies show Viagra does not work for most women. Another treatment that's had some success is the over the counter supplement DHEA. In the body, it converts to testosterone, which women need to have a sex drive. This woman said she had no sex drive, but then she took DHEA.

UNIDENTIFIED FEMALE: And suddenly when I would look at someone that was attractive or something that was sexually stimulating, I started feeling things that I'd never felt before.

COHEN: Before taking DHEA, doctors had told her the problem was all in her head. That's the old way of thinking. The new way of thinking is that female sexual dysfunction is a real medical problem that needs real medical attention.

(END VIDEOTAPE) COHEN: Studies show that women actually have more problems with sex than men do. About 40 percent of women said they had one or more sexual problems in the past year, but only 10 percent of those women ever saw a doctor about it. For women, sexual dysfunction is a combination of physical and psychological elements.

Most difficulties can be broken into four disorders -- problems with sexual desire, orgasms, sexual arousal and sexual pain.

Sexual desire disorder is the most common problem for women across-the-board. It occurs when there's a persistent lack of desire or absence of sexual fantasies. In other words, you're rarely in the mood. You neither initiate sex nor seek stimulation. It can be caused by the use of -- by the overuse, sometimes, of prescribed drugs, like anti-depressants, birth control pills or high blood pressure medicine. Menopause, stress, depression and relationship problems can lessen sexual desire, as well.

We'll talk about the other disorders throughout this program, but we want to hear your questions now. Call us at 1-800-807-2620 or send us an e-mail at housecall@cnn.com.

Dr. Irwin Goldstein is making a return engagement this weekend to answer your questions. He's doing research on the front lines of women's sexuality at the Boston University Medical Center for Sexual Medicine.

Thanks for joining us, Dr. Goldstein.

DR. IRWIN GOLDSTEIN, DIRECTOR, INSTITUTE FOR SEXUAL MEDICINE: Hi, Elizabeth.

How are you this morning?

COHEN: We're doing fine.

We're very interested in hearing from all these people who've called us. This is a special program asked for by our viewers, so let's get straight to one of our viewers, Michelle from Wisconsin.

Welcome to House Call.

What's your question for Dr. Goldstein?

MICHELLE: Well, good morning.

GOLDSTEIN: Good morning, Michelle.

How are you?

MICHELLE: I'm doing pretty good.

My question is what help is there for sexual dysfunction due to medication?

GOLDSTEIN: Which medication are we talking about, Michelle? MICHELLE: Anti-depressants.

GOLDSTEIN: Anti-depressants are very commonly used and are very needed in many situations, but have a major problem on desire and orgasmic response. So there are different anti-depressants you can use. Wellbutrin is a depressant, anti-depressant that has limited adverse effects on sexual function. But in all cases of sexual dysfunction, Michelle, you need to see a psychologist, you need to see a physician, you need to have blood tests, you need to have sensory testing of the genitals, you need to maybe have blood flow testing, you need at least at a minimum a history and a physical examination.

The entire evaluation is needed to better understand the effects of your anti-depressants on your sexual response.

COHEN: Well, we're glad to hear that men also care about female sexual problems. We have this e-mail from a concerned husband in Chicago. He writes, "My wife experienced a significant decrease in sexual desire two to three years into our relationship. We first suspected this might have coincided with her regular use of oral birth control, but she's been moved to a few different varieties with no change. Could you please discuss the possible reasons why a woman would see a significant decreases in libido at the age of 25?"

GOLDSTEIN: Elizabeth, this is a huge problem. I'm so glad you have this e-mail. I really believe birth control pills have a lot of issues with sexual problems. The birth control pill turns off the ovary and that's its desired function. It stops the brain's messages to the ovary, so it stops making the eggs.

One of the synthetic functions of the ovary, however, is to make testosterone, which is an absolute requirement for sexual function. A second issue is that there's a binding protein called sex hormone binding protein, otherwise called sex SHBG. Elevations in SHBG bind the testosterone, rendering the free or unbound component very low, and that's the basis for sexual response.

So, birth control pills really do cause a lot of sexual problems. So we see so much of this and we need to change and readdress our very frequent use of birth control pills in young women.

COHEN: Do you think maybe some women see a sexual, a decrease in sexual appetite with birth control pills but not even notice it?

GOLDSTEIN: Well, they do notice it. They, very often women see diminished desire and diminished lubrication on the birth control pill, and when they get off it, that returns. Unfortunately, what we're finding is X percent of women, almost even up to a third, when they stop the birth control pill, their sexual dysfunction remains as a permanent problem in their lives.

COHEN: We have a phone call now from Rosie in Tennessee.

Rosie, go ahead with your question for Dr. Goldstein.

ROSIE: Yes, doctor, I have RSD and I take a lot of medication. And I'm wondering if you're ever going to come out with anything for us women. My husband sometimes thinks I don't love him, but I do. It's just I don't desire, you know?

GOLDSTEIN: Did you say you have I.C., like interstitial cystitis?

ROSIE: RSD, reflex sympathetic dystrophy.

GOLDSTEIN: Oh, OK. Well, I would love to have the opportunity to examine you. I think the, as we said to the first individual who called, sexual dysfunctions require a detailed evaluation. You need to see a psychologist. You need to see a physician. You need a sexual history, a medical history. You need a detailed physical examination of the vestibule and vulva. You need blood tests. You need sensory testing.

Once women get into this concept that, you know, like you have a broken bone and a broken leg or a heart problem, you see a physician, a plan is created, we can get on to management. We have a 70 percent restoration of function rate in women with whom we have this integrated biology and psychology approach.

So I would encourage you to get that evaluation.

COHEN: Another e-mail now from a concerned husband. Zack from Wisconsin writes, "My wife started taking Avlimil. I was wondering if it really works. Do you know of any studies on these pills? Are we just wasting our money?"

Dr. Goldstein, can you start out by saying exactly what Avlimil is.

GOLDSTEIN: Well, it's a collection of about a dozen or so herbs and spices. Unfortunately, there really is not good science behind some of these new products that display or mention the fact that we are now the treatment for sexual dysfunction.

I encourage women who have sexual problems to really get an appropriate evaluation. Go see the psychologist. Go see the physician. Get the blood tests and identify what is the plan by finding out what the issues are.

I think the hope is that you take a pill and this thing will go away, and I think Avlimil tries to address those issues. But that is really not the issue here. These are mind/body and relationship issues, they're relatively complicated, they require sex therapy, physical therapy, sometimes medical therapies, hormonal therapies, to really get at the entire problem.

COHEN: We have some Avlimil right here and certainly this is -- it looks like a medicine. When you open it up it's sort of in a way that you often see medicines being presented. And...

GOLDSTEIN: It's very slick marketing, Elizabeth.

COHEN: The makers of Avlimil say that they have done studies showing that it works and they say that most women who take it do, indeed, see an improvement in their sex life.

We've got to take a break now.

When we come back, we'll take a look at what childbirth can do to your sex life. Beyond the obvious lack of time alone with our spouse, there are some other physical effects that can dampen your sexual desire.

Call us with your questions. Our number is 1-800-807-2620. Or e-mail us at housecall@cnn.com.

COMMERCIAL BREAK

COHEN: Did you know that the smell of licorice candy is the most arousing scent for women? Who knew? That's according to a study by the Smell and Taste Treatment And Research Foundation in Chicago. Men's after shave actually, it turns out, is a turnoff for women, decreasing blood flow to the genitalia. And maybe we all spend too much money on perfume. It turns out that men are most aroused by the smell of cinnamon buns. I guess preferably smothered all over the body. Pumpkin pie came in a close second, so start baking.

This is Weekend House Call and we're talking about female sexual dysfunction. If you're having issues in the bedroom, this is the place for answers. Call us with your questions about 1-800-807-2620, or e-mail us at housecall@cnn.com.

While we're getting your phone calls and e-mails lined up, let's check our daily dose health quiz.

Which hormone holds the most promise for women with sexual dysfunction, estrogen, progesterone or testosterone?

We'll have that answer in 30 seconds.

Stay with us.

COMMERCIAL BREAK

COHEN: Checking the daily dose quiz, we asked which hormone holds the most promise for women with sexual dysfunction, estrogen, progesterone or testosterone?

The answer is testosterone. It's called the hormone of desire and it's the focus of new research by several pharmaceutical companies, as the next best libido prescription.

This is Weekend House Call and we're talking about female sexual dysfunction. Another disorder many women struggle with is sexual arousal. This is when you're interested in sex but your body just isn't cooperating. You're not able to get excited. You lack natural genital lubrication and you have no nipple sensitivity or swelling. Lubrication is dependent on the swelling of blood vessels in the vaginal area, so any impediment to blood flow could be the cause of the problem. Hysterectomies can cause loss of feeling. So can vaginal tearing at childbirth or blood flow diseases like high blood pressure, diabetes or high cholesterol. Hormonal changes from menopause, childbirth or medications can lessen your arousal, as well.

We're joined by Dr. Irwin Goldstein in Boston.

Dr. Goldstein, we have a caller on the phone.

Go ahead with your question.

It's Betty in California.

BETTY: Good morning.

GOLDSTEIN: Hi, Betty.

My sister's name is Betty. I like that name.

BETTY: Oh, good. It's a good name.

I have had a total hysterectomy 11 years ago and I've gone through the testosterone and estrogen...

GOLDSTEIN: How old were you when you had the hysterectomy?

BETTY: Eleven years ago.

GOLDSTEIN: How old was that?

BETTY: Well, I'm 68 now, so I guess I was 57.

GOLDSTEIN: OK.

BETTY: But right now...

COHEN: Betty, go right ahead.

BETTY: Hello?

COHEN: Betty, are you still there? Go ahead with your question.

BETTY: Yes. Well, I was just curious because I've been through the hmm therapies and the testosterone, you know, had the side effects of the facial hair and so forth. And it really wasn't all that effective. Where can I go now?

GOLDSTEIN: Betty, you can supplement -- first of all, you need to have normal hormones. So I would continue and maintain the hormones correctly. We, of course, we need to do an appropriate history and see if you're on anti-depressants or any other medications. Women in their 60s are often on blood pressure medicines or cholesterol medicines. The drugs, the PD5 inhibitors that increase blood flow to men are actually very effective, if the hormones are normal, in women in your age group. So the new Levitra drug or Viagra drug can be used. There's also a vacuum therapy device from Eros which, if you do this exercise, say, 10 minutes three times a week, will increase sensitivity to your clitoris and frenular area, and increase sensitivity and increase lubrication response.

So there are things we can do and you should seek medical help and don't give up, Betty.

COHEN: We have an e-mail question now from Vantrese in Texas. She wants to know, "Since I gave birth two years ago, my libido has decreased significantly. My husband's getting frustrated because I really have no desire to have sex these days. Before the baby, we had the same sexual appetite. Who should I talk to about this problem?"

And Dr. Goldstein, I think there's sort of two parts here. One, there's loss of desire after childbirth, and, two, who do you go to? What kind of doctor do you go to?

GOLDSTEIN: Oh, a sexual medicine doctor and integrate the biology with the psychology. There are, American Association of Sexual Educators, Counselors and Therapists, certified sex therapists and sexual medicine doctors to take care of this problem.

The leading reason we see women -- in our clinic we've seen 2,000 women now -- is sexual dysfunction after childbirth. One of the most amazing things that we're seeing is that women go from their pubertal like hmm values back to the same values of hormones they've had prior to their puberty. And really our therapy is to reintroduce puberty back into their lives by giving them agents like DHEA and testosterone, which you used as your quiz, Elizabeth.

The other issue is once the hormones are normal, we can do what we did for Betty. If lubrication is required, we can add drugs that increase blood flow. Because there's lots we can do for women, and they're usually younger, who have changes in sexual problems, sexual function after their childbirth times.

COHEN: We have a caller now, Susan from Florida.

Susan, welcome to Weekend House Call.

Why do you go ahead with your question.

SUSAN: Good morning, Dr. Goldstein.

GOLDSTEIN: Hey, Susan, how are you doing?

SUSAN: I have always been a highly sexual person.

GOLDSTEIN: God bless you, Susan.

SUSAN: Yes, and I always loved it. But suddenly I experienced an atrophied clitoris.

GOLDSTEIN: An...

SUSAN: I have very, very little sensation in the clitoris area.

GOLDSTEIN: OK.

SUSAN: What can be done?

GOLDSTEIN: Well, we need to document and verify that. A physical examination would be very important. There's a hood that overlies the clitoris that sometimes closes down and encroaches. We call that fimosis (ph) of the clitoris. There's testing we can do called quantitative sensory testing. We have examinations that measure the sensation of the clitoris.

I must say that the Eros may be a useful product to improve sensation and I'll say again that we've talked about hormones throughout the morning here. Hormones can increase sensitivity. We have animal studies where the nerve to the clitoris, if you remove the hormonal support, deteriorates. And when you reapply hormones systematically, we can get better function in the sensation to the genital area.

So, again, as I've tried to say over and over today, please see a sex therapist and a medical doctor, get a full evaluation. All these issues can be resolved with this new medical therapy.

COHEN: Dr. Goldstein mentioned the Eros device. I have one right here. This is the only FDA approved device that's actually on the market for female sexual dysfunction. It is a clitoral vacuum and it works like this. If I just use it on my hand here, you can see it creates a bit of suction. So these are available if you take a look on their Web site. Again, Eros.

We're going to be back soon with more questions. The elusive orgasm -- if you've never had one, is it a problem? We'll talk about it when Weekend House Call continues.

COMMERCIAL BREAK

COHEN: Welcome back to Weekend House Call.

We're talking about female sexual problems and the ability, or lack thereof, to have an orgasm. Not having an orgasm usually has a psychological cause. It can be due to a relationship problem, anxiety, past sexual trauma, negative feelings about sex or inadequate stimulation. There are two types of orgasmic disorders, primary, meaning you've never had an orgasm before, and secondary, meaning you used to be able to, but can't anymore.

We have an e-mail question on this topic from Trina in Virginia. She writes, "I've been married to the same man for 30 years and I've never, ever had a climax. I never feel satisfied. My husband knows sometimes that I don't have a climax, but I've never shared with him that I have never had one. We try all kinds of things, but nothing seems to work. Sometimes I get a good sensation, but never to the point that I hear others speaking of. Is there something wrong with me or is my husband not doing something right? Please help."

Dr. Irwin Goldstein is here with us from Boston University.

Dr. Goldstein, do you think you can help Trina?

GOLDSTEIN: God bless Trina.

Please come and get an evaluation. There are so many things that it could be. But I'll tell you, in the end, Elizabeth and Trina, an orgasm is a neurologic reflex. You have to provide sufficient stimulation to the spinal cord and then it activates a reflex, which is ultimately an orgasmic response.

Many, many women have diminished sensation in their genitals for reasons that we don't know. They could be horseback riders, they could be spinners, they could be bicyclists, where the nerve to the genital area gets locally damaged. They could have diabetes or systematic disorders were there's neurologic intervention. You've mentioned the relationship issues. Hormonal problems, interestingly enough -- I brought it up before -- they cause, for some reason, diminished sensation to the genitals.

For women who have difficulty with orgasm, vibrators and vibrator like mechanical devices are excellent tools. You know, if you can't hear, you sort of turn up the volume. If you can't have an orgasm, the equivalent of turning up the volume is to use a vibrator.

But please get an evaluation. These treatments are very successful in women with orgasmic problems.

COHEN: We have a phone call now from Jim from Missouri.

Jim, welcome to our show.

Go ahead with your question.

JIM: Thank you.

I'm 47. My wife is 48. We're in a long -- we've been in a long- term marriage for a lot of years. And it's a monogamous marriage with a lot of trust, so it's not a relationship issue. My wife has given birth to three children. At the -- 14 years ago, when she gave birth to our last child, she had a tubal ligation. In the past two to three years, she seems to have lost the desire and she's suffering from vaginal dryness.

She is multi-orgasmic when we do have sex, but she's afraid of any repercussions or health issues with hormones.

COHEN: Dr. Goldstein, dryness, pain, are these common things someone in this age, in their 40s, after giving birth to three children?

GOLDSTEIN: Yes, absolutely. And I'm so excited that Jim is on to talk about women's sexual health issues. This just goes to show you what a couple's issue this is. This is such a dramatic conversation we're having on national and international TV. Listen, Jim, it's the same issue. Your wife desperately needs to get an evaluation. Of most interest, she needs her hormones measured. There are 10 to 12 hormones that really need to be measured. Check them out on our Web site. There's the list of which ones are needed. Go to your doctor and get them done and get them evaluated.

For women of her age group, hormones are very important. Orgasms, if she maintains her orgasms and the problem is desire, hormones are really very, an important item here. In particular, DHEA and testosterone gel have been found to be helpful.

COHEN: When we come back, Dr. Goldstein -- we're running out of time right now -- but when we come back, we'll have some final thoughts on female sexual dysfunction.

COMMERCIAL BREAK

COHEN: Welcome back to Weekend House Call.

We've been talking to Dr. Irwin Goldstein, who helps women with female sexual dysfunction.

Dr. Goldstein, tell us your bottom line for women with female sexual dysfunction.

GOLDSTEIN: Become empowered. Go, you have a right to sexual health. If you're distressed with your sexual problem, become empowered and seek medical help. Be optimistic, but be realistic. These are complicated issues that take time to develop.

I want to say one thing, Elizabeth. 8/30/03, remember this date. This is an historic time. We have done medical and psychological discussion on an international news broadcast system. This is an historic moment. This is a great moment in sexual medicine, really.

Thank you very much.

COHEN: Well, thank you, Dr. Goldstein, for joining us.

CNN SATURDAY MORNING continues now.

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