For men who have difficulty attaining an erection, the medication sildenafil (Viagra), which increases blood flow to the penis, may be very helpful, though it must be taken 1 to 4 hours prior to intercourse. Men who take nitrates for coronary heart disease should not take sildenafil. Mechanical aids and penile implants are also an option for men who cannot attain an erection and who find that sildenafil isn’t helpful.
Women with vaginal dryness may be helped with lubricating gels, hormone creams, and — in cases of premenopausal or menopausal women — with hormone replacement therapy. In some cases, women with androgen deficiency can be helped by taking testosterone. Vulvodynia can be treated with testosterone cream, with use of biofeedback, and with low doses of some antidepressants, which also treat nerve pain. Surgery has not been successful.
Simple, open, accurate, and supportive education about sex and sexual behaviors or responses may be all that is required in many cases. Some couples may benefit from joint counseling to address interpersonal issues and communication styles. Psychotherapy may be required to address anxieties, fears, inhibitions, or poor body image.
