LETTERS

Physical treatment before sexual counseling

When attempting to help a patient with arousal and/or orgasmic dysfunction, so well described in “Break the silence: discussing sexual dysfunction” [March], by Barbara Levy, MD, my first line of treatment typically involves physical and mechanical measures. For example, if cunnilingus and lubrication during foreplay don’t work, I usually suggest the use of a vibrator. Also, couples can refer to books and training films on sexual techniques. I recommend counseling only when all these practices fail.

With regard to libido, low doses of testosterone usually will help women in committed relationships. One caveat: Testosterone is not absorbed from the gastrointestinal tract. Therefore, I prefer to prescribe sublingual tablets. While there are no good studies with regard to the dosage, I recommend 1.5 to 2 mg to start.