doctor in a white coat holding a green medicine bottle, sitting across from a patient

It’s been 18 years since the landmark Women’s Health Initiative (WHI) initial hormone therapy (HT) results. They gained worldwide attention by throwing HT “under the bus,” alleging the risks outweighed the benefits. I didn’t, and still don’t, endorse that conclusion, because estrogen therapy reduces the risks for heart disease, Alzheimer’s disease, and osteoporotic fractures among other benefits. Regardless of one’s point of view, almost 80% of women abruptly went off their HT.1 Here, I want to talk about the latest “potential” benefit of estrogen therapy… prevention of COVID-19 infection, and reduction in disease severity. Yes, you heard me, I can’t make this “stuff” up!2,3

The basics are these:

  • The severity of coronavirus infection appears to be greater in men than in women.
  • Estrogen reduces both influenza virus growth (replication) and the inflammation it causes.
  • These benefits of estrogen (replication and inflammation) are eliminated in animals when they lose ovarian function, like menopause, and are restored if those animals receive estrogen.
  • Pregnant women have high levels of reproductive hormones, including estrogen. 92% of pregnant Chinese women from Wuhan with COVID-19 had mild symptoms, and the other 8% all recovered from their disease. There were no deaths in pregnant women.

Taken together, estrogen seems to be protective against COVID-19, both the prevention of infection, and reduction in disease severity. So much so that clinicians and scientists from Stony Brook University Hospital in New York have launched a clinical trial using menopausal estrogen patches for the reduction of COVID-19 severity in both women and MEN!4,5 Yes, we are now giving menopausal estrogens to MEN. So, before you throw away your menopausal hormone therapy, think twice, it may be helpful in this COVID-19 pandemic.

 

  1. Sprague BL, Trentham-Dietz A, Cronin KA. A sustained decline in postmenopausal hormone use: results from the National Health and Nutrition Examination Survey, 1999-2010. Obstet Gynecol. 2012;120(3):595‐603. doi:10.1097/AOG.0b013e318265df42
  2. Suba Z. Prevention and therapy of COVID-19 via exogenous estrogen treatment for both male and female patients. J Pharm Pharm Sci. 2020;23(1):75‐85. doi:10.18433/jpps31069
  3. https://www.healio.com/endocrinology/hormone-therapy/news/online/%7B334d4dd8-cc70-4672-952f-735440eef7da%7D/study-investigates-estrogen-patch-use-to-lessen-covid-19-complications
  4. https://clinicaltrials.gov/ct2/show/NCT04359329
hazelnuts and walnuts

I’m frequently asked whether there’s anything to change in one’s diet to improve sexual function. While there’s absolutely nothing dietary that can treat a severe erectile dysfunction, or ED or significant arousal disorder in women (for that visit us at www.IntimMedicine.com) there are number of dietary habits or lifestyle changes which may help. The most important of these is to lose weight. Most of us could shed a few a few pounds and perhaps the best “pro-sexual or sex positive way” to do this is to substitute a plant-based diet for one rich in animal protein and fat. You don’t need to become a vegan overnight, but a dramatic reduction in animal products will help. This approach improves vascular function which is exactly how erections in men and arousal in women happens. It’s all about blood flow! When people lose weight, their blood vessel function improves, ED improves and, as weight is lost testosterone levels rise in men and estrogen concentrations in women increase and menstrual cycles become more regular. Looking for a shorter-term fix to temporarily improve sexual function, that’s nuts! Specifically, walnuts and pistachios.

It turns out that some nuts (remember peanuts aren’t nuts, but legumes), can be very good for sexual function. They improve vascular dilation and lower blood pressure both directly and indirectly by virtue of their positive impact on gut bacteria. Two nuts documented to improve sexual function are walnuts and pistachios. It’s very important that you read the following carefully, because there’s no free lunch. Nuts typically come with both calories and fat. If you’re going to consume a lot of nuts, you’ll need to increase your exercise or decrease your calories from other sources in order to remain weight neutral.

It turns out that about 20-30 walnuts a day for as short as 6 weeks can improve sexual function. However, those 20-30 walnuts/day come with 400 to 650 calories, about 80% of which is fat. This means that your new sex-positive walnut habit is a meal replacement. And while walnuts have been shown to curb appetite, and do so even better than almonds, unless you want to gain a bunch of weight, you will also need to bump up your exercise and/or eat less…a typical meal less.

100 Grams of Pistachios

Pistachios are also a good nut for sex. It turns out that 100 g of pistachios per day for as short as three weeks can improve erectile function. These nuts can also improve blood flow, lower blood pressure, and improve the cholesterol profile (increasing the good cholesterol, HDL, and decreasing both total cholesterol and bad cholesterol, LDL). However, this approach, too, requires a lot of pistachios.100 grams of pistachios, about 3 servings, contain about 560 calories, and 44 grams of fat. Yes, another meal replacement.

All of which raises another question, what do you do with all those shells. Two thoughts: 1) they can be put at the bottom of your potted plants for drainage, or if well-dried, they can serve as kindling for a fire to curl up in front of with your lover. So, lose the weight, and go nuts for sex!

Esposito K, Ciotola M, Giugliano F, Schisano B, Autorino R, Iuliano S, Vietri MT, Cioffi M, De Sio M, Giugliano D. Mediterranean diet improves sexual function in women with the metabolic syndrome. Int J Impot Res. 2007 Sep-Oct;19(5):486-91.

Salas-Huetos A, Muralidharan J, Galiè S, Salas-Salvadó J, Bulló M. Effect of Nut Consumption on Erectile and Sexual Function in Healthy Males: A Secondary Outcome Analysis of the FERTINUTS Randomized Controlled Trial. Salas-Huetos A, Muralidharan J, Galiè S, Salas-Salvadó J, Bulló M. Nutrients. 2019 Jun 19;11(6).

Tindall AM, McLimans CJ, Petersen KS, Kris-Etherton PM, Lamendella R. Walnuts and Vegetable Oils Containing Oleic Acid Differentially Affect the Gut Microbiota and Associations with Cardiovascular Risk Factors: Follow-up of a Randomized, Controlled, Feeding Trial in Adults at Risk for Cardiovascular Disease. J Nutr. 2020 Apr 1;150(4):806-817.

Aldemir M1, Okulu E, Neşelioğlu S, Erel O, Kayıgil O. Pistachio diet improves erectile function parameters and serum lipid profiles in patients with erectile dysfunction. Int J Impot Res. 2011 Jan-Feb;23(1):32-8.

Doctor and patient, women

Catching Cancer in Patients with Lynch Syndrome

Does your patient have cancer in their family history? If they have Lynch Syndrome, a simple screening can catch cancer before it’s too late.

It’s easy to merely glance over the obligatory medical history form that new patients fill out, scanning for information pertinent only to their presenting problem. But, as we at IntimMedicine Specialists look over a new patient’s medical history, we are always on the “look out” for a family history of cancer. How about a family history of Colon, Uterine, or Ovarian cancer? These and a number of other cancers could indicate that you and your family has Lynch Syndrome.

Lynch Syndrome is named after Dr. Henry Lynch, who is considered the father of hereditary cancer. He named this syndrome the “Cancer Family Syndrome” in 1966, which was later called “Lynch Syndrome” in 1984 by other authors, after which point Lynch himself began calling it Hereditary Nonpolyposis Colorectal Cancer, or HNPCC. It is now known as HNPCC or Lynch Syndrome, and it is characterized by members of the same family line born with a predisposition to develop ovarian, colorectal, endometrial, or other cancers.

For those of us in the fields of sexual health, we are in a unique position to be able to spot this syndrome and help our patients get the screenings they need to catch these potential cancers early. 1 in 400 people are at risk for Lynch Syndrome. It is projected that up to 1 million people in the United States have Lynch Syndrome, but due to a lack of public education about it, only about 5% of people who have Lynch Syndrome have been diagnosed with it.1 Patients with Lynch Syndrome are at a much higher risk of developing these cancers, and it is recommended that their screenings start at an earlier age and are repeated more frequently than patients without Lynch Syndrome. For example, a patient with a family history of colon cancer starting before age 50 might have Lynch Syndrome, and it is recommended that they begin colonoscopies at age 20-25, rather than wait until it may be too late.

IDENTIFYING LYNCH SYNDROME

  • If a patient has a family history of colon cancer – particularly if a family member developed colon cancer before age 50
  • If a patient has a family history of extracolonic cancers including endometrial, ovarian, small bowel, biliary, renal pelvis, ureter, or glioblastoma (a particular brain cancer)
  • If a female patient has abnormal uterine bleeding and a diagnosis of complex endometrial hyperplasia or endometrial cancer and she is younger than age 50

If any of these criteria are met, it is time to order a hereditary cancer panel. This panel will test for multiple cancer syndromes at once and is now the standard of care.

We are in a unique position to be able to catch cancer before it strikes. Ask your patients more about their family history of cancer. A simple screening process can make all the difference.

The specialists at IntimMedicine are experts in post-cancer sexual health. If you or a loved one is being treated for cancer or has been treated for cancer, talk to us at 202.293.1000, or email us at info@intimmedicine.com.

Learn more about Lynch Syndrome in this article.

1 https://www.contemporaryobgyn.net/gynecologic-cancers/keys-identifying-lynch-syndrome

closeup of a doctor with a stethoscope in his pocket and a sexual health pin on his lapel

We are pleased to share a recent article in Washingtonian Magazine featuring an interview with our own Dr. James Simon, “The Menopause Whisperer!” In the article, Dr. Simon discusses female sexual dysfunction, the state of sexual healthcare for women, and his hopes for its future.

Read the article “Sexual Dysfunction in Women Has Long Been Taboo. Washington’s Menopause Whisperer Is Here to Help.” in Washingtonian Magazine

Here is an excerpt from the article about one of Dr. Simon’s patients:

Palim stumbled on a Washington Post article that mentioned Simon’s practice; he put her on testosterone, and her condition rapidly improved. But if she hadn’t happened upon that story, “that might have just been the end for me of a part of my life and of my relationship with my husband that was meaningful and fun—and why? Why should I have had to give that up just because nobody bo

 

If you know someone who might benefit from seeing Dr. Simon or one of our sexual medicine experts at IntimMedicine Specialists, please feel free to share this post with them, or call us at 202.293.1000to make an appointment for yourself.

Dr. Rachel Rubin
Dr. Rachel Rubin

Until recently, I never knew sexual medicine was its own specialty. I mean, of course there has to be a field of sexual medicine, since there are medical fields for every other aspect of biological human life, but when I first heard about IntimMedicine Specialists, I had lots of questions. What does a sexual medicine specialist do? What can they offer that a general physician can’t? What could I expect at an appointment, and what would I make an appointment for?

I got to sit down with Dr. Rachel Rubin, an expert in sexual medicine and urologist on staff at IntimMedicine, and ask her some of these questions. She put me at ease right away, asking me about myself with genuine interest before we got to the questions I had for her. I hope you’ll find her answers as enlightening as I did!

Dr. Rubin trained as a urologist at Georgetown University Hospital. Early on she realized that talking about sexual issues was very uncomfortable for patients and even more uncomfortable for the doctors who were trying to train her. “Research has shown that medical professionals don’t do a very good job of bringing sexual issues up with their patients, often because they feel there is a lack of time and expertise to be able to follow up on the questions they get asked,” she said. Dr. Rubin found that she was not afraid to ask people questions about sexual issues, and her interest in treating sexual dysfunction only grew. She completed a sexual medicine fellowship in San Diego and then joined the team at IntimMedicine.

“Sexual medicine is a relatively unknown field made up of many different types of providers who believe strongly in quality of life and improving the sexual health of their patients and their partners,” said Dr. Rubin. “We see people with erectile dysfunction, low libido, penile curvature, pelvic pain, urinary incontinence, and hormone issues, among other things.”

Many times, Dr. Rubin said, patients and their doctors are not only uncomfortable discussing sexual health—they also don’t have time in a 15-minute visit to address such intimate issues. “We don’t see 50 patients a day. We spend a lot of time with our patients, and I pride myself on being able to work within the medical community to build a multidisciplinary team to help each individual patient and couple. Sometimes there needs to be medical treatments or surgeries, and sometimes we need specialized physical therapists to be involved. We often team up with mental health professionals as well, because no one ever taught us how to talk about sex and getting a ‘coach’ to help with that is extremely important. Sexual medicine is very much a ‘team sport’ in terms of figuring out which team members need to be involved with each individual case – it’s not a one-size-fits-all model.”

Another member of that team? The patient’s partner. Dr. Rubin encourages patients who feel comfortable doing so to bring their partners to appointments.

“It is not uncommon that I see a patient and then their significant other comes to see me later, realizing it ‘takes two to tango,’” she said. “Oftentimes you have to think of each patient in the context of a couple, and it’s important to help both people.”

Maybe you have something that is bothering you about your sexual health, but you’ve got too much else going on or you’d rather not think about it, and definitely not talk about it. I asked Dr. Rubin what she would say to people who keep putting off seeing a sexual medicine specialist. “Quality of life is incredibly important,” she said. “Focusing on yourself and your health as a couple is valuable.” Dr. Rubin went on to emphasize that sexual health is closely connected to general health. She also added that “focusing on your sexual health may actually benefit many other parts of your life.” For example, “Erectile dysfunction can be a sign of early cardiovascular disease.”

“Before I see a new patient, I always have a screening phone call with them first, just to make sure it’s a good fit for them before they make an appointment,” Dr. Rubin told me when I asked her what people could expect from an appointment with her. “When people come into my office, they sit across from me, fully clothed, and we just have a conversation. I spend a lot of time showing them anatomical diagrams and explaining everything we’re going to do before we ever do an exam or procedure. Nothing invasive ever happens without a full discussion and without the opportunity for lots of questions to be asked.”

Dr. Rubin’s tone became both more impassioned and gentler when I asked her to name one thing she wished people understood about sexual dysfunction. It was clear to me that she cared deeply about this when she answered. “People are often afraid to admit that they have a problem, because they’re so afraid that it means there is something different or abnormal about them. I understand that it can provoke a lot of anxiety to just come out and say ‘I have a problem, and it’s sexual,’ even to a doctor. Nobody taught any of us how to talk about sex to our partners, or to our doctors, so it can feel very isolating, but the truth is all of these issues are so incredibly common. After speaking with me, my patients are very comforted in knowing that they’re not alone and that there is help.”

As we ended our chat, Dr. Rubin said, “This is all we do,” referring to the team at IntimMedicine Specialists. “Our patients have access to all of the expertise we represent and receive very individualized care. We’ll take the time to get to know you and help you focus on your sexual health.”

So now, I have a question for you: why are you waiting to start working on your sexual health?

 

Call 202.293.1000 to make an appointment with IntimMedicine Specialists in Washington, D.C.

Also: follow Dr. Rubin on twitter @rachelsrubin1 and the IntimMedicine team @intimmedicine

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