older woman sitting on a couch, smiling

Testosterone Therapy

I have been involved in the development of testosterone products for women for many years. My research has been included in the original Princeton Consensus on Testosterone Insufficiency in Women back in 2002, and in the testing of Estratest and Estratest HS for female sexual function (both of which are still on the U.S. market), in the development of the Intrinsa Testosterone Patch for women by Proctor and Gamble, (which was never approved by FDA, but was approved and available for years in Europe), as well as in a testosterone gel for women, Libigel (which also failed to win FDA approval). Some of my additional publications on this topic can be found here

Needless to say, after all of this time, I am grateful to have been part of the International Menopause Society’s global consensus that testosterone treatment for post-menopausal women is viable and useful for female sexual dysfunction. It is time the medical community accepted this so that women can get the help they need and start feeling like themselves again for the second half of their lives.


What are the benefits/risks of testosterone supplementation? 

The primary benefits discussed in the global consensus include increased interest in sex and easier arousal and orgasm, but testosterone also contributes to increased lean muscle mass, increased bone density, and improved energy and sense of well-being. 

There literally are no risks to proper transdermal testosterone therapy if testosterone levels are kept within the normal range. If testosterone exceeds the normal range (and this can easily happen when women use men’s products not approved for use by women) women can sometimes: lose the hair on their heads, develop dark facial hair – even beards – get hairy elsewhere, have their voices change to a lower register, get an enlarged clitoris which can be too sensitive, and possibly increase one’s risk of heart attack or venous blood clots.

When testosterone treatment is taken under a doctor’s supervision and properly monitored, these side effects will typically not occur.

 

What patient population is testosterone treatment indicated for? 

All postmenopausal women may benefit from testosterone treatment, but particularly those with induced menopause (i.e. women who have had their ovaries removed, have had their ovaries radiated [even accidentally] and ovary failure ensued or had chemotherapy and their ovaries failed as a result). 

 

Testosterone and Sex Drive

I recently described a dose-response relationship-specific for testosterone for sex in women and how it is different for testosterone for sex in men. Basically, women can get too much testosterone, and it either does not increase and may actually decrease their interest in sex. As current President of ISSWSH, The International Society for the Study of Women’s Sexual Health we have nearly completed a “how-to” paper on how to use testosterone in women. In the absence of an approved product specifically for women, and the possible negative side effects of inappropriate use at high doses, this publication will be used a practice “bible” for uses of testosterone in menopausal women in the future.

 

If you think you might benefit from testosterone therapy…

Call us and make an appointment at 202.293.1000. We take the time with each of our patients to determine possible causes of complaints and develop a treatment plan that will work for you. Don’t wait to start living your life again, so make that call and let us help you!

an open bottle lying on its side with golden capsules emerging and on the table beside it

Sex supplements are everywhere and easy to access, but do they actually work?

Studies have shown that even Viagra, an FDA-approved prescription drug, has a placebo effect of over 30%, which tells me that if you believe Viagra or a sex supplement will work, it just might. But is it worth the negative effects that sex supplements can have?

Most sex supplements include ingredients that have not been tested or studied and may not be safe at all to take. Several common ingredients in sex supplements, including ginseng, yohimbe, tribulus, and ginkgo biloba, can have adverse side effects from headaches to seizures. It is just not worth it!

There are several FDA-approved options for you that are both safe and effective, such as Addyi for women or Viagra and several similar medications for men. Addyi helps women who have HSDD, or Hypoactive Sexual Desire Disorder, which is the most common form of sexual dysfunction in women. HSDD by definition is lowered sexual desire. If you’re unsatisfied with your current level of sexual desire, or feel as if you had a higher desire for sex before, you might have HSDD, and Addyi could help! Viagra and several similar medications are common treatments for erectile dysfunction or ED, which can even effect men in their 20s. It’s not just for seniors! In fact, 50% of men in their 50’s, 60% of men in their 60’s and 70% of men in their 70’s have ED.

We also specialize in hormone replacement therapy, which can be used to treat a myriad of symptoms, including low libido and low testosterone. Hormone replacement therapy is safe to use, and we will create a cocktail of hormones specific to your body’s needs. Sometimes we can even package it up in a pellet, which we would then insert under your skin in a quick and relatively painless office procedure, so you can forget about it and get on with enjoying your life!

In addition, we will work with you to find out the root of your sexual problems, not just treat the symptoms. Just getting enough sleep or making small changes to your diet and exercise can improve sexual function, and make you feel a whole lot better. Maybe seeing a sex therapist will help you and your partner uncover what is holding you back. There are a number of effective ways to treat sexual dysfunction, but taking sex supplements is not one of them!

I understand the appeal to buying “over-the-counter” sex supplements instead of talking to a doctor about your sexual problems. It can feel embarrassing to talk about, and it’s been documented that many primary care physicians are equally awkward and embarrassed when the topic is breached, which is why seeing a sexual medicine specialist is a way to go. Sex is our bread and butter. We welcome the awkward questions!

Make an appointment to see one of our experts by calling 202.293.1000. Leave the sex supplements behind and get a tailored treatment plan that will actually work for you.

Pellet Hormone Replacement FAQ

We know that Hormone Replacement Therapy is essential for managing severe menopause (or “manopause!”) symptoms, and hopefully there is an easy way to deliver it, right? Fortunately, there is! IntimMedicine offers an easy outpatient procedure to place a bioidentical hormone pellet under the skin. Outta sight, outta mind, and you get to start living your life again!

What is it?

Pellets are compounded bioidentical hormones for women (our team of experts will determine exactly what’s right for you – the right amount can help you regain your hormonal balance). Pellet therapy is actually FDA approved for men, as well. Pellets are typically naturally occurring hormones that are pressed into a solid, little insert, about the size of a grain of rice.

How does it work?

Your pellet will release a small amount of your hormonal regimen straight into your bloodstream, similar to what your ovaries or testes would normally have produced in your younger years. Research shows that pellets are able to deliver a consistent level of hormones to your body, unlike some creams, gels, or pills which are also compounded. Pellets also reduce the risk of blood clots (venous thrombosis) associated with oral hormone replacement therapy because the hormones released from pellets enter the bloodstream directly and do not cause changes in blood clotting factors made in the liver the way oral medications can. It’s a win-win!

How is it used?

Hormone Replacement Pellets are used like any other Hormone Replacement Therapy to help our bodies regain some of its hormonal balance, which will improve everything from the emotional roller coaster to hot flashes. The pellet is just a convenient delivery method! It’s not for everyone, but getting your hormones “just right” no matter the method is critical.

How long does the procedure take?

It is a quick and painless (with numbing medication) outpatient office procedure. We will insert the HRT pellet right into your hip, abdomen or buttock area, and you’ll be on your way and back to your life!

How long till I see results?

It will only take 7-10 days for you to notice your HRT Pellet working on your symptoms.

How long will my pellet last?

HRT Pellets typically last 3-6 months for men and women.

How can I make an appointment? Call us at 202.293.1000 or email us to set up a consultation appointment with one of our specialists here in Washington, DC. Don’t wait to get back to living your normal life – call us today!

man and woman in bed, separated, unhappy

Study Shows that Deep Dyspareunia can Improve with Interdisciplinary Treatment

There is good news for women who are suffering from Deep Dyspareunia! Dyspareunia is the fancy medical term for painful sex, and can be categorized two ways: superficial (affecting just the entrance of the vagina or vulva), or deep (pain during deep penetration).

In a recent study published in the Journal of Sexual Medicine, researchers had 278 women self-report pain scores related to their Dyspareunia symptoms on an 11-point scale. The women and their physicians decided which treatment options to pursue, including “minimally invasive surgery, hormone therapy, pain education, physiotherapy, or psychological therapy” (ISSM). This is what is considered an “interdisciplinary approach,” since treatments were not limited to one course of action.

After a year, researchers followed up with the women who participated in the study and found that the 28% of women who had reported absent or mild pain had increased to 45% of women, the 17% who rated their pain as moderate increased to 25%, and the 55% of women who said they were experiencing severe pain decreased to 30% of women. These are great results and should give hope to women who are still experiencing painful sex!

It should be noted that having depression and being at a younger age were considered predictors for having continuing deep dyspareunia after a year, because depression can also “affect the sexual response cycle, pelvic floor function, relationships with partners, and emotional aspects of pain” (ISSM). More research needs to be done about how depression can affect deep dyspareunia, but the authors of the study recommend treating your depression first and foremost should you be suffering from it, as your other symptoms can improve with that treatment.
Because the women and their doctors chose different plans of action to treat the symptoms, we can’t be sure exactly which treatments were most effective, but the bottom line is that after only a year your symptoms can improve if you are able to attack the problem holistically. That’s where we come in. IntimMedicine Specialists are well-known for our holistic, tailored approach towards treating our patients. If you are experiencing painful sex, give us a call, or e-mail us! Our experts here in Washington, DC would love to discuss which options to try with you to start treating your pain and improve your sex life and beyond!

Dr. Rachel Rubin of IntimMedicine Specialists

Dr. Rubin at Planned Parenthood DC’s “I Like It” Event

“Nobody taught us about the clitoris in medical school, and doctors rarely ask women if they can orgasm…but they should!”

That’s what our very own Dr. Rachel Rubin told the audience at a local Planned Parenthood “I Like It” a fundraising event held at George Washington University earlier this year. 

The discussion followed a screening of “The Female Orgasm,” an episode of the Netflix Original Series Explained. Dr. Rubin, joined on the panel by a sex therapist and sex educators, discussed the “orgasm gap,” what happens to the body during female orgasm, and ways to talk about what feels good. You can watch highlights of the discussion here.

panel members at "I Like It" at Planned Parenthood DC

Dr. Rubin is a board-certified urologist with fellowship training in sexual medicine. She believes in a multidisciplinary and individualized approach to care for men, women, and couples, with the first step being an in-depth consultation with enough time to truly understand her patients’ concerns.

Follow Dr. Rubin and follow IntimMedicine on Twitter to find out about future events where you can hear Dr. Rubin and our other experts speak.

 

Let's talk about IT - MonaLisa Touch

Let’s Talk About IT

Introducing MonaLisa Touch, a groundbreaking vaginal treatment for menopausal women.

“IT” is vaginal discomforts, including dryness, burning, itching, and painful sex, all which fall under the umbrella term, “vaginal atrophy.” Vaginal atrophy can occur after vaginal childbirth and/or during menopause. Around 40% of menopausal women suffer from vaginal atrophy, but these women rarely talk to their gynecologists about it. If you’re one of them, it is time to stop suffering in silence and get back to enjoying your sex life!

We at IntimMedicine Specialists are very happy to offer you a vaginal laser procedure called MonaLisa Touch from our office here in Washington, DC. MonaLisa Touch is a painless and minimally invasive therapy that requires 1-3 treatments over the course of a few months. We know you have questions – we have answers!

Who is MonaLisa Touch for?

MonaLisa Touch is for any woman who wants to prevent or treat vaginal symptoms related to a decrease in estrogen, which can occur during menopause, after childbirth during breast feeding, or after many different cancer treatments, especially following breast cancer. If you are looking for a treatment that does not require hormones or surgery, MonaLisa Touch might be your answer!

How does MonaLisa Touch work?

MonaLisa Touch is a laser treatment that reactivates the production of collagen and rebalances the conditions of the superficial vaginal tissues. It does this by gently acting on the vaginal walls. This is a safe and painless process that only takes a few minutes.

Does it hurt?

MonaLisa Touch is completely painless! Patients have reported feeling a slight vibration, and some say that it feels no different than getting a pap smear. For extremely sensitive patients, a form of “Novocaine” can be topically applied without injections to eliminate any discomfort of the procedure.

How long is the recovery, and how long does it take to start working?

We recommend refraining from vaginal intercourse for 3-4 days after each treatment, but you’ll start to notice a positive difference almost right away! More treatments may be recommended depending on the severity of symptoms, but typically 3 sessions are needed for best results.

How long does the treatment last?

Treatments can last for at least a year, depending on the severity of symptoms and your age and lifestyle. We can revisit the need for additional treatment sessions with you after a year or if symptoms recur.

We can help you restore your vivacity! If MonaLisa Touch vaginal therapy sounds right for you, give us a call at 202.293.1000 or email us to make an appointment for a consultation at IntimMedicine in Washington, DC.

Men have Pills for their Sexual Dysfunction, Why Can’t Women?

A Response to “How Addyi, the ‘Female Viagra,’ Can Do More Harm Than Good” By Dr. James A Simon

Earlier this month, Dr. Janet Brito, a sex therapist based in Hawaii, raising a few questions about the efficacy and wisdom in using Addyi, known as the “Female Viagra,” to treat sexual dysfunction in women. The article she wrote has been removed from that site that posted it due to the inaccuracy of the information the article contained. In spite of this, I felt that it was important to address her concerns, and to explain how Addyi is, in fact, an empowering tool that women who are suffering from hypoactive sexual desire (HSDD) or female sexual interest/arousal disorder (FSAD).

Efficacy and Use

Regarding the efficacy and use of Addyi, Dr. Brito makes several claims that are either blatantly false or not based in fact. She states that Addyi “needs to be taken every day for at least 8 to 16 weeks before it starts working.” According to the package insert itself (approved by the FDA), if Addyi isn’t working by 8 weeks, its use should be discontinued.

Brito brings up the fact that “according to the Addyi website, ‘it’s exact mechanism of action is not fully understood,’” without any other comment, perhaps implying that this is a reason it should not be used, but this fact is also true for all antidepressants, pain killers, appetite altering medications and most medicines generally.

“Initially, flibanserin was slated for the treatment of depression. After two rejections by the FDA, Addyi was approved in 2015 to treat low sexual desire in premenopausal women — despite trials showing only minimal results compared to a placebo,” states Dr. Brito. Addyi was originally developed to treat depression, but in people with major depressive disorder where Addyi didn’t work for depression, it increased sexual desire. That’s correct, it worked to increase sexual desire even in women that were clinically depressed.

Thus, the company behind Addyi pursued sexual dysfunction as an option to help women suffering from hypoactive sexual desire disorder or HSDD or female sexual arousal disorder or FSAD. The drug was rejected twice by the FDA, in my opinion, because the FDA kept changing their mind about what they wanted.

The company was trying to develop a first-in-class medication where the tools for assessing efficacy weren’t invented yet. For responders to the medication (excluding all the non-responders), they had 5.7 sexual events per month, which can’t be considered minimal, and which the responders themselves judged as a meaningful improvement.

“Their desire stats did change and show an increase when researchers measured it according to the Female Sexual Function Index — but if participants didn’t notice their own response, can it really be considered effective?” asks Dr. Brito. The Female Sexual Function Index is a validated questionare answered by the study participants, an approach agreed upon with the FDA. Participants reply to the FSFI based on how they, the participants, feel.

Social Oppression and Relationships

Dr. Brito spends a great deal of the article drawing a connection between a pill to treat sexual dysfunction for women and a long history of societal oppression of women. I fail to see the connection, as Addyi is only prescribed to patients who wanted to increase their sexual desire for one reason or another, not because their partners or society had problems with their libidos as Brito suggests.

Brito’s other accusation that those who prescribe Addyi are not taking into account any of the other factors that might contribute to low sexual desire, is not based in fact. Study participants were excluded from entering the research studies if they had any other reason for their loss of sexual desire, any reason. Such reasons would have included: depression or other medical conditions, medications known to affect sexual function, and any relationship problems, just for examples. Erectile Dysfunction has many causes and factors, and yet men are prescribed Viagra without a second thought. Shouldn’t women have equal access to a pill that can help them with their sexual function, too?

Like those who are prescribed a pill for depression, Addyi can help women start living their lives again, and get back to their old selves.

Brito also writes, “…sometimes the issue is about the relationship you have with yourself, not others.” On this point, I totally agree. But women with relationship problems with themselves or their partners were excluded from the clinical development of Addyi as noted above. Addyi is there for women who have been diagnosed with HSDD or FSAD, who are in a healthy relationship with their partners, and who want to get back to enjoying their partners sexually.

Dr. Brito concludes the article with this line, “Instead, ask yourself, honestly, if any of the aforementioned factors are impacting your life. And, if so, what lifestyle changes to embark on to start to feel better on your terms.” Addyi, Viagra, anti-depressants, and a slew of other medications may not be the best choice for every patient, but the patient does have a choice.

Why a sex therapist (who cannot even prescribe Addyi or medication generally) is ruling out a drug that is effective, readily available, and which delivers on the promise to increase “sexual desire and satisfying sexual events,” is beyond me.

To discuss if Addyi might help you or determine if you might be suffering from HSDD or FSAD, give us a call at 202.293.1000 or e-mail us to make an appointment at our office in Washington, D.C.

man pretending to eat the sun
Daily Dose of Vitamin D

Maybe you’ve heard of taking Vitamin D supplements to help slow down bone loss, but what about taking it to improve your sexual function and satisfaction?

According to a recently published study which took place in Italy over the last 15 years, Vitamin D deficiency might play a part in erectile dysfunction and other sexual dysfunctions in men. Each of the 114 participants were assessed for five aspects of male sexual life, including erectile and orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction, and over the course of the study, researchers found that higher levels of Vitamin D was associated with higher scores for all five of those aspects.

Some of the participants of the study were given Vitamin D supplements over the course of their treatment for sexual dysfunction. “Vitamin D levels are directly able to influence all sexual function parameters,” the authors of the study wrote. “Evaluation of our study clearly shows the improvement of erectile function after vitamin D replacement therapy.”

Vitamin D is also a necessary nutrient for both men and women’s health, and Vitamin D deficiency has been linked to various cancers, cognitive impairment in older adults, depression and tiredness, and an increased risk of heart disease, so it’s worth making sure you’re getting a sufficient amount of Vitamin D even if you are satisfied with your sexual function. It can be difficult to know that you’re getting the right amount of Vitamin D just from exposure to the sun, and particularly during the Winter it can be tough to get enough sunlight. Seasonal affective disorder (SAD) is linked to a lack of Vitamin D during the winter months and rainy seasons, and results in depression. All of this can be treated with a daily Vitamin D supplement.

As we go through the Winter season, think about how much Vitamin D you’re getting from natural sunlight and if you might benefit from more time spent outside or from a supplement. You can always call us at 202.293.1000 to make an appointment at our office in Washington, DC, if you have questions about how a lack of Vitamin D might be affecting your sexual function.

woman holding a baby in her lap
Postpartum

Treating Postpartum Vaginal Laxity

If you’ve given birth, you know all the physical and emotional distress associated with the process! And if you’ve given birth vaginally, you know it can be difficult to bounce back to normal “down there,” which can have a major effect on your sex life.

Vaginal Laxity, or “looseness” as it relates to vaginal childbirth occurs when the muscles in the walls of the vagina are over-stretched as you push that bowling-ball sized baby’s head through it. The vagina naturally relaxes in response to sexual arousal, but regular sexual activity will not contribute to the vagina “loosening” because the vaginal will naturally re-tighten itself afterwards. The relaxing of the vaginal wall also naturally occurs during childbirth, but there are limits to its elasticity. You can stretch out a waistband or a sock in the same way – over-stretch it, and it will never be the same… or will it?

Sometimes Vaginal Laxity sorts itself out along with a host of other post-partum body complaints that new moms have once their babies have transitioned over to solid food and stopped breast feeding. But, Vaginal Laxity can also persist, and can contribute to sexual dysfunction. Not everyone who experiences Vaginal Laxity has complaints about their sex life, but it can reduce pleasurable sensation during intercourse and result in less sexual satisfaction for you and your partner, which of course contributes to less sexual intimacy. Add Vaginal Laxity to the list of other life-altering changes that baby brings and it can seem like your love life is over!

The good news is, you do not have to live with Vaginal Laxity! There are many ways to treat it. Talk to your OB/GYN about it at your next appointment, try pelvic floor physical therapy, and keep up with your Kegel exercises, but your vaginal walls might still need a little extra help. That’s where we come in! IntimMedicine Specialists is host to several ongoing clinical trials, and we are excited to offer a free treatment in a study on a new technology to help with vaginal tightening! If you’ve given birth vaginally at least six months ago and are experiencing sexual dysfunction related to vaginal laxity, you may qualify. Medical insurance is not required for study participation and compensation for time and travel is provided.

If Vaginal Looseness is keeping you from enjoying sex, it’s time to treat it! Space is limited, so call to schedule your appointment with Laura Barbee at 703-242-6362.

older couple embracing and smiling

Sexual well-being is an important part of any person’s life, and when things aren’t going well or working right, it can be embarrassing and difficult to talk about with your sexual partner and your doctor. But it doesn’t have to be, and your life does not have to be dictated by sexual dysfunction. Below are a few common problems you or your partner might be experiencing. Read on to learn what to do to make an appointment with one of our sexual medicine specialists!

LOW TESTOSTERONE

It is true that a man’s sex drive decreases as he ages due to a natural decline in testosterone over the course of his life. But, sometimes testosterone production slows down too fast, resulting in low testosterone, or Low T. Low T can be connected to Erectile Dysfunction (ED), but it is not always the cause of ED. Low T is also connected to heart disease, obesity, diabetes, and depression. If you are experiencing a reduced sex-drive as well as weight gain, depression, and irritability and brain fog, you might have Low T. Fortunately, our team of specialists are on the cutting edge of testosterone replacement therapy and we’ve got you covered.

ERECTILE DYSFUNCTION

Erectile Dysfunction (ED) is difficulty getting or maintaining an erection firm enough to have sex, and it has many causes. It can be caused by problems with blood flow due to heart problems, high blood pressure, or heavy smoking or alcohol use, all of which can contribute to damage to the blood vessels that create the blood flow into the penis, resulting in an erection. It can also be caused by nerve supply or hormone levels (see Low Testosterone above). Sometimes it is psychological, or it’s caused by interference from prescription drugs. Because Erectile Dysfunction can be caused by so many things, you’ll want to talk to our specialists about what might be causing it in your case. Dr. Rubin at IntimMedicine Specialists is a urologist with fellowship training in Sexual Medicine and performs extensive testing unique to each patient’s individual needs. Fortunately, ED is treatable! From behavioral changes to medications, hormone replacement therapy (HRT) to penile implants, there is a solution out there for you.

STRESS OR DEPRESSION

Low sex drive or erectile dysfunction are often linked to stress and depression, either resulting from it or causing it. Talk to us about what’s going on in your life. Our holistic approach includes treating each patient as a whole person, with every aspect of their lives in mind. If stress or depression is a symptom of sexual dysfunction or is causing it, we are here to listen and to help you get relief from it.

None of these symptoms or sexual problems should rule your life. Often, men report depression and relationship problems that stem from sexual dysfunction. Don’t let these problems keep you from enjoying your life! The good news is that our very own urology specialist Dr. Rachel Rubin is on the cutting edge of today’s urology procedures and practices, and she is ready to listen and help create a treatment plan specifically for you – call 202.293.1000 to make an appointment with Dr. Rubin in the Washington, DC area to get your confidence and your life back today!

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