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.

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.

 

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.

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

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!

African American couple smiling with beverages and soft pretzels

If you or a loved one has an enlarged prostate known as benign prostatic hyperplasia (BPH), you are well aware of the negative effects it can have on your life, such as difficult or frequent urination. Maybe you’ve considered surgery, but the risks–including potentially worsening erectile or ejaculatory dysfunction, which you may already be experiencing due to BPH or the medications you’re taking in the first place–kept you from choosing that option.

We know living with BPH, which affects 12 times as many men as prostate cancer, can be a struggle. Men with BPH are more likely to suffer from depression, decreased productivity, a diminished quality of life, and interrupted sleep. Not treating BPH can cause symptoms to worsen and even lead to permanent damage to your bladder. What is one to do with these scary statistics and no good answers?

That’s where we come in! We are excited to share that the American Urological Association (AUA) now recommends on the UroLift® System “as a standard of care treatment for lower urinary tract symptoms due to benign prostatic hyperplasia (BPH),” and our very own Dr. Rachel Rubin, a urologic surgeon, and sexual medicine specialist, is one of the early adopters of this new treatment option for men with BPH. The UroLift System is a “proven, minimally invasive treatment that fills the gap between prescription medications and more invasive surgical procedures.”

“The Urolift System is one of the few sex-friendly treatment options we have for BPH,” Says Dr. Rubin. “It is shown to improve flow, urinary frequency, and urgency, all while allowing men to maintain their ability to ejaculate normally and not increase the chances of erectile dysfunction.”

The UroLift System consists of a UroLift Delivery Device and small UroLift Implants. The implants widen the urethra within the enlarged prostate, alleviating the irritating symptoms related to BPH. Men who have received UroLift Implants report “rapid and durable symptomatic and urinary flow rate improvement without compromising sexual function,” according to clinical data collected in a study by the manufacturer of UroLift. You can learn more about some of the men UroLift has helped on the company’s website.

So what are you waiting for? Make an appointment with Dr. Rachel Rubin here in Washington, D.C. today to discuss the UroLift System and get relief for BPH now!

Upon hearing a cancer diagnosis a person’s world changes immediately and forever. The person becomes a patient. The patient has to make myriad decisions about treatment plans, and the possibility of surgery, radiation, and chemotherapy. These treatments, while life-saving, are also life-altering. The side effects can modify body image, reduce or end fertility, change sexual identity and sexual function. Approximately 60 percent of cancer survivors have long-term sexual dysfunction. Oncology teams (who may focus more on the life-saving aspects of care) aren’t always taking the time to discuss fertility or sexual health matters as much as they should. But the good news is that our practice can help save a women’s eggs, or a man’s sperm for future use; mitigate and reverse most hormonal changes, and starting in September, we will also offer treatment for men with urological or sexual complaints in our practice. Our newest colleague, Rachel S. Rubin, MD, is specially trained to treat hormonal and sexual dysfunction in both men and women.

Talking about sexual health outside of the bedroom, in the office of a compassionate physician is key to holistic wellness. The emotions of being a cancer survivor can be overwhelming in and of themselves, but to add infertility or sexual dysfunction to the list of health issues can be daunting. We’re here to help you get back on track.

For Men
Following prostate cancer treatment, for example, the ability to have and maintain an erection becomes difficult and for some men, impossible, without help from a medical practice such as ours. Many men may not feel comfortable talking about these intimate issues, but there is help. Our compassionate and caring staff can help men who experiene treatable symptoms. It’s not just about physical symptoms, cancer affects sexual identity and when men are unable to perform as they could prior to cancer treatment, it can have a serious and detrimental effect on one’s psyche. Getting the courage to seek help is the first step to getting back to the “new normal.”

For Women
Breast cancer, when surgery is required, may alter a woman’s body and can hinder sexual identity and function. Breasts, once part of the sexual experience for both partners, are no longer the same. Even when reconstructed, the breasts may feel different, lack the pleasurable sensitivity they once had, or might even be painful and distracting. Sensation might even be completely gone. Partners may also feel hindered by the feeling of the new breasts. This can be uncomfortable for both partners. With any cancer treatment (i.e. chemotherapy, surgical removal of the ovaries or even hysterectomy) a patient may find herself in early/premature menopause with hot flashes, night sweats, disturbed sleep and weight gain. This is also accompanied by vaginal dryness, and pain with genital touching or intercourse. There are options to help enhance the sexual experience that we have available at the office, and that are not available anywhere else.

A wonderful Newsweek article about these issues does a deeper dive from both the patient and physician perspective that we welcome you to read for additional information.

If you are just starting cancer treatment, going through it, or are in the post-treatment phase and are facing future or current fertility concerns, hormonal deficiencies, or sexual dysfunction, we can help. Please call our office at (202) 293-1000 to make an appointment with one of our caring and compassionate members of Dr. James A Simon’s team.

Electronic medical records (EMRs) are patient records of health-related information that can be created, gathered, and managed by authorized clinicians and staff within one health care organization. EMRs were designed to streamline the daily workflow of a busy medical office and could have potential to provide substantial benefits to physicians, clinic practices, and health care organizations. The word could is used here because the technology that is currently in use, is good, but not great, just yet.

EMRs vs EHRs
EMRs differ slightly from electronic health records (EHRs) which can move with the patient to various medical practices but these terms are usually used interchangeably. The upside is that these types of records cut way down on the glut of paperwork, filling in medical offices, and lessens the chance that a record could get lost, among other benefits.

Patient Privacy to Consider
Although there are benefits to moving to a paperless system, the concern that we have at our practice is patient privacy and cyber security. A recent wave of cyberattacks that have shut down hospitals highlights the weaknesses that are still problematic in some of these software programs and online systems currently in existence. Our patients rest assured of the utmost compassion and privacy when discussing the most intimate details of their sexual health with us. Patients deserve not only the highest level of care, but also the most stringent form of privacy.

We Love Technology, But…
We are thrilled with some existing technologies, such as email, our website, and social media avenues of communication, that enable us to continue the conversation about patient health, while educating and continuing to encourage patients outside of the examination room and our offices. So, until cybersecurity improves a lot, we will keep our “UN-hackable” paper health records. We hope other practices and hospitals that use electronic health records are following the recommendations provided by the Health Care Industry Cybersecurity Task Force.

Six Action Items for Practices (They are also good rules for your home computer systems, too.)

1. Ensure that computer operating systems and antivirus software are updated with available upgrades and patches.

2. Establish policies against opening emails and attachments from unknown sources and from accessing websites with suspicious content.

3) Continuously educate staff (your kids, grandchildren and parents) about those policies in number 2 above.

4. Hire a cybersecurity firm to conduct penetration tests, a common practice in other industries, where security professionals test their clients’ computer systems and staff to find vulnerabilities that attackers could exploit.

5. Consider implementing technologies that allow staff (or family members) to open suspicious emails and attachments in a contained environment segregated from other systems and computers.

6. Prohibit unauthorized access to patient data; enforce passcodes, and automatic logoffs.

7. Never share password. Period!

Amused young African American couple sitting and hugging

Amused young African American couple sitting and huggingAs most of us know, a great relationship doesn’t start and end with sex. But a healthy sex life does form an integral part of it. In fact, almost 80% of men and 66% of women view sex as important to their relationships. And research shows that when one’s sex life is assessed as “good”, it adds 15-20% positive value to a relationship. But when one’s sex live is reported to be “bad or non-existent”, it plays an inordinately powerful negative role, draining the relationship of its positive value, by 50-70%!

And for the critics out there, it’s important to note that sex isn’t just physical. It’s an opportunity to express feelings that words cannot … an emotional experience that brings you closer with your partner … and, for some, the ultimate expression of their love. Not only does it foster a unique closeness, it can also provide comfort in times of stress, anxiety or other troubles. And it can help to keep things fresh and exciting, as couples “rediscover” each other through varied forms of sexual expression.

Timing and Frequency
Unfortunately, “importance” can be very subjective. While one person might view daily sex as crucial, another might think they’re doing a pretty good job fitting it in once every week or two. As long as a couple is on the same page, there are typically no problems. If it works for both of you, great! It’s when there is a difference in opinion that problems begin to arise.

Sex Drive Compatibility
If one person has a higher sex drive than their partner, they can start to feel unfulfilled. The other partner may wonder what the big deal is. (“Come on, it’s just sex!”) But for the unfulfilled partner, it can be a huge deal. They may begin to feel unwanted or unloved, and may even turn to sex substitutes, such as food, alcohol, drugs, even infidelity. Or they may just become angry and resentful. As a result, the relationship starts to suffer on all levels, which in turn, leads to even less sex, thus perpetuating a vicious cycle of conflict.

Making Time
The key to a healthy sexual relationship is often compromise – whether you’re the one who occasionally has sex when you’re not in the mood, or the one who goes without for a few days. Another key is being proactive – trying new things in the bedroom, seeking counseling, or simply making time for sex. There are a number of things that can slowly but surely erode your sex life – from busy schedules and kids to aging/changing bodies and lack of communication – but if you make sex a priority (instead of letting it become the white elephant in the room), you can keep the passion alive and your relationship healthy.
Interested in women’s sexual health? Contact us for an appointment.

The phases of a cancer diagnosis might be compared with those of dealing with the death of a loved one: denial, bargaining, anger, and eventually acceptance. Fortunately for many, there IS life after cancer. A sexual life too, that part of one’s life may have been put on the back-burner during cancer treatment. The statistics on survivorship are astounding, creating a “before” and “after” picture for many.  It is important to understand both of them. Progression-free survival rates indicate no new tumors have formed. Whereas disease-free survival rates refer to remission, cancer free. The death rate from breast cancer has fallen 34% since 1991. Following the grueling chemotherapy, radiation, and/or surgery, it might not immediately occur to patients and their partners to re-connect through sexual activity.  I would encourage you or anyone you know in the survivorship phase, however, to make it a priority. Absent sexual activity, all genital tissues (skin, mucus membranes, and muscles), suffer from disuse atrophy. The good news is this: with the intention to connect or reconnect with your partner, and the use of various products available (if necessary), solutions to sexual activity may result in your “new normal.” Your body image, to the degree it suffered during cancer treatment may need a boost and a re-boot. A renewed sexual life can often help.

Sexual Healing
Whether due to cancer, certain medications that interfere with sexual response such as antidepressants, or menopause, sexual response changes during a lifetime. Menopause can be a premature consequence of cancer treatment. Both chemotherapy and pelvic radiation can result in menopause regardless of a woman’s age. Lubricants and vaginal moisturizers are readily available, but I caution you to look at the ingredients, as some may be irritants to those delicate tissues. Ingredients such as those found in spermicides, benzyl alcohol, and materials such as latex can cause discomfort for some.

With the sudden onset of menopause from surgery, radiation or chemotherapy, many women find that they experience intense vaginal dryness, and pain with sex (usually at the time of penetration). To mitigate this issue, vaginal moisturizers which are used on a routine basis whether one is having sex or not, can help to bring water into the vagina. Think about vaginal moisturizers like the moisturizer you use on your skin…you don’t just apply it when you are getting your picture taken. You use it on a regular basis. And lubricants (they aren’t the same as moisturizers) which come in oil, silicone, water-based, and mixtures of each of these can solve the dryness and lack of natural lubrication missing after some cancer treatments. Lubricants are used at the time one is having sex. They help the vagina operate as it once did naturally, and can make sexual activity more pleasurable by easing friction and lessening pain.

Enhance Sexual Pleasure
The marketplace has been flooded with sex-positive devices to enhance the sexual experience for both men and women. Toys, vibrators, dildos, and much more have piqued the curiosity of people who want to try something new. A medically accurate fantastic and friendly site middlesexmd.com/ can help educate you and your partner about new products, techniques and “tools” to keep your sensual side smoldering. Our office stocks a variety of such sexual aids and can help with proper selection, especially when sexual function is hampered. Keeping an open and honest discussion with your partner about your needs and interests, as they change in the “new normal” can alleviate anxiety and further build on a relationship that has endured and surpassed, the diagnosis of cancer. Get personal. Have fun. Explore.
To learn more please call the office at (202)293-1000 or email the practice at info@dev.loebigink.com.

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