Sexual empowerment not only applies to equality in the boardroom of the work place, but in the bedroom as well. Equality in comfort and sexual satisfaction, and equality in the types and numbers of treatments available. Women who have had their last menses sometimes say good-bye to their enjoyable sex lives because of pain during sexual activity, due to vulvar or vaginal changes, lack of lubrication, all of which can affect one’s libido. Societal cues, shame, or embarrassment about this lack of sexual equality are not being addressed enough and there are solutions. These physical symptoms are brought on by menopause, whether medically-induced menopause or natural menopause, but because the symptoms may “sneak up” on a woman, the connection to menopause is often lost, and women commonly assume this is just another symptom of getting older, like arthritis. There is certainly nothing natural about a sudden halt in one’s sexual life when pain and dryness interfere. We have answers.

Why the Disconnect?
Many postmenopausal women are relatively unaware of how the symptoms of menopause affect them sexually, and what treatments are available, according to findings presented at the Annual Meeting of the North American Menopause Society.

Results of the Women’s EMPOWER survey reveal that women generally didn’t recognize vulvar and vaginal atrophy symptoms, and were reluctant to discuss them with their healthcare professionals. This second part is most concerning to me. I’m available to discuss, mitigate, and resolve sexual issues. Participants in the survey also reported that they lacked knowledge about therapeutic options to alleviate these bothersome symptoms. When compared with six previously conducted surveys — REVEAL, VIVA US, Healthy Women #1, REVIVE, CLOSER North America and Healthy Women #2 — evaluating knowledge, behaviors and attitudes related to vulvar and vaginal atrophy, EMPOWER demonstrated yet again that women failed to recognize vulvar and vaginal atrophy symptoms, and were reluctant to discuss them. Further, participants reported that they lacked knowledge about therapeutic options to alleviate the symptoms. But, there is no reason to suffer in silence. Speak up!

Experts such as myself, a reproductive endocrinologist, sexual medicine and menopause specialist, and Clinical Professor at George Washington University in Washington, DC, and my colleagues seek to address these issues and have released a study on a new treatment that will enable women to reclaim their sexual vitality.

TX-004HR is as soft gel capsule containing low-dose, solubilized, natural, bioidentical 17 B-estradiol.  Our team team conducted a phase 3, randomized, double-blind, placebo-controlled, multicenter REJOICE trial that demonstrated this treatment to be safe and effective for treating moderate to severe dyspareunia (painful intercourse) in postmenopausal women with vulvar and vaginal atrophy (VVA). In total, 764 women were eligible to participate in the study, of which 704 (92%) completed the study.

The study used the Female Sexual Function Index (FSFI) as a measurement of the impact of this treatment on sexual function. The FSFI is a self-reporting tool to assess sexual function during the past 4 weeks. It consists of 19 questions categorized into six domains of sexual function (desire, arousal, lubrication, orgasm, satisfaction, and pain).

VVA affects more than 30 million women who go untreated, in part, because of the perceived risks of estrogen, which I have explained in an earlier post,  Estrogen and Breast Cancer Risk: Separating Fact from Fiction.  But this new treatment  aims to alleviate the symptoms without adding any risk by providing a treatment that goes to the source of the issue, the vagina and vulva, with little or no systemic absorption of estrogen. The REJOICE study compared the effects of 12-weeks of treatment with TX-004HR at varied doses with placebo in postmenopausal women (40 to 75 years old) with VVA and moderate to severe dyspareunia (i.e., difficult or painful intercourse).

The Good News
The research team found that TX-004HR improved sexual function in postmenopausal women with moderate to severe VVA and dyspareunia. After 12 weeks, all three TX-004HR doses increased the average total FSFI score.

This treatment shows promise for women who  experience these symptoms and they should talk with their partners and their medical team to address issues as they arise. If these symptoms are affecting your sex life, I encourage you to give our office a call to help develop a plan for a healthy and happier sexual life going forward.


Leading researchers are urging the medical community to rethink how they treat patients who experience severe menopausal symptoms. Mache Seibel, MD., former 20-year veteran of Harvard Medical School faculty, editor of My Menopause Magazine and Professor of OB/GYN, University of Massachusetts –was inspired by his wife’s experience, and took it upon himself to help her and countless others, manage this important phase of life. Dr. Seibel studied the hormones given to women to treat symptoms and revisited the research in the Women’s Health Initiative (WHI) from 2002. After an up-close look at the data, he realized that further educating people about the role of hormones in health was necessary.

Jane Doe Lost Her Mojo

Many women who are in the prime of their lives and height of careers struggle with the debilitating symptoms associated with menopause. Consider this scenario: A healthy woman, aged 51, is looking forward to engaging in a night of foreplay, fun and sex with her partner, but is unable to enjoy herself, because of the lack of natural moisture she’s had all of her life until now. The “dry sex” she now has leads to pain during intercourse–two common symptoms of menopause. Following an unsatisfying sexual experience, she eventually falls asleep, only to be awakened by hot flashes and night sweats, soaking her sheets. The next day she wakes up tired, frustrated, and in a mental fog, only to have this experience happen the next night, and the next, and the next, and again the week after that. Knowing that sexual desire for women starts in the brain, she became unsure about how to connect her desire for intimacy with her body’s sexual response the way she used to, and her overwhelming fatigue makes her wonder if it’s worth the effort. The good news is that the experience of the menopausal transition can be positive, given the appropriate treatment, which varies depending on the age and health-status of each woman.

Understanding Menopause
The process of menopause is like the process of puberty—but in reverse, says Dr. Seibel in his revolutionary book, “The Estrogen Window: The Breakthrough Guide to Being Healthy, Energized, and Hormonally Balanced–through Perimenopause, Menopause, and Beyond.” Although puberty is well understood, menopause, which effects every woman, is less so. Women may assume that the surge of estrogen during early menses will suddenly shut off like a spigot, but it is more subtle and takes longer than one might imagine, leaving in its wake, uncomfortable symptoms, which were broadly treated with hormones such as estrogen and synthetic progesterone (progestin) until the WHI study results were released in 2002.

The WHI hormone studies have increasingly come under fire for the way they were designed, most importantly the inclusion of women up to age 79 years. The results of these studies have reverberated through the medical community as the changes they caused may have been both too broadly applied and in some cases simply incorrect. The findings that hormone therapy was putting many women at risk for certain conditions such as breast cancer and cardiovascular conditions caused many women to go off their hormone-replacement therapy “cold turkey” without knowing how to address the consequences, and not fully understanding the risks versus rewards. For example, some of the patients in the WHI study were already at risk for cancer or cardiovascular disease because of life-long smoking, being overweight and the age at which they started hormone therapy. However, otherwise healthy women should be able to use these therapies to ward off the symptoms that affect sexual health and pleasure.

Opening the Estrogen Window
Dr. Seibel calls the estrogen window, the “decade-long time-frame between the ages of 50 and 60, or 10 years from the time of menopause,” which is defined as at least 12 consecutive months menstrual period-free.

His book outlines important recommendations that are not a one-size fits all approach. Here are several key takeaways for improving and maintaining sexual vitality:

Low estrogen levels at midlife are common causes for genitourinary syndrome of menopause that causes bladder leakage, vaginal dryness, and elasticity in vaginal tissue to change–leading to discomfort during sex (location 3014).

The estrogen window for vaginal estrogen always remains open; it never closes (location 836).

Estrogen alternatives exist for women with medical histories (e.g., breast or endometrial cancers, blood clots, liver disease, pregnancy, undiagnosed uterine bleeding) that make it inadvisable to take estrogen (location ,787 814).

This book is available online and at the website This website contains downloadable bonus material, including the Menopause Checklist, Sleep Diary, and much more. Armed with this information, a visit to your gynecologist can lead to better overall health and importantly, a continuation of a satisfying sex life, well into advanced age.

To learn more please call the office at (202)293-1000 or email the practice at

177614807Women have more choices than ever before when it comes to birth control: the Pill, the patch, IUDs. Technology and modern medicine continue to revolutionize the contraceptive landscape. A recent article in Time even shared developments on what could be the first microchip birth control.

So, with so many options, how do you decide which is best for you? The short answer is “…that’s a discussion you need to have with your doctor”. Your health, family planning goals, even medical history, all comes into account when finding the right birth control for you.

If you’re not even sure where to get started, here’s a quick primer that’s taken recent developments into consideration:

Oral Contraceptives

Even the Pill has changed drastically over the last decade. Now, women can choose from conventional, continuous or low-dose pills.

  • Conventional pills offer 21 or 24 active pills taken to block ovulation and seven or four inactive pills that contain no hormones. Bleeding will occur when the inactive pills are taken.
  • Continuous or extended cycle usually have 84 active pills and seven inactive pills. Bleeding generally occurs only four times a year.

The dosing of pills can even vary brand to brand. Some pills have the same amounts of hormones; others fluctuate week by week based on your cycle. Recent developments have even delivered low-dose birth control pills for women sensitive side effects from hormones such as weight gain, headaches or irritability.

The most common complaint, or shortfall, of the Pill is that women must remember to take the Pill every single day. This is something that is very easy to forget with a hectic schedule.

Birth Control Patch

The patch makes it a little easier to remember: woman who wear a patch need to replace it once a week, rather than once a day. The patch resembles a square Band-Aid and releases estrogen and progestin slowly into the body to block ovulation.  Women typically wear the patch three weeks a month. Bleeding will occur during the “off” week.

Intrauterine Devices (IUD)

Slowly gaining traction among women are intrauterine devices (IUDs) that are inserted directly into the uterus through the cervix. Some IUDs release hormones to prevent pregnancy and heavy periods. Others are hormone free.

A long-lasting form of birth control, IUDs can be worn for anywhere from 3-12 years and are generally considered the most effective form of birth control among the medical community. Recently, The American Academy of Pediatrics recommended IUDs and other long acting reversible contraceptives (LARCs) as first line contraceptive choices for adolescents. Read the AAP’s statement on IUDs, and learn more about IUDs on my previous blog post.

We at James A. Simon, MD, PC are conducting an exciting research trial for women requiring contraception. We are studying a very promising new contraceptive patch. If you or someone you know might be interested in participating in the study, call the office (202-293-1000) and ask for details.


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Every women that I talk to who is dealing with infertility is surprised to discover becoming pregnant may not be as easy as they expected. Some of my most surprised patients are those who already have a baby – and didn’t need fertility treatments the first time around. They’re dealing with secondary infertility. And it affects approximately 3 million women in the U.S.

To help you understand secondary infertility, I’ve listed some of the most common questions I get from my fertility patients.

What is secondary infertility?

Secondary infertility refers to the inability to get pregnant naturally even though you previously had a child without the aid of fertility treatments.

What are the signs of secondary infertility?

The main sign is that you aren’t able to get pregnant after frequently trying. That means 12 months of unprotected sex if you’re younger than 35, or 6 months if you’re over 35.

What causes secondary infertility?

Approximately 30 percent of the time it’s female infertility; 30 percent it’s male factor infertility and the rest is unexplained. Here’s more information about each of those:

  • Female infertility can be caused by a number of different factors ranging from a blocked fallopian tube, polycystic ovary syndrome (PCOS), endometriosis or age. Age plays a big role in fertility because it becomes much more difficult to conceive naturally as women get older.  According to the American Society for Reproductive Medicine (ASRM), a healthy, fertile 30-year-old woman has a 20 percent chance of becoming pregnant each month she tries to conceive; a 40-year-old woman has less than 5 percent chance of conception with each cycle.
  • Male factor infertility could be related to low sperm count or low motility, which means they move slowly – making the trip up the fallopian tube seem like an ultra-marathon.
  • Unexplained infertility is when test results do not indicate a problem that is specifically causing infertility.

What should I do if I have signs of secondary infertility?

Schedule an appointment with a physician who specializes in infertility. I work with women struggling with infertility every day and can offer a wide spectrum of care from identifying what the issue may be to recommending surgery to address that issue (if necessary). I work closely with each patient, identifying an appropriate course of treatment and a plan that offers the greatest chance for success.

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I always tell women who are trying to become pregnant to have some fun. But one thing many couples reach for off the bedside table to increase pleasure may actually lower your chance of conceiving – personal lubricants.  A recent study found that some common lubricants found in stores may actually harm sperm and reduce the chance of pregnancy.

The study found that certain store-bought lubricants slowed sperm motility, making it more difficult for sperm to travel to the fallopian tubes and meet an egg ripe for fertilization. Pre-seed, a lubricant designed specifically for conception, did not impact sperm movement.

Important news for couples facing fertility problems

When you’re dealing with infertility, you want to boost your chances for success whatever way you can. That’s why these findings are important for couples coping with fertility treatments. Some fertility medications may actually cause vaginal dryness. Personal lubricants may erroneously be provided to men who need to masturbate at a fertility clinic to collect a semen specimen for a sperm count and motility check, or to be used for fertility treatments like intrauterine insemination or in vitro fertilization.

So what can you do if you’re trying to have a baby and need, or want, to use a lubricant? Reach for canola oil, baby oil, sesame oil or mineral oil instead. It’s cheaper for you and may be better for conception. But, the best lubricant choice is Pre-seed. It’s been specifically designed to use when you’re trying to conceive. And make sure it’s available at your fertility clinic. You may be surprised.

One final word of caution, just because personal lubricants may reduce your chance of getting pregnant does not make it an effective form of birth control.


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Get your new year started right with these five tips for a better sex life.

1. Commit to “date night”

While I recommend once a week, that may not be practical for all couples. Date night doesn’t de facto mean “sex night.” It means getting out, just the two of you (no kids, no parents, no distractions) to focus and spend some quality time with each other…as grown-ups…as individuals…and as a couple. Devote some time to the issues/challenges you face together. Research shows that regular “date nights” can lead to more frequent “sex nights.”

2. Get Recharged

One in every two couples has a personal massager, a vibrator, and has incorporated it into their sexual play. Women who use vibrators have significantly more positive sexual function (i.e. more desire, better arousal and lubrication, and less pain). And more than 80% of men feel that vibrator use can enhance the sexual relationship with their partner. So, why not buy one, or buy a new one? At least get a fresh supply of batteries!

3.  Lube Up

Buy a personal lubricant and use it, even if none is needed! Recent studies show that couples using lubricant during sex actually have more sexual pleasure. Maybe it’s the act of putting the lubricant on, rather than the action of the lubricant itself, but it works to enhance one’s sexual experience. If you’ve been using a lubricant, try a new one, a flavored one, or an arousing one (unless you are menopausal or have very sensitive tissues, then the flavored, and arousing varieties may be too irritating).

4. Lend a Helping Hand

Do something for your partner that is totally out of character for you.  What does your partner hate doing? Is it vacuuming, doing the laundry, taking out the garbage? Try for something you seldom ever do, that will ease a burden on your partner, and even make him or her laugh. What you do may have no commercial value, but make sure it is valuable to your partner.

5.  Break Out of the Ordinary

Plan an erotic surprise for you and your partner. Most couples slip into a sexual rut, particularly in long-standing relationships. We all like variety and surprises. Planning an erotic surprise seldom brings the ridicule many anticipate that it will. Even if the gift is out of character for the giver or even a little out of context, that just makes it more of a surprise. Just do it! What you get in return may be the biggest surprise of all.

By making some of these small changes you’re sure to make 2014 your sexiest year yet!


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Vibrators are often the punch line of the joke; the gag gift at the bridal shower or the cause of an embarrassing situation in a sitcom. But, the reality is, personal massagers are no joke. Vibrators can be an important part of a healthy sex life. Used alone or with a partner, they enable many women to have a happy, enjoyable sex life. And that’s nothing anyone should be embarrassed about.

Personal massagers are believed to play such an important role in women’s sex life that doctors and researchers have conducted studies to identify how women use them, and what men and women think about them. The results were enlightening:

  • Think no one uses a vibrator? Think again. Research found that over 52 percent of women have used a vibrator at least once.
  • Male partner worried you won’t be interested in sex with him if you use a vibrator? He couldn’t be more wrong. Heterosexual women who used vibrators experience an increased desire for sex.
  • Most women (49 percent) started using a personal massager for fun or curiosity.

The bottom line is that vibrators shouldn’t be relegated to the back of the nightstand drawer, and you shouldn’t be too embarrassed to buy or use a vibrator – alone or with a partner. It’s something to consider if you’re curious or want to get your sex life buzzing again. Doctors think vibrators may even help treat common symptoms of menopause. We do sell a variety of vibrators to our patients. Special expertise and training may be required to match the proper personal massager to a patient’s unique needs. We can help.


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I think we all know sex is, or should be, enjoyable. Then why do lawmakers insist on giving it a bad rep? Sometimes we’re the culprit, claiming food, coffee, shopping, dancing, or just about anything can be better than sex. And that seems to be the only time we’re not too embarrassed to talk about sex – when we talk about what’s better than it. Margot Kaplan, assistant professor of law at Rutgers School of Law-Camden, recently wrote an op-ed piece in the Washington Post that should serve as an eye-opening reminder for women and men about the value of talking about sex.

In the piece, she offers fascinating insight on Supreme Court rulings and the impact it has on our society when we continually push sex back in the bedroom, sweep in under the rug or downplay the pleasure it brings:

  • Griswold v. Connecticut (1964): When the court ruled a law unconstitutional that banned the of contraceptives, they were clear to distinguish that they were protecting private acts in marriage, and not acknowledging that sex could happen anywhere outside the marriage bed. Kaplan’s take: Sex was considered bad, but marriage helped justify the act.
  • Eisenstadt v. Baird (1972): Kaplan points out that when the court down a Massachusetts law denying unmarried people access to birth control, Justices were more concerned about protecting the right to avoid pregnancy. Their ruling was “oddly silent” on why unmarried individuals may want to have sex.
  • Lawrence v. Texas (2003): A landmark case that ruled a sodomy ban unconstitutional focused on sex being more than just pleasure. When, in fact, as Kaplan acknowledges, sex is sometimes just about pleasure.

Kaplan believes that for society to be truly sexually free, we must speak openly and honestly about our sex lives. That’s something I wholeheartedly agree with. She goes so far as to challenge lawmakers to review the logic of certain laws. I, however, would just be happy if more people starting speaking more frankly about sex. When we speak openly about sex with our partners, we discover new things – from new fantasies to more honest feedback about what feels good, and what may not. My bet is, once you start talking openly about sex, you won’t be able to find a cake, book or anything better than the joy sex can bring.


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It may not seem like the stuff of sitcoms when it’s happening to you, but my sister pointed out to me the other day that menopause was the theme of a recent CBS show called Mom – and it’s a great reminder that a solid sense of humor can be a terrific asset.

The show is built around the evolving relationships between a mom, her daughter and her mother – three generations of women and the changing nature of their interaction.  In a recent episode, the matriarch of the family started experiencing some textbook symptoms, and her daughter recognized what was at play while her mother went to sitcom-level extremes to deny what was happening.

My sister pointed it out to me, saying the episode has value “even if you don’t watch the show or know the characters”. In her words, “If we can’t laugh about it, we’ll just melt away in a pool of our night sweats.”

Truth is, trying to manage the mood swings, the sleeplessness, the realization of changing sexuality – all a natural part of the aging process – is challenging, maddening…and yes, if you allow it, funny.  When a woman is deep in the middle of trying to manage the symptoms and her reaction to them, the idea of laughing about it all may not be the most top-of-mind approach to consider.  But once things are put into perspective, maybe with the help of some hormone therapy, it does make sense to consider that a strong sense of humor may be at least as valuable as other medically based ways to help manage the process.  And that’s something I strongly recommend in conjunction with the most helpful of clinical approaches.


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New research provides an additional benefit of frequent sexual activity – higher earnings. So says a Greek researcher who reports that people who have frequent sexual activity made about five percent more money than those who have less.

The findings are based on a year-long survey of 7,500 Greek households, from January through December in 2008. The researcher stresses that frequent sexual activity doesn’t cause a higher salary, only that there’s a correlation between the two. He theorizes that more sex makes people healthier and happier or that a person with a higher income may attract more sexual activity. The correlation was most evident among people between the ages of 25 and 50 years old.

The research also noted that the increased sexual activity link to higher income was the same for heterosexuals as it was for homosexuals. It also found that wages were higher for sexually active earners even if they had impaired health.

The study’s author says the findings are relevant as they pertain to a variety of factors impacting income levels, including health, cognitive and non-cognitive skills and personality. He also suggests that sexual activity is an indicator of other quality of life metrics like health, happiness and well-being.


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