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.

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.

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.

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!

Let’s face it: Pain during intercourse is problematic for many women across the lifecycle, especially after childbirth and later during the menopausal transition. The delicate skin of the vagina changes over time and with hormone fluctuations, a lot of women experience discomfort, dryness, and pain. These challenges can make intimacy uncomfortable (if not impossible) for some. But there is new laser-based technology available that can treat these issues affecting sex after childbirth and menopause.

This treatment is based on a special fractional CO2 laser, specifically created for the delicate vaginal mucosa. The treatment prevents and resolves estrogen declines in the vaginal tissue (typically occurring during menopause or after childbirth) by re-activating the production of new collagen and reestablishing the conditions that the vaginal mucosa once had.

No Surgery Required
This effective non-surgical, non-hormonal, and non-pharmacological solution helps to prevent and treat vaginal atrophy and is now available in our office! Please call us to make an appointment at (202) 293-1000 or to learn more about the benefits of this procedure.

I’d like to clear up some confusion regarding the use of estrogen to offset the symptoms of menopause. I won’t bury the lead; vaginal estrogen IS a safe menopause treatment for almost all menopausal women to use. Women using vaginally applied estrogen to minimize menopause symptoms do not increase their risk of heart disease, stroke, deep vein thrombosis, dementia or certain cancers including breast cancer in spite of what it might say in the Information for Patients (the package insert) which comes with this therapy.

But now, the back story.

The federally funded Women’s Health Initiative (WHI) Clinical Trials studies documented that oral estrogen or oral estrogen plus progesterone pills increased the risks for heart disease, stroke, deep vein thrombosis, dementia and certain cancers including breast cancer. These results from studies published in 2002 and 2004 have come into much clearer focus more recently. Unfortunately, the patient population evaluated in these studies included women who had pre-existing health conditions such as being overweight, having high blood pressure, etc., and most importantly the study participants outside of the “estrogen window” for safety FOR SYSTEMIC HORMONE THERAPY. This confounded the results of the study, since most of the study participants were over 60 years old, and some were 79 years old, when they started on their treatments. However, the WHI researchers continued to look into safer options for the correct patient population, in order to alleviate symptoms which hinder a women’s overall quality of life and sexual wellness.

The “Estrogen Window”

Following the confusing outcomes of the WHI Randomized Clinical Trials (referred to above), researchers began to closely review other WHI data. The latest publication from the Observational part of the WHI (Carolyn J. Crandall, MD, and colleagues. Breast cancer, endometrial cancer, and cardiovascular events in participants who used vaginal estrogen in the Women’s Health Initiative Observational Study. Menopause: The Journal of The North American Menopause Society. Vol. 25, No. 1, pp. 000-000, 2017. ePUB ahead of print) focuses on vaginal application of estrogen only for the treatment of vaginal symptoms of menopause. These included women’s experiences related to the deficiency of estrogen on the vagina, bladder and urethra, and particularly focused on the safety of vaginal estrogen treatments.

These symptoms investigated include:

  • dyspareunia (insertional or deep pain during sex)
  • lubrication/dryness issues during sex
  • vaginal atrophy
  • recurrent urinary tract infections
  • painful urination
  • generalized vulvar or vaginal discomfort
  • bleeding after sex

The one common group of symptoms that vaginal estrogen does not mitigate is hot flashes, night sweats, and disturbed sleep.

Risks and Rewards

The team aimed to find out if and how severe health risks affected women who were using this vaginal form of estrogen. Cardiovascular disease, breast, colorectal, and endometrial cancer, as well as deadly blot clots were health events that warranted a risk assessment in this study.

The data showed that among women with an intact uterus, the risks of stroke, invasive breast cancer, colorectal cancer, endometrial cancer, and pulmonary embolism/deep vein thrombosis were not significantly different between vaginal estrogen users and nonusers.

I will emphasize that this was estrogen-only administration of therapy and none were taken by mouth. Oral therapies that travel through a patient’s digestive system and blood stream may also be safe for many, but that is not the administration route under the microscope in this paper recently published in the Menopause journal; by the North American Menopause Society. The “take home” message: vaginal estrogen can be safely used without fear of cardiovascular events caused by such therapy, after menopause.

It is important to visit a practice like ours that understands hormones and the role that they play during each phase of a woman’s life. The fluctuations you experience are not only normal, but very treatable. If you have questions about hormones, the menopause window, or whether you can safely use hormones, please call our office at (202) 293-1000 to make an appointment with our compassionate and knowledgeable staff.

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!

Fiera sexual wellness device

Fiera sexual wellness deviceA new sexual wellness device is revolutionizing women’s sexual health care.  It’s not a vibrator exactly (but it does vibrate). A vibrator stimulates the clitoris directly or indirectly through vibration and pulses (that’s why it’s called a vibrator). Fiera is different. Fiera is a self-adhering clitoral vacuum that increases blood flow to the clitoris, and also vibrates in several modes to stimulate sexual arousal and increase the likelihood of orgasm. Fiera is ideal for women who need a little help to jump start their sexual pleasure, arousal and orgasm experience. It was designed to “level the playing field” since many women require much more stimulation and time to orgasm than men. The device has adjustable speeds and is small enough that it can be “worn” during sexual intercourse or without a partner.

Sexual Desire
Sexual desire and function are a vital part of quality of life and general well-being during a woman’s life cycle, and continues to be important during midlife and beyond. However, the changes that occur during menopause and with aging can inhibit sexual function or at least slow it way down. The natural decline in estrogen and testosterone levels that occurs during perimenopause/menopause and with aging has been shown to negatively impact blood flow to the clitoris and other “erectile tissues” in women, affecting engorgement as well as vibratory sensation. This, in turn, can decrease genital arousal during sexual activity and decrease overall sexual satisfaction. But there is hope with devices such as Fiera, which offers a resurgence in sexual activity when desire or function begins to wane.

The Science Behind Fiera
To learn specifically how Fiera works to helps women to achieve sexual satisfaction, a team of scientists and engineers studied thermographic imaging of the external genitalia. Skin tissues that are warm have more blood flow than tissues that are cool or room temperature. Changes in blood flow can then be assessed when associated with sexual activity. Thermographic imaging documented markedly increased blood flow to the clitoris and surrounding areas which persisted for 10 minutes immediately following removal of Fiera. Patients used the device for up to 15 minutes or until the time they achieved orgasm. They described their experience as a pleasurable feeling of warmth, tingling, or fullness in the genitals. To date, there has been limited information quantifying the degree of genital engorgement produced by products like Fiera that incorporate either vibration and/or clitoral suction. The time to onset of sexual arousal with such products is significantly shortened, bringing into greater equilibrium her response time and his.

Have Questions?
Feel sexy again. You deserve it. Experiencing sexual satisfaction can spill over to other areas of one’s life so it is important to keep your sex life going. If you are having sexual function issues and would like to discuss your options, or would like to learn how Fiera can help you, please call our office at 1 (202) 293-1000.

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