Did you know the penis is just a muscle?

Did you know Viagra works just by relaxing this muscle?

How the penis and its supporting muscles contract and relax can affect erectile function, orgasm, ejaculation, and urination.

We’ve all experienced how it feels when muscles are too tight or too weak and become sore and painful. If you’ve ever received a shoulder massage, you have “felt the burn” when a tense muscle gets pressed on.

Breaking this down a bit more, the penis is a type of muscle called smooth muscle, which means it’s under the influence of the fight or flight system called the autonomic nervous system.  For example, if you are running away from a tiger in the jungle, it would probably be pretty hard to get an erection. Unfortunately, we don’t have complete control of the penis muscle itself.

However, the muscles that surround the penis and the pelvis are skeletal muscle, the type of muscle we have control over. These skeletal muscles can be trained, strengthened, and assessed just like if you needed rehab on your shoulder or hip.

Did you know there are physical therapists who specialize in the muscles of the penis and pelvic floor? Seriously! Your pelvis is a bowl full of muscles and problems with these muscles are very common.

These pelvic floor physical therapists can help with urinary incontinence, urinary frequency, urgency, constipation, and pelvic pain.

There is even evidence out there that says pelvic floor physical therapy helps men with erectile function, ejaculatory function, and other sexual issues.

But not all pelvic floor physical therapists are trained in these specialized techniques.

So I set out to change that, along with Dr. Jessica Probst, an incredibly talented, evidence-based and cutting-edge pelvic floor physical therapist and owner of Thrive Again Physical Therapy in Washington, DC. Dr. Probst and I hosted an advanced course for physical therapists to help them develop a better understanding of treating the pelvic floor to help men with erectile dysfunction and pelvic pain.

Physical therapists came from all over—including Richmond, Baltimore and as far away as Massachusetts—for this advanced training. To provide hands-on experience for our physical therapists, we brought in male patients who have had incredible success with pelvic floor physical therapy.

Many doctors know how to treat the symptoms of erectile dysfunction. We use pills, injections, vacuum erection aids, and surgically implanted penile prostheses. I prescribe these treatments often, but I also believe strongly in diagnosing the underlying cause of sexual dysfunction and working in a multidisciplinary fashion to find ways that we can fix the underlying problem.

After all, the penis is just a muscle.

Course Directors

Rachel S. Rubin MD Urologist and Sexual Medicine Specialist

Jessica Probst PT, DPT, MTC, PRPC  Thrive Again Physical Therapy & Wellness

Male Pelvic Pain and Erectile Dysfunction Course on September 28, 2019

COURSE AGENDA:

9:00-9:15       Introduction to male pelvic pain/ED (Dr. Jessica Probst)

9:15-9:45       Physiology and pathophysiology of erections and erectile dysfunction, treatment of erectile dysfunction (Dr. Rachel Rubin)

9:45-10:15     Male pelvic pain (Dr. Rachel Rubin)

10:15-10:30   Male pelvic floor anatomy and the role of the pelvic floor in male sexual function (Dr. Jessica Probst)

10:45- 11:00   Lab 1:  Palpation and manual technique warm-up (therapists will practice on each other to warm up)

11:00-11:30    Lab 2: Locate the bulbospongiosus, ischiocavernosus, superficial transverse perineal muscle, obturator internus externally and feel for contractions

11:30-11:45    Lab 3: Treatment techniques for OI (externally), ischiocavernosus and  bulbospongeosus in basic and alternate positions

11:45-12:15    Lab 4: Internal rectal assessment in supine with focus on anterior portion of puborectalis and OI

12:15- 12:45   Lab 5: Advanced manual treatment techniques and strategies

1:00-1:30        Case studies and Q&A with Dr. Jessica Probst and Dr. Rachel Rubin

1:30-1:45        Post-test and course evaluations

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.

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!

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

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!

holding hands

Ever since we were infants, skin-to-skin contact meant closeness, calm and intimacy. So when disorders of the skin like Psoriasis interfere with such an important sexual organ (the skin, our largest by far), there are consequences. Psoriasis is more than a skin condition; it can affect everything from your self-esteem and your mood to your sexual health and well-being. According to a recent study, psoriasis is directly linked to sexual dysfunction and erectile dysfunction. But, it doesn’t have to be that way.

Psoriasis is an autoimmune disease, which means the body’s immune system attacks itself. With psoriasis this means the white blood cells known as T cells attack the skin cells, causing your body to over-produce skin cells and resulting in the red, scaly pile-up of skin cells, or plaque, that is associated with psoriasis. Psoriasis is genetic and non-contagious, but nearly one-third of people with psoriasis report that it has a negative effect on their sex lives.

Psoriasis flare-ups usually occur on a person’s hands, feet, face, neck, scalp, and in the joints, but have also been known to affect the genital area. Having psoriasis is sometimes embarrassing; if you are having a bad flare up it might make you want to stay covered up and avoid intimate situations with a partner, and having a flare-up on your genitals can make sex physically uncomfortable if not impossible.

Depression and anxiety are also more likely for people with psoriasis because the disease can be frustrating to treat and can affect one’s self-esteem. Stress can cause flare-ups, which can lead to more stress, and it might seem like you’re caught in a never-ending battle with your psoriasis. All this can make it difficult to seek out or be receptive to sexual intimacy with a partner.

Does this mean if you have psoriasis you can’t ever hope to have good sex again? Of course not!

woman, thoughtful

  New research published this month on the JAMA Network Open indicates that 7.0% of women and 10.3% of men have what is now classified as compulsive sexual behavior disorder (CSBD). CSBD is defined as “failing to control one’s sexual feelings and behaviors in a way that causes substantial distress and/or impairment in functioning.” There are a few things we can glean from this data, but it might tell us a whole lot more about our society than it does about human sexuality.

  First off, the results are self-reported and based on perceptions of one’s own behavior. Negative stigma about sexual urges or thoughts within certain cultures and sub-cultures in the United States could result in what researchers are now calling a disorder, but might actually be healthy urges interpreted through an unhealthy social lens. Psychologists have argued about what constitutes “healthy” sexual behavior since the dawn of the field, and the discussion is nowhere near a conclusion. Unfortunately, using a self-reporting survey does not allow researchers to be able to distinguish between participants feeling distressed about compulsive and intrusive sexual impulses, and participants feeling distressed about their sexual urges because of moralistic pressures within their sub-cultures.

  Secondly, the close percentage of men and women who are now diagnosed with CSBD could be telling, or it could not be. The long unspoken “rules” about male and female sexuality in the US could be at play here. Men have been told that their sexual urges cannot be repressed and that it is unhealthy to do so, while women have held the role as “sexual gatekeepers.” Those societal factors and gender roles may have led to fewer men and more women reporting distress due to their sexual urges and behaviors. On the other hand, it could be interpreted that men and women actually have similar sex drives and sexual habits. With interpretations of sexuality in America in such a complicated place, it is difficult to make a determination about this.

  The bottom line is this: if your sexual behaviors or urges are causing you distress or impairment in functioning, whatever that means to you, it is worth talking about! It is our goal to help you feel whole and healthy, and we believe sexual wellness is a huge factor in achieving that goal. Give us a call at 202.293.1000 or email info@dev.loebigink.com to make an appointment with one of our specialists today. We are here to help.

 

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