hazelnuts and walnuts

I’m frequently asked whether there’s anything to change in one’s diet to improve sexual function. While there’s absolutely nothing dietary that can treat a severe erectile dysfunction, or ED or significant arousal disorder in women (for that visit us at www.IntimMedicine.com) there are number of dietary habits or lifestyle changes which may help. The most important of these is to lose weight. Most of us could shed a few a few pounds and perhaps the best “pro-sexual or sex positive way” to do this is to substitute a plant-based diet for one rich in animal protein and fat. You don’t need to become a vegan overnight, but a dramatic reduction in animal products will help. This approach improves vascular function which is exactly how erections in men and arousal in women happens. It’s all about blood flow! When people lose weight, their blood vessel function improves, ED improves and, as weight is lost testosterone levels rise in men and estrogen concentrations in women increase and menstrual cycles become more regular. Looking for a shorter-term fix to temporarily improve sexual function, that’s nuts! Specifically, walnuts and pistachios.

It turns out that some nuts (remember peanuts aren’t nuts, but legumes), can be very good for sexual function. They improve vascular dilation and lower blood pressure both directly and indirectly by virtue of their positive impact on gut bacteria. Two nuts documented to improve sexual function are walnuts and pistachios. It’s very important that you read the following carefully, because there’s no free lunch. Nuts typically come with both calories and fat. If you’re going to consume a lot of nuts, you’ll need to increase your exercise or decrease your calories from other sources in order to remain weight neutral.

It turns out that about 20-30 walnuts a day for as short as 6 weeks can improve sexual function. However, those 20-30 walnuts/day come with 400 to 650 calories, about 80% of which is fat. This means that your new sex-positive walnut habit is a meal replacement. And while walnuts have been shown to curb appetite, and do so even better than almonds, unless you want to gain a bunch of weight, you will also need to bump up your exercise and/or eat less…a typical meal less.

100 Grams of Pistachios

Pistachios are also a good nut for sex. It turns out that 100 g of pistachios per day for as short as three weeks can improve erectile function. These nuts can also improve blood flow, lower blood pressure, and improve the cholesterol profile (increasing the good cholesterol, HDL, and decreasing both total cholesterol and bad cholesterol, LDL). However, this approach, too, requires a lot of pistachios.100 grams of pistachios, about 3 servings, contain about 560 calories, and 44 grams of fat. Yes, another meal replacement.

All of which raises another question, what do you do with all those shells. Two thoughts: 1) they can be put at the bottom of your potted plants for drainage, or if well-dried, they can serve as kindling for a fire to curl up in front of with your lover. So, lose the weight, and go nuts for sex!

Esposito K, Ciotola M, Giugliano F, Schisano B, Autorino R, Iuliano S, Vietri MT, Cioffi M, De Sio M, Giugliano D. Mediterranean diet improves sexual function in women with the metabolic syndrome. Int J Impot Res. 2007 Sep-Oct;19(5):486-91.

Salas-Huetos A, Muralidharan J, Galiè S, Salas-Salvadó J, Bulló M. Effect of Nut Consumption on Erectile and Sexual Function in Healthy Males: A Secondary Outcome Analysis of the FERTINUTS Randomized Controlled Trial. Salas-Huetos A, Muralidharan J, Galiè S, Salas-Salvadó J, Bulló M. Nutrients. 2019 Jun 19;11(6).

Tindall AM, McLimans CJ, Petersen KS, Kris-Etherton PM, Lamendella R. Walnuts and Vegetable Oils Containing Oleic Acid Differentially Affect the Gut Microbiota and Associations with Cardiovascular Risk Factors: Follow-up of a Randomized, Controlled, Feeding Trial in Adults at Risk for Cardiovascular Disease. J Nutr. 2020 Apr 1;150(4):806-817.

Aldemir M1, Okulu E, Neşelioğlu S, Erel O, Kayıgil O. Pistachio diet improves erectile function parameters and serum lipid profiles in patients with erectile dysfunction. Int J Impot Res. 2011 Jan-Feb;23(1):32-8.

smiling woman

older woman sitting on a couch, smiling

Testosterone Therapy

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

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


What are the benefits/risks of testosterone supplementation? 

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

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

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

 

What patient population is testosterone treatment indicated for? 

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

 

Testosterone and Sex Drive

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

 

If you think you might benefit from testosterone therapy…

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

Doctor and patient, women

Catching Cancer in Patients with Lynch Syndrome

Does your patient have cancer in their family history? If they have Lynch Syndrome, a simple screening can catch cancer before it’s too late.

It’s easy to merely glance over the obligatory medical history form that new patients fill out, scanning for information pertinent only to their presenting problem. But, as we at IntimMedicine Specialists look over a new patient’s medical history, we are always on the “look out” for a family history of cancer. How about a family history of Colon, Uterine, or Ovarian cancer? These and a number of other cancers could indicate that you and your family has Lynch Syndrome.

Lynch Syndrome is named after Dr. Henry Lynch, who is considered the father of hereditary cancer. He named this syndrome the “Cancer Family Syndrome” in 1966, which was later called “Lynch Syndrome” in 1984 by other authors, after which point Lynch himself began calling it Hereditary Nonpolyposis Colorectal Cancer, or HNPCC. It is now known as HNPCC or Lynch Syndrome, and it is characterized by members of the same family line born with a predisposition to develop ovarian, colorectal, endometrial, or other cancers.

For those of us in the fields of sexual health, we are in a unique position to be able to spot this syndrome and help our patients get the screenings they need to catch these potential cancers early. 1 in 400 people are at risk for Lynch Syndrome. It is projected that up to 1 million people in the United States have Lynch Syndrome, but due to a lack of public education about it, only about 5% of people who have Lynch Syndrome have been diagnosed with it.1 Patients with Lynch Syndrome are at a much higher risk of developing these cancers, and it is recommended that their screenings start at an earlier age and are repeated more frequently than patients without Lynch Syndrome. For example, a patient with a family history of colon cancer starting before age 50 might have Lynch Syndrome, and it is recommended that they begin colonoscopies at age 20-25, rather than wait until it may be too late.

IDENTIFYING LYNCH SYNDROME

  • If a patient has a family history of colon cancer – particularly if a family member developed colon cancer before age 50
  • If a patient has a family history of extracolonic cancers including endometrial, ovarian, small bowel, biliary, renal pelvis, ureter, or glioblastoma (a particular brain cancer)
  • If a female patient has abnormal uterine bleeding and a diagnosis of complex endometrial hyperplasia or endometrial cancer and she is younger than age 50

If any of these criteria are met, it is time to order a hereditary cancer panel. This panel will test for multiple cancer syndromes at once and is now the standard of care.

We are in a unique position to be able to catch cancer before it strikes. Ask your patients more about their family history of cancer. A simple screening process can make all the difference.

The specialists at IntimMedicine are experts in post-cancer sexual health. If you or a loved one is being treated for cancer or has been treated for cancer, talk to us at 202.293.1000, or email us at info@intimmedicine.com.

Learn more about Lynch Syndrome in this article.

1 https://www.contemporaryobgyn.net/gynecologic-cancers/keys-identifying-lynch-syndrome

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