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April 2, 2019October 11, 2019

Let’s Talk About IT

Introducing MonaLisa Touch, a groundbreaking vaginal treatment for menopausal women.

“IT” is vaginal discomforts, including dryness, burning, itching, and painful sex, all which fall under the umbrella term, “vaginal atrophy.” Vaginal atrophy can occur after vaginal childbirth and/or during menopause. Around 40% of menopausal women suffer from vaginal atrophy, but these women rarely talk to their gynecologists about it. If you’re one of them, it is time to stop suffering in silence and get back to enjoying your sex life!

We at IntimMedicine Specialists are very happy to offer you a vaginal laser procedure called MonaLisa Touch from our office here in Washington, DC. MonaLisa Touch is a painless and minimally invasive therapy that requires 1-3 treatments over the course of a few months. We know you have questions – we have answers!

Who is MonaLisa Touch for?

MonaLisa Touch is for any woman who wants to prevent or treat vaginal symptoms related to a decrease in estrogen, which can occur during menopause, after childbirth during breast feeding, or after many different cancer treatments, especially following breast cancer. If you are looking for a treatment that does not require hormones or surgery, MonaLisa Touch might be your answer!

How does MonaLisa Touch work?

MonaLisa Touch is a laser treatment that reactivates the production of collagen and rebalances the conditions of the superficial vaginal tissues. It does this by gently acting on the vaginal walls. This is a safe and painless process that only takes a few minutes.

Does it hurt?

MonaLisa Touch is completely painless! Patients have reported feeling a slight vibration, and some say that it feels no different than getting a pap smear. For extremely sensitive patients, a form of “Novocaine” can be topically applied without injections to eliminate any discomfort of the procedure.

How long is the recovery, and how long does it take to start working?

We recommend refraining from vaginal intercourse for 3-4 days after each treatment, but you’ll start to notice a positive difference almost right away! More treatments may be recommended depending on the severity of symptoms, but typically 3 sessions are needed for best results.

How long does the treatment last?

Treatments can last for at least a year, depending on the severity of symptoms and your age and lifestyle. We can revisit the need for additional treatment sessions with you after a year or if symptoms recur.

We can help you restore your vivacity! If MonaLisa Touch vaginal therapy sounds right for you, give us a call at 202.293.1000 or email us to make an appointment for a consultation at IntimMedicine in Washington, DC.

February 11, 2019October 11, 2019

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!

December 17, 2018December 23, 2019

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 health and wellness is a huge factor in achieving that goal. Give us a call at 202.293.1000 or email info@intimmedicine.com to make an appointment with one of our specialists today. We are here to help.

September 17, 2015October 11, 2019

For those who read, Part 1, sorry to leave you hanging (pun intended) last week.

This time, yes, I am talking about penis size. For men, it is often all about size, thus the term “penis envy”. But for women, the penis is perceived as just another masculine feature, like muscles, a flat stomach, or being tall. If women do have a focus on a particular physical part of the male anatomy, it’s most likely to be the buttocks, a subject I will save for another time. (See, for reference: A Billion Wicked Thoughts: What the World’s Largest Experiment Reveals about Human Desire by Ogi Ogas and Sai Gaddam; Putnum Group, 2011)

The availability of abundant, free Internet sexual content portraying men with huge penises as “the norm” has created a bit of a one-eyed monster, if you will. I have now seen a significant number of female patients who have completely unrealistic expectations for the penis size of their partners, not to mention, a skewed idea of how long their partners should be intimate without breaking a sweat or ejaculating. Some women have actually done the unspeakable, telling their partners, ”Your penis is so small!” Ouch! Talk about hitting below the belt.

Pornography, which is the portrayal of sexual subject matter for the purpose of sexual arousal, has created such common, unrealistic expectations (beyond penis size) that it has actually spawned an excellent TED talk, as well as a “realistic porn” site: Make Love Not Porn.

So, if you imagine, even for one minute, that a Genoa-salami-sized-penis is “normal,” here are the actual facts: The range of erect penis length for most men is 5 – 6.5 inches. The circumference of the average man’s erect penis is 4 – 5 inches. This means the corresponding erect penis diameter is 1.27 – 1.6 inches. This size information has been confirmed multiple times among different ethnic groups and populations with only minimal variation (www.kinseyinstitute.org/resources/bib-penis.html or https://en.wikipedia.org/wiki/Human_penis_size). While these sizes “are only numbers,” and as they say “a picture is worth a thousand words,” there is actually some good pictorial information that can provide meaningful visual perspective.

So, while fantasy is fine and actually very healthy, the reality of having sex with Jonah Falcon, the man with the world’s largest penis (a giant, freakish, colossus of 13.5 inches in length), could be completely terrifying! The takeaway here, Ladies and Gentlemen, is to be careful what you wish for, because you might not know what to do with it should you get it.

Interested in women’s sexual health? Contact us for an appointment.

September 2, 2015October 11, 2019

No, this post isn’t about penises or vibrators. (Why do our minds always go there!) I’ll reserve that subject for Part 2. This is about the clitoris. Yes, the clitoris, “a small erectile female organ located within the anterior junction of the labia minora that develops from the same embryonic mass of tissue as the penis and is responsive to sexual stimulation” (according to Merriam-Webster on-line dictionary). While seldom the subject of much scientific research, a recent publication* investigated the relationship between clitoral size and sexual function (including the extensive internal portion – “out of sight, out of mind” you might say).

In a small convenience sample of women having a pelvic MRI for other reasons (such as fibroid tumors), these researchers compared clitoral size and each woman’s sexual function as measured by several validated scales. Paradoxically, women with the smallest clitorises (yes, that’s the correct pleural of clitoris), specifically the clitoral body and crus (see diagram below), had the best sexual function. Those women with a smaller clitoris tended to have better desire, arousal, lubrication, and orgasm. The authors of the study suggest that a greater density of nerves, basically squeezing the same number of nerves into a smaller space, is what leads to better function.

There are several limitations to this study, so take these findings with a grain of salt. The relatively few women who participated were having their MRIs done for other medical reasons besides participation in this sexual function study. Therefore, the findings may not actually be generalizable to all women, especially “normal” women without another existing medical condition. But, this study does give a whole new potential meaning to the oft-quoted “good things come in small packages” idea. And that’s c.o.m.e., not c.u.m! Really, does your mind always go there?

Interested in women’s sexual health? Contact us for an appointment.

* Vaccaro CM, Fellner AN, Pauls RN. Female sexual function and the clitoral complex using pelvic MRI assessment. European Journal of Obstetrics & Gynecology and Reproductive Biology 180: 180–185, 2014.

August 19, 2015October 11, 2019

fda approved addyi today Dear Patient, Supporters and Friends,

Today the FDA made #HERstory for women with the approval of a first-ever medical treatment option for women’s most common sexual dysfunction, known as Hypoactive Sexual Desire Disorder, or HSDD. You can think of this disorder (HSDD) as: distressing low desire that can affect a woman, her partner or both and that lasts and lasts and lasts for more than 6 months regardless of circumstances, mood, vacation, health, etc. After enjoying normal sexual function, and then totally losing one’s interest in or desire for sex for longer than 6 months gives you some idea of the scope and impact of HSDD.

I know all of you have been closely monitoring the national conversation over the “little pink pill” or the “female Viagra” during the last year as the drumbeat has built among organizations such as ours – and among hundreds of thousands of people across the country – for treatment options for a condition that the FDA itself has recognized as a key unmet medical need. We at James A. Simon, MD, PC have been actively involved in the development of Flibanserin, or its new trade name ADDYI, for many years and have conducted several of the clinical trials used for FDA approval right here in the Washington, DC, office. For those of you who participated in those clinical studies, we want to personally thank you. Whether you received the active treatment in those trials or the matching placebo, soon you will be able to take “the real thing.”

James A. Simon, MD, PC is proud to be a part of such a thrilling moment in women’s sexual health and for the 16 million American women currently living without a single FDA-approved medical treatment option for HSDD.

With the FDA’s action today, The Agency not only approved a first-ever medical treatment option for HSDD, it also demonstrated that there IS a viable regulatory pathway forward toward approval of additional therapies for this and other female sexual health indications. Further, Flibanserin’s (ADDYI’s) approval today, opens the pipeline for other future options yet to come for women’s sexual health. In that vein, we are currently conducting additional studies on other medications for female sexual dysfunction right here at James A. Simon, MD, PC, and we are always looking for qualified study subjects/volunteers.

Women with HSDD deserve the safety and peace of mind that comes with access to FDA-approved medical treatment options, and today we write a new chapter in the fight for equity in sexual health.

Sincerely,
The entire James A. Simon, MD, PC family

Interested in women’s sexual health? Contact us for an appointment.

August 1, 2015October 11, 2019

Vulvovaginal Atrophy

Vulvovaginal atrophy (VVA) is a common condition associated with the decreased estrogenization of the vaginal tissues. It occurs most often after menopause, but it can also develop during breast-feeding or at any other time your body’s estrogen production declines.

The inevitable estrogen deficiency that accompanies reproductive aging and menopause results in universal changes in the vaginal ecosystem associated with a variety of vulvovaginal and urogenital complaints. At some point in their lives, the majority of women will experience these symptoms, collectively termed the genitourinary syndrome of menopause (GSM), a term which has recently replaced vulvovaginal atrophy (VVA) in the accepted nomenclature. VVA or GSM symptoms usually develop gradually and become most bothersome as women transition to the mid-to-late 50’s. These symptoms typically follow the vasomotor symptoms of menopause, such as hot flashes and night sweats. Unlike VMS, which usually subside after several years, the symptoms of GSM (see below) persist and increase in both frequency and intensity as women age.

With estrogen deficiency, the epithelium (aka the surface cells) of the vagina and vulva thins and loses its rugal folds. Those folds are really important. Think of the difference between a pair of pants with elastic, or a skirt with pleats vs one without. Imagine how you would feel trying to put them on if you’ve gained 20 pounds. Which pants would you like to squeeze into? With menopause and increasing VVA or GSM, the elasticity provided by those rugal folds diminishes, and susceptibility to injury, even with minor trauma, can ensue. Estrogen deficiency also leads to diminished vaginal glycogen and decreased acidity of the vaginal secretions (increased pH), thereby reducing the vagina’s natural defense against local pathogens (i.e. yeast and coliforms [the most common bacteria of fecal material]). The close proximity of the lower urinary tract to fecal contamination is associated with an increased risk for acute and recurrent urethritis and cystitis (bladder infections).

When a woman doesn’t have intercourse or other vaginal sexual activity on a regular basis following menopause, her vagina may also become shorter and narrower. Continuing to have regular vaginal sexual activity through menopause helps keep the vaginal tissues thick and moist and maintains the vagina’s length and width. This can help keep sexual activity pleasurable. This has euphemistically been referred to as “use it or lose it”.

If you do experience vulvovaginal symptoms (dryness, irritation, burning, itchiness, pain) do not automatically assume that reduced estrogen levels are the reason for these symptoms. Because vaginal discomfort can arise from many different sources, persistent symptoms should be brought to the attention of your healthcare provider for evaluation.

Interested in women’s sexual health? Contact us for an appointment.

July 15, 2015October 11, 2019

Is the FDA Approval of the “Pink Pill” a Probable Outcome?

A failure to approve flibanserin would set a dangerous precedent. Why? Because the pharmaceutical company did everything the FDA asked it to do, and the results came out statistically significantly better than placebo—which was the desired endpoint. If the FDA were to deny approval of the drug, it would be saying, in effect, that it can change its mind in the middle of the argument.

In reality, the FDA is likely to say yes to approval, but with restrictions, as that is what its advisory committee recommended. What those restrictions will be remains to be determined, but they are likely to resemble those of other drugs in the class, such as selective serotonin reuptake inhibitors (SSRIs), including a warning to be careful using flibanserin with alcohol until the drug’s effects are clear.

Interested in women’s sexual health? Contact us for an appointment.

April 20, 2012October 11, 2019

Did you know that the female sexual response changes throughout a woman’s lifetime? It’s true. When a woman is young and in love, her sexual response is drive in great degree by desire, meaning she is much more likely to seek out and be receptive to sexual activity.

So what causes this change in sexual response? It’s mostly due to hormonal and physiological changes that take place as a woman ages. And while a change in sexual response isn’t a problem in and of itself, it can often lead to worry for the partner. Men may think that their partner’s feelings for them have diminished. That’s why it’s so important to keep the lines of communication open and educate your mate about the changes you’re experiencing.

There are times, though, when lack of desire, arousal or orgasm is a serious issue that needs to be addressed by your physician. In fact, this is probably more common than you think, as an estimated 44 percent of women experience sexual dysfunction at some point in their lives. The good news is that there are low-risk, non-complicated hormonal and non-hormonal options for women that can bring back that loving feeling. Watch for an upcoming blog, which will discuss these options in greater detail.

Interested in women’s sexual health? Contact us for an appointment.

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