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

Pellet Hormone Replacement FAQ

We know that Hormone Replacement Therapy is essential for managing severe menopause (or “manopause!”) symptoms, and hopefully there is an easy way to deliver it, right? Fortunately, there is! IntimMedicine offers an easy outpatient procedure to place a bioidentical hormone pellet under the skin. Outta sight, outta mind, and you get to start living your life again!

What is it?

Pellets are compounded bioidentical hormones for women (our team of experts will determine exactly what’s right for you – the right amount can help you regain your hormonal balance). Pellet therapy is actually FDA approved for men, as well. Pellets are typically naturally occurring hormones that are pressed into a solid, little insert, about the size of a grain of rice.

How does it work?

Your pellet will release a small amount of your hormonal regimen straight into your bloodstream, similar to what your ovaries or testes would normally have produced in your younger years. Research shows that pellets are able to deliver a consistent level of hormones to your body, unlike some creams, gels, or pills which are also compounded. Pellets also reduce the risk of blood clots (venous thrombosis) associated with oral hormone replacement therapy because the hormones released from pellets enter the bloodstream directly and do not cause changes in blood clotting factors made in the liver the way oral medications can. It’s a win-win!

How is it used?

Hormone Replacement Pellets are used like any other Hormone Replacement Therapy to help our bodies regain some of its hormonal balance, which will improve everything from the emotional roller coaster to hot flashes. The pellet is just a convenient delivery method! It’s not for everyone, but getting your hormones “just right” no matter the method is critical.

How long does the procedure take?

It is a quick and painless (with numbing medication) outpatient office procedure. We will insert the HRT pellet right into your hip, abdomen or buttock area, and you’ll be on your way and back to your life!

How long till I see results?

It will only take 7-10 days for you to notice your HRT Pellet working on your symptoms.

How long will my pellet last?

HRT Pellets typically last 3-6 months for men and women.

How can I make an appointment? Call us at 202.293.1000 or email us to set up a consultation appointment with one of our specialists here in Washington, DC. Don’t wait to get back to living your normal life – call us today!

Let's talk about IT - MonaLisa Touch

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.

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!

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!

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 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.

 

The postcoital feeling of deep connection, known as the “afterglow” is something couples can rely on to continue for a long time after the actual sexual encounter, according to a new report. The title, “Quantifying the Afterglow” published in Psychological Science, may sound like scientists are breaking it down beyond an emotional and physical connection, and although it is, that warm feeling (aka “the warm fuzzies”) is also physiological and has an evolutionary purpose—strengthening pair bonding. When the sex act concludes with fireworks (i.e., orgasm), how long do the sparks reverberate? Researchers sought to find that out by looking at data of two studies on newlyweds.

Spouses reported their daily sexual activity and sexual satisfaction for 14 days and happiness in marriage at baseline and 4 or 6 months later. It turns out that sexual satisfaction remained elevated about 48 hours after sex, and spouses experiencing a stronger afterglow reported higher levels of marital satisfaction both at baseline and over time.

Sex is Romantic, but also Scientific
Fast forward from being newlyweds to new parents. Overwhelmed, the new dad is tired, the new mom sore from nursing and may not feel like being touched after putting the newborn down to sleep. Those precious few hours before the next feeding might be needed for sleep or alone time. The amount of sexual intercourse that the couple took the time to have to create their baby, may come to a slow-down if not an all-out stopping point for a while. What’s a couple to do? Discuss. Then schedule sex.

Hilda Hutcherson, MD, a Columbia University assistant professor of obstetrics and gynecology and mother of four, said, it’s critical to just do it. Your physical connection, she says, bolsters your emotional connection: sex releases endorphins, the feel-good hormones, and also oxytocin, the bonding hormone new parents have, promotes feelings of trust and devotion.

Make sex a priority as important as working your 9-to-5 job, getting out for a date night, and keeping up with the bills. Keeping love-making a priority can remind the tired couple why they are together in the first place, and if they can manage to hold on to that “afterglow” feeling for a bit longer each time, the new phase of parenting life may be more enjoyable and less stressful.

Talk it Out
Are you both on the same page? Maybe not, but talking about the feelings and expectations you are both having, now that your family life is different is critical. Maybe your sexual yin and yang are off balance. By being honest about wants and needs, you may be able to get to a new place. Touch each other through non-sexual moments through-out that day to let each other know, “Hey I’m still here” even if you don’t want to have sex in the same way or as often as you once did. And who knows, the more “you” put yourself out there, the honest ideas you are having, could lead to deeper discussions, more fulfilling interactions, all of which strengthen relationships. Once the infant is on a sleep schedule, sex may get back to the way it used to, and if not, keep talking, keep touching, keep an open mind.

Later in Life
Remember those newlyweds? They’ve been married 20 years and have a kid in college. Their sex life should be as important as it ever was, even with the changing bodies as they age with grace. The new normal may be extra foreplay along with lubricants, moisturizers or other enhancements to make the sexual experience more enjoyable for both partners. The pair bonding that the couple enjoyed in the early marriage may still be going, if the couple was able to challenge themselves and each other during the other phases of life so that they can enjoy another “new normal” during this vibrant time of their lives.

A tiny butterfly-shaped gland at the base of your neck has an important role in overall well-being; it helps regulate body temperature as well as metabolism (how fast you burn calories). When the thyroid is under-performing or over-performing, issues start to crop up and women, who this mostly affects, begin to feel off, gaining weight, feeling more tired or listless than usual.

An interesting study on subclinical hypothyroidism alerts us to issues such as weight gain and hair loss that may be symptoms of the thyroid being overactive or underactive. However, before jumping to a self-diagnosis, you should consider your family’s genes and inherited traits related to weight and hair, because these also show up at middle age, just simply as a factor of getting older. If you have eliminated those as family traits as possibilities, it may be time to consider some blood tests to see what is going on.

The confounding factor about the thyroid is that the range of normal levels of most hormones is very wide. Because of this, a person may have thyroid hormone levels on the threshold for needing treatment, but still in the “official” normal range. Getting too much thyroid medication to optimize one’s blood results, can lead to other serious medical complications such as heart attacks and cardia arrhythmias (irregular beats), as well as bone loss, osteoporosis, and fractures. So, it is imperative to get the dosage just right. An expert in medical endocrinology or reproductive endocrinology (like me), understands these issues and can make slight adjustments to optimize thyroid replacement or supplementation, which often results in the patient feeling much better, with less fatigue, while minimizing the risk of side effects such as cardiovascular and skeletal disorders.

I always try and look at the whole patient, not just their symptoms or their laboratory values. I take into account the other medications that patients may be taking, which could have an impact on well-being. For example, if a patient is taking an oral hormone therapy to mitigate menopause symptoms, this can upset the normal thyroid balance, so it is vital to find the right balance of both these hormones. Similarly, younger women on birth control pills may experience excessive weight gain because their contraception has thrown off their thyroid. Once the optimal thyroid treatment is determined, the patient can stay on that dosage for a long time. Like butterflies, each patient is unique and a personalized approach works best.


Key Points

  • There is no “one size fits all” thyroid treatment.
  • Most women should be screened around the onset of menopause, if there they are considering going on hormone treatment, to find the thyroid’s baseline levels.
  • Women with rapid and excessive weight gain should be tested.
  • If there is a family history, patients should be screened at age 35 or if other signs of hyper or hypothyroidism are present.
  • Heart attacks, cardiac arrhythmias, and bone loss – occur later in life and are asymptomatic until they occur. Over-treatment with thyroid medication can causes these disorders down the road.
  • To learn more please call the office at (202)293-1000 or email the practice at info@intimmedicine.com.

 

Hot Flashes

For women going through the menopausal transition, there’s no better discovery than a safe, natural, nonhormonal treatment for hot flashes that really works.

So a study just presented at the annual scientific meeting of the American College of Obstetricians and Gynecologists caught our eye. It focused on an over-the-counter botanical extract derived from pollen. Could such a simple remedy really improve symptoms and quality of life?

To learn more, we spoke with the study’s author, James A. Simon, MD, an ob-gyn in private practice in Washington, DC, and professor at The George Washington University School of Medicine and former president of the North American Menopause Society.

Relizen, the brand name in the US of the botanical extract, was developed after an accidental discovery—a Swedish beekeeper noticed that when bees feasted on the pollen of a particular flower, they seemed more energetic. So he wondered if giving that pollen to men and women would make them more energetic, too.

“It didn’t work,” said Dr. Simon. “But menopausal women who took it said that their hot flashes were better.” So the extract was developed using just the cytoplasm (material inside the cell) of the pollen—according to the manufacturer, that removes the pollen allergens. It’s actually been available in Europe under different names for about 15 years, and it is backed up by peer-reviewed research. In a 2005 double-blind placebo-controlled study of 64 menopausal women, 65% of those who took it had fewer hot flashes—compared with 38% of those who took a placebo. It’s been used by more than a million women in Europe.

In the new study, 324 women going through the menopausal transition took Relizen daily for three months. To get into the study, the women had to be having hot flashes—and be bothered by them.

Results: 86% had fewer hot flashes, and for 91%, their hot flashes were less severe. What the new study adds is an emphasis on self-assessed quality of life—fatigue, irritability, sleep quality. These all got better, says Dr. Simon, who has no financial stake in the company that makes Relizen. “Their sense of well-being improved,” he said. The mechanism—how this extract works—isn’t well understood. Side effects, such as stomach upset, were rare and tended to go away after a week or two.

AN ADDITIONAL BENEFIT FOR BREAST CANCER SURVIVORS

Because research has confirmed that it doesn’t affect hormones, Relizen may have a particular role to play for women who have survived breast cancer who have been told that hormonal treatments aren’t safe for them. Currently, the only nonhormonal FDA-approved prescription for relief of menopausal symptoms such as hot flashes is the antidepressant paroxetine (Brisdelle, which has the same active ingredient as the antidepressant Paxil). But this antidepressant not only has side effects such as headaches, nausea, weight changes, reduced sex drive and interference with the ability to have an orgasm—it may also interfere with the action of Tamoxifen, the drug that is often prescribed after breast cancer treatment to prevent recurrence. Relizen, according to a recent study in Menopause, doesn’t affect the action of Tamoxifen.

SHOULD YOU TRY IT?

If you want relief from hot flashes and night sweats, Relizen is one of many options, said Dr. Simon. Hormone therapy, such as estrogen, is certainly the most effective for symptomatic relief, but many women want to avoid taking systemic hormones based on safety concerns. (We’ll revisit this controversial issue in an upcoming article.)

Plant-based supplements that have estrogenic effects can help, and Dr. Simon occasionally recommends Remifemin, an over-the-counter product that contains the estrogenic herb black cohosh. “I double the dose on the package insert to achieve the best results,” he said. Purified soy phytoestrogens also work for some patients, he notes. If you decide to pursue either option, he recommends that you work with a health-care professional, as there are safety questions for some women in taking estrogenic compounds, especially women with or at high risk of developing breast cancer.

Among nondrug approaches, he’s seen success with hypnosis. Even acupuncture, which hasn’t been shown in studies to be effective for hot flashes, appears to work for some people, said Dr. Simon.

What he likes about Relizen is that it’s so safe—for any woman, including those with a history of hormone-sensitive breast cancer—that it’s fine to try on your own. “A patient can acquire it by herself and see if it’s beneficial—before seeing her practitioner,” said Dr. Simon. “If it doesn’t work after two or three months, she can see her health-care professional for other options.” (Note: Relizen is currently available through the manufacturer’s website.)

Sources: Study titled “Nonhormonal Treatment of Perimenopausal and Menopausal Climacteric Symptoms” by James A. Simon, MD, CCD, NCMP, clinical professor of obstetrics and gynecology, The George Washington University School of Medicine, and René Druckman, MD, presented at the American College of Obstetricians and Gynecologists Annual Scientific and Clinical Meeting 2016. Dr. Simon is a Washington, DC–based physician who provides patient-focused care for women across the reproductive life cycle, from adolescence to childbirth, and through the menopausal transition.

Save

Recent Posts

Categories

Archives