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 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.

 

Vulvovaginal Atrophy

vulvovaginalVulvovaginal 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.

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

18jdwo1qlvkujjpgA 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.

 

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Opposition to the “Pink Pill” –  New View Campaign Has an Old View (Part 1 of a 4-Part Series)

During the public hearing portion of the advisory committee meeting, most of the testimony came from women seeking approval of the drug. However, there were some naysayers. Their arguments against approval boiled down to 4 perspectives. In my opinion, the arguments against the drug miss the mark.

The view is presented that development of flibanserin represents “medicalization” of a disorder that can be treated effectively with psychotherapy and education. This perspective is best embodied by an organization called the New View Campaign.

Refuting this perspective, however, is research in animal models that clearly demonstrates that HSDD (or its equivalent in animals) is the result of an imbalance between dopamine and norepinephrine on the positive end and serotonin on the negative end. These findings are supported by functional magnetic resonance imaging (MRI) and positron emission tomography (PET) scans of the brains of women with HSDD who are shown erotic stimuli. The scans demonstrate that their brains respond differently from those of normal women. So if it’s all about education and counseling, why are the brains of women with HSDD functioning differently?

I would argue that, if depression and HSDD are both abnormalities of the serotonergic system (flibanserin is essentially an SSRI), then how can depression be a biologically based disorder but HSDD can’t? In my opinion, the New View Campaign isn’t new at all.

Continue reading “Opposition to the “Pink Pill””

The “Pink Pill”-Who Is It For?

Pink PillsThe “pink pill”, flibanserin, was developed for premenopausal women. Although preliminary data on flibanserin use among postmenopausal women are available, the drug was studied primarily in premenopausal women with Hypoactive Sexual Desire Disorder (HSDD), the indication sought at this time.

In the premenopausal population, problems such as pain with intercourse or hyperestrogenism aren’t typically present, simplifying the identification of HSDD. In clinical trials of the drug, HSDD was secondary, generalized, and acquired—that is, it followed a period of normal sexual function. And it didn’t come and go but was present regardless of location and circumstance.

Study participants had had a normal sex drive before their desire “turned off,” an occurrence they found distressing.

Clinicians, myself included, have been frustrated by our inability to prescribe an effective treatment for this common problem. The recent recommendation of an FDA Advisory panel to approve flibanserin for the treatment off HSDD in premenopausal women brings us a step closer to having additional options for treatment.
(Excerpted from an editorial by Dr. James Simon published in OBG Management, July 2015)

 

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

Sexual HealthDid 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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