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!

Men have Pills for their Sexual Dysfunction, Why Can’t Women?

A Response to “How Addyi, the ‘Female Viagra,’ Can Do More Harm Than Good” By Dr. James A Simon

Earlier this month, Dr. Janet Brito, a sex therapist based in Hawaii, raising a few questions about the efficacy and wisdom in using Addyi, known as the “Female Viagra,” to treat sexual dysfunction in women. The article she wrote has been removed from that site that posted it due to the inaccuracy of the information the article contained. In spite of this, I felt that it was important to address her concerns, and to explain how Addyi is, in fact, an empowering tool that women who are suffering from hypoactive sexual desire (HSDD) or female sexual interest/arousal disorder (FSAD).

Efficacy and Use

Regarding the efficacy and use of Addyi, Dr. Brito makes several claims that are either blatantly false or not based in fact. She states that Addyi “needs to be taken every day for at least 8 to 16 weeks before it starts working.” According to the package insert itself (approved by the FDA), if Addyi isn’t working by 8 weeks, its use should be discontinued.

Brito brings up the fact that “according to the Addyi website, ‘it’s exact mechanism of action is not fully understood,’” without any other comment, perhaps implying that this is a reason it should not be used, but this fact is also true for all antidepressants, pain killers, appetite altering medications and most medicines generally.

“Initially, flibanserin was slated for the treatment of depression. After two rejections by the FDA, Addyi was approved in 2015 to treat low sexual desire in premenopausal women — despite trials showing only minimal results compared to a placebo,” states Dr. Brito. Addyi was originally developed to treat depression, but in people with major depressive disorder where Addyi didn’t work for depression, it increased sexual desire. That’s correct, it worked to increase sexual desire even in women that were clinically depressed.

Thus, the company behind Addyi pursued sexual dysfunction as an option to help women suffering from hypoactive sexual desire disorder or HSDD or female sexual arousal disorder or FSAD. The drug was rejected twice by the FDA, in my opinion, because the FDA kept changing their mind about what they wanted.

The company was trying to develop a first-in-class medication where the tools for assessing efficacy weren’t invented yet. For responders to the medication (excluding all the non-responders), they had 5.7 sexual events per month, which can’t be considered minimal, and which the responders themselves judged as a meaningful improvement.

“Their desire stats did change and show an increase when researchers measured it according to the Female Sexual Function Index — but if participants didn’t notice their own response, can it really be considered effective?” asks Dr. Brito. The Female Sexual Function Index is a validated questionare answered by the study participants, an approach agreed upon with the FDA. Participants reply to the FSFI based on how they, the participants, feel.

Social Oppression and Relationships

Dr. Brito spends a great deal of the article drawing a connection between a pill to treat sexual dysfunction for women and a long history of societal oppression of women. I fail to see the connection, as Addyi is only prescribed to patients who wanted to increase their sexual desire for one reason or another, not because their partners or society had problems with their libidos as Brito suggests.

Brito’s other accusation that those who prescribe Addyi are not taking into account any of the other factors that might contribute to low sexual desire, is not based in fact. Study participants were excluded from entering the research studies if they had any other reason for their loss of sexual desire, any reason. Such reasons would have included: depression or other medical conditions, medications known to affect sexual function, and any relationship problems, just for examples. Erectile Dysfunction has many causes and factors, and yet men are prescribed Viagra without a second thought. Shouldn’t women have equal access to a pill that can help them with their sexual function, too?

Like those who are prescribed a pill for depression, Addyi can help women start living their lives again, and get back to their old selves.

Brito also writes, “…sometimes the issue is about the relationship you have with yourself, not others.” On this point, I totally agree. But women with relationship problems with themselves or their partners were excluded from the clinical development of Addyi as noted above. Addyi is there for women who have been diagnosed with HSDD or FSAD, who are in a healthy relationship with their partners, and who want to get back to enjoying their partners sexually.

Dr. Brito concludes the article with this line, “Instead, ask yourself, honestly, if any of the aforementioned factors are impacting your life. And, if so, what lifestyle changes to embark on to start to feel better on your terms.” Addyi, Viagra, anti-depressants, and a slew of other medications may not be the best choice for every patient, but the patient does have a choice.

Why a sex therapist (who cannot even prescribe Addyi or medication generally) is ruling out a drug that is effective, readily available, and which delivers on the promise to increase “sexual desire and satisfying sexual events,” is beyond me.

To discuss if Addyi might help you or determine if you might be suffering from HSDD or FSAD, give us a call at 202.293.1000 or e-mail us to make an appointment at our office in Washington, D.C.

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

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!

Upon hearing a cancer diagnosis a person’s world changes immediately and forever. The person becomes a patient. The patient has to make myriad decisions about treatment plans, and the possibility of surgery, radiation, and chemotherapy. These treatments, while life-saving, are also life-altering. The side effects can modify body image, reduce or end fertility, change sexual identity and sexual function. Approximately 60 percent of cancer survivors have long-term sexual dysfunction. Oncology teams (who may focus more on the life-saving aspects of care) aren’t always taking the time to discuss fertility or sexual health matters as much as they should. But the good news is that our practice can help save a women’s eggs, or a man’s sperm for future use; mitigate and reverse most hormonal changes, and starting in September, we will also offer treatment for men with urological or sexual complaints in our practice. Our newest colleague, Rachel S. Rubin, MD, is specially trained to treat hormonal and sexual dysfunction in both men and women.

Talking about sexual health outside of the bedroom, in the office of a compassionate physician is key to holistic wellness. The emotions of being a cancer survivor can be overwhelming in and of themselves, but to add infertility or sexual dysfunction to the list of health issues can be daunting. We’re here to help you get back on track.

For Men
Following prostate cancer treatment, for example, the ability to have and maintain an erection becomes difficult and for some men, impossible, without help from a medical practice such as ours. Many men may not feel comfortable talking about these intimate issues, but there is help. Our compassionate and caring staff can help men who experiene treatable symptoms. It’s not just about physical symptoms, cancer affects sexual identity and when men are unable to perform as they could prior to cancer treatment, it can have a serious and detrimental effect on one’s psyche. Getting the courage to seek help is the first step to getting back to the “new normal.”

For Women
Breast cancer, when surgery is required, may alter a woman’s body and can hinder sexual identity and function. Breasts, once part of the sexual experience for both partners, are no longer the same. Even when reconstructed, the breasts may feel different, lack the pleasurable sensitivity they once had, or might even be painful and distracting. Sensation might even be completely gone. Partners may also feel hindered by the feeling of the new breasts. This can be uncomfortable for both partners. With any cancer treatment (i.e. chemotherapy, surgical removal of the ovaries or even hysterectomy) a patient may find herself in early/premature menopause with hot flashes, night sweats, disturbed sleep and weight gain. This is also accompanied by vaginal dryness, and pain with genital touching or intercourse. There are options to help enhance the sexual experience that we have available at the office, and that are not available anywhere else.

A wonderful Newsweek article about these issues does a deeper dive from both the patient and physician perspective that we welcome you to read for additional information.

If you are just starting cancer treatment, going through it, or are in the post-treatment phase and are facing future or current fertility concerns, hormonal deficiencies, or sexual dysfunction, we can help. Please call our office at (202) 293-1000 to make an appointment with one of our caring and compassionate members of Dr. James A Simon’s team.

Researchers have discovered many of facets related to women’s biological and physiological reactions, but when it comes to sexual response, there is still a learning curve. However, there is great news! A recent study on sexual pleasure among women, reports that certain variations of genital touch are pleasurable, preferable, and/or associated with orgasm. Women know this but at what level? As we discussed in our previous blog, women’s early sexual partners provided them with their only sex education; with little knowledge and much fumbling, clitoral pleasure, for example, was discovered almost by accident. Sharing sexual history is important for women as patients, medical professionals, and sexual wellness educators. Helping women to communicate as honestly as they can with their medical care team, can help to improve women’s sexual health and wellness and overall fulfillment.

Sexual Pleasure Study
A large-scale study about women’s pleasure was conducted in partnership with OMGYes Sexual Pleasure Project: Women and Touch and researchers at Indiana University’s School of Public Health and The Kinsey Institute in 2015. The team asked 1,055 women ages 18 to 94 years to take an internet study that asked specific questions about genital touch, sensation, pleasure, and orgasm. Previous studies that have focused on more specific techniques related to women’s sexual pleasure and orgasm have not fully examined types of touching in detail. Rather, they have often focused on stimulation of particular body sites such as the clitoris, “g-spot,” or breasts/nipples, and so on. But this study was specifically focused on one area, to gather as much information in greater detail than has been previously recorded. The full report is in the July issue of the Journal of Sex and Marital Therapy.

Orgasm during Intercourse
Of the survey respondents, 347 women who ever had intercourse reported that they needed clitoral stimulation in order to have an orgasm; 341 said that although they did not require clitoral stimulation for orgasm during intercourse, adding it enhanced orgasm; and 174 reported that vaginal penetration alone during intercourse was sufficient for orgasm. The remaining 71women reported they did not have orgasms during intercourse.

We’re All Different and That’s Okay
Respondents varied widely on at least four areas: (1) location, (2) pressure, (3)
shape/style, and (4) patterns. Women might find it helpful to think about these different dimensions of genital touch or stimulation when exploring their sexual response during solo or partnered sexual play. Having these four dimensions of touch in mind may give individuals or couples more direction to experiment and find out what works best for her/them!

Results also shed light on orgasm during penile-vaginal intercourse. In the study sample, some women reported experiencing orgasm from penetration alone (without additional clitoral stimulation), however more than half do so infrequently. Specifically, more than have the respondents experienced orgasm 50% of the time without clitoral stimulation, sometimes less so.

Question and Answers
As an example of how detailed this study was this question exemplifies the desire to better understand the source of pleasure when being touched:

“When you or your partner use fingers/hands/mouths/tongues, where
primarily do you prefer your genitals to be touched?” with the ability to choose all that applied.

Options were:

  • directly on clitoris, on the skin around clitoris
  • avoid touching clitoris directly
  • occasionally brushing over clitoris but not applying pressure to it
    on vaginal lips (labia minora or labia majora)
  • on the mons (the pubic mound; the triangular part where pubic hair grows)
  • Something else, please describe.

What’s Next?
The purpose of this study was to provide data on sexual pleasure among women, and specifically some variations of genital touch that are pleasurable, preferable, and/or associated with orgasm. Overall, results demonstrated substantial variability among American women’s preferences. Some kinds of genital touching or stimulation were more often preferred than others and most women endorsed a narrow range of touch techniques, underscoring the value of partner communication to sexual pleasure and satisfaction. We can learn a lot by asking questions of our patients and our partners.

If you have questions about your sexual wellness please contact our compassionate and caring staff at (202) 293-1000.

Amused young African American couple sitting and hugging

Amused young African American couple sitting and huggingAs most of us know, a great relationship doesn’t start and end with sex. But a healthy sex life does form an integral part of it. In fact, almost 80% of men and 66% of women view sex as important to their relationships. And research shows that when one’s sex life is assessed as “good”, it adds 15-20% positive value to a relationship. But when one’s sex live is reported to be “bad or non-existent”, it plays an inordinately powerful negative role, draining the relationship of its positive value, by 50-70%!

And for the critics out there, it’s important to note that sex isn’t just physical. It’s an opportunity to express feelings that words cannot … an emotional experience that brings you closer with your partner … and, for some, the ultimate expression of their love. Not only does it foster a unique closeness, it can also provide comfort in times of stress, anxiety or other troubles. And it can help to keep things fresh and exciting, as couples “rediscover” each other through varied forms of sexual expression.

Timing and Frequency
Unfortunately, “importance” can be very subjective. While one person might view daily sex as crucial, another might think they’re doing a pretty good job fitting it in once every week or two. As long as a couple is on the same page, there are typically no problems. If it works for both of you, great! It’s when there is a difference in opinion that problems begin to arise.

Sex Drive Compatibility
If one person has a higher sex drive than their partner, they can start to feel unfulfilled. The other partner may wonder what the big deal is. (“Come on, it’s just sex!”) But for the unfulfilled partner, it can be a huge deal. They may begin to feel unwanted or unloved, and may even turn to sex substitutes, such as food, alcohol, drugs, even infidelity. Or they may just become angry and resentful. As a result, the relationship starts to suffer on all levels, which in turn, leads to even less sex, thus perpetuating a vicious cycle of conflict.

Making Time
The key to a healthy sexual relationship is often compromise – whether you’re the one who occasionally has sex when you’re not in the mood, or the one who goes without for a few days. Another key is being proactive – trying new things in the bedroom, seeking counseling, or simply making time for sex. There are a number of things that can slowly but surely erode your sex life – from busy schedules and kids to aging/changing bodies and lack of communication – but if you make sex a priority (instead of letting it become the white elephant in the room), you can keep the passion alive and your relationship healthy.
Interested in women’s sexual health? Contact us for an appointment.

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.

I’m pleased to share with you some exciting news about a treatment for low sexual desire that has an unintended consequence you may actually appreciate–weight loss. Some patients reported that after using flibanserin for as short as 8 weeks, that they began noticing that their clothes were looser and the number on the scale was surprisingly lower. Sounds too good to be true, I know, but let’s take a look at what flibanserin is and how it affects the brain.  Flibanserin is a serotonin 1A receptor agonist and a serotonin 2A receptor antagonist, which influences biological and neurological processes. While its primary effect is to increase sexual desire, it also has an impact on anxiety, appetite, memory, mood, and sleep. Researchers found that this treatment reaches the part of the brain that experiences sexual desire, but it may also impact satiety, that feeling of fullness at the end of a meal. Unlike some weight loss medications, there appears to be no weight regain with flibanserin (at least for about 18 months of study). More research will help us learn more about these effects, both sexual desire and weight, over the long term, but this is considered clinically meaningful in my book.

Flibanserin was first approved by the Federal Drug Administration (FDA) in August 2015 for low libido in women and was immediately dubbed the “female Viagra” although that is a misnomer.  Viagra treats a blood-flow issue to the penis, a physical issue, not desire which is an issue of the mind. For most women, sexual desire starts “north,” in the brain.

The Science Behind Improving Sexual Desire
Flibanserin was originally created as an antidepressant and although it didn’t work very well for depression, patients noted a pleasant side effect, an increase in sexual desire. It went back to the lab for further research, leading us to this moment in a new sexual revolution for premenopausal women. Considering that many women experience sexual dysfunction at some point, it is worth going for an evaluation with your doctor, ruling out extenuating circumstances (i.e., relationship problems), and see if this loss of desire is an actual diagnosable disorder, hypoactive sexual desire disorder or HSDD. If it is there is a solution.

Optimal Timing and Dose
The effectiveness of the 100 mg bedtime dose of flibanserin was evaluated in three pivotal 24-week trials of 2,400 premenopausal women with hypoactive sexual desire disorder (HSDD), otherwise known as “not ever in the mood for sex…ever!” The average age of women in the trials was 36 years, and these women had experienced diminished sex drive for about five years. While many have said that this medication only works in a small percentage of patients, and only has a little benefit at that, our experience is that those who respond do so in 8 weeks, and really recognize the difference. However, flibanserin has not been shown to enhance sexual performance in normal women, but it’s a starting point for women who have not been able to put a name to their low sexual desire condition, or have not found an effective treatment.  Additional treatments such as vaginal estrogen and or testosterone may be used for physical issues such as vaginal dryness or pain with intercourse.

Flibanserin is not without some side effects such as dizziness and in a few cases, lower blood pressure. But taken as directed, specifically, at bedtime, and without alcohol, you may be in for a satisfying sexual experience and some weight loss, which you will be thankful for all year long.

The phases of a cancer diagnosis might be compared with those of dealing with the death of a loved one: denial, bargaining, anger, and eventually acceptance. Fortunately for many, there IS life after cancer. A sexual life too, that part of one’s life may have been put on the back-burner during cancer treatment. The statistics on survivorship are astounding, creating a “before” and “after” picture for many.  It is important to understand both of them. Progression-free survival rates indicate no new tumors have formed. Whereas disease-free survival rates refer to remission, cancer free. The death rate from breast cancer has fallen 34% since 1991. Following the grueling chemotherapy, radiation, and/or surgery, it might not immediately occur to patients and their partners to re-connect through sexual activity.  I would encourage you or anyone you know in the survivorship phase, however, to make it a priority. Absent sexual activity, all genital tissues (skin, mucus membranes, and muscles), suffer from disuse atrophy. The good news is this: with the intention to connect or reconnect with your partner, and the use of various products available (if necessary), solutions to sexual activity may result in your “new normal.” Your body image, to the degree it suffered during cancer treatment may need a boost and a re-boot. A renewed sexual life can often help.

Sexual Healing
Whether due to cancer, certain medications that interfere with sexual response such as antidepressants, or menopause, sexual response changes during a lifetime. Menopause can be a premature consequence of cancer treatment. Both chemotherapy and pelvic radiation can result in menopause regardless of a woman’s age. Lubricants and vaginal moisturizers are readily available, but I caution you to look at the ingredients, as some may be irritants to those delicate tissues. Ingredients such as those found in spermicides, benzyl alcohol, and materials such as latex can cause discomfort for some.

With the sudden onset of menopause from surgery, radiation or chemotherapy, many women find that they experience intense vaginal dryness, and pain with sex (usually at the time of penetration). To mitigate this issue, vaginal moisturizers which are used on a routine basis whether one is having sex or not, can help to bring water into the vagina. Think about vaginal moisturizers like the moisturizer you use on your skin…you don’t just apply it when you are getting your picture taken. You use it on a regular basis. And lubricants (they aren’t the same as moisturizers) which come in oil, silicone, water-based, and mixtures of each of these can solve the dryness and lack of natural lubrication missing after some cancer treatments. Lubricants are used at the time one is having sex. They help the vagina operate as it once did naturally, and can make sexual activity more pleasurable by easing friction and lessening pain.

Enhance Sexual Pleasure
The marketplace has been flooded with sex-positive devices to enhance the sexual experience for both men and women. Toys, vibrators, dildos, and much more have piqued the curiosity of people who want to try something new. A medically accurate fantastic and friendly site middlesexmd.com/ can help educate you and your partner about new products, techniques and “tools” to keep your sensual side smoldering. Our office stocks a variety of such sexual aids and can help with proper selection, especially when sexual function is hampered. Keeping an open and honest discussion with your partner about your needs and interests, as they change in the “new normal” can alleviate anxiety and further build on a relationship that has endured and surpassed, the diagnosis of cancer. Get personal. Have fun. Explore.
To learn more please call the office at (202)293-1000 or email the practice at info@intimmedicine.com.

Recent Posts

Categories

Archives