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

woman holding a baby in her lap
Postpartum

Treating Postpartum Vaginal Laxity

If you’ve given birth, you know all the physical and emotional distress associated with the process! And if you’ve given birth vaginally, you know it can be difficult to bounce back to normal “down there,” which can have a major effect on your sex life.

Vaginal Laxity, or “looseness” as it relates to vaginal childbirth occurs when the muscles in the walls of the vagina are over-stretched as you push that bowling-ball sized baby’s head through it. The vagina naturally relaxes in response to sexual arousal, but regular sexual activity will not contribute to the vagina “loosening” because the vaginal will naturally re-tighten itself afterwards. The relaxing of the vaginal wall also naturally occurs during childbirth, but there are limits to its elasticity. You can stretch out a waistband or a sock in the same way – over-stretch it, and it will never be the same… or will it?

Sometimes Vaginal Laxity sorts itself out along with a host of other post-partum body complaints that new moms have once their babies have transitioned over to solid food and stopped breast feeding. But, Vaginal Laxity can also persist, and can contribute to sexual dysfunction. Not everyone who experiences Vaginal Laxity has complaints about their sex life, but it can reduce pleasurable sensation during intercourse and result in less sexual satisfaction for you and your partner, which of course contributes to less sexual intimacy. Add Vaginal Laxity to the list of other life-altering changes that baby brings and it can seem like your love life is over!

The good news is, you do not have to live with Vaginal Laxity! There are many ways to treat it. Talk to your OB/GYN about it at your next appointment, try pelvic floor physical therapy, and keep up with your Kegel exercises, but your vaginal walls might still need a little extra help. That’s where we come in! IntimMedicine Specialists is host to several ongoing clinical trials, and we are excited to offer a free treatment in a study on a new technology to help with vaginal tightening! If you’ve given birth vaginally at least six months ago and are experiencing sexual dysfunction related to vaginal laxity, you may qualify. Medical insurance is not required for study participation and compensation for time and travel is provided.

If Vaginal Looseness is keeping you from enjoying sex, it’s time to treat it! Space is limited, so call to schedule your appointment with Laura Barbee at 703-242-6362.

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!

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!

Women have the only organ in the human body exclusively dedicated to pleasure: the clitoris! This humorous brief documentary educates people and reveals something very telling: the clitoris has been ignored and hidden—by society, medical professionals, and educators. For many women, their early sexual partners provided them with their only sex education; with little knowledge and much fumbling, clitoral pleasure was discovered almost by accident.

Clitorologist?
Think about it. Have you ever been taught how to look at your clitoris? Has a doctor ever asked you about your clitoris or examined it? Medical professionals are not routinely taught the anatomy of the clitoris (Even some of the most famous textbooks don’t mention it!), and it is not considered part of the routine female pelvic exam. This poses a big problem. If doctors don’t know what a normal clitoris looks like, how will they know what to do when questions or problems come up? What kind of doctor do you see if you have a problem with your clitoris? (Pssst: There is no such thing as a clitorologist!)

Clitoral Problems
Pain in the clitoris (called “clitorodynia”) is considered a localized form of vulvodynia (vulvar pain) and is thought to occur in 5% of women who complain of painful intercourse. Pain can be due to adhesions or scarring of the clitoris where the clitoral hood (aka the prepuce) gets stuck to the glans clitoris. This can lead to trapping and buildup of oils and dead skin cells which cause underlying irritation and infection. Women describe the pain as burning, stinging, or sharp—some have likened it to the sensation of having a grain of sand in your eye. It can affect the whole pelvis and just feel like “pain down there.” Clitorodynia can make a sexual experience difficult, if not impossible. As well as potentially leading to female sexual dysfunction, it can also make everyday life excruciating because the “pain down there” can be present all the time, even without sexual activity.

Help is here
Doctors trained in sexual medicine can diagnose and treat clitoral problems! With a specialized physical exam and several diagnostic tests, the underlying cause for your pain can be found. Luckily a number of successful medical and surgical treatment options are available.

For example, at a recent national conference, our newest practice member urologist Rachel Rubin, MD, presented research on a new minimally invasive in-office procedure to remove clitoral adhesions. In this study, 15 women with clitorodynia reported complete resolution of their adhesions after the treatment, with the majority reporting improvement in or elimination of their pain symptoms.

Speak up
Sexual health is an important part of your general health. You deserve a pleasurable, pain-free sexual experience. If you have discomfort or pain, we are here to help. Please call us at (202) 293-1000 if you are experiencing any symptoms so we can work together to improve your sexual health.

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.

Sexual empowerment not only applies to equality in the boardroom of the work place, but in the bedroom as well. Equality in comfort and sexual satisfaction, and equality in the types and numbers of treatments available. Women who have had their last menses sometimes say good-bye to their enjoyable sex lives because of pain during sexual activity, due to vulvar or vaginal changes, lack of lubrication, all of which can affect one’s libido. Societal cues, shame, or embarrassment about this lack of sexual equality are not being addressed enough and there are solutions. These physical symptoms are brought on by menopause, whether medically-induced menopause or natural menopause, but because the symptoms may “sneak up” on a woman, the connection to menopause is often lost, and women commonly assume this is just another symptom of getting older, like arthritis. There is certainly nothing natural about a sudden halt in one’s sexual life when pain and dryness interfere. We have answers.

Why the Disconnect?
Many postmenopausal women are relatively unaware of how the symptoms of menopause affect them sexually, and what treatments are available, according to findings presented at the Annual Meeting of the North American Menopause Society.

Results of the Women’s EMPOWER survey reveal that women generally didn’t recognize vulvar and vaginal atrophy symptoms, and were reluctant to discuss them with their healthcare professionals. This second part is most concerning to me. I’m available to discuss, mitigate, and resolve sexual issues. Participants in the survey also reported that they lacked knowledge about therapeutic options to alleviate these bothersome symptoms. When compared with six previously conducted surveys — REVEAL, VIVA US, Healthy Women #1, REVIVE, CLOSER North America and Healthy Women #2 — evaluating knowledge, behaviors and attitudes related to vulvar and vaginal atrophy, EMPOWER demonstrated yet again that women failed to recognize vulvar and vaginal atrophy symptoms, and were reluctant to discuss them. Further, participants reported that they lacked knowledge about therapeutic options to alleviate the symptoms. But, there is no reason to suffer in silence. Speak up!

Experts such as myself, a reproductive endocrinologist, sexual medicine and menopause specialist, and Clinical Professor at George Washington University in Washington, DC, and my colleagues seek to address these issues and have released a study on a new treatment that will enable women to reclaim their sexual vitality.

The REJOICE Trial
TX-004HR is as soft gel capsule containing low-dose, solubilized, natural, bioidentical 17 B-estradiol.  Our team team conducted a phase 3, randomized, double-blind, placebo-controlled, multicenter REJOICE trial that demonstrated this treatment to be safe and effective for treating moderate to severe dyspareunia (painful intercourse) in postmenopausal women with vulvar and vaginal atrophy (VVA). In total, 764 women were eligible to participate in the study, of which 704 (92%) completed the study.

The study used the Female Sexual Function Index (FSFI) as a measurement of the impact of this treatment on sexual function. The FSFI is a self-reporting tool to assess sexual function during the past 4 weeks. It consists of 19 questions categorized into six domains of sexual function (desire, arousal, lubrication, orgasm, satisfaction, and pain).

VVA affects more than 30 million women who go untreated, in part, because of the perceived risks of estrogen, which I have explained in an earlier post,  Estrogen and Breast Cancer Risk: Separating Fact from Fiction.  But this new treatment  aims to alleviate the symptoms without adding any risk by providing a treatment that goes to the source of the issue, the vagina and vulva, with little or no systemic absorption of estrogen. The REJOICE study compared the effects of 12-weeks of treatment with TX-004HR at varied doses with placebo in postmenopausal women (40 to 75 years old) with VVA and moderate to severe dyspareunia (i.e., difficult or painful intercourse).

The Good News
The research team found that TX-004HR improved sexual function in postmenopausal women with moderate to severe VVA and dyspareunia. After 12 weeks, all three TX-004HR doses increased the average total FSFI score.

This treatment shows promise for women who  experience these symptoms and they should talk with their partners and their medical team to address issues as they arise. If these symptoms are affecting your sex life, I encourage you to give our office a call to help develop a plan for a healthy and happier sexual life going forward.

 

Leading researchers are urging the medical community to rethink how they treat patients who experience severe menopausal symptoms. Mache Seibel, MD., former 20-year veteran of Harvard Medical School faculty, editor of My Menopause Magazine and Professor of OB/GYN, University of Massachusetts –was inspired by his wife’s experience, and took it upon himself to help her and countless others, manage this important phase of life. Dr. Seibel studied the hormones given to women to treat symptoms and revisited the research in the Women’s Health Initiative (WHI) from 2002. After an up-close look at the data, he realized that further educating people about the role of hormones in health was necessary.


Jane Doe Lost Her Mojo

Many women who are in the prime of their lives and height of careers struggle with the debilitating symptoms associated with menopause. Consider this scenario: A healthy woman, aged 51, is looking forward to engaging in a night of foreplay, fun and sex with her partner, but is unable to enjoy herself, because of the lack of natural moisture she’s had all of her life until now. The “dry sex” she now has leads to pain during intercourse–two common symptoms of menopause. Following an unsatisfying sexual experience, she eventually falls asleep, only to be awakened by hot flashes and night sweats, soaking her sheets. The next day she wakes up tired, frustrated, and in a mental fog, only to have this experience happen the next night, and the next, and the next, and again the week after that. Knowing that sexual desire for women starts in the brain, she became unsure about how to connect her desire for intimacy with her body’s sexual response the way she used to, and her overwhelming fatigue makes her wonder if it’s worth the effort. The good news is that the experience of the menopausal transition can be positive, given the appropriate treatment, which varies depending on the age and health-status of each woman.

Understanding Menopause
The process of menopause is like the process of puberty—but in reverse, says Dr. Seibel in his revolutionary book, “The Estrogen Window: The Breakthrough Guide to Being Healthy, Energized, and Hormonally Balanced–through Perimenopause, Menopause, and Beyond.” Although puberty is well understood, menopause, which effects every woman, is less so. Women may assume that the surge of estrogen during early menses will suddenly shut off like a spigot, but it is more subtle and takes longer than one might imagine, leaving in its wake, uncomfortable symptoms, which were broadly treated with hormones such as estrogen and synthetic progesterone (progestin) until the WHI study results were released in 2002.

The WHI hormone studies have increasingly come under fire for the way they were designed, most importantly the inclusion of women up to age 79 years. The results of these studies have reverberated through the medical community as the changes they caused may have been both too broadly applied and in some cases simply incorrect. The findings that hormone therapy was putting many women at risk for certain conditions such as breast cancer and cardiovascular conditions caused many women to go off their hormone-replacement therapy “cold turkey” without knowing how to address the consequences, and not fully understanding the risks versus rewards. For example, some of the patients in the WHI study were already at risk for cancer or cardiovascular disease because of life-long smoking, being overweight and the age at which they started hormone therapy. However, otherwise healthy women should be able to use these therapies to ward off the symptoms that affect sexual health and pleasure.

Opening the Estrogen Window
Dr. Seibel calls the estrogen window, the “decade-long time-frame between the ages of 50 and 60, or 10 years from the time of menopause,” which is defined as at least 12 consecutive months menstrual period-free.

His book outlines important recommendations that are not a one-size fits all approach. Here are several key takeaways for improving and maintaining sexual vitality:

Low estrogen levels at midlife are common causes for genitourinary syndrome of menopause that causes bladder leakage, vaginal dryness, and elasticity in vaginal tissue to change–leading to discomfort during sex (location 3014).

The estrogen window for vaginal estrogen always remains open; it never closes (location 836).

Estrogen alternatives exist for women with medical histories (e.g., breast or endometrial cancers, blood clots, liver disease, pregnancy, undiagnosed uterine bleeding) that make it inadvisable to take estrogen (location ,787 814).

This book is available online and at the website drmache.com/Estrogen-window-book. This website contains downloadable bonus material, including the Menopause Checklist, Sleep Diary, and much more. Armed with this information, a visit to your gynecologist can lead to better overall health and importantly, a continuation of a satisfying sex life, well into advanced age.

To learn more please call the office at (202)293-1000 or email the practice at info@intimmedicine.com.

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