Dr. James Simon discusses the importance of sexual health at menopause and encourages clinicians to open up the conversation with patients. He reviews treatment options and resources. (www.menopause.org)
Is penetration ever painful for you? Whether it’s with fingers, toys, or penises, you’re not alone: An estimated 50% of menopausal women with sexually active partners experience pain during vaginal penetration. And that’s just women in menopause. (Note: Here’s a Partner’s Guide to Menopause)
Dyspareunia is a very general term for pain with penetration during intimate sexual contact. Deep pelvic pain, or deep dyspareunia, usually emerges because of other existing disorders hidden in the pelvis—either adjacent to or touching the upper portions of the vagina.
There are a few different possible causes for this deep pelvic pain (or deep dyspareunia), which include:
- fibroid tumors in the uterus
- cysts in the ovaries
- tumors on the ovaries
- scarring from pelvic infections or prior surgery
While the disorders that we just listed above are relatively common, the deep pelvic pain that can result from them is not nearly as common. Most people with these disorders won’t have the correlating deep pelvic pain, but if you experience a new onset of deep pain during sex, which can be triggered by a new partner or experience, you should talk with a doctor or other health professional.
More common causes of both superficial and deep pelvic pain include:
- Vaginal atrophy following menopause (AKA vulvovaginal atrophy, genitourinary syndrome of menopause, or GSM)
- Vestibulodynia (vulvar vestibulitis)
- Pelvic floor muscle dysfunction
Regardless of the cause, pain during penetration is not fun, and it certainly isn’t comfortable. To provide additional context, this typically happens when there’s any restriction of movement at the opening of, or at the top of the vagina.
The vagina is meant to slide on its neighboring organs (i.e., ovaries, tubes, uterus, intestines, rectum, etc.). When the top of the vagina (or the vaginal apex) is restricted or bumps up against a tender neighboring organ or disorder, like a fibroid or an ovarian cyst, during penetration, it can cause deep pain.
Other relevant factors include:
- Depth of penetration
- Sexual position
Let’s do some quick math—Depending on the length and girth of the fingers, penis, or toy that’s penetrating you + the length of your vaginal canal = deep pelvic pain may only occur intermittently, for example, only with sex in particular positions, with a particular partner, or with a particular partner in a particular position.
If you are experiencing deep pelvic pain from penetration, regular or otherwise, a diagnosis can usually be determined with a vaginal or abdominal ultrasound (sonogram). Vaginal ultrasounds are preferred since the probe that’s inserted into the vagina can be used to reproduce or simulate the pain that’s felt during penetrative sex—quickly demonstrating exactly where and how the pain is initiated.
If endometriosis is the cause, there are a couple of things to note:
- Endometriosis often goes undiagnosed for many years.
- Endometriosis can be difficult to diagnose.
- A complete evaluation may require a careful rectal exam; this is because endometriosis causing deep penetrative pain during sex may best be felt on a rectal exam.
Typically, treatment of deep pelvic pain is focused on any underlying disorder. It may be surgical (i.e., fibroids, ovarian cysts, endometriosis, or scarring) or responsive to medication (i.e., fibroids, ovarian cysts, endometriosis).
When surgery isn’t preferred or necessary, there are medical therapies to shrink the size of fibroid tumors and reduce the heavy menstrual bleeding associated with them, and other medical treatments have been developed to shrink endometriosis, and reduce the associated pain, including deep sexual pain. These treatments include oral contraceptives, and both the injectable GnRH agonists (i.e., Leuprolide, Triptorelin) and the oral GnRH antagonists (i.e., Elagolix, Relugolix, Linzagolix). These GnRH modulating drugs are used to temporarily create a menopausal hormone milieu, because menopause typically shrinks these pathologies and clears the way for unrestricted movement of the upper vagina.
Typically, medical approaches are favored initially, and surgery reserved as a last resort. However, exceptions to this rule are common. For example, if fibroid tumors are causing infertility or recurrent miscarriages and there is related deep pelvic pain during penetration, surgery may be the only choice that can address all three problems: the infertility, pregnancy loss, and deep pelvic pain.
Additional remedies include pelvic floor physical therapy, including treatments like trigger point injections and pelvic floor “Botox,” which can be helpful in reducing the reactive pain, and can help your pelvic muscles to unlearn the guarding they do related to these disorders.
A very simple and non-invasive at-home remedy for pain with deep penetration is reducing the depth of penetration. Testing various positions that shorten penetration can help to achieve this, as can the OhNut, a wearable device that allows you to customize the penetration depth of penises and/or toys.
What else have you found to help? Comment with any thoughts, questions, or concerns. Or you can always give us a call to setup a consult.
Yong PJ. Deep Dyspareunia in Endometriosis: A Proposed Framework Based on Pain Mechanisms and Genito-Pelvic Pain Penetration Disorder. Sex Med Rev. 2017 Oct;5(4):495-507. doi: 10.1016/j.sxmr.2017.06.005. Epub 2017 Aug 1. PMID: 28778699.
Donnez J, Stratopoulou CA, Dolmans MM. Uterine Adenomyosis: From Disease Pathogenesis to a New Medical Approach Using GnRH Antagonists. Int J Environ Res Public Health. 2021 Sep 22;18(19):9941. doi: 10.3390/ijerph18199941. PMID: 34639243; PMCID: PMC8508387.
Orr N, Wahl K, Joannou A, Hartmann D, Valle L, Yong P; International Society for the Study of Women’s Sexual Health’s (ISSWSH) Special Interest Group on Sexual Pain. Deep Dyspareunia: Review of Pathophysiology and Proposed Future Research Priorities. Sex Med Rev. 2020 Jan;8(1):3-17. doi: 10.1016/j.sxmr.2018.12.007. Epub 2019 Mar 28. PMID: 30928249.
Eid S, Loukas M, Tubbs RS. Clinical anatomy of pelvic pain in women: A Gynecological Perspective. Clin Anat. 2019 Jan;32(1):151-155. doi: 10.1002/ca.23270. Epub 2018 Dec 3. PMID: 30390350.
Hypoactive sexual desire disorder (HSDD), which affects about 10% of women in the United States, is defined as the persistent or recurrent deficiency or absence of sexual desire accompanied by personal distress. There are treatments to help you deal with these symptoms, and it is possible to regain sexual desire and libido.
Although HSDD impacts patient quality of life and interpersonal relationships, the disorder often goes unaddressed or untreated. Recent studies of the burden of illness in women with HSDD, especially pre-menopausal women, are limited.
I co-authored an article in the Journal of Women’s Health assessing the burdens that women face when they have HSDD, or lack of libido and desire. You can read the highlights of the study here:
Materials and Methods: A 45-minute web-based survey was designed to investigate the experience of women seeking treatment for HSDD and the impact of this disorder on several psycho-social aspects of women’s lives.
Women were recruited from an online panel of patients who participated in research studies for compensation. Validated questionnaires assessed sexual function and health-related quality of life, including mental and physical component scores.
Results: A total of 530 women, aged 18+ years, diagnosed with HSDD were included in the study. Pre-menopausal women indicated greater overall HSDD symptom burden compared with post-menopausal women. Patients with HSDD reported lower quality of life scores compared with the general population.
A multivariable regression analysis demonstrated that psycho-social factors influencing the burden of HSDD, including interference with relationships with their partner, mental and emotional well-being, and household and personal activities, negatively affected quality of life mental component scores.
Conclusions: In the current survey, HSDD had a significant negative impact on sexual and mental health, social relationships, and general well-being. The impact was greater among pre-menopausal women compared with post-menopausal women.
And if you’d like to discuss treatments to help you deal with HSDD symptoms, including an increase in sexual desire and libido, you can fill out an appointment request form.
There is so much misconception about hormone replacement therapy (HRT) and menopause. I was recently featured on #justASK, a healthcare podcast dedicated to providing evidenced-based information from a team of sexual health experts. #justASK is hosted by Tara Thompson and Heather Quaile.
It was great to break down some of those misconceptions, and dive into the importance of hormone replacement therapy, solutions to frustrating peri-menopause and menopause symptoms, and myths and taboos surrounding these topics.
Women’s health has been under-researched and under-funded for way too long, and that’s a large reason why there is such a lack of comprehensive information.
A few notes you’ll hear me address in the podcast:
- One of the biggest problems around lack of access to hormones is that there’s an entire generation of practitioners (physicians, nurses, PAs) who heard hormones were risky and were never trained to administer HRT. The medical community is finally coming around to addressing this misinformation and are finally being trained to replace hormones safely.
- Hormones fluctuate throughout our lives. Fun fact: The only time in a woman’s life when her hormones are the same level as they are after menopause is when she’s breastfeeding. In the context of breastfeeding, those low hormone levels are a good thing, whereas it can be incredibly harmful during menopause.
- Hormones prevent bone loss, and ultimately prevent fractures. Hormone therapy, and non-hormonal medications, can all help strengthen bones and prevent osteoporosis.
- There tends to be an increase in sex drive around the middle of a menstrual cycle. These are the same hormones that can stimulate libido during menopause, and we can apply them so that they stimulate the brain and can help increase interest in sex beyond reproductive years.
Listen to the full podcast below, and feel free to comment with any questions. You can also make an appointment to figure out if hormones are right for your body.
How many times have you shuddered the moment someone mentions your parents or your grandparents having sex?
As a doctor specializing in sexual health, I’ve seen that inevitable gasp time and time again. The mere mention of our parents, or worse, our grandparents, “rolling around in the hay” leads to grimaces followed by an expression of “really!?” “yuck” or “gross”. This reaction is natural in our often times sex-phobic, even puritanical culture, but these attitudes set too many people up for failure. A fear of aging and an inability to associate sex with aging undermines the many health benefits gained simply by continuing sexual activity through our 70s and beyond. These health benefits are often overlooked by healthcare practitioners as well. A recent NYT Magazine article, “The Joys (and Challenges) of Sex After 70” attempts to normalize sex in older adults.
Here are 5 important points we wanted to highlight for you:
- People frequently have sex up until the end of their life.
- Everything about sex after 70 usually takes longer, is slower, but generally still works.
- Sex is so much more than penetration. Too often we are taught that sex is only penis-in-vagina (PIV), but that’s incredibly limited. If PIV is your definition of sex, that may need to change as you age.
- Communication is one of the most critical components when it comes to good sex, especially since pleasure and desire change as we age.
- There are effective medications and non-medical treatments for sexual problems related to aging, regardless of your sex or gender.
As men age there are plenty of medications approved to increase their sexual health—we’re sure you’ve heard of Viagra or Cialis? And there are many other brands designed to do the same thing, plus no fewer than 25 different testosterone formulations for men.
For women, on the other hand, there are just two FDA-approved options: Addyi (Flibanserin), and Vyleesi (Bremelanotide). And while they both work for women well beyond menopause, as of right now, neither of the two have been approved by the FDA for postmenopausal women, simply because FDA requirements have not been satisfied. And while pharmacologic treatments are not for everyone, both Addyi and Vyleesi should work for women of any age. Data on Addyi’s benefits in menopausal women was published almost 8 years ago, and is approved by Health Canada for use in women up to age 60. Many of our patients at IntimMedicine Specialists find it to be beneficial regardless of their age.
It is extremely frustrating that there are currently no testosterone products approved for women’s sexual health in the US. This past year, off label use of male testosterone products and compounded testosterone treatments for women had become so prevalent that the International Society for the Study of Women’s Sexual Health (ISSWSH) developed a manifesto for healthcare practitioners. This “how to” is a classic citation of safe and effective use of “male” testosterone products in women.
As emphasized in the NYT Magazine article, people often face many physical challenges in the bedroom as we age. It is normal for bodies to change, and for the ways we access pleasure to shift. For example:
- Vaginal dryness is a normal shift in the body.
- Erections are often not as naturally hard, as reliable, or as long-lasting.
- Physical movements and positions may become more limited, but that doesn’t mean that adaptive positions can’t be just as pleasurable.
While pharmacologic options can be really helpful, they aren’t for everyone, and there are other resources that can help normalize and troubleshoot sexuality through the aging process. You should check out the following:
- A study of sexuality and health among older adults in the US
- What we don’t talk about when we don’t talk about sex
- Sex For Grownups: Dr. Doree Reveals the Truth, Lies, and Must-Tries for Great Sex After 50
Next time you shudder at the mention of your parents or grandparents still enjoying sex, consider the age you want to stop having sex – our guess is that you don’t ever want that. So, if you (or that parent or grandparent) need a little help, let us help identify the problem and offer some solutions for your body (or theirs). We can help, just reach out.
Illustration by Lori Malépart-Traversy
Women have the only organ in the human body exclusively dedicated to pleasure: the clitoris! This humorous, brief documentary gives an illustrated and educational history of the clitoris; it also reveals something very telling: the clitoris has long 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 or accuracy and much fumbling. Clitoral pleasure was discovered almost by accident. (More on that in The Clitoral Truth…)
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, even how to properly examine it, 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: Unfortunately, there is no such thing as a clitorologist!)
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. Given the lack of comprehensive research, it could be more.
Pain can be due to adhesions or scarring of the clitoris where the clitoral hood (aka the prepuce) gets stuck to the glans of the 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,” or it can be very focal with pain at a small, targeted location.
Clitorodynia can make sexual experiences difficult, if not impossible. As well as potentially leading to sexual dysfunction, it can also make everyday life excruciating because the “pain down there” can be present all the time, even without sexual activity.
While there might not be a clitorologist, doctors trained in sexual medicine can diagnose and treat clitoral problems, we promise! With a specialized physical exam and several diagnostic tests, the underlying cause for your pain can be found. Luckily, successful medical and surgical treatment options are available. For example, clitoral adhesions can be removed in a minimally invasive, in-office, procedure using local anesthetics. In a high percentage of women with painful clitoral adhesions, such a procedure is curative.
Sexual health is an important part of your general health. You deserve a pleasurable, pain-free sexual experience and life. If you have discomfort or pain, we are here to provide solutions. If any of the symptoms we mentioned sound familiar, our providers are trained to help. Let’s work together to improve your sexual health.
Actress Gwyneth Paltrow, founder of the wellness and lifestyle brand goop®, recently launched a new “sexual health supplement” marketed under the name DTF. According to advertisements, this product is intended to “support women’s sexual desire, arousal, and mood.” We believe this claim to be an example of a misleading campaign marketed to consumers that is unsupported by scientific evidence.
As a member of the International Society for the Study of Women’s Sexual Health (ISSWSH), which is comprised of leading academics, researchers, clinicians, and educators in female sexuality, IntimMedicine supports and agrees with ISSWSH’s concern around frequent, unsubstantiated claims made about many over-the-counter (OTC) products marketed to women for sexual enhancement. goop®’s latest product, DTF, is one of these products that concerns us.
While we applaud the attempt to investigate herbal ingredients which are in use by consumers, the statement by goop® that the ingredients in DTF are “clinically studied to support female sexual health and function” is egregiously misleading. Here’s why:
According to their own website, DTF “hasn’t been evaluated by the FDA” and “is not intended to diagnose, treat, cure, or prevent.”
According to the goop® website, DTF contains three main ingredients: Libifem®, a fenugreek seed extract, shatavari root extract, and saffron stigma extract. While one small study published in Phytotherapy Research in 2017 appears to support some potential benefit of one ingredient in DTF specifically to women with the vasomotor symptoms of “hot flushes, night sweats and other associated symptoms,” which are typically associated with the menopause, we were unable to find any data to demonstrate safety, efficacy or tolerability of the combination of active ingredients in DTF for women of any age to whom goop® makes these claims on female desire, arousal and mood.
As experts in the sexual health field committed to the highest standards of scientific research and medical care of women’s sexual health, we are not only concerned about the lack of proven benefit from such supplements, but also the potential harm to individuals who choose to take these products.
43% of U.S. women report some type of sexual problem for a multitude of bio-psycho-social reasons. Lumping all sexual problems together is unlikely to lead to an appropriate treatment and improvement, which is why qualified healthcare providers, like IntimMedicine staff, diagnose a sexual problem before recommending a relevant treatment.
Hypoactive sexual desire disorder (HSDD) is a diagnosable and treatable medical condition experienced by upwards of 10% of U.S. women. In 2018, ISSWSH published an HSDD process-of-care to assist healthcare providers in the diagnosis and management of pre- and post-menopausal women with HSDD. This open access article is freely available online.
In order to properly address low libido and HSDD, women should avoid self-treating with OTC products, like DTF, without the guidance of a licensed healthcare provider.
There are two FDA-approved treatment options (flibanserin and bremelanotide) available in the U.S. for pre-menopausal women with acquired, generalized HSDD with extensive safety and efficacy data. Flibanserin is also approved in Canada for pre-menopausal women and naturally post-menopausal women ≤60 years of age.
As a practice that is focused on the advancement of women’s sexual health, it is our mission, alongside ISSWSH, to promote the dissemination of evidence-based information. Women should know that the medical community has treatments approved by regulatory agencies and processes of care to guide their healthcare providers in the delivery of evidence-based medicine.
- O’Malley, K. Gwyneth Gwyneth Paltrow’s Goop just launched a supplement to boost female libido.
- Reilly, K. Do Gwyneth Paltrow’s new ‘DTF’ libido supplements really work? Doctors weigh in.
- Sydora BC, Fast H, Campbell S, Yuksel N, Lewis JE, Ross S. Use of the Menopause-Specific Quality of Life (MENQOL) questionnaire in research and clinical practice: a comprehensive scoping review. Menopause 2016;23:1038-1051.
- Steels E, Steele ML, Harold M, Coulson S. Efficacy of a proprietary Trigonella foenum‐graecum L. de‐husked seed extract in reducing menopausal symptoms in otherwise healthy women: a double‐blind, randomized, placebo‐controlled study. Phytotherapy Research 2017;31:1316-1322.
- Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA 1999;281:537-544.
- Shifren JL, Monz BU, Russo PA, Segreti A, Johannes CB. Sexual problems and distress in United States women: prevalence and correlates. Obstetrics & Gynecology. 2008;112:970-978.
- Brotto LA. The DSM diagnostic criteria for hypoactive sexual desire disorder in women. Archives of Sexual Behavior 2010;39:221-239.
- Clayton AH, Goldstein I, Kim NN, Althof SE, Faubion SS, Faught BM, Parish SJ, Simon JA, Vignozzi L, Christiansen K, Davis SR. The International Society for the Study of Women’s Sexual Health process of care for management of hypoactive sexual desire disorder in women. Mayo Clinic Proceedings 2018;93:467-487.
Adapted from ISSWSH’s official statement.
If your partner is going through menopause, here’s a brief guide for survival.
Menopause isn’t just a challenging time for the person going through it, but it can also be difficult for partners, friends, and children. Hormones are very real, and they have a very real-life impact on our bodies and our relationships.
Dr. James Simon, Medical Director and Founder of IntimMedicine Specialists in Washington, DC, shared his expertise with True Women’s Health on how to best survive menopause as a partner, and we’ve distilled that for you here.
(Note: Not all women have a uterus so not all women go through menopause, and not all people with a uterus are women, so we will be using gender-neutral language throughout this guide.)
Step One: Understand What’s Going On
The first step in understanding what’s going on with your partner is to know exactly what menopause is. Here is a quick guide to help you understand a bit more of what’s happening before, during, and after menopause:
1. Perimenopause—This means “around menopause” and refers to the time when someone with a uterus is making the transition to menopause, usually age 45-50.
At this time:
- Periods become more irregular and/or heavier.
- Ovaries begin producing less estrogen, and as menopause becomes closer, the drop in estrogen increases, causing symptoms like hot flashes, night sweats, disturbed sleep, lower sex drive, weight gain, and mood swings.
It’s important to note that during perimenopause, pregnancy is still possible.
2. Menopause—This is the time when the last spontaneous menstrual period occurs. Once a full year has gone by without having a period, the date of that last period is the moment of menopause. This usually occurs, for most people, around the age of 50.
Your partner might experience the symptoms listed above, as well as other symptoms, like vaginal dryness, pain with sex, and decreased sexual desire.
3. Postmenopause—This is the time after your partner has gone through menopause. In other words, after an entire year without a period, postmenopause has officially begun. For some people, menopausal symptoms, such as those listed above, may become less frequent and less intense. However, sometimes those symptoms can last for many years after the menopause transition.
Step Two: Listen to Your Partner
It can feel really bad when your partner is tired and cranky, and it might even feel like you did something wrong. You might even feel rejected romantically and physically, and that lack of desire and touch can lead to something called skin hunger – where you crave touch, and begin to feel lonely without it. But your partner is also going through all of this. And it is nobody’s fault. You can’t support your partner and your relationship if you don’t really understand what’s going on. And sometimes, your partner won’t understand what’s going on either.
The easiest thing to do is to ask what your partner needs, and what would feel good. And when it comes to sex, it’s about thinking outside of what’s “normal” for you in your relationship.
Dr. Simon has done significant research on the impact of painful sex after menopause, and nearly two-thirds of people experienced painful sex after menopause, causing them to avoid sex and lose interest in sex. This shift in desire can have a large impact on relationships.
First, consider different ways to connect intimately. Perhaps penetrative sex isn’t a viable option right now. What about mutual masturbation? Or oral sex? What kind of touch sounds good to you and your partner? These conversations can be difficult if we aren’t used to having them, but communication is one of the most important aspects of sex.
There are treatments for painful sex, and that will be different for each person, but may include:
- Vaginal lubricants or moisturizers
- Vaginal estrogen
- Vaginal dilators
- Sex therapy
- Pelvic floor physical therapy
Dr. Simon has found that nearly 60% of couples who went through post-menopause treatment for painful sex felt that their sex life (and their relationship) was significantly better than even before menopause!
Step Three: Count Sheep
Sleep is imperative for all humans, especially for those going through menopause. The constant night sweats cause more than disturbed sleep: weight gain, mood swings, and decreased sex drive are all results of a change in sleep habits.
If you’re in a relationship with someone who is currently experiencing these changes, then you probably know what I’m talking about. If you think it’s difficult for you, just imagine what your partner is going through. And, if you’re concerned about your partner, it’s okay to seek professional help individually or as a couple. Menopause can feel so isolating, especially when dealing with sleep deprivation.
If you see that your partner is isolating by setting up barriers, it will be especially important to work together to create a support plan with professional help. Mood swings, for example, may be related to PMS or heavy bleeding, and taking birth control can actually help lessen these symptoms. There are answers, but your partner may need that extra understanding and a gentle push from you to take the steps to get help.
Step Four: But, What Can I Do?
- Take Initiative to Learn—There are so many books, articles, and podcasts with good information on the topic of menopause. This is a great place to begin educating yourself. Asking your partner to do the emotional labor to educate you about menopause generally will be just as exhausting, and you want to help, not hinder. That doesn’t mean that you shouldn’t ask questions about what your partner is going through, how things feel, and what support would look like—questions like these can be really validating.Websites like menopause.org and isswsh.org have so much information that can help people navigate the struggles of menopause. You can also make an appointment with IntimMedicine—we often setup meetings with individuals and couples to better grasp how to handle menopause with a bit more ease. Having basic information before you talk with your partner will convey that you are really trying to understand what’s going on.
- Have Compassion—This can be a difficult time for everyone, and hormones are fierce. Reminding yourself and one another that no one is at fault can be helpful. Take a beat before responding during heated conversations, and remember that, again, hormones are real and they actually alter the chemical state of the brain. If you’re feeling hurt, confused, or lonely, consider talking with a therapist or journaling about what you’re going through.
- Use “I” Statements—When discussing your emotions around this whole menopause experience, try to use “I” statements. For example, saying “I feel _(hurt, rejected, sad, lonely)_ when I initiate intimacy with you and you turn away” is much better than saying, “You never want to have sex anymore.” Having an intentional conversation about your experiences of emotions can be really productive.
Menopause isn’t easy for anyone involved. As a provider who specializes in caring for people who are at this stage of their life, this is Dr. Simon’s best advice: Understand what’s happening with your partner and know why it’s happening. This can help you navigate your way through the challenges of menopause—together. Now that you know more about menopause than perhaps you ever thought you would – use that information like a tool to work together with your partner to foster a healthy, compassionate relationship, even when things feel tough.
And if you and your partner are looking for hormone balancing or menopause treatment options, Dr. Simon and the IntimMedicine staff are ready to help.
Back in April 2020, an article in the Journal of Women’s Health prompted me to think about the differences between men and women’s life and death responses to COVID-19. That article illustrated what we’ve heard in the news over, and over, and over again. Namely, that men tend to fare much worse than women if hospitalized with coronavirus (sars-cov-2) related diseases. Since then, we have come to know that, in this context, men are clearly the weaker sex. But even more data has emerged around the why, demonstrating that reproductive hormones are, in fact, an important part of women’s resistance to severe COVID-19 disease and can possibly even prevent death.
For most postmenopausal women, whether currently using menopausal hormone therapy or not, hormone therapy in early menopause (i.e., started in the first 10 years since their last menstrual period) is of significant benefit. Menopause specialists strive to determine the risk-benefit ratio for any woman before starting hormone therapy. It’s now clear that early menopausal women without absolute contraindications should seriously consider utilizing hormone therapy for disease prevention (i.e., heart attack and osteoporosis) and now to help prevent severe COVID-19 infections and even death.
Prevention of severe cases of COVID-19 may not be a good enough single reason to start hormone therapy, particularly as vaccinations are becoming more readily available. However, recent evidence documents that in women who start on hormone therapy for its basic, well-established benefits (treatment of hot flashes and night sweats, vaginal dryness and pain with sexual activity, prevention of osteoporosis etc. etc. etc.), may also benefit from the protection it provides against COVID-19 disease.
So, if you or someone you know wants a consultation to evaluate the benefit/risk ratio of postmenopausal hormone therapy, factoring in the potential benefits against severe COVID-19 infections, make an appointment to talk with us about all the options. All staff at IntimMedicine Specialists are fully vaccinated and we maintain careful CDC precautions, though we are also available for virtual visits. Menopausal hormone therapy may not only be good for you, it may save your life!
I’m frequently asked whether there’s anything to change in one’s diet to improve sexual function. While there’s absolutely nothing dietary that can treat a severe erectile dysfunction (ED) or significant arousal disorder in women, there are number of dietary habits or lifestyle changes which may help. The most important of these is to lose weight. Most of us could shed a few a few pounds and perhaps the best “pro-sexual or sex positive way” to do this is to substitute a plant-based diet for one rich in animal protein and fat.
You don’t need to become a vegan overnight, but a dramatic reduction in animal products will help. This approach improves vascular function which is exactly how erections in men and arousal in women happens. It’s all about blood flow! When people lose weight, their blood vessel function improves, ED improves, and, as weight is lost testosterone levels rise in men and estrogen concentrations in women increase and menstrual cycles become more regular.
Looking for a shorter-term fix to temporarily improve sexual function? That’s nuts! Specifically, walnuts and pistachios.
It turns out that some nuts (remember peanuts aren’t nuts, but legumes), can be very good for sexual function. They improve vascular dilation and lower blood pressure both directly and indirectly by virtue of their positive impact on gut bacteria. Two nuts documented to improve sexual function are walnuts and pistachios. It’s very important that you read the following carefully, because there’s no free lunch. Nuts typically come with both calories and fat. If you’re going to consume a lot of nuts, you’ll need to increase your exercise or decrease your calories from other sources in order to remain weight neutral.
It turns out that about 20-30 walnuts a day for as short as 6 weeks can improve sexual function. However, those 20-30 walnuts/day come with 400 to 650 calories, about 80% of which is fat. This means that your new sex-positive walnut habit is a meal replacement. And while walnuts have been shown to curb appetite, and do so even better than almonds, unless you want to gain a bunch of weight, you will also need to bump up your exercise and/or eat less…a typical meal less.
Pistachios are also a good nut for sex. It turns out that 100 g of pistachios per day for as short as three weeks can improve erectile function. These nuts can also improve blood flow, lower blood pressure, and improve the cholesterol profile (increasing the good cholesterol, HDL, and decreasing both total cholesterol and bad cholesterol, LDL). However, this approach, too, requires a lot of pistachios.100 grams of pistachios, about 3 servings, contain about 560 calories, and 44 grams of fat. Yes, another meal replacement.
All of which raises another question, what do you do with all those shells. Two thoughts: 1) they can be put at the bottom of your potted plants for drainage, or if well-dried, they can serve as kindling for a fire to curl up in front of with your lover. So, lose the weight, and go nuts for sex!
Esposito K, Ciotola M, Giugliano F, Schisano B, Autorino R, Iuliano S, Vietri MT, Cioffi M, De Sio M, Giugliano D. Mediterranean diet improves sexual function in women with the metabolic syndrome. Int J Impot Res. 2007 Sep-Oct;19(5):486-91.
Salas-Huetos A, Muralidharan J, Galiè S, Salas-Salvadó J, Bulló M. Effect of Nut Consumption on Erectile and Sexual Function in Healthy Males: A Secondary Outcome Analysis of the FERTINUTS Randomized Controlled Trial. Salas-Huetos A, Muralidharan J, Galiè S, Salas-Salvadó J, Bulló M. Nutrients. 2019 Jun 19;11(6).
Tindall AM, McLimans CJ, Petersen KS, Kris-Etherton PM, Lamendella R. Walnuts and Vegetable Oils Containing Oleic Acid Differentially Affect the Gut Microbiota and Associations with Cardiovascular Risk Factors: Follow-up of a Randomized, Controlled, Feeding Trial in Adults at Risk for Cardiovascular Disease. J Nutr. 2020 Apr 1;150(4):806-817.
Aldemir M1, Okulu E, Neşelioğlu S, Erel O, Kayıgil O. Pistachio diet improves erectile function parameters and serum lipid profiles in patients with erectile dysfunction. Int J Impot Res. 2011 Jan-Feb;23(1):32-8.