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!


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, DC.

Follow Dr. Rubin on Twitter at @RachelsRubin1 and the IntimMedicine team at @IntimMedicine

Women featured in the Observer

We at IntimMedicine are thrilled about the positive changes happening in our culture surrounding the discussion on female sexuality. In a recent article in The Guardian, Sharon Walker interviews five women who are on the forefront of a new sexual revolution: reclaiming women’s sexual pleasure. For far too long, today’s culture has downplayed female desire and the pleasure that women can get from sex, whether that sex is solo or with a partner. From a squeamish discomfort around female anatomy to a male-centric view on sex within modern society, women have not been given the language or even a place to speak about their own sexual desires or what actually feels good. It is time to destigmatize female sexual anatomy, desire, and pleasure!

The five women in the article have vastly different approaches to breaking down barriers to these discussions. A sex therapist, an installation artist, a computer scientist, an author, and a dominatrix all chime in with the various ways they are challenging the way our culture views female sexuality. Of particular interest to us at IntimMedicine was the work by Stephanie Theobold, Camilla Mason, and Kate Moyle.

Stephanie Theobold, author of the new memoir, “Sex Drive,” argues that the taboo on honest language about female sexuality is one of the last to fall. “I believe it’s positively dangerous not to talk about honest female sexuality. That old chestnut that corporations love to use, ‘female empowerment’, means nothing unless sex is in the mix, too,” Theobold told Walker in her interview. In her memoir, Theobold takes a road trip around the United States to meet the first wave of 1970s and 80s sex-positive feminists, including Betty Dodson and Joycelyn Elders. She says “the pleasure revolution is about women asserting their own power” in the face of the male-dominated discussion on sex and sexuality, and a positive response to the #MeToo movement, which focuses on “men imposing their pleasure on women.”

Betty Dodson, who Theobold meets in her book “Sex Drive,” says “we really need to start using the correct words for our genitals. We have a ‘vulva’ not a ‘vagina’; the vulva incorporates the clitoris, the inner lips, the outer lips, the urethra, and the vagina – which only has sensation in it because of nerves from the clitoris. If we say ‘vagina’, then we’re leaving out the primary female sex organ, which is the clitoris.” IntimMedicine’s own Dr. Rachel Rubin has addressed using the proper language for female sexual anatomy and helping women feel more comfortable discussing sex and sexual desire in her recent presentation, “Below the Belt.”

Closely related to this work on the language around female sexuality is the work of performance artist Camilla Mason. Mason is on a team that creates an installation of an interactive and anatomically correct representation of female genitalia at the annual Shambala music festival. Mason makes the point that sexual anatomy is rarely discussed in schools, with even more of a taboo on female genitalia, and her goal with last year’s art installation of the “vulva cave” was to help facilitate those conversations. Feedback was excellent, and according to Mason, the installation “brought up all these topics of conversation that revolve around female sexuality and genitalia and just femalehood in general, which was the main agenda for me.”

Kate Moyle, a psychosexual therapist, works hard to help normalize discussions about sex and sexuality, especially for women. She argues that women have been fed a sanitized, Hollywood version of their own sexuality, which has resulted in shame about their bodies and their sexual function. “It’s about understanding the difference between the realistic and unrealistic, because that’s where the gap is,” Moyle says in her interview. “The problem is that we’re playing catch-up in an environment where sex is everywhere you look … and the assumption is that everyone else is having great sex.” She also makes an encouraging observation that it’s “not only women who want to have better sex. Men want their women to have better sex, too – we’re all in this together.”

Moyle and Theobold both make the point that female sexual dysfunction is only now becoming part of the conversation even though it is quite common. Research on and treatments for female sexual dysfunction only attract a fraction of the attention of male sexual dysfunction research/therapy. We at IntimMedicine agree that this needs to change, and change now.

We applaud the work these women are doing to break down the barriers in discussing female sexuality and sexual function! The specialists at IntimMedicine are internationally renowned experts on sexual wellness with an emphasis on helping our patients find pleasure in sex again and eliminating unwanted pain during sex. We treat nearly all sexual dysfunction and conditions in women of all ages, including dyspareunia, vulvodynia, loss of desire, poor arousal and weak or absent orgasm, to name just a few. Please call us at 202.293.1000 or email us to make an appointment with someone on our compassionate care team to talk about what’s causing you pain, develop a tailor-made treatment plan for you and your body, and help you make your sex life great again!

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