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Sexual Health at Menopause video still

Dr. James Simon discusses the importance of sexual health during menopause and encourages clinicians to open up the conversation with patients. He discusses several treatment options and resources with Dr. Marla Shapiro.

Dr. Marla Shapiro:

Hello, I’m Dr. Marla Shapiro. I’m a past president of the North American Menopause Society and today I’m joined by Dr. Jim Simon, who is also a past president of the North American Menopause Society. For our healthcare practitioners who may not know you, please tell us who you are.

Dr. Jim Simon:

Thank you. I’m happy to be here. I’m Dr. Jim Simon. I’m a reproductive endocrinologist and clinical professor at George Washington University. I’m the immediate past president of the International Society for the Study of Women’s Sexual Health.

Dr. Marla Shapiro:

That’s where we’re going to start today. We’re going to talk about sexual health because often as healthcare practitioners we’re not trained or we’re not comfortable. So, what are some of the most common issues that we see in women in and around menopause and in menopause when it comes to their sexual health?

Dr. Jim Simon:

So, I like to consider this in three different buckets. It makes it easy for me to keep it straight. So as women transition to menopause, it’s very clear that they have vasomotor symptoms, and disturbed sleep. Disturbed sleep has many downstream consequences, two of which are weight gain and that affects one’s self-image, which has an adverse effect typically on sexual interest. The other is fatigue, which clearly affects one’s interest in any kind of extracurricular, shall we say, activity.

Dr. Jim Simon:

Then the other two buckets are sexual pain, which occurs after menopause most commonly and as women approach their 60th year in particular, and loss of sexual desire as women’s hormones synergize with their loss of sleep.

Dr. Marla Shapiro:

So, for many practitioners and even some of our patients, there’s this bias that this is aging. There are often no questions that are asked by the healthcare practitioner, and women often just assume this is the way it is and don’t bring it up as well. So how do we break that barrier and open the door for the conversation?

Dr. Jim Simon:

So, this is a really critical question because patients don’t bring it up and there’s good scientific evidence that they don’t, and practitioners don’t bring it up and there’s good scientific evidence that they don’t bring it up. So, it’s kind of a Mexican standoff, if you will. No one’s talking about it, so it doesn’t get talked about.

Dr. Jim Simon:

The problem is that someone’s got to break the ice and I really think that it’s got to come from patients. We in practice think that there are many more important things to women. Whether that’s true or not for an individual woman is not the least bit clear. But if women will bring it up, then we have an opportunity to jump in or at least be triggered to go to the library, refer the patient, or learn ourselves and intervene.

Dr. Marla Shapiro:

So, let’s talk about what’s new in sexual medicine because for so many years, multiple drugs for men all over television and media giving it the legitimacy to talk about this. But for women, there is this sense that there’s nothing out there. So, what’s there to talk about anyways?

Dr. Jim Simon:

So, there are a couple of very interesting occurrences that have happened in the last year or so in the answer to this question. The first, and I’ll bring it back to Canada, is that the Canadian government, Health Canada approved the use of flibanserin, which is sometimes called the pink pill for women after menopause and up to age 60.

Dr. Jim Simon:

This is a big deal. There’s been data on this for almost a decade now, yet no approval for women after menopause who clearly need it in higher percentages than younger women. So that’s one thing that’s happened in this last year.

Dr. Marla Shapiro:

Aimed to treat low desire.

Dr. Jim Simon:

Correct. Aimed at treating hypoactive sexual desire disorder, which simply put is low sexual interest or absent sexual interest and wanting to fix it. Being distressed about having lost that sexual desire.

Dr. Jim Simon:

The other two things that happened in this last year or so was an international global consensus paper on the importance of testosterone in menopausal women. We know that women lose estrogen at menopause. They lose testosterone from about age 30 on, becoming more of a crisis as they approach age 60. Testosterone is a pivotal and important hormone for women of all ages.

Dr. Jim Simon:

Then lastly, because there are no approved medications in North America for testosterone therapy in women, there are about 30 in the US for men, the International Society for the Study of Women’s Sexual Health with an international group of experts came out with a how to use testosterone in postmenopausal women. So no practitioner should have to be fiddling around trying to figure it out.

Dr. Marla Shapiro:

So where are we going? We now have this position paper with evidence in science, and very clear indications. It’s not one size fits all every postmenopausal woman needs testosterone. We have flibanserin. Has it opened up the door to more investigations, more products for women’s sexual health, and more let’s get it out into the mainstream?

Dr. Jim Simon:

So, in addition, we also have an injectable as desired treatment in the US for low sexual desire called Bremelanotide, or Vyleesi. It’s on the market and available to add to your list.

Dr. Jim Simon:

But I also want to say that for women who either can’t use those products, or have a contraindication to those products, there are a number of products that have let’s say a side effect of stimulating sexual desire, either at the dose that they’re approved for another indication, or either a lower dose or a higher dose than with knowledge can be brought to bear for an individual woman with low sexual desire to boost that desire.

Dr. Marla Shapiro:

And those medications…

Dr. Jim Simon:

So, they fall into medications that typically affect the neurotransmitters in the brain, increasing dopamine and decreasing serotonin. That’s a pro-sexual effect. Medications like Trazodone at very low doses, which can be used for sleep as well as improving sexual desire.

Dr. Jim Simon:

Buspirone, which is usually considered an anti-anxiety agent, is also pro-sexual in many ways. So, a woman who’s anxious about sex and has low desire because of her anxiety could be treated for both with Buspirone. Bupropion, which is an anti-depressant, but at high doses is known to stimulate sexual interest, and arousal and improve orgasm.

Dr. Marla Shapiro:

Well, I want to thank you for joining us because opening up this conversation, lets our healthcare practitioners know that there are options out there, and if you’re unaware of the options, it’s not that difficult to get that education.

Dr. Jim Simon:

Absolutely. Critically important. For those women who cannot find a knowledgeable provider or whose practitioners wish to get additional information, both the North American Menopause Society and the International Society for the Study of Women’s Sexual Health have found provider functions on their websites and both providers and patients can go there to get some help.

Dr. Marla Shapiro:

Thank you so much for joining us today.

Dr. Jim Simon:

My pleasure. Thank you.

 

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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.

Image of couple riding in an orange Thunderbird convertible

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.

Read the full Journal of Women’s Health article, co-authored by Dr. Simon, here.

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.

Dr. Simon explains why even doctors need to be educated on menopause.

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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!

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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 questionnaire 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.

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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

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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.

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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!

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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!

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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.

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