Frequently Asked Questions
- Is there a common age for women to experience loss of sexual desire?
According to a recent survey, 43% of women report sexual dysfunction and more specifically, 30% of women report low or no sexual desire. Although many women report a decrease in overall libido following menopause due to changes in circulating hormones, many younger women also complain of the same symptoms. Women of childbearing years may also report low sexual desire due to medications such as birth control pills, pain with intercourse, unhealthy sexual relationships, lack of knowledge about their own bodies, pregnancy, breastfeeding, stress and illness, just to name a few.
- I had a hysterectomy and went through menopause at the age of 45. I have been taking oral Premarin which helps my hot flashes but my libido has continued to decrease. Is there hope?
Many women in your situation complain of similar symptoms. Although there is no clear link between hormone levels in women and libido, there is ongoing research to learn more. The main hormones in women during childbearing years are estrogen and progesterone. Although more of a male hormone, testosterone is also present at lower levels. It is suspected that testosterone may play a role in libido in some women although there is currently no approved testosterone replacement specifically for libido. While all three of these hormones decrease following menopause, Premarin replenishes only estrogen. This may explain why your hot flashes are improved but other symptoms remain. You may need to speak with your prescribing provider regarding a more tailored approach to treating your libido.
- Is there a Viagra for women?
Unfortunately, no. Women are more complicated than men with regard to sexual functioning. Viagra works to specifically enhance erection, not desire. The good news is there are many alternative options for treating female sexual dysfunction including off-label hormone replacement therapy, herbs, compounded creams, etc. You simply need to speak with your provider, or someone who is familiar with these treatment protocols to learn more about a safe and effective plan for you. Research in the field of female sexual dysfunction is ongoing and we hope to have more treatment options available in coming years.
- I just had a baby 5 months ago. Although my doctor released me to have sex 6 weeks after her birth, I haven’t been able to tolerate it due to pain. I was told I had a third degree tear during the delivery. Is it possible that this has not completely healed?
This is certainly a possibility, but most likely your gynecologist would have detected a problem at your 6 week checkup. More than likely, you may have some vaginal dryness or hypersensitivity at the site of the tear. Breastfeeding can suppress circulating hormones and result in vaginal dryness resulting in too much friction during intercourse and sometimes pain. I would speak with your gynecologist about your current symptoms. You will need a physical examination to identify the exact issue. In the meantime, use a glycerin-free lubricant such as “Slippery Stuff” with any sexual activity. You also need to make sure you partake in at least 10 to 20 minutes of foreplay before attempting intercourse. This will allow the tissue to soften and lubricate, and the vagina to open, allowing for comfortable penetration.
- I am 70 years old and I was widowed 15 years ago. I assumed I would never be sexually active again but then I met a wonderful man with whom I attempted sexual relations. Unfortunately, we were not successful due to pain and dryness. He told me it felt like he was trying to penetrate a “brick wall”. Is there any hope or do I have to give up this aspect of my relationship?
Congratulations on your aspirations to rekindle your sexuality! Although many women in your situation experience similar issues, there is never an age at which women have to “give up” on sex. Given your age, I can assume that you are postmenopausal, and therefore, you are probably suffering from vaginal dryness due to lack of estrogen within the vaginal tissue. In severe cases, atrophic vaginitis occurs. This is inflammation of the vagina due to thinning and dryness from lack of estrogen. This can be extremely painful, making intercourse difficult or even impossible. If you are able to use hormones, you may want to speak with your gynecologist about vaginal hormone replacement. There are products such as creams, a pill and a ring, which can help restore vaginal estrogen. If you are not a candidate for hormone replacement, there are alternative options to help replenish lost lubrication and promote tissue elasticity. In this case, you would need to speak with your gynecologist or a sexual health provider.
- I recently became married and my husband and I were both virgins at the time of our wedding. Although we were both very excited to have sex for the first time on our honeymoon, we were disappointed to have multiple failed attempts. It feels as if my vagina just closes up any time he attempts to penetrate. Why can I not just relax?
There is a medical condition called vaginismus that you may be suffering from. This is an involuntary muscle spasm of the vagina that interferes with penetration, whether during intercourse, tampon insertion or pelvic examinations. Although common to women who have a history of negative sexual experiences such as forced intercourse, rape and molestation, many women without this history experience the same involuntary response. Some women report only difficulty with sex, although most women experience tremendous pain with attempted penetration. This often results in fear of future sexual experiences, which worsens the situation and results in a dysfunctional sexual relationship. Thankfully, there are treatment options for this condition, but it is important to understand that treatment often consists of a long term plan involving the patient, sexual health provider, physical therapist and sex therapist. Many women who are receptive to and diligent with the plan overcome this disorder and go on to enjoy successful and fulfilling sex lives.
- I have a history of recurrent yeast infections. It seems like every time I take an antibiotic, I get a huge yeast infection with vaginal discharge, itching and burning. It is miserable. And sometimes the same symptoms occur but my gynecologist cannot find yeast. Could this be something more serious?
This is a common gynecologic and urologic complaint. Sometimes yeast is the culprit, but other times certain conditions can mimic the same symptoms. There is a condition called vestibulitis that causes burning and stinging pain at the vaginal opening. This is a chronic inflammatory condition that can occur spontaneously or due to recurrent infections. Symptoms are similar to a yeast infection. This is why women with this condition are often misdiagnosed and inappropriately treated. Sometimes women will assume they have a yeast infection and will purchase over the counter products such as Monistat. Such over the counter products can actually worsen vestibulitis due to the harsh preservatives and other ingredients. Patients with vestibulitis need to be treated by a provider familiar with this condition and also follow some basic rules regarding vulvovaginal hygiene. These include avoiding douching, wearing only white cotton brief underwear, only using natural or organic soaps/perfumes/detergents, avoiding dryer sheets with underwear and no over the counter vaginal products just to name a few. Although there is no FDA approved medicine for this condition, there are many researched protocols for treating vestibulitis. A tailored approach by an provider familiar with this disorder is necessary for each patient.
- About a year ago, I developed itching just outside my vagina. It has become so intense that it often wakes me up at night. The only thing that relieves my itching is scratching, sometimes to the point of bleeding. I examined myself when this first started and I did not notice anything. I recently looked again and the tissue looked white and feels thick. I never feel clean “down there” and the last thing I want to do is have sex. What should I do?
You certainly need to speak with your gynecologist about this. You may need a biopsy for confirmation of a diagnosis. I suspect a specific skin condition such as lichen simplex chronicus (LSC). This is a complex skin condition characterized by chronic itching and scratching although there are many other possibilities for your symptoms. Regardless of the diagnosis, it is important that you have this evaluated and treated appropriately. Rarely, these symptoms can be related to more serious conditions such as vulvar cancers. Many skin conditions are worsened by the itch-scratch cycle. If you do not respond to traditional treatments, you may require a more unique approach, for instance, using prescribed compounded medications.
- I am so embarrassed to ask this, but I am 36 years old and I have never had an orgasm. Is something wrong with me? I am happily married and I enjoy sex but I feel like I am missing out.
According to a recent survey, one in four women reported no orgasm for at least a few months in the previous year. Problems related to orgasm are the second most frequently reported sexual problems in women after desire issues. Primary anorgasmia refers to never having experienced orgasm and secondary anorgasmia refers to the loss of ability to achieve orgasm. Orgasm is essentially release of sexual tension following heightened sexual excitement. It is important to understand that this can only be diagnosed if a woman reports receiving sufficient sexual excitement with sex play. A common issue is lack of appropriate genital stimulation. The vagina itself lacks significant nervous tissue. Therefore, intercourse alone does not often result in orgasm. Many women require 10-20 minutes of direct clitoral or “G-spot” stimulation in order to achieve orgasm. Also, women respond most easily to vibration. If you have never tried using a vibrator, I would recommend trying one. There is no right or wrong way to use a sex toy, as long as it does not cause pain. I recommend the website www.goodvibrations.com. Although some women are averse to using sexual aids and toys, I encourage you to think of using a vibrator as a “therapy” just like you would have a massage for a sore back. Open your mind, relax and have fun! Following these basic recommendations, if you are still unable to become aroused to the point of orgasm, I encourage a full history and physical with a sexual health provider to discuss possible other causes and more aggressive treatment options.
- After menopause, I noticed a decrease in my ability to become aroused. It used to be so easy. Now I have to use a vibrator and I still barely notice the “tingling” sensation that I used to enjoy so much. Orgasm is nearly nonexistent. Is there a way to restore my arousal and orgasm?
Menopause involves many changes with the body and while some women report improvement in their sexual relationships, others unfortunately experience symptoms similar to yours. The good news is, there are options for enhancing your arousal and orgasm. It is likely that loss of circulating hormones has led to difficulty becoming aroused and achieving orgasm. We also have to consider that the vulvar and vaginal tissue is sensitive to these fluctuations in hormones. When estrogen is low, women often experience vaginal dryness, thinning of tissue, decreased genital sensation or even pain, difficulty or delay in achieving orgasm, pelvic floor muscle weakness, loss of vulvar anatomy and/or narrowing of the vaginal opening. Sometimes treatment is as simple as using a hormone based vaginal cream and sometimes treatment requires more aggressive therapies such as compounded arousal oils, oral supplements and devices geared toward enhancing blood flow to the pelvis and genitals and even pelvic floor physical therapy to strengthen the muscles.
- I am 24 years old and I suffer from chronic pelvic pain. I constantly experience a deep aching sensation that often limits my daily activities. This has been ongoing for 5 years and I have seen multiple providers about this. I am not currently sexually active and I have never been pregnant. My gynecologist performed laparoscopic surgery to look for endometriosis and everything looked normal. I also had an ultrasound and CT scan, both of which were negative. An STD screen was also negative. I am overall healthy, other than occasional flares of irritable bowel syndrome. A recent colonoscopy was negative. I am so frustrated by my pain, I am considering a hysterectomy even though I want to have children. Is there anything that I should consider first?
Chronic pelvic pain in women is one of the most frustrating conditions to suffer from and also to treat because there are so many possible explanations for these symptoms. The pelvis houses gynecologic structures such as the uterus, cervix, fallopian tubes, ovaries, vagina and vulva, urologic structures such as the bladder and urethra and gastrointestinal structures such as the bowels, rectum and anus. There is also extensive musculature within the pelvis as well as multiple bones that make up the frame of the pelvis and the tendons and ligaments that hold this all together. So you can see that while the pelvis is a small area compared to the rest of the body, there are many components to it that need to be considered with chronic pain.
- I am 29 years old and I have had 3 beautiful babies with vaginal deliveries. Since having my last baby 1 year ago, I’ve noticed that when I jump on my kid’s trampoline, I leak urine. It is so embarrassing. I don’t even want to talk to my doctor about it.
Do not feel alone. One in three women will experience loss of urine at some point in their lives. While it is unfortunately common for women to experience loss of pelvic support following vaginal childbirth that results in increased frequency of urinary incontinence, this is not normal and should be dealt with like any other medical issue. Incontinence, or leakage of urine, occurs in multiple forms. The two most common are stress and urge. Stress incontinence refers to loss of urine with coughing, sneezing, laughing, running and even jumping on trampolines. Urge incontinence refers to the loss of urine following a spontaneous, unwarranted urge to urinate. It is possible to have a mixture of these types of leakage as well. The good news is that while this is an embarrassing problem, there are ways to manage and treat these symptoms. Certain medications can reduce urgency and frequency, while devices and procedures can help with leakage due to relaxation of the bladder and/or urethra. There is now even an FDA approved medical device that can be surgically implanted to work as a bladder pacemaker and regulate bladder functioning. Speak to your urologist about these options. It is likely that a full physical examination will be necessary to appropriately diagnose and treat your specific symptoms.
- I am 44 years old and other than multiple sclerosis that was diagnosed 5 years ago, I am overall healthy. Recently, I started to notice episodes of urgency to urinate. If I do not go immediately to the restroom, I often completely went my pants. What is causing this and how can I treat this?
Approximately 74% of patients with multiple sclerosis will develop bladder problems at some point in the history of their disease including urinary urgency, frequency, leakage, difficulty emptying , etc. This is caused from MS attacking the nerves that help the bladder function normally. Oftentimes, bladder symptoms will present as the first or most noticeable problem. It is important to establish a urologist that is familiar with MS if you do not already have one. Most likely, a test will be ordered called urodynamics that will evaluate the current function of the bladder. This will be repeated once every 1-3 years depending on your progression of bladder symptoms. While this is an incredibly frustrating and embarrassing problem, there are treatment options available.
- I developed a large bulge in my vagina a couple of weeks ago that my doctor diagnosed as a cystocele. He told me that I would need surgery but I am scared of the risks. What should I expect?
A cystocele is a prolapsed bladder, or when the bladder drops into the vagina due to lack of proper support in the pelvis. This is typically not a painful or serious condition but it can result in the sensation of pressure in the vagina, difficulty urinating and urinary tract infections due to trapped urine in the bladder. This is often surgically repaired by a urologist and there have been many advances in the past decade that have helped to reduce complications and increase success from this surgery. If you are not a good surgical candidate or if you would like to avoid surgery, there are other options. If a prolapse is mild, pelvic floor physical therapy can help strengthen the muscles around the bladder and improve some of the symptoms of the prolapse. Also, most prolapses can be corrected with use of a pessary. This is a device that fits in the vagina and helps support the bladder (or any other structure that has fallen) without surgery. The pessary is typically removed, cleaned and replaced on a regular basis by a medical provider. You would need to speak with your urologist to determine the best option for your situation.
- I am 40 years old and I have always been prone to yeast infections. I feel like I am always on antibiotics which seem to cause my yeast infections. This past year alone, I have had 6 infections. Are there any other options or ways to prevent infections?
First, it is important to know if your yeast infections were documented with actual cultures. Often times, women think that they have a yeast infection and it is something completely different, such as a bacterial infection, allergic reaction or skin condition. If you have been self treating, I would recommend that you see your medical provider for an evaluation the next time that you think you have an infection. If your culture is negative, you will need a more extensive workup to evaluate the cause for your symptoms. Now, it is true that antibiotics often cause subsequent yeast infections in some women. In this case, prophylactic treatment can be considered, meaning that whenever you take an antibiotic, you use anti-yeast medication at the same time. It is important to know that some over the counter products for treating yeast contain additives, chemicals and preservatives that can further irritate already inflamed skin and therefore, self treatment is not advised. Assuming you are experiencing actual yeast infections and typical prescription therapies are not working, you need to see a provider who specializes in recurrent infections and who can provide you with alternative options for treating yeast.