Sexual Health

Conditions We Treat

Vulvodynia / Vestibulodynia

It is characterized is a marked sensitivity or chronic pain felt at the opening of the vagina. While symptoms can vary for many women, women with Vulvodynia frequently find penetrative intercourse and even light touching to the vulva extremely painful. Vulvodynia is considered a chronic pain disorder. Various studies have shown that vulvodynia affects approximately 15% to 20% of adult women. It is the most common cause of sexual pain in premenopausal women and one of the most difficult for most doctors to correctly diagnose and treat.

Vulvodynia or vestibulodynia may be the result of many different causes. In the past few years’ sexual health organizations have produced a small amount of evidence-based literature surrounding this disorder but there is still more to be learned and not every patient presents in the same fashion. As of now, providers have been unable to determine the exact cause of the disorder, however, causes may include inflammatory and infectious disease processes, neurologic conditions, genetic factors, stress factors, and hormone factors. As a result, one management strategy for all women with complaints of vulvar pain will likely not be successful.

Treatments may include psychotherapy and/or behavioral counseling, pain medication, pelvic floor physical therapy, hormone treatments, if indicated, and surgical interventions in some cases. Your healthcare provider at Augusta Anti-Aging Medicine will work with you to outline an individualized, holistic treatment plan based on a bio-psycho-social approach to encompass all aspects of care.

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Female Sexual Interest / Arousal Disorder (FSAID)

Female sexual arousal interest disorder is a complex and hardly understood condition affecting women of all ages and ethnicities. It may be impacted by biologic, social, psychological, environmental and hormonal factors. Conditions affecting FSIAD may be affected by mood and/or anxiety disorders; panic attacks, depression, phobias or bipolar disorder. Specific knowledge of this is extremely relevant in developing a treatment plan for the disorder; with an expectation of improvement in the enjoyment of sexual activity by the patient. FSIAD may also be impacted by a stored memory or secret can play in inhibiting sexual enjoyment. As well, general sexual dysfunction takes a variety of forms; but Female Sexual Interest/Arousal Disorder is much more specific (American Psychiatric Association, 2013).

Female sexual interest/arousal disorder is defined as a complete lack of or significant reduction in sexual interest or sexual arousal. It is diagnosed with three or more of the following symptoms are manifested. These include the absence of an interest in sexual activity; or a decided reduction of such; and an absence of fantasizing or even experiencing erotic sexual thoughts. These symptoms last for six months and have a negative impact on the relationship or the individual. There may be no evidence of a physical, biological or substance induced cause of the condition. The problem may be lifelong or acquired; and its severity may fall on a continuum of mild to moderate or severe. Finally, the problem may be situational – occurring only in some instances and not others; or generalized – with no apparent limitations.

Prior to a final diagnosis it is recommended that a female who presents with complaints regarding sex should undergo a complete physical examination to ensure the source of the problem is not physiological. Abnormal physical examination findings or suspected comorbidities are then addressed. This may require medications, pelvic floor physical therapy, or counseling depending on the cause.

It is always a good idea to reduce or eliminate the use of substances such as alcohol, nicotine, caffeine, and prescription medications; under the supervision of your prescribing clinician. Smoking may directly affect libido because it causes constriction of blood flow to the sexual organs and can directly decrease sexual arousal. Too, physical activity causes an increase in blood flow and the release of endorphins that can improve stamina; both are important to all areas of life including sexual activity. Physical activity also reduces stress which is an inhibitor to optimal sexual health. But, perhaps most important of all is to maintain open communication with your sexual partner. Women are often embarrassed to discuss sex and this alone may be the root of the problem.

Equally as important is creating a schedule that includes time for the couple to be together; alone and away from distractions. Creating an environment that is private and inviting for intimacy- no television, exercise equipment, or laundry piled in a chair. The bedroom should be a haven for the couple to enjoy each other’s company, clean, warm and an inviting environment is the foundation for sexual possibilities.

Psychotherapy may be part of the treatment plan for FSIAD; it should become a part of the routine. Therapy is important; and it may require individual and couple’s sessions.

Finally, Female Sexual Interest/Arousal Disorder is a common problem among couples, especial as the couple ages, don’t be too hard on yourself; this may only exacerbate the problem. If you are the partner of a person with this disorder then patience and supportiveness will be important to the healing process.

Treating Female Sexual Interest/Arousal Disorder can be complicated and rarely has a single causative factor. For this reason, a comprehensive exam and interview with both sexual partners are recommended. Treatment begins with patient education. Often women have no expectation of what is ‘normal’ or how to express themselves.

Finally, pharmacologic treatments may be a treatment option for treating physiologic needs, imbalances, or symptomatic complaints, and comprise only one part of the overall management of patients with female sexual disorders. For a comprehensive evaluation, book an appointment today.

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DYSPAREUNIA (PAINFUL SEX)

Female sexual pain (dyspareunia) may present in a variety of ways and stems from many causes. Dyspareunia may have substantial impact on a woman’s relationships and quality of life. The estimated prevalence of dyspareunia is approximately one out of every five or six women experiences significant dyspareunia.

Dyspareunia is defined as “pain associated with sexual intercourse which includes pain with attempted or completed vaginal entry”. Although dyspareunia can be caused by a multitude of conditions, the most common cause of dyspareunia in menopausal women is atrophic vaginitis and the most common causes in pre-menopausal women are vestibulodynia, interstitial cystitis, pelvic floor hypertonus, vulvar dermatologic conditions, and endometriosis

Specific Causes Of Dyspareunia

Atrophic vaginitis occurs in 10-40% of postmenopausal women, and is due to low estrogen levels. This occurs most commonly with menopause and aging, but can result in younger women due to hypothalamic amenorrhea, hyperprolactinemia, lactation, and usage of anti-estrogenic medications. Occasionally, usage of extra-low dose contraceptive pills and cancer therapy may cause similar symptoms.

During the reproductive years, estrogen plays a major role in maintaining a normal vaginal environment. This includes healthy vaginal tissue, increased blood flow and lubrication, a balance in healthy vaginal bacteria, and a low (<4.5) pH. With reduced estrogen levels during menopause, significant changes occur in the vagina, resulting in the tissue becoming pale, thin, and less flexible. Vaginal changes include: dryness, thin vaginal walls that are prone to mechanical damage and tear with sexual activity. With prolonged estrogen deficiency, the vagina may become shorter, narrower, and less elastic. All of these changes increase the likelihood of trauma, infection and pain.

Estrogen therapy is the most effective treatment for atrophic vaginitis, but some authors advocate lubricants and moisturizers as first line therapy. Because the overall dose of estrogen is lower and is associated with less systemic absorption, intravaginal estrogen therapy is generally considered safer and can be less concerning to patients.

Vestibulodynia (formerly called The Vulvar Vestibulitis Syndrome) refers to pain which is limited specifically to the vulvar vestibule, thereby causing pain with initial vaginal penetration. Vestibulodynia is characterized by: severe pain upon vestibular touch or attempted vaginal entry, tenderness to pressure localized within the vulvar vestibule, and physical findings limited to vestibular erythema. It is important to note that one third of women with IC/PBS avoid sexual intercourse due to unbearable pain during intercourse.

Treatment of IC/PBS can be challenging. Treatment options include dietary changes, instillations of steroids, heparin, and lidocaine directly into the bladder, oral medications, and hydrodistention of the bladder.

Pelvic Floor Hypertonus (also called Levator Ani Spasm), or the chronic spasm of the muscles of the female pelvic floor (levator ani muscles), is becoming increasingly recognized as a cause of chronic pelvic pain and dyspareunia in women. Pelvic floor muscle spasm (vaginismus) may occur as a primary event or secondary to other physical or psychological factors. This condition may be treated with pelvic floor physical therapy, Sex therapy, vaginal dilation, and pelvic botox has been effective in the treatment of sexual pain.

There are many dermatologic conditions which may affect the vulva and cause symptoms, including dyspareunia. The most common dermatologic disorders which affect the female vulva include allergic or irritant dermatitis, lichen sclerosus, and erosive lichen planus. Fissures at the back of the vaginal opening may also be considered, but is not a true dermatitis. The best way in which to diagnose one of these conditions is with a careful physical examination (aided by a colposcope) and vulvar biopsy evaluated by a dermatopathologist.

Endometriosis is the most common cause of chronic pelvic pain in women. Symptoms of endometriosis include recurrent painful menstrual cycles which may become more severe with time, infertility, chronic lower abdominal and back pain and deep dyspareunia.

There is considerable variation in how female sexual pain is defined as well as diversity in how women who suffer from this condition present for medical care. There are many causes of dyspareunia and frequently there may be more than one cause for a given individual. Providers who care for these patients should possess not only the necessary medical knowledge, but also empathy and compassion.

At Augusta Anti-Aging Medicine, our treatment protocols aim to bring relief to the pelvic floor which can drastically improve intimate relations. Many individuals may be hesitant to discuss dyspareunia-related symptoms with medical professionals. However, due to the wide range of conditions that cause dyspareunia, it’s important to schedule an appointment with a healthcare provider that specializes in sexual health conditions to establish a confidential, comprehensive, personalized treatment plan to regain your sexual health.

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Hypoactive Sexual Desire Disorder (HSDD)

Hypoactive sexual desire disorder (HSDD), is the most common sexual dysfunction in women. It has been associated with negative emotional and psychological states, as well as medical conditions including depression. HSDD is the most common female sexual dysfunction and affects about 1 in 10 women. It can happen at any age. The Mayo Clinic notes that as many as 40% of women have HSDD at some point in their lives, according to some studies. 5% to 15% of women have the problem continuously.

Hypoactive sexual desire disorder (HSDD) refers to a woman’s chronic or ongoing lack of interest in sex, to the point that it causes her personal distress or problems in her relationships.

It’s normal for women to lose interest in sex from time to time. A woman’s libido can change throughout her life. It might be high when she’s feeling good about her relationship or if she’s excited about a new one. It might decline when she’s under emotional stress or dealing with hormonal changes from pregnancy or menopause.

HSDD can be frustrating for a woman and her partner. But it is a treatable condition. Even though it might take some time to discover what’s causing it, a woman with HSDD can return to a satisfying sex life.

There are many ways to treat HSDD. Treatments for the physical causes depend on the individual. For example, changes in medication or diabetes control may be in order. A woman might need to make some lifestyle changes to combat stress and fatigue.

Some women also benefit from counseling or sex therapy. Specialists can help them cope with any past sexual trauma. They can help women improve their self-esteem and understand their relationships with their partners. A sex therapist can help women improve their ability to openly discuss sexual concerns with partners. They might also introduce ways to make intimacy a bigger priority – and more interesting.

Hormonal Therapies

Some women find estrogen therapy helpful. Estrogen is sex hormone that affects libido, among other functions. It can be administered in the form of a pill, patch, gel, or injection. This type of therapy, called systemic estrogen therapy, helps the brain make its needed chemical connections to increase desire. Local estrogen therapy can be applied through a vaginal cream or ring. This increases blood flow to the vagina and stimulates arousal.

In some cases, you may require a combination of estrogen and progesterone to treat HSDD.

Testosterone is another hormone that affects the sex drives of both men and women. While the FDA has not approved of the use of testosterone therapy in women, off-label prescribing has shown benefit in the treatment of HSDD. It is critical that you seek treatment with a healthcare provider who is trained in the management of hormone replacement therapy to avoid unthwarted complications.

At Augusta Anti-Aging Medicine, your healthcare provider is trained in the management of hormone replacement therapy and speaks nationally to train other clinicians on the safe use of hormone replacement therapy and the treatment of HSDD.Your healthcare provider will work with you to develop a confidential treatment plan that includes a Bio-Psycho-Social approach to helping you regain optimal sexual health.

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Sexuality After Cancer

Many cancer patients face sexual problems from cancer treatment. Diminished libido, arousal difficulties, pain, vaginal dryness, erectile dysfunction (ED), and ejaculation trouble are some of the more common effects.

In some cases, patients can make decisions about sexual function when they plan their treatment with their oncology team.

Some examples include:

Testosterone is an important sex hormone for men and women, as it drives much of the libido and sexual function. Some men and women feel that their quality of life would suffer if they were not able to experience intimacy the same way as they did before cancer. Some men may decide on a less aggressive cancer treatments that preserve testosterone levels, even if that means their prognosis is poorer.

Nerves play an essential role in sexuality. When a person is sexually stimulated, nerves carry messages between the brain and the genitals. This starts the arousal process – such as an erection for men or vaginal lubrication and arousal for women.

Some cancer treatments, such as radical prostatectomy (surgical removal of the prostate gland) can potentially damage nerves related to sexual function. In nerve-sparing procedures, surgeons preserve as many nerves as possible to lower the risk of ED.

Hysterectomies and colorectal surgeries may also be done in a nerve-sparing manner.

Women with breast cancer may choose nipple-sparing mastectomy, which preserves the nipple area. Breasts can then be reconstructed around the nipple. Women may not feel the same nipple sensations as they did before surgery, but keeping the nipples can foster a more positive body image, which contributes to better sexual function.

Keep in mind that there is no one-size-fits-all approach for preserving sexuality after cancer treatment. Patients should ask their healthcare providers what will work best for their personal situation.

While some physical aspects can be addressed, it is still important to maintain healthy intimate relationships with partners and take advantage of products and services that can help maintain sexual function.

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Persistent Genital Arousal Disorder (PGAD)

Persistent genital arousal disorder (PGAD) is a chronic sensation of sexual arousal, not related to sexual thoughts or stimulation in any way.

The sensation can last for hours, days, weeks, or months. Unfortunately, the condition is not always taken seriously, and women may feel too embarrassed to discuss it with their doctor. However, women with PGAD do not want to feel sexually aroused. The sensations are not welcome and can be distressing.

PGAD affects women of all ages. This condition is possible, but rare, in men.

Women with PGAD may describe the genital sensations as tingling, burning, throbbing, or itching. There can be genital pressure or pain. Some women become lubricated, as if their body is preparing for sex. Vaginal contractions and spontaneous orgasms may also occur.

Orgasm might relieve symptoms for a little while, but the feelings tend to come back.

The exact causes of PGAD are unknown, but stress and anxiety often trigger symptoms, making PGAD even more distressing. Other common triggers may be movement (such as riding in the car or climbing a ladder), sounds, and urination.

PGAD may be associated with certain medications; other health conditions like Tourette syndrome, epilepsy, and restless leg syndrome; or spinal conditions.

PGAD can be difficult to treat. Some women may find the following strategies helpful:

Applying an ice pack to the genitals or taking an ice bath
Topical numbing agents that can be applied directly to the genitals
Pelvic floor physical therapy
Antidepressants or anti-seizure medications
Medication changes (with a healthcare provider’s guidance)
Electroconvulsive therapy (ECT refers to electrical stimulation of the brain while the patient is under anesthesia. This treatment can be especially helpful for women who struggle with both PGAD and depression.)
Surgery (if nerve or spinal problems are identified)

Women with PGAD may also benefit from counseling or support groups. For many patients, managing stress and anxiety is a key way to reduce symptoms. Therapy can also address psychological issues that stem from PGAD itself. PGAD symptoms can start at inopportune moments, and learning how to cope with such episodes in important.

If you’re dealing with constant feelings of arousal, even when you don’t want to have sex, call a trained sexual health care provider at Augusta Anti-Aging Medicine for a comprehensive evaluation.

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Orgasm Problems

Anorgasmia refers to an inability to reach orgasm within a desired amount of time. Some people with anorgasmia are unable to climax at all. Their bodies become aroused but no orgasm occurs.

Orgasmic disorders can happen to both men and women and can be distressing for both members of a couple. The person with anorgasmia may feel frustrated and sexually dissatisfied. Partners may worry that they are inadequate or not exciting enough which may impact the partner’s performance.

Orgasmic disorders are often caused by psychological factors or social factors, such as:

performance anxiety
stress
problems in relationship
past sexual trauma or abuse
negative attitudes about sex
guilt about sex
sexual inexperience
inadequate setting (e.g. lack of privacy, inappropriate timing – too late)

Orgasmic disorders can also be the precursors or the results of other sexual dysfunctions, e.g. low sexual desire, arousal problems (erectile dysfunction, lack/low lubrication, or sexual pain).

However, anorgasmia may have physical causes, too.

Here are some examples:

Medications
Diabetes
Hypertension
Excessive drug and alcohol use
Chronic pain
Spinal cord injury
Multiple sclerosis
Hormonal problems
Physical disability (motor problems like those in Parkinson’s disease, tremor, rigidity, difficulties in staying in a sexual position)
Attention problems, hyperactivity (ADD or ADHD)

The first step in treating orgasmic disorders is seek help from a healthcare provider trained in sexual health.

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