The Patty Brisben Foundation for Women’s Sexual Health (PBF)’s speaker series, #SexualHealthMatters, is an opportunity for community members to talk with women’s sexual health experts and medical professionals and discover resources for issues impacting their sexual health. The series is designed to educate and empower local women to take charge of their sexual well-being.
#SexualHealthMatters
SEXUAL HEALTH YEAR IN REVIEW
By: Cheryl B. Iglesia, MD FACOG
2020 A.D. is unforgettable for many reasons beyond the SARS-Cov-2 pandemic which has impacted global industries including small businesses, restaurants, travel, lodging and entertainment. Dating and sexual relations beyond one’s pod has proven particularly problematic. Early on in the pandemic, the New York City Health Department came out with the most practical guidelines related to Safer Sex and Covid-19, including promotion of masturbation (“you are your safest sex partner”), selective kissing, social distancing through sexting and web chat platforms, and creative use of barriers and positions to get intimate while wearing a mask.1
One of the most reassuring papers on sexual health this year was published by Antosh Antosh et al2 on behalf of the Systematic Review Group of the Society of Gynecologic Surgeons. In this comprehensive review of 67 original articles, sexual function after surgery for pelvic organ prolapse (a condition of sagging vaginal organs that is associated with a lifetime risk of surgery for 12.6% of US women ), sexual function improved or remained unchanged and there was no worsening after pelvic reconstructive surgery. The risk for new onset painful sex was low at less than 9% after surgery and did not differ between mesh and no mesh repairs.
Furthermore, two of the hottest topics related to sexual health are low libido (Hypoactive Sexual Desire Disorder or HSDD) and vaginal dryness (Genitourinary Syndrome of Menopause or GSM). In a well-written clinical review of early menopause, defined as menopause before age 45, and premature menopause (before age 40), Kingsberg et al3 list the negative physical and mental health effects of early and premature menopause including higher risk for cardiovascular disease and early death, osteoporosis, joint and muscle stiffness, dementia, depression, anxiety, female sexual dysfunction and sleep difficulties which can lead to worsening memory.
With respect to sexual function, the younger the onset of menopause (for example due to removal of ovaries for prevention of cancer or as a result of chemotherapy or genetic disorders) the worse the symptoms including decreased desire, inability to orgasm, vaginal dryness and pain with sex. Hormone therapy in patients with early menopause is generally indicated until a woman reaches the age of natural menopause (51 years on average) for prevention of severe health consequences and not just for symptom relief. For those with GSM not responding to hormone therapy, additional local treatment with estrogen tablets, rings, creams, or other hormonal formulations (prasterone and ospemifene) may also be indicated.
Finally, for HSDD, there are no FDA-approved testosterone formulations for women; however, there are two non-hormonal drugs approved for the treatment of HSDD in premenopausal women –flibanserin and bremelanotide—and these likely would show benefit in women with early menopause. Treatment with antidepressants and psychotherapy for associated mood and sleep disorders should be considered for improved quality of life.
In summary, this pandemic year has presented many challenges but there are some bright lights with respect to sexual health. Pelvic reconstructive surgery has a positive impact in sexual function among women with pelvic support problems. Many hormonal and non-hormonal therapies can prevent sexual and quality of life problems in women with early menopause.
Cheryl B. Iglesia, MD FACOG is a member of the Patty Brisben Foundation for Women’s Sexual Health Medical Advisory Board. Dr. Iglesia is a Professor in the Departments of OBGYN and Urology at Georgetown University School of Medicine. She is also Director of the Section of Female Pelvic Medicine and Reconstructive Surgery at MedStar Health in Washington, D.C.
References
- Covid-Sex-Guidance by New York City Health Department accessed on December 22, 2020. https://www1.nyc.gov/assets/doh/downloads/pdf/imm/covid-sex-guidance.pdf
- Antosh, Danielle D. MD; Kim-Fine, Shunaha MD; Meriwether, Kate V. MD; Kanter, Gregg MD; Dieter, Alexis A. MD; Mamik, Mamta M. MD; Good, Meadow DO; Singh, Ruchira MD; Alas, Alexandriah MD; Foda, Mohamed A. MD; Balk, Ethan M. MD, MPH; Rahn, David D. MD; Rogers, Rebecca G. MD Changes in Sexual Activity and Function After Pelvic Organ Prolapse Surgery, Obstetrics & Gynecology: November 2020 – Volume 136 – Issue 5 – p 922-931 doi: 10.1097/AOG.0000000000004125
- Kingsberg, Sheryl A. PhD; Larkin, Lisa C. MD, FACP; Liu, James H. MD, NCMP Clinical Effects of Early or Surgical Menopause, Obstetrics & Gynecology: April 2020 – Volume 135 – Issue 4 – p 853-868 doi: 10.1097/AOG.0000000000003729
#SexualHealthMatters with Dr. Krychman
Featuring: Dr. Michael Krychman
Now more than ever, our health— including our sexual health, is so important! We are excited to have board-certified OBGYN, clinical sexual counselor and author, Dr. Michael Krychman, on our board and available to answer your sexual wellness questions and concerns during this time. If you have a sexual health question, head to our “contact us” page to submit it and Dr. Krychman is happy to answer. Check out some of our top questions below!
I haven‘t had sex in almost 5 years. I don’t have the urge like I used to and I barely have the urge to "help myself. When they say "if you don‘t use it, you lose it" and it feels like that’s true. Will I ever be normal again?
Sexual interest, whether with a partner or with yourself develops because of the synergy between biological and psychological factors. Here are a few pieces of advice:
- Get an exam and some lab tests. Just like you have to tune up a car before driving, your body needs to be buffed and shined from an anatomical and hormonal perspective. Sometimes lowered testosterone or lowered estrogen levels could be the culprit. Underlying medical conditions such as thyroid dysfunction can also lead to sexual problems. A good examination is important.
- Do a life survey. Check on psychological, relationship, cultural and even family stressors that maybe impacting your sexual desire.
- It’s important to remember some women have what is called reactive libido. A reactive libido start off as neutral, but once it gets going, the experience becomes enjoyable.
- Most importantly. Remember, you are not alone. The condition is very common! Up to 10% of women have NO sexual desire and it’s quite distressing. Do not be afraid to seek help. If your health care professional doesn’t feel comfortable with talking about sexuality, it might be time for a second opinion or a new provider. There are health care professionals who are specifically trained in sexual concerns that can and want to help. Some great resources to find a provider include the American Association of Sex Educators, Counselors and Therapists or the International Society for the Study of Women’s Sexual Health.
I have never felt pleasure with sex other than using a vibrator. Lately, even that is a challenge. Also, I have been experiencing pain on occasion for the past couple of years. I’m 45, and everything checks out physically on exam. Do you have any recommendations?
Sexual pain can be a multifaceted phenomenon and it’s important to have a good gynecological exam to rule out any underlying medical conditions such as endometriosis, fibroids or even hormonal imbalances. As we age, sometimes the vibration and or pressure we need from a vibrator may increase… perhaps try a higher speed vibrator, apply more pressure or even consider enhancement creams for arousal that can be topically applied to the genital area. Also, remember that the whole body has erotic and erogenous areas that are arousable— the nipples, clitoris or even labia are new exciting spots to stimulate.
What do you do if your partner has a low sex drive or doesn’t want to ever have sex. How do I help?
Sexual desire mismatch is a very common issue between couples. Sometimes it’s best to start the communication process by discussing what the obtainable realist goals are. One partner might want sex 7 days a week, while the other partner might only want it 2 times a week. It’s important for the two of you to come to a compromise and meet in the middle. Perhaps the best question to ask is not “what” but why? Why is there lowered desire in one partner? Sexuality is a multifaceted phenomenon and often it can be a medical issue (low testosterone or even thyroid dysfunction) or perhaps a psychological or behavioral issues (stress, fatigue, etc.). It’s best to discuss the issues and perhaps seek medical professional care to understand the “why”.
My dildo causes me to be sore afterwards and stopped using it. Then, I started dating someone bigger than it and it scared me. Do you know if there are ways to help not being sore for days afterwards?
Being sore after play with a larger than usual dildo or having had intercourse with a particularly well-endowed partner can be concerning to the women experiencing these symptoms.
Here are some helpful tips:
- Go slow. Remember that the vagina is a space that has the potential to stretch and accommodate the birth of a child. Even the smallest baby has a large head. It’s important to go slowly to allow yourself to get aroused and lubricated. The vagina also needs some time to expand. Try to increase your time in foreplay and ensure adequate lubrication and arousal.
- Even if your aroused and lubricated, it’s helpful to try some good lube. Many sexual medicine experts recommend silicone-based lubricant for its lubricity, slickness and ease of use. It’s particularly helpful when having a prolonged sexual interlude or when there is excessive friction.
- It’s a lock and key phenomena. Sometimes the lock is too small for a big key. Sexual Medicine experts often recommend graduated vaginal dilators that you can sequentially place within the vagina. Vaginal dilators gradually increase in diameter, so progressive use over time can help stretch a narrow or tight vagina. Go slowly, don’t rush your progress with vaginal dilators and ask for medical help should you need instructions.
- Get a sexual health evaluation. On rare occasions there may be some underlying medical condition that warrants evaluation. See your gynecologist, healthcare specialist or sexuality expert. Sometimes your vaginal muscles can be in spasm and that may make intercourse painful.
#SexualHealthMatters: Sexual Health After Trauma – November 12, 2019
Featuring: Sarah Klein
#SexualHealthMatters: Sexual Health & Menopause Panel Discussion – July 9, 2019
#SexualHealthMatters: Youth Sexual Health Panel Discussion – April 4, 2019
#SexualHealthMatters: Youth Sexual Health Panel Discussion – January 17, 2019
#SexualHealthMatters Q&A – January 17, 2019
How do you talk to your special needs 14 year old daughter about sex and boys? I have never really thought about it till my friend told me she had a boyfriend. She didn’t even tell me, and he even gives her gifts.
Young people with special needs will want to understand their bodies, develop interpersonal relationships, and will have romantic and sexual interests, just like their peers. For youth with special needs, conversations about sexual development and sexuality can be modified in a way to meet their learning or health needs. Parents can ensure their child is told correct information about sex and encourage the correct language for body parts. Discussions about personal boundaries and privacy should include information appropriate and inappropriate touching, and the young person’s right to say “no” when they feel a personal boundary has been crossed. Sometimes role playing possible scenarios so that the young person can practice saying “no” is helpful. Youth with special needs should understand their rights and choices for health sexuality.
– Dr. Sarah Pickle
The key things to emphasize in this situation are safety and honesty. With my patients, I stress the following points as being very important: delaying physical & sexual intimacy until she is older, is in a safe and consensual relationship and feels emotionally ready to engage in this; choosing the appropriate partner who is trustworthy and honest with her; and avoiding unsafe situations.
– Dr. Rula Kanj
What is a healthy rate of masturbation for a teen girl? What is a healthy rate of masturbation for a teen boy?
Masturbation is a part of normal human sexual experience, for all genders and at all ages. There is not a certain frequency of masturbation that is considered healthy or not healthy. If masturbation is interfering with normal routines, responsibilities or play, then a further discussion with the child’s physician may be helpful.
– Dr. Sarah Pickle
What are your thoughts on verbiage- using private vs. personal. I’ve heard a lot of negative connotation to private- then if something goes “wrong” they are leery to share- so stick to saying personal?
Using either the term “personal parts” or “private parts” to discuss the boundaries of appropriate and inappropriate touch are okay, as long as the child knows that there are trusted adults (parents, etc) who they can talk to if there is a concern about these areas of the body or inappropriate touching.
– Dr. Sarah Pickle
Either one is fine; it depends on the child. I typically use “private” and explain what that means: private to the child, and only to be seen by people whom they trust and who help take care of them (e.g., parents, grandparent who helps with bathing, etc.) and doctors/nurses when they (the child) gives permission for that area to be looked at, “to make sure you are healthy.” The term “personal” may be more confusing, as their entire body should be considered personal parts!
– Dr. Rula Kanj
How early can you start Hormone Replacement Therapy?
Starting gender-affirming hormones (also known as “hormone replacement therapy”) in transgender youth involves an individualized approach that takes into consideration the youth’s age, development, other health conditions, and youth and family preferences. National and international professional guidelines recommend to consider gender-affirming hormones after the youth has been on puberty blockers for a few years or has gone through puberty.
– Dr. Sarah Pickle
When my daughter was 4, she told me she wished she had a penis like her twin brother because “it’s more fun.” I told her girls’ vulvas can be fun too. She then asked me to show her, and so I encouraged her to just explore her body & do whatever feels good. Is there more I should teach her about her own body & sexual pleasure? I didn’t even know girls could orgasm until I was 19!
All kids will develop at their own pace, and their interests in their parts will ebb and flow depending on where they are on this developmental trajectory. I think your response was good. If she wants to know more, she will ask you.
– Dr. Suzanne Sampang
Should I freak out my 7 year old kissed her 5-6 year old niece? How do I teach other parents that if cousins have kissed the world won’t end?
Definitely don’t freak out. Your 7 year old may just be mimicking what they’ve seen. Kisses are also a sign of affection, no need to assign more meaning to is than just that.
– Dr. Suzanne Sampang
What if a child walks in on parents having sex and then tries to mock what they saw with other kids? Even after having a talk that it’s an adult activity?
Don’t over-react or freak out. Don’t punish or shame them. Let them know that when they play with their friends, they should respect each other and touching their friend’s private parts is not okay. Teaching kids about personal boundaries is important.
– Dr. Suzanne Sampang
My son is 6 and I’m 30. I walk around in my underwear and he always makes comments like “Mom, I can see your butt!” When should I stop walking around in my underwear?
Decisions about what is considered OK as far as clothing in their own home or showering together are personal family decisions. Some families decide everyone should be fully clothed outside of the bathroom and bedroom, and others are more comfortable about less clothes or no clothes at all being OK in the privacy of the family home. Some families are OK if same gender members shower together in their own home. One thing to instruct children is that different families can have different policies on this- you would want to try to prevent misunderstandings if your child goes to a sleep-over in another family’s home. An important concept to keep in mind in this discussion is not to create shame in children about the human body if your family decides to change their thoughts on this topic, and it is OK to change your “policy on clothing/showering” over time. As children grow into pre-teens and teens, it is a natural developmental step for them to crave more privacy- so there may come a time in the future where everyone in the house does want to cover up more or not shower together to respect that development. I am not saying your 6 year old is becoming a pre-teen yet, but you could use this time to follow his lead and change your clothing practices to anticipate the changes that may come for him as a pre-teen or teen. But you have to do what works for you and your family- there is not one correct answer.
– Dr. Corinne Lehmann
My 6 year old son gets erections often. They are uncomfortable for him and disruptive to activities at times. What do I say to help him cope- I just tell him to take a deep breath and try not to apply pressure.
For most boys, spontaneous erections happen in the context around sleep, but they can happen at other times too. This is normal even for boys that have not gone through puberty yet, similar to masturbation also being a normal developmental stage for children. You can explain to your son that erections are a normal function of the body and it is a sign that he is growing normally. However, as the penis is a private or personal part of the body, it is best to just let family members know when these have happened when you are in the home or a private setting (this is similar to the way you might handle masturbation as well). For erections that happen in the daytime, is there a particular situation or activity when the erections occur? Maybe you can adjust those situations to help decrease these episodes as he finds them uncomfortable. If these are truly happening on a frequent basis, you may want to seek medical attention with your regular primary care provider. Some children, for example with sickle cell, can experience erections as a complication of their disorder and that does require medical evaluation. For most boys, I agree with your own actions of taking deep breaths to help him when the erections occur. You may also want to direct him to seek a bathroom or private area if he can get to one when these occur as well. You could also consider a distraction or something to alternatively focus his mind- like a portable video game player, although this does not always help. A great place for further advice is www.healthychildren.org, which is organized by the American Academy of Pediatrics. The site has great information for families on many aspects of raising children!
– Dr. Corinne Lehmann
I have a 9 year old daughter that has a best friend that was diagnosed with Leukemia at a very young age. And, the chemo killed her hormones. How do I explain the difference in puberty?
This is a great story of how to be supportive of a cancer survivor. Even beyond cancer, children who have experienced significant medical illnesses may have delayed puberty. Delayed puberty also occurs in a certain percentage of the healthy childhood population normally as well. It would be a great thing to let your daughter know that many people go through puberty in different ways and it is all OK. As many medical providers have described “puberty is a predictable series of events but there is variance in timing of onset, sequence, and tempo.” This means some children will start puberty early, others will start late, some children will start and then stall out for a bit, and others will go through the process quickly. If a parent is concerned about the timing of puberty in any of these ways, they should check in with their primary care provider. There are some good videos produced that speak directly to children regarding this process that you may be able to purchase or get from the library or school. This would be a good topic to suggest to your local elementary school to include in their health teaching of the students too. Learning this at school will reinforce what you tell your children at home.
– Dr. Corinne Lehmann
I would explain that every child starts to develop into a teenager at a different age, and continues to develop at different speeds. Sometimes, kids have to receive medicines and treatments that change the time that they will start puberty. There is not one way that is better or worse, and eventually, everyone will develop into an “adult” body.
– Dr. Rula Kanj
#SexualHealthMatters: Women’s Sexual Health Panel Discussion – September 25, 2018
#SexualHealthMatters Q&A – September 25, 2018
I have entered menopause. My husband thinks I should be “willing” all of the time, I have hardly any libido. I’m not really interested in sex at all. He is frustrated, and so am I. I have no passionate feelings. I can orgasm, but only with clitoral stimulation. Then, when it’s his “turn,” I get really sore in my outer labia. Then, I’m sore for days. Please HELP!! :(
Dysfunction with orgasm is common in women. Unfortunately, pain with intercourse or stimulation is also very common. The most common reason is low levels of hormones.
There are a multitude of different treatment options including prescription medications, lasers, and hormones. You do not have to live like this. Sex can be pleasurable again for the both of you.
– Dr. Somi Javaid
How did you decide on this career path of sexual health empowerment?
I always knew I wanted to empower women. I nearly lost my mom at the age of 45 when she was misdiagnosed. Being a board-certified OB/GYN I began to listen to stories from women who were frustrated and turned away when they tried to discuss their sexual health concerns. Being married to a medical oncologist brought even more of these patients to my attention. I knew there was a better way I knew there were treatment options out there so I sought further training in sexual health and menopause. Now my practice has nearly 5500 patients and I feel so rewarded taking care of patients.
– Dr. Somi Javaid
If a man has had controlled diabetes for 8 plus years, has tried viagra and testosterone over the years but still struggles with being able to maintain/get hard enough to have intercourse and seems to be smaller in size, girth over time is there anything that can assist us as a couple or recommendations of doctors to see!
I recommend seeing a urologist who specializes in men’s health to further discuss your particular circumstances because everyone’s situation is unique and there are many underlying medical conditions, medications, or life stressors that can contribute to worsening erections. In addition, a urologist can give you recommendations on many different options for improved erection. Viagra is the best known of medications, but it is just one of many treatment options you can discuss further with a urologist.
In general, it is important to remember that the quality of your erection is a reflection of many underlying processes working together – blood supply, nerves, libido, etc. The best recommendation to maintain healthy erections is to keep your body healthy with diet and exercise, avoid smoking, and follow your doctor’s advice for managing your medical conditions.
-Dr. Courtney Plattner
#SexualHealthMatters: Women’s Sexual Health Panel Discussion – June 7, 2018
#SexualHealthMatters Q&A – June 7, 2018
Desire is wonderful, but when you’re my age and your gentleman friend is 71 sometimes it is more a matter of physical opportunity and when he is able to perform whether I am in the mood or not.
Whatever your age it is good to identify how you feel desire. Get away from the idea of performance; that sex can only happen if there is an erection, there is insertion and an orgasm happens, otherwise you’ve failed. So, I think it is important to talk to your partner about how to take time for some kind of sexual engagement: an hour to stimulate each other, some caressing and learning each other’s bodies, finding other ways to experience pleasure without having to focus on intercourse.
We tend to be so focused on penetrative sex, but it isn’t the end all be all of sexual pleasure and satisfaction.
What is the general age that women come to the doctor for pelvic pain, and is it normal to see a young and non-sexually active teenage girl experiencing pelvic pain?
Pelvic pain happens at all ages and the time of life will be different based on causes. At the age you described endometriosis is a common cause but can also be pelvic spasm or bladder pain syndrome. The most important thing is to find a doctor who really listens to you because pelvic pain is a complex issue and while it may be gynecologic it could also be a GI issue or a number of other causes. So, find a doctor who will listen to your concerns and make the right referrals when necessary. A chronic problem isn’t going to be fixed in one visit, so finding someone you can relate with and whom you trust is extremely important.
How do we get women to find the right physicians? What do they look for?
Word of mouth is huge. Yelp and Facebook are great but what really matters is the opinion of people you trust. Ask your friends how they felt in the office and if the physician listened or if they were dismissive. There are websites with specific credentials in various areas to help you find specialists, and make sure the individual has what you are looking for listed on their website, be it pelvic pain, sexual health or sex therapy, make sure you are finding a practitioner who has experience dealing with the issues you are coming to them with.
I was diagnosed with stage 3 breast cancer and I want to know if you see a lot of patients between 25-35 with extreme breast cancer who’ve dealt with hysterectomy after cancer?
A lot of gynecologists don’t know how to deal with these issues because it isn’t a common part of their training, but there are resources for survivors and providers who know how to treat the various issues that they face in terms of their sexuality and fertility after treatment. There are many more options available in terms of fertility today than there was in the past and there are great onco-fertility teams in Cincinnati. Being able to talk about the complexity of being a survivor and the priorities within your own life with your provider is so important because it is your life. Women’s healthcare is still behind men’s in a lot of ways and we need to advocate for ourselves and for each other.
I’ve heard about Mona Lisa Touch for menopause and vaginal atrophy, can you tell me more about that?
The technology behind this is that if you treat the entire vaginal wall with carbon dioxide at a certain frequency it will essentially “remodel” the vaginal wall. Basically, this stimulates new cell growth which looks more like premenopausal tissue than the scar tissue that forms in the vagina during and after menopause. It is typically a series of 3 treatments and has been shown to be about 90% effective. They are in the process of testing to see what other ailments this may be an effective treatment for. And there are also several other lasers approved for use as well, Mona Lisa just being the most commonly known.
IUDs seem to be more and more common as a method of birth control, what are your experiences with these? Do you have any advice for women who choose this method?
Dr. Bartlett is a “huge fan” she says that she has had two herself and wouldn’t recommend them to patients is she didn’t think they were a great option. She says that in general she sees fewer problems with IUDs than she does birth control pills. They go inside the uterus and do not contain estrogen, (there is a nonhormonal version and several that contain progesterone) and since the progesterone is localized you tend to not get the whole-body side effects that are more common with other forms of hormonal birth control. So this is a great option for women with hormone sensitives. One of the side effects of hormonal birth control is decreased libido and vaginal dryness which isn’t an issue with the IUD. It is convenient, you don’t have to think about it, and more effective than almost any other form of birth control available.
How do you determine if the issues behind period cramping are related to endometriosis and how do you treat them?
The definitive answer comes laparoscopy or biopsy but you really don’t have to go that route. If a patient comes in with symptoms that mirror endometriosis you try them out on a birth control or other treatment that is effective for treatment and see if the symptoms go away. If you struggle with diagnosis after that then you look into other tools. It comes down to finding a doctor who listens to your concerns and is wiling to spend time helping you look for answers.
Can we talk about lubricants? There are so many out there, some are water based and some are not, and it can be overwhelming. What do you think are the safest and healthiest lubricants available?
First, make sure you avoid petroleum products, so no Vaseline. Use a product that is meant to be a lubricant and not something else from your medicine cabinet or kitchen.
Second, no one works harder on developing safe lubrication that Pure Romance, so find a consultant to help you determine what best suits your needs. There are formulas for vaginal sex, anal sex, and for use with bedroom toys and talking to someone trained in the differences can help you make the right decision.
What is your perspective on ablation?
There are a lot of misconceptions about ablation, but it is important to remember that it is not intended as a form of birth control. The intention is to burn the lining of the uterus, so it can’t regenerate and can be very effective as a treatment for extremely heavy and unmanageable periods. The rate of hysterectomy went down significantly after they became common.
Can we talk about weight gain and sexual health? When I go to my doctor they tell me that when I turn 35 I’m going to gain weight and I just don’t think that is an acceptable answer.
Body image and weight gain can be managed different ways and often things like thyroid activity and nutrient levels are overlooked unless the patient is morbidly obese, so finding a doctor who will listen and look at you as a whole person is very important.
Also, from a sexual health perspective, excess weight can exasperate pelvic floor issues and bladder control issues. Not to mention the fact that our body image can take a toll on our libido and self-image. Try to find something you love about the way you look and focus on that. No matter where you are in your journey make the space to look at yourself in a positive light daily.
When I was 65 my gynecologist told me I never had to have another pap smear. I asked why, and she said it was because by the time a the HPV virus caused changes in the cervix I would be in my 80’s and they wouldn’t treat for cervical cancer. Is this true?
Yes, for certain women in low risk groups meaning they have never shown cervical dysplasia in the 20 years prior. However, just because you don’t need the same type of cancer screening as younger women you still need a trusted gynecologist in your corner to take care of their other sexual health needs. There is more to routine women’s health care than just a pap smear.
As a teenager I experienced extreme vaginal tightness and pain making it difficult to even use a tampon. Doctors were often dismissive telling me it was just how I was shaped. How much of that is true and is there treatment for these physiological issues?
Sex shouldn’t hurt. Ever. And if there isn’t a physical issue maybe they need a lubricant or increased communication about likes and needs with your partner.
With young girls, sometimes they have fully intact hymens which can be treated simply and easily in the office. For issues like vaginismus there are lots of treatments involving therapeutic, medical and physical. It’s just a matter of finding the right practitioner who can help you navigate the issue and the root of it. Sometimes it is physical, but sometimes it is more multifaceted and needs a team approach.
I have PCOS and always associated my period pain with that. A few years ago, my mother had a hysterectomy and had severe endometriosis without really ever having symptoms. Should I be checked for that?
Any time you have pelvic pain you should see your doctor!! Yes, it is possible for someone to have endometriosis without any symptoms and there is a hereditary component, so it is worth getting checked out.
Gardasil was something that was very popular years ago, I received that shot. Not people are telling me that they are having trouble all these years after receiving it and I’m wondering if you are seeing women who have issues years later?
We see women who have trouble from NOT having the vaccine. This vaccine has been widely tested at the highest level and is proven safe and effective as a cancer preventative. More than 90% of adults have been exposed to HPV and we aren’t sure why only some of these individuals develop the chronic response that turns into cancer, but we do know that the vaccine is hugely effective in preventing these cases.
To kegel or not to kegel?
This is a complex question. Kegels can assist with symptomatic relief of many pelvic floor disorders such as stress incontinence that is mild, overactive bladder, muscle strengthening, and sometimes retraining nerve responses in the pelvic floor.
It is less effective for pelvic pain and may even cause increased pain if the patient has vulvar or vaginal pain related to nerve entrapment or muscle spasm.
It is really important to know you are doing a regimen of kegels correctly, however. Ask your gynecologist or Urogynecologist to help you ensure proper usage. There are also physical therapists and some home devices with Bluetooth to your phone to show progress.
Is it normal to have pain just at certain angles and do you recommend being checked out if it’s only certain angles that make it hurt during sex?
Vaginas are kind of like snowflakes in the no two are alike. In saying that, there are usually preferences for intercourse positions for many women due to irritation, discomfort, or just not being comfortable in general with the idea of certain positions. Many women also have different ‘tilts’ to the uterus which can change preferences and also pain levels in certain positions. The most important message is to be open with your partner about what is uncomfortable, so you can figure out if there is a way to manipulate the position or avoid it.
I’ve had such bad luck with gynos. I have bad cyclical pelvic pain and feel like I can never establish a good relationship or medical history with a doctor. How can I find the best doctor for me?
Dr Bartlett would be happy to see you! Otherwise, she recommends talking to friends and family to see if they’ve had a good experience with their doctors. And make sure to schedule a visit to specifically discuss this problem (not just mention it at your annual visit). You need to have adequate time to dig into it at your appointment.
Stay updated and learn more about women’s sexual health.
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