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Keeping Your Teen Healthy Posted by on Aug 26, 2013

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Finding Love After Cancer Posted by on Jan 22, 2014

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Perfecting The Kegel Posted by on Nov 12, 2013
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Finding Love After Cancer

Jan 22, 14 Finding Love After Cancer

For many single women, re-entering the dating scene after the diagnosis and treatment of cancer can be a very daunting task.  The possibility of rejection, concerns over body image and fertility, lowered self-esteem, sexual function difficulties after treatment, and fear of recurrence can, understandably, leave women feeling vulnerable.

Finding love after cancer can truly be both an intimidating and thrilling experience. However, it is a decision that, for many, should not be embarked upon without some planning beforehand to ensure greater success. Here are some helpful tips to improve confidence and make the process of dating again seem less frightening:

  • Ease into the dating scene:  become comfortable in other social situations first, such as the gym
  • Practice telling friends or strangers about your diagnosis
  • Decide when it is the right time to disclose your diagnosis to a date
  • Be honest about upcoming treatments and surgeries
  • If there are sexual function concerns, see a clinician who specializes or has an interest in sexual medicine before entering the dating scene
  • Don’t wait until after the relationship has become sexually intimate. This can cause distrust or tension in the relationship
  • Whether or not a person has had cancer, rejection is always a possibility when dating– Be prepared for it
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The G-Spot: Myth or Reality?

Jan 06, 14 The G-Spot: Myth or Reality?

For many women, the quest for the elusive G-spot orgasm has taken on mythic proportions.  Reports of this vaginally-activated orgasm describe sensations that are different, and often more intense, than those achieved by stimulation of the clitoris. In reality, most women typically experience orgasms through stimulation of the clitoris only. However, women who have failed in their efforts to achieve the G-spot orgasm may experience a sense of inferiority or lowered sexual self-esteem. Here is the dilemma: debate continues among researchers as to whether or not the G-spot actually exists. The G-spot has been described as an area on the anterior vaginal wall close to the vaginal opening. It was named after Dr. Ernst Grafenberg, a German physician in the 1950s who identified an erotic zone in the vagina near the urethra.

There are several theories that have been proposed over the past 30 years regarding what structure actually makes up the G-spot. Here are 2 of the most commonly proposed:

  1. The Clitoris: here is a piece of information that most people don’t know about – the clitoris is actually 15cm long. Dr. Odile Buisson from France and her colleagues performed ultrasounds on women during clitoral stimulation to try and identify the G-spot. There research shows that it is most likely the deeper components of the clitoris surrounding the vaginal opening that are being stimulated during vaginal penetration. This is different from direct stimulation of the glans, or external portion of the clitoris. 
  2. Skene’s Glands: In 2008, an article published in the Journal of Sexual Medicine showed that women who experienced orgasms with stimulation of the anterior vaginal wall had thicker tissue in this area thought to most likely represent the Skene’s glands. These glands are what would have developed into the prostate in men.  This area is believed to be rich in nerve endings. In the study, the women who could only achieve clitoral orgasms did not have the same findings on exam on the vaginal wall.  Many researchers believe that, if the G-spot truly exists, it is probably made up of a combination of the Skene’s glands and the surrounding erectile tissue of the clitoris. During arousal these glands may fill up with a fluid that is secreted either before or during orgasm. This is often referred to as female ejaculate.

Little debate exists as to whether there is a difference between vaginal and clitoral orgasms. Functional fMRI studies have revealed that brain activation occurs in different regions depending on whether a woman experiences orgasms from clitoral or vaginal stimulation. If they were the same type of orgasm, then presumably, brain stimulation patterns would be the same.

There are several ways to try and achieve a vaginal orgasm. It is important to keep in mind that, for many women, this type of stimulation can lead to discomfort and a strong urge to urinate.  There are vibrators available that have G-spot enhancement attachments.  A woman’s partner can stimulate the area on the anterior vaginal wall manually or during penetrative intercourse (typically more difficult in the missionary position).  An expensive procedure referred to as G-spot amplification is available, but not recommended by the American College of Obstetricians and Gynecologists. There is no data on safety or efficacy. In this procedure, the area of the presumed G-spot is injected with a collagen preparation that has only temporary effects.  The procedure promises heightened sexual arousal due to enlargement of the “G-spot”.

At the end of the day, whether or not a woman has vaginal orgasms vs. clitoral orgasms is not important. What is important is being able to enjoy sexual activity. The definition of sexual enjoyment varies from woman to woman, and often times, may not even include having an orgasm. Placing emphasis on trying to achieve a “G-spot” or vaginal orgasm can often lead to disappointment.

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The Quest For The Elusive “Viagra For Women”

Dec 12, 13 The Quest For The Elusive “Viagra For Women”

     Today, it was announced that the FDA and Sprout Pharmaceuticals have reached an impasse regarding Flibanserin,  an oral medication developed for the treatment of low libido in women. This rejection is yet another “slap-in-the-face” to the 43% of women in the United States experiencing difficulties with their sexual function (low libido being the most common). The impasse is essentially over the FDA’s characterization of Flibanserin’s risks outweighing it’s benefits. In the clinical study, the women taking Flibanserin had twice as many sexually satisfying events as the women taking placebo. I certainly consider it significant if a woman has the potential to go from having no sexually satisfying events per month to having some or even many! I am sure that most of my patients who avoid dating because of their absent or low sex drive, would agree.  The side effects of Flibanserin include sleepiness, headache, nausea, and dizziness. In a study published in the journal Menopause last month, 38% of women given Flibanserin had improvement in their sex drive, while only 30% experienced side effects.  Of those 30%, only 8% reported that the side effects were bad enough to stop taking the drug. Overall, Flibanserin showed a statistically significant improvement in sexual desire and  sexually satisfying events, as well as a decrease in distress associated with sexual activity.

     Many of us in the field of female sexual medicine felt that Flibanserin had the best shot at being the first FDA-approved “Viagra for Women” – the holy grail for women with persistent low sexual desire in whom other treatments have failed (relationship therapy, sex therapy, off-label medications,etc).  With this latest rejection, I ask you to consider the following: 43% of women in the US compared to 31% of men suffer from a sexual function complaint. There are currently 2 drugs that are FDA-approved for female sexual dysfunction (both for the treatment of postmenopausal painful intercourse due to vaginal dryness) compared to over 10 FDA-approved treatments available to men.  When the FDA approved Viagra in 1998 for erectile dysfunction, did the risk of death not outweigh the benefit of an erection? Did the possibility of having an erection lasting over 4 hours requiring needle drainage of blood from the penis in the ER not outweigh the benefit? Are these potential side effects truly less risky than those seen with Flibanserin? In my blog, I try to keep my opinions to myself for the most part and just present the facts. Tonight is the exception. It is time for the puritanical beliefs that founded this country to exit the political arena when it comes to evaluating drugs for female sexual dysfunction.  It is time to approve a medication, like Flibanserin, that has been shown to be effective and to have acceptable side effects. It is time to show the world that our government  recognizes female sexual dysfunction as a condition with equal importance to male sexual dysfunction. I invite each and every one of you  to visit www.yourvoiceyourwish.com and sign the Women’s Initiative in Sexual Health (WISH) petition to have your voice heard by our government as future treatment options for women are considered for approval.

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Insomnia….The Scourge of 40-Something Women Everywhere

Nov 26, 13 Insomnia….The Scourge of 40-Something Women Everywhere

Something funny happened when I turned 40. It was as if, overnight, the many years of uninterrupted sleep I had experienced jumped right out the window rarely to be heard from again.  I followed some sage advice and did all of the following to improve my “sleep hygiene”:

  • no use of technology after getting into bed – farewell my dear iPhone…. 
  • no exercise after 8pm
  • keep the room temperature cold  - usually arctic
  • hide the baby monitor so that I have no access to it in the middle of the night
  • lastly, no caffeine, alcohol (or drinks of any kind) after 7 pm

You get the idea. After 1 week of perfect hygiene, I was still waking up every night at 3 a.m. like clockwork.  As I lay there tossing and turning, secretly hoping that my husband would wake up so that I could have someone to talk to, the stress of everyday life came pouring in. Why do we, as women, believe that 3 a.m. is the perfect time to figure out all of the world’s problems?  There was no counting of sheep that could solve this problem. After some evidence as well as nonevidence-based research, I realized that I was not alone in my middle-of-the-night saga. Fellow women in their 40s, both friends, colleagues, and patients, were experiencing exactly the same thing. Could it be caused by a change in hormones? stresses of everyday life ( work, kids, etc)? caffeine intake to help get us through the day? The answer was a resounding YES to all of the above.

Insomnia is diagnosed when a person has difficulty falling asleep, staying asleep, or wakes up too early. This disruption of sleep typically causes challenges with daytime function.

  • Acute Insomnia: defined as insomnia lasting less than a month and associated with an identifiable stressor. It typically goes away once the stressor resolves.  These stressors may include: caffeine intake late in the day or before bed, changes in bedroom environment, work, school, relationship or family stress, sad events, new medications, alcohol intake
  • Longer Duration (Chronic)  Insomnia: generally lasting more than a month, can be associated with primary insomnia where no other cause is found, poor sleep hygiene, medications, or certain psychiatric and neurologic disorders. Children who can only fall asleep with a parent or a “lovie” present, may develop insomnia if those objects are not close by.

When it comes to women in their 40s, it is most likely a combination of decreasing estrogen & progesterone levels as well as increasing life stressors that contribute to episodes of acute insomnia. Although a woman in her early 40s may be years away from menopause, the change in hormones can manifest itself as sleep disturbance even when other signs or perimenopause, such as hot flushes and night sweats, are absent.  Simple changes can makes the difference in falling and staying asleep:

  1. treat any underlying disorders that may be associated with sleep changes
  2. try to go to sleep at the same time every night
  3. avoid caffeine after lunchtime
  4. avoid alcohol in the evenings
  5. don’t go to bed hungry
  6. avoid excessive exposure to light immediately prior to bed: bright lights in bedroom, tablets, smartphones, TV, etc
  7. get daily exercise; however, avoid high impact exercise in the few hours before bed
  8. deal with life stressors before bed
  9. the bed should be reserved only for sleep and sexual activity
  10. avoid daytime napping

If these interventions don’t work, discuss cognitive behavioral therapy and/or medications used to treat insomnia with your primary clinician.

Wishing you all sweet, uninterrupted dreams!

 

 

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Perfecting The Kegel

Nov 12, 13 Perfecting The Kegel

     Tonight’s post is dedicated to the many women who neglect that one very important exercise…the Kegel. Here are some of the best excuses that I have heard for why women avoid this task: “I hate working out…my vagina is no different”, “I thought that I was only supposed to do the Kegels at stop lights when driving…I forgot to tell you that I take the train to work”.   The purpose of the Kegel exercise is to strengthen the levator ani, a hammock of muscles that creates the pelvic floor. These can become weak during pregnancy or childbirth, or as a result of aging, weight gain, connective tissue disease, and even chronic cough.  When these muscles lose their tone, urinary and fecal incontinence  as well as pelvic organ prolapse can occur.  The great thing about Kegels, is that they can be done anywhere without anybody knowing, don’t require a gym membership, and can produce results in 2-3 months! An added bonus: Kegel exercises can improve the intensity of a woman’s orgasm (stronger muscle tone = stronger muscle contraction)

This is how I counsel my patients to do their Kegels:

  1. Start by standing over the toilet while urinating. Stop the flow of urine midstream and identify which muscles in the vagina you are  using to do that – these are your Kegel muscles (don’t forget to finish emptying your bladder)
  2. When first starting out, it helps to lie down in a quiet environment. Squeeze the Kegel muscles for 5 seconds and relax for 5 seconds. Repeat for a total of 10 squeezes.
  3. For the first week, perform the exercise once a day only
  4. At the start of the second week, try holding each squeeze for 7 seconds. Now perform the exercises twice a day (10 squeezes each time)
  5. At the start of the 3rd week, try holding each squeeze for 10 seconds. Increase the frequency of Kegel exercises to 3 times a day.
  6. By this time, you will be so good at the Kegel, you can do it anywhere: at your desk, in the car, standing in line at the grocery store, etc

 

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Ask The Expert: The Impact of Cancer Therapy on Female Fertility

Nov 06, 13 Ask The Expert: The Impact of Cancer Therapy on Female Fertility

     For young women diagnosed with cancer, infertility due to premature menopause is a potentially devastating consequence of chemotherapy, radiation or surgery. In the newest installment of “Ask The Expert”, Dr. Lynn Westphal, Associate Professor of Obstetrics and Gynecology and specialist in Reproductive Endocrinology and Infertility at Stanford University School of Medicine, shines a light on this important issue and discusses how advances in assisted reproductive technology may be able to provide a second chance at motherhood to women affected by cancer.

Dr. Westphal, how common is ovarian failure, or premature menopause, following chemotherapy?

  • “The risk of ovarian failure depends on the age of the patient and the type of chemotherapy she receives.  Women are born with all of their eggs and are usually losing hundreds every month.  Some types of chemotherapy can increase how quickly the eggs are lost.  Alkylating agents, such as cyclophosphamide, tend to be particularly toxic to the ovaries.  Since younger women have more eggs left in their ovaries, they are less likely to go into menopause at the time of their treatment.  Older women, especially those in their 40’s, have fewer eggs and are less likely to resume having periods”.

How do you counsel women who are preparing for chemotherapy but are still interested in future pregnancy?

  • “There are many factors to consider in counseling these women, but the most important are her age, cancer diagnosis, how much time she has before starting treatment, and the type of chemotherapy.  Young women who are at low risk of ovarian damage may not need to undergo any type of fertility preservation treatment.  Women who are at higher risk may consider embryo or oocyte cryopreservation; these procedures usually take about two weeks to complete.  Ovarian tissue cryopreservation is an experimental procedure but may be considered in situations where established options are not possible”.

How successful is pregnancy using frozen oocytes vs. frozen embryos?

  • “Until 2012, the American Society for Reproductive Medicine considered oocyte freezing to be experimental.  However, recent studies have shown that oocyte freezing can have very good success rates, and it is now considered a standard option for cancer patients.  As with any fertility treatment, the success of pregnancy will vary depending on individual patient factors.  Overall, age is the most important predictor, and pregnancy rates are higher in younger patients”.

How soon after cancer treatment should a woman who has experienced premature menopause consider getting pregnant?

  • “Timing of pregnancy after cancer will depend on the type of cancer and the health of the woman.  In general, most oncologists will want the patient to wait 1-2 years before trying to conceive.  Breast cancer survivors on tamoxifen may need to wait longer if they are going to complete this part of their treatment.  For women who are not well enough to be pregnant or do not want to wait, there is the option of using a gestational carrier (surrogate)”.

Are there any ways to prevent premature ovarian failure as a result of chemotherapy?

  • “Unfortunately, there are no established methods to prevent damage to the ovaries during chemotherapy.  Medications to suppress the ovaries (GnRH agonists) have been studied but there is not good evidence that these are effective.  Since there are no known ways to protect the ovary during chemotherapy, women should consider having a consultation with a fertility specialist (reproductive endocrinologist) about the impact of the planned cancer treatment on their individual fertility”.

 

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Improving Intimacy Through Mindfulness

Oct 30, 13 Improving Intimacy Through Mindfulness

     There comes a time in every woman’s life when the best time to run through her weekly “to-do” list is during sex. In fact, if I had a dollar for every time a patient told me that, mid-coitus, she finds herself thinking about the grocery list, what to make for dinner, or whether the dry cleaning is ready for pick up, I would probably be writing this blog from a villa in Tuscany.  In this era of multitasking and perfectionism, women strive to be great at everything they do: motherhood, career, wife, partner, etc.   They are one step ahead of the game, always looking to the future. What ever happened to the idea of  stopping to smell the roses? The blessing and the curse of the modern woman is that she is always on the go and often forgets to enjoy the here and now.  The end result is that the quality of the attention paid to all these tasks is sacrificed.  Sex is not exempt from this behavior.  When a patient tells me that she is having difficulty becoming aroused or having an orgasm during sexual activity, the first question I ask is, “what is actually going through your head while you are in the moment?”  The answer always surprises me. It usually has something to do with the home, the finances, the kids, work, the pets, etc. It’s no wonder female sexual complaints are so common. Sexual problems can have many causes, but life stressors tend to be a common denominator.

     Mindfulness has it’s roots in Buddhism and is the practice of focusing one’s attention on the present moment.  It allows an individual to pay attention to their current thoughts and sensations without judgement. It is often used in behavioral health practices and is used for treating conditions such as anxiety, stress, depression, eating disorders, and sexual dysfunction. In their research, Silverstein et al. found that women who practiced mindfulness became faster at registering sexual response and had lower anxiety and self-judgement compared to the control group.

     In the setting of intimacy, mindfulness can be employed in the following way:

  • Start by eliminating external chatter: turn off the TV, silence the cell phone, turn down the volume on the baby monitor
  • Create a romantic setting
  • Focus on your breathing as well as that of your partner’s. Try to breathe in-sync 
  • Pay attention to how your partner tastes and smells. Notice how their body feels when you touch it.
  • How do you feel when your partner touches you? It’s ok to have a negative emotion. Acknowledge it and send it on it’s merry way. Stay focused on the positive.

Mindfulness takes time to master so patience is key.  Practicing mindfulness in all aspects of daily life will make it easier to achieve during moments of intimacy. The inner workings of the female brain during sex can be a woman’s best friend or worst enemy. With mindfulness, the brain has the potential to truly become the main sex organ!

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