“Why would anyone do this with their life?” A patient recently asked me this during a particularly comical exchange. She was new to sexual health and had no idea that providers specialize in sexual medicine. I asked her how she found out about me and the practice.

She said that she was sharing issues she was having in the bedroom with her friend and her friend referred her to me. She did not believe her friend, googled HERmd and then ended up in our office.

My conversation with her left me thinking. I bet a lot of people do not know that there are specialists that help with sexual health and sexual dysfunction. Even more so, there are many women who do not even think about their sexual health or know that they have sexual dysfunction. What exactly do sexual health providers do all day? What conditions do we treat? And lastly, why did I do this with my life? The answer to that is simple, yet astonishing. I saw too many women who were ignored, their sexual health issues dismissed by their gynecologists, told to just live with it. I was going to do something about it – I was going to help them, give them a voice, and make them feel heard.

Who Am I?

I am a board certified OB-GYN, who specializes in sexual health, menopause and gynecology. So, I still see patients for their annual visits, birth control, pap smears, and problems like infection and heavy bleeding. I also operate and read sonograms of the pelvis to detect abnormalities in the uterus and ovaries. I am involved in clinical research trials to advance women’s healthcare as we know it. I consult with the FDA and I teach other physicians.

So what kind of sexual problems do patients come to me for?

Over 40% of women struggle with some type of sexual dysfunction in their lifetime. You read that right, over 40%. There are four very common sexual health complaints, or sexual dysfunction:

Low libido (sex drive) also known as HSDD, or hypoactive sexual desire disorder
Pain (dyspareunia)
Orgasm dysfunction
Arousal disorder
I also treat vaginismus, the involuntary contraction of muscles surrounding the vaginal opening that can make intercourse or tampon insertion painful or impossible. Persistent genital arousal disorder (PGAD) is another very painful distressing condition that women need treatment for. This condition is best described as the painful persistent feeling of arousal that is not relieved by orgasm.

When a woman comes to my office with anyone of the above issues, we take a thorough history, perform an exam, and order labs and imaging if necessary. Then, I can determine the diagnosis and review treatment options with her. Much of my day is spent teaching women our anatomy – oftentimes we are not taught about our bodies – so we have some not so scary teaching tools in the office, to help people understand their bodies.

What is HSDD, or low libido?

HSDD affects millions of women in this country (1 in every 10 women) and up until 2015 there were no FDA approved treatment options to treat HSDD. To be diagnosed with HSDD the following criteria must be met

the absence of sexual thoughts and desires for more than 6 months
distress due to the lack of desire
the loss of desire must not be attributable to a medication or medical condition.
Many factors can be responsible for low sex drive – problems with hormones, relationship issues, neurotransmitters, or pain are just some of the causes of low libido.

What are the treatment options for HSDD?

There are 2 FDA approved medications that sexual health providers can prescribe to treat HSDD; Addyi and Vyleesi. They both work on neurochemistry and are non-hormonal and require a prescription. Addyi is a pill that is taken everyday, whereas vyleesi is an injectable administered prior to intercourse. Another treatment option is testosterone which is a vital hormone for women and their sexual health. Currently there is no FDA approved testosterone only option for women in this country – crazy right? It’s a hormone manufactured in our bodies, measurable in our bloodstream, yet there is no FDA approved option for women. So how do healthcare providers order testosterone treatment for women? We order it from compounding pharmacies.

Why does sex hurt? Is that normal?

Many of my patients tell me sex hurts, and it always has for them. This should not be the case! Dyspareunia or painful sex is a very common condition that occurs in women. Pain can occur in multiple locations, the external genitalia, known as the vulva, in the vaginal canal, or deep in the pelvis and abdomen.There are many causes of pain and therefore many treatment options. Menopause can cause an imbalance in hormones leading to a condition called GSM – genitourinary syndrome of menopause – which presents with painful sex. Skin conditions, hormonal imbalance, fibroids,cysts, infection, and endometriosis can all cause sexual pain.

How can painful sex be treated?

A visit to a sexual health provider allows a diagnosis to be made and treatment options to be offered. An examination called a vulvoscopy, performed by a sexual health provider with a microscope, allows us to see changes in the vulvar skin and anatomy that may be leading to sexual pain. Treatment can include hormones, suppositories, medications, surgery, laser or radiofrequency treatments.

Why do I have trouble orgasming?

Orgasm dysfunction presents in a few different ways:

Complete absence of orgasm
Delayed orgasm
Weakened orgasm or
Anhedonic orgasm – an orgasm that has the physical component of contractions but the absence of the intense pleasure that comes from our brain.

What can I do if I suffer from orgasm dysfunction?

There are currently no FDA approved treatment options for orgasm dysfunction – but after a thorough history and an exam a sexual health provider may be able to offer an off-label (a medicine that is FDA approved for a different condition but has shown benefit for orgasm dysfunction) medicine to treat orgasm dysfunction), an over the counter treatment option or they may recommend a procedure. The treatment plan depends on why the problem with orgasm is occuring in the patient: is it an issue in the brain, the spinal cord, the pelvic floor, the hormones, with blood flow?

What are some of the options that have shown positive effects in women to help treat orgasm dysfunction?

Off label Prescription
Testosterone therapy

Votiva treatment
CO2RE Intima

How do I know if I have problems with arousal? Isn’t that the same as low libido?

There is a key difference in HSDD and Female Sexual Arousal Disorder (FSAD). FSAD is marked by a lack of response to sexual stimulation. So, while desire is present, physical arousal does not occur. There are also no FDA approved treatment options for arousal disorder but treatments can be offered depending on the cause.

The Rosy app for women is something I recommend to my patients who struggle with FSAD. Rosy provides women with resources and classes on sexual dysfunction, and also has erotica aimed at the female consumer. Erotica can help some women who suffer from FSAD.

What is Vaginismus?

Vaginismus is a condition that makes intercourse painful or impossible due to involuntary contractions of the muscles surrounding the vagina.The most heartbreaking thing about this condition is what patients have to endure until they get to the right provider. Many patients believe that it is their fault. They have been told things like “Just relax” or “You need to grow up.” The truth is, it is not under their control. The muscles are firing because the brain is trying to protect them from pain.

To treat the condition, you must break that pain cycle. Once the diagnosis is made, patients can undergo pelvic floor physical therapy, or use dilators and medications to relax the pelvic floor. Another option is to treat it with botox. At HERmd we are one of the few centers around the country to offer botox – a toxin which paralyzes muscle – as a treatment option for vaginismus. I inject botox into the muscles surrounding the vagina. So, how does botox work to treat vaginismus? Botox relaxes the muscles around the vagina allowing sexual intercourse to be a possibility. This procedure is done in our surgical suite, while the patient is asleep.
Sexual health care providers rely on a team approach to treat all of these conditions. I rely on the help of sexual health counselors and pelvic floor physical therapists in addition to the medications and treatments that we offer at HERmd. Patients that are treated with this multidisciplinary team approach fare the best and are most likely to be able to reclaim their sexual health.

So, why do I do this with my life?

I nearly lost my mother when she was only 45 due to dismissals by her healers, her providers. I knew that I wanted to be an advocate for women. I learned early on that a huge gender disparity existed for women in healthcare, and was especially prevalent in sexual health care. There are SO many barriers to sexual health care: not enough trained providers, funding, research, leadership or treatment options. Practicing sexual healthcare allows me to be part of the solution, part of the promise of a better tomorrow for women’s healthcare. I truly believe it is HER time in healthcare.