Women's Wellness Blog: 2017

I stepped off the bus apprehensive about the scene unfolding in front of me. The Infirmary or “Home for the Poor” as it was otherwise known, was a collection of dilapidated barracks housing abandoned physically and mentally ill men and women who were deemed to have no value to either family or society. The Infirmary was located on a purposefully isolated knoll in coastal Jamaica symbolically situated to reinforce their desire to forget its existence. The contrast surrounding its physical location was as stark as the dichotomy of the island itself. A lush forest populated with exotic fruit trees and bathed in rainbow colored foliage surrounded the ramshackle open aired barracks originally commissioned by Queen Victoria in 1898. On an island where five star luxury resorts share the same zip code as cockroach infested hovels, the mocking beauty of the surrounding forest was in contradistinction to the decaying dormitory of the forgotten.

We were greeted gleefully (and a bit unexpectedly) at the door of the men’s quarters by a thirtyish Jamaican, physically mature but with the mind of a child. Richard had a toothless smile the size of the island itself as he exclaimed, “Oh boy, they’re here! Oh boy, they’re here!” in raid fire succession. His repetitive phrases were sincere and he instantly touched our hearts and calmed some of our apprehensions. We came to learn that Richard had been housed at the Infirmary all of his adult life, and his apparent inability to understand the destitution of his surroundings was counted as a blessing.

Entering the first cinder block building I was struck by numerous sensations all vying for attention. Visually the scene was disturbing: cot after cot of ancient bodies positioned as if trapped in their bed by some invisible barrier. The distinctive odor, one I had come to associate with hopelessness, was a mixture of urine, putrid food, and stale, unmoving air, and it covered the room like an unseen fog.

Our small band of church mission workers spent an hour in the Infirmary talking, praying, bathing and cleaning our hosts. Soon, we loaded up a few of the less ill and mobile onto our bus and made the short trip to the Jamaican beachfront frequented by the locals. There were no hotels, Tiki bars, or swimming pools, just a few kids and adults enjoying a respite from the oppressive heat. Those who were ambulatory walked arm in arm with their chaperone to the shoreline, while others were carried fireman style to the water. We sat in the cool, shallow waters of the Caribbean and spent the next few minutes rubbing soft sand on the resident’s life-weary skin, all the while hoping that they might forget for just a moment that they had to return to their reality.

Earlier in the day, I had observed a skeleton-thin, talkative gentleman pacing to and fro among the cots greeting other residents all the while holding up an obviously grossly oversized pair of trousers. As I sat in the gentle cleansing waves with Zebe, the owner of the XXL pants, I asked him if he could have anything in the world - anything at all - what would he ask for? He took the question quite seriously and pondered it briefly then looked me in the eye and in his most thoughtful voice exclaimed, “A belt. Yes, I would very much like a belt!”

This is a time of year when we invoke thankfulness in an almost nonchalant fashion. I have to remind myself to punch through the complacency of abundance and rethink what it means to be thankful. We are bombarded with admonitions to be thankful for a free country, good health, and material comforts. All of these things are grand and worthy of thanks; however, thinking of Zebe reminds me that the things that I see as worthy of thanks are largely due to my perspective.

Regardless of circumstances, I can choose to be thankful. Tethering my appreciation only to objects or accomplishments is a set up for disappointment as those things may not always be present; however, if my basis for thankfulness is rooted in my ability to choose, then no circumstance can dissuade me. Choosing to be thankful for your good health (and your ability to change it if you are not satisfied) leads to joy, peace of mind, and goodwill.

I see the world through my own lens. In other words, where you are in the world, physically, emotionally and spiritually, colors how you understand thankfulness. If I had cancer, I would be very thankful for the anti-nausea medicine that follows the powerful chemotherapy; whereas, such medicine would not enter my thoughts otherwise. If I have all my worldly possessions stashed under a six by three foot cot, I am thankful for a belt. It is a matter of perspective.

Let us celebrate this season of thankfulness with an understanding and appreciation of our choices, and hopefully, this will lead us to action that will translate into healthy blessings for ourselves and others.

One of those consequences of excess cortisol is it turns on the fat storing enzymes and turns off the fat burning enzymes. The result is an accumulation of body blubber. As if this storage of body fat wasn’t bad enough, the fat that sticks tends to be belly fat. A significant amount of this is known as visceral fat, or the fat around the internal organs. You might be asking, “Who cares if there is fat around my spleen, I just want to look good in my bikini.” Unfortunately it is this type of fat that increases your risk of heart disease, stroke, diabetes, and cravings for Oreo Blizzards. Cortisol can also throw your blood sugars in a tizzy, which, in turn, can spike insulin.

Normally this is a good thing, normalizing sugars and all, but too much insulin can also favor fat storage. Adrenaline also pours into the body when we are stressed creating feelings of anxiety and nervousness. And what do many of us do when we feel anxious? Hide the doughnuts and Ding Dongs because when your stressed you”re “hangry” and not a speck of junk food is safe. I don’t have to tell you that most of that type of food is hermetically sealed to your thighs once ingested. When we are chronically stressed, (i.e. parenthood) we crave “comfort foods,” such as a bag of Cheesy Puffs or a tub of Rocky Road ice cream. These foods tend to be easy to find, highly processed, and high in fat, sugar, or salt. They also tend to be fatalicious on your bootylicious.

So you can see, stress can be a big player in the battle of the bulge and bailing your teenager out of the poky for sassing a police officer can definitely qualify as stressful. So next time your prepubescent germ carrier tells you that you are overweight, simple remind them it is their fault and then smack them with the cotton candy you were eating.

Since the dawn of time, humans have been obsessed with sex. I suspect it is a good thing as species propagation is somewhat a necessary function, yet the biological functionality and the sensual reality often get blurred. Putting aside the drive to procreate, the desire for sexual intimacy is about as complex as Neal deGrasse Tyson’s brain. For centuries man, and yes…it has been mostly men, have searched for the ultimate sex toy…a real aphrodisiac. The holy grail of sexuality is a substance, ingredient, activity, or state of mind that would enhance a dampened sexual desire, or recreate one that has been long lost. If you could find and patent such a substance you would have the bucks of Bill Gates and the legacy of Masters and Johnson.

Throughout history, most aphrodisiacs were limited to food and possibly herbs. I guess since there was no electricity our ancient experimenters couldn’t get too creative. Some ancient lust enhancers were oysters, skink flesh, and sparrow brains. It’s not hard to see why oysters may have caught on since the other two don’t sound particularly appealing. “Excuse me a moment my dear while I chug down this sparrow brain.” Just doesn’t do it for me. That crazy Greek physician Galen listed a number of foods in his writings as possible aphrodisiacs including carrots, asparagus, anise, mustard, nettles, and sweet peas. I really think he was just trying to make a market for his vegetable garden.

The reasons these substances were thought of as desire deepeners were just as entertaining as the substances themselves. The oyster was thought to be potent, not due to a double blind placebo controlled study, but because it resembled the female genitalia. As a professional Gyn I beg to differ, but that’s just my opinion.

The Mandrake root was labeled as effective for libido and fertility because its shape resembled a woman’s thighs. Here is a tip for you, don’t ever compare your wife’s thighs to a Mandrake root. Look it up. Those things define ugly.

Saint Thomas Aquinas, who I wouldn’t have thought would write about this topic, but did, spoke of meat and wine as enhancing hanky panky. I can definitely see the wine, but I never thought a lamb chop would put me in the mood.

The fabled Spanish Fly is a real substance derived from blister beetles. The main ingredient, cantharidin, can irritate genital tissue and for some reason, some Spanish bozo thought it would be a good aphrodisiac. The only problem is that it doesn’t work and too much can cause renal failure and GI bleeding. How’s that for dampening the mood!

The bottom line is that there are no foodstuffs that consistently get you in the mood and have been proven to be effective in decent clinical trials. There are some medications that can address desire issue and sexual dysfunction, but I will save that for another day.

Clinical studies have proven that the best modern day aphrodisiac is a candle, Barry White, and chilled Chardonnay, and it also helps if you are a nice person and love and respect your partner.

A lot of things can make you fat. Twinkies, Ding Dongs, ethnic mothers who insist on you eating everything and more, and even hanging out with other fat folks, but there are a few
things that can put on the pounds that may be hidden from your conscious mind, much like that weird dream about going to school naked. These surprising yet amazingly common practices can literally be the difference between looking good in a thong or making yoga pants a staple of your wardrobe.

First, and possibly most surprising is that you may not be sleeping enough. This seems counterintuitive, like black lipstick, because you would naturally think that staying awake and doing stuff burns energy, but you would be wrong. Quality sleep is key to maintaining a healthy weight, so says really smart people like the National Sleep Foundation (no, this isn’t a plug for “My Pillow”). Studies from places like the NIH and Harvard (that Yankee school full

of smart snobs) indicate that too little sleep causes a change in your hormones (drat those hormones!) that turn on the fat conserving enzymes and turn off the fat-burning enzymes. It seems that around 7-8 hours of quality sleep a night is ideal for promoting weight management, but this is only an estimate. Each person’s hormonal control is a bit different (tell me about it!) and it also seems to vary by age.

Bottom line, you snooze, you lose…literally. Next, if you're stressed like a hooker at a police convention, you might have trouble losing weight. Stress, in any form, can create an internal, physiological environment that makes you convert that barbecue pork to ham hocks on your thighs. It’s somewhat of a conundrum as gaining weight can stress you out, which in turns makes you gain more weight.

In fact, if I see one more commercial with Marie Osmond talking about how she lost weight by drinking some nasty shake, I’ll be so stressed I might pop some buttons on my drawers. Stress makes you secrete cortisol which in turn triggers pathways that lead to added weight, especially around your belly. All I can say is Rosie O’Donnell must be really stressed! The simple answer is to not be stressed, and if you think that is simple I know a Nigerian Prince who has some emails you need to read.

In this day of a pill for every ailment, it’s not surprising that many medicines can propagate portliness. A classic example is steroids for infections and other maladies. Taking a Medrol dose pack over a few days for a sinus infection won’t create havoc with your weight, but chronic use, like in arthritis, can put a pooch in your paunch. Some other medicines that can potentially do this are insulin, antidepressants, anticonvulsants, and even some blood pressure medicines.

Some would include marijuana in this group, largely because of the munchies. The real rub is that most folks aren’t just taking these meds for the fun of it, they have a problem that needs attention, kind of like Uncle Ned and online porn, but occasionally you can find other medicines in the same class that don’t have as many negative side effects.

As always, consult your doctor, if you can find him, before making any changes.
that needs attention, kind of like Uncle Ned and online porn, but occasionally you can find other medicines in the same class that don’t have as many negative side effects. As always, consult your doctor, if you can find him, before making any changes. The National Institute for Environmental Health Sciences (I’m not kidding, there really is such a thing) recently published a paper on “Obesogens".

These are substances (i.e. chemicals) in the environment that can contribute to obesity. At first, I was a bit skeptical, given the whole conspiracy theory thing, but in truth, the studies support that certain pollutants, like Kenny G albums, can make you fat. For example, cigarette smoke, some pesticides, and Bisphenol A (in plastics) can trigger cellular changes that alter normal fat regulating enzymes. This leads one to speculate that you should never smoke while crop-dusting your broccoli crop after drinking from your plastic water bottle. In fairness to the pesticide fan club members, I suspect the impact of all these things is minor compared to other influences. So, brave weight watchers, sleep soundly, chill out, don’t smoke, and avoid medicines and you may be well on your way to a healthy weight…or a nervous breakdown.

Good science is generally thought to be based on empirical data, like climate change exists, Sasquatch doesn’t, and nobody really likes the way rutabagas taste. A critical yet often misunderstood tenet of science is the difference between an association and a cause and effect. Without completely nerding out on you, let me try to explain the difference. Hang with me, this is going somewhere, unlike the Calhoun Expressway (it’s just a road, it’s not an expressway…okay I feel better now).

If I was to eat rutabagas every day (I know, I know, fat chance, but bear with me) and then one sad day was told I had cancer of the uvula, then some smart lawyer could claim that my eating a daily portion of rutabagas may have had something to do with causing my cancer. He would immediately file a 200 billion dollar lawsuit against Canada (the leading source of rutabagas in the world, I can’t make

this stuff up!). The savvy lawyers for Canada would go to the literature to see if there have been any studies on rutabagas and uvula cancer only to find one study from Angola in 2001 that looked at 50 staunch rutabaga enthusiasts, 2 of whom developed uvula cancer, giving uvula cancer in these Angolans a 1out of 25 chance of getting this unfortunate disease. The problem, they discover, is that there was no control group, and when they searched Wikipedia, they found that the average Angolian has a 3 out of 25 chance of getting uvula cancer (probably due to watching US reruns of I Love Lucy).

So indeed, I can say that there may be an association between rutabagas and uvula cancer, but not a cause. I walk away with no 200 billion and a bruised ego…and uvula cancer.

But what if five years later, a research scientist in Iceland discovers a molecular pathway that shows that a chemical in bananas, say… bananalase, alters DNA in uvular tissue and makes them cancerous. Now we have a true cause and effect and happily my lawsuit against Canada can go forward because I ate a banana on my Fruity Pebbles every morning. Unfortunately, I died 2 years prior as uvula cancer is a bad mama jama. In one instance something was simply associated with something else, and in another something caused something else.

If you are still reading after the rambling diatribe, get a life, but my point is that talc (baby powder, clean and dry, etc) has been associated with ovarian cancer, but there has never been any proof of it causing ovarian cancer. This is a critical distinction (hopefully I don’t have to tell you that by now) because the most important factor in whether you get cancer are those that are causally related. Most of the controversy surrounds talc that has asbestos and those that don’t. Most of you know, unless you have been living under a bridge for 40 years, that asbestos has been shown as both an association and causation for cancers, specifically lung cancers. Not so for ovarian, and especially not something that is applied externally.

In my opinion, I feel it is safe to powder up, but if your really paranoid and think UFOs exists, simply use asbestos free talc.

Few things are more unpleasant than painful urination. (Wee Wee for those folks perpetually arrested in the kindergarten stage of development).

Unfortunately, this is such a common occurrence I feel compelled, obligated, and otherwise obliged to give a brief overview of the five most common causes in women along with some common treatments. If you are a guy and reading this and your WeeWee hurts…Just let it fall off.

Number one with a bullet is a urinary tract infection.

Commonly called a bladder infection, cystitis, or that raging pain from Hell that makes me want to throw up a lung. These infections are characterized by frequency and urgency along with the burning. Most bladder infections are limited to the lower urinary tract (bladder and urethra) as to be distinguished from a more serious infection involving the kidneys. Luckily, theses are usually easily treated with antibiotics and prayer.

A common but less recognized cause of painful urination is Interstitial Cystitis (IC). Besides sounding like a cool name for a band, IC is not an infection but an inflammation (a somewhat technical and nerdy distinction, but important) so antibiotics will do nothing for this problem. Patients who suffer from IC are horribly frustrated because their classic history is having been treated for multiple bladder infections, and the darn things keep coming back. The reality is that many never had an infection at all and they just paid for their doctor's new car with all their visits to the clinic. If it is properly diagnosed, there are treatments available including medicines and bladder installations (as opposed to military installations).

Third is our perennial culprit, menopause.

Of course menopause has been blamed for everything from hair loss to first-degree murder, but in this case, it actually can lead to an woe in the wee. In menopause, the urethral and vaginal tissues can get thin and you can lose lubrication, resulting in burning both during urination and if the urine hits the labia and vulva. This rather distasteful outcome can be thwarted by a little estrogen cream (a little dab will do ya!) or a new laser treatment cheekily called MonaLisa Touch.

One of my favorite causes is linked to bladder infections, but I feel it deserves its own category because of its catchy name, honeymoon cystitis. In this day of couples living together and virginity at marriage being as rare as an honest congressman, this is somewhat a misnomer simply because it is tied to the initiation and/or frequency of sexual activity. In days gone by, when the earth was still cooling and couples actually waited until the honeymoon to jump each other’s bones, many women complained of urinary burning when they came back from Niagara Falls.

It was more related to repetitive friction (do I really have to paint a picture here?) than infection, but that sometimes occurred. Anyhoo, women still can get this problem if they suddenly have an active evening…I mean a real active evening…out of their norm. The good news is that many times this resolves spontaneously, especially if you have a headache every evening for a couple of weeks.

(wink, wink)

Last, and definitely least, is our friend the STD. For those over 50, that is a sexually transmitted disease. One of the most common of these is the herpes virus. In this day of HPV and AIDs, herpes has become somewhat forgotten (much like Justin Bieber) but it still runs rampant.

The little ulcers that signal an outbreak often are first noticed when urine hits them. Think hydrochloric acid on a paper cut. Herpes cannot be cured but it can be managed with a variety of medicines. Unfortunately, it’s the gift that just keeps on giving.

There are some over the counter medicines (AZO, uristat, uricalm, StopTheBurningOrI’llScream) that can act as a Band-Aid for the problem, but just remember, to really treat things properly you have to get the proper diagnosis, and that only comes from contributing to your doctor’s daughter’s college fund.

It used to be that in polite company you didn’t talk about politics, religion, or sex. That doesn’t necessarily apply today as often times when discussing politics, sex seems to be a factor. Nevertheless, I am going to stay away from politics and religion and focus on sex. In particular, I want to focus on a very common problem, especially in the menopause, of pain and/or discomfort with intercourse. It is estimated that upwards of 75% of women after age 51 will at some time complain of this issue, and that may be underestimated as many feel the incidence is underreported due to women not telling their doctor about it in the first place. Many women mistakenly believe that this is just a normal part of aging and there is nothing to be done about it. There is nothing further from the truth.

The technical term, dyspareunia, comes from a Greek word (don’t they all!) “dyspareunos”, which means “badly mated”. Those who suffer from this malady can confirm that pain every time you have sex creates “bad mating” as well as other problems. The first step in solving this dilemma is properly identifying the factors that play a role. As I mentioned, this is a much more common occurrence in the menopause, although it definitely can occur at other seasons of life. After menopause, either natural or surgical, estrogen levels decline and periods cease. The cells that line the vaginal walls are very hormone sensitive tissues, and with a lack of hormones, the normally thick and lush epithelium (lining cells) can become thin and much less elastic. Over time this results in dry, less pliable tissue that can cause a variety of symptoms. The old terminology for this problem was atrophic vaginitis, however this has been revised to genitourinary syndrome (GS) to properly encompass the potential wide ranging nature of the problem. The tissues of the vagina, vulva, and bladder can all be effected as they are all dependent on estrogen for continued proliferation and lubrication.
Potential symptoms of GS include:
Burning and irritation of reproductive organs and structures
Dryness, discomfort, or pain with intercourse
Urinary urgency
Dysuria(pain with urination)
Recurrent infections.

It is important to remember that not all women will be afflicted with this problem, and some women will only manifest a single symptom. Nevertheless, GS is the leading cause of painful intercourse in peri and postmenopausal women.
So what’s a girl to do?

There are a number of treatment options for solving this problem. First realize that doing anything is predicated on the fact that it is a problem. I have a number of patients that have some symptoms, but they are either minor or not a problem given their current situation. If that is the case then realistically nothing needs to be done. Treatment is dependent on the presence of bothersome symptoms. One of the tried and true approaches is to replenish estrogen to these tissues. This can be done in the form of local therapy like a cream, gel, or a silastic ring implanted with the hormone. A woman can also be placed on a systemic treatment like a pill or patch and see improvement in vaginal tissues and symptoms. Any use of hormones has advantages and disadvantages, and I don’t have space to delve into that quagmire here. Suffice it to say that the use of estrogen is a legitimate and effective treatment, but not your only option.

There is a class of medicines called SERMs (selective estrogen receptor modulators) that are used to help vaginal dryness and pain with sex. One in particular has been approved for this use, but again there are potential side effects to be considered.

A relatively recent and novel approach is to use a CO2 laser to stimulate collagen and epithelial growth essentially “rejuvenating” the vaginal tissue and eliminating or lessoning the pain symptoms. This is a painless office procedure that has been extremely successful in clinical trials in improving lubrication, decreasing pain with sex and aiding elasticity.

In addition to menopause, various other causes can be responsible for painful intercourse. Any type of vaginal infection can temporarily create irritation and pain. Obviously treating the infection is key to resolution. Scar tissue in the pelvis from prior surgery or infections can do the same. Urinary tract infections (bladder infections) and even chronic antihistamine use (drying of the vaginal tissues) can be culprits. There is a relatively rare condition called vaginismus where a woman experiences involuntary muscle contractions in the vaginal wall while attempting sexual relations which results in pain and an inability to allow penetration.

This common problem can be adequately addressed in most situations and it is a matter of telling your doctor about your symptoms and together seeking a solution.

Obesity is a chronic illness. The time has come to put away misperceptions, politically correct dialogue, and downright ignorance and understand this medical problem. Being overweight is not a lack of willpower, a character flaw, or anyone’s fault. It is a complex medical disease state that has a multitude of causal factors including genetics, environmental, psychological, metabolic, nutritional, and social.

To understand the complexity of both the origin and treatment of obesity you first have to understand the terminology. Obesity is a clinical diagnosis based on various guidelines, the most common being the Body Mass Index, or BMI. Using this scale a person is considered either normal, overweight or obese based on their height divided by their weight. There are problems with this standardization, as there are with all scales, but suffice it to say for this discussion that there is a difference between being overweight and obese. Most of the medical complications due to excess body fat arise in those folks who fall into the obese category. Granted it is a continuum, with a steady rise in problems as BMI and percent body fat rises, but understand that I am not talking about the middle aged woman who puts on an extra ten pounds. She is not obese and doesn’t have this disease. That is a simple but important distinction.

For those who would challenge this characterization of obesity as a disease I offer the following. The most recent statistics from the American Cancer Society report that:

80% of type II diabetes is related to obesity.

70% of cardiovascular disease is related to obesity.

42% breast and colon cancer diagnosed among overweight individuals.

30% of gall bladder surgery related to being overweight.

26% of overweight people have high blood pressure.

100,000 new cases of cancer a year due to obesity.

The reality is that this is simply the tip of the iceberg as it applies to chronic illnesses and obesity. Any other physical condition that created such a list of maladies would probably have its own telethon by now!

And any who suffer obesity understand clearly that it is a chronic problem. When you consider the physiologic changes that happen in the body - in the endocrine system, brain, and metabolism - you quickly realize that the duration of the problem is often lifelong. Considering the increasing role genetics plays in obesity, one can easily surmise that this is a chronic problem.

Unfortunately, the treatment of obesity has suffered greatly due to the lack of understanding of the origins of the disease. Many if not most approaches are focused on simply one aspect of obesity. For example, many so called treatments simply restrict calorie intake. This is largely based on the fallacy of the energy balance equation that says to lose weight you simply take in less than you burn off. Not only is this a complete oversimplification of the problem, but it can actually worsen the situation. Studies are abundant now that illustrate very low calorie diets that result in rapid weight loss actually alter a person’s metabolism such that once they return to a life sustaining “normal” dietary intake, they gain back all their lost weight and even more. Any therapy that focuses on only one factor is doomed to failure.

That brings me to another important consideration in the treatment of this disease. It would be rather ludicrous for someone with diabetes, for example, to get treatment from a celebrity spokesmodel on a TV infomercial. Yet that is what happens all the time with obesity. Most of the commercial products and diet plans don’t make a distinction between the person who is 10 pounds overweight and the person with clinical obesity, they just lump them all into the category of “folks we can sell stuff to.” Yes, you may be able to lose a few pounds by drinking some shake or eating a prepackaged meal (but 98.6% of the time you won’t keep it off) but understand this is not a treatment for a disease. It is marketing hype and often bad science.

As you can surmise from the preceding rant, treating obesity is not for one size fits all. Not every plan works for everyone…but everyone needs a plan. Here is a quick way to tell if the plan you hope to use is worthwhile. It must meet these basic criteria or I would look elsewhere:

Is it healthy?

Is it meant for the long term?

Does it involve exercise?

Can you learn from it?

Are there ways to hold you accountable?

Is it flexible?

Is it easy to follow?

Does it meet the “smell” test?

If your approach falls short, so will your weight loss.

The only reasonable approach to treating a chronic disease is to first have a qualified and knowledgable doctor evaluate your individual situation and understand what factors are contributing to your specific condition. There is absolutely no room for a cookbook approach to weight control. Next, you need a multi pronged management plan that looks at all factors including nutrition, genetics, lifestyle, associated medical conditions, activity level, social and economic factors, and psychological influences. Just as every person with diabetes has a detailed plan of differing medications and lifestyle changes, so the person with obesity should have an approach to treatment that is individually tailored.

The final critical factor in treatment is understanding that this is a lifelong issue. Once a person reaches a goal weight, their treatment plan has to include ways to maintain and persist. Reaching a goal is certainly reason to celebrate, but understand that this treatment process is a marathon, not a sprint. You are setting yourself up for failure if you don’t have a plan in place to maintain your success.

After the publication of my book, A Woman’s Guide to Hormone Health, I had the opportunity to speak around the country to audiences of women about some very “feminine” subjects. I was in San Diego speaking to a group called The Red Hot Mammas (sort of a cross between a menopause support group and a motorcycle gang) and during the question and answer session a grandmotherly octogenarian sheepishly raised her hand and asked, “Doc, my sex drive has driven off and I don’t have a map! What do I do?” I heard an audible “thank goodness” from several other folks in the audience as they wanted to ask the same question but didn’t have the courage of my blue haired inquisitor. Over the ensuing years I don’t think I have ever hosted a forum where this topic didn’t raise its libidinous head.

Next to questions about losing weight, a declining or absent sex drive is one of the top complaints heard in gynecologist’s offices nationwide. A recent report from the National Institutes of Health states that 43% of women will experience some form of sexual dysfunction at sometime in their life. A majority of these problems, especially in perimenopausal and menopausal women, is a lack of desire. Loss of libido is defined by the Diagnostic and Statistic Manual (the book doctors use to categorize diseases) as "persistently low sexual desire resulting in distress or relationship dysfunction, where lack of desire is not due to another condition or circumstance." There are two important parts of this definition that are cogent to understanding the causes and treatments of this problem. First, the lack of desire must cause a problem either in the person’s psyche or in their relationships. So, for example, a woman with a low desire who is purposefully abstinent may not view that lack of desire as bothersome. Secondly, the low libido should not be due to a physical problem or medication. A common example of this in the menopause is the woman who experiences pain with intercourse due to vaginal changes in lubrication. It only makes sense that if it hurts, consciously or unconsciously, you are going to avoid intimacy like Republicans avoid taxes. Also various medications can have libido squashing side effects. For example, many of the anti depressants such as Prozac and Zoloft can flatten libido like a steamroller on asphalt.

The causes of a low or non-existent sex drive are legion, but they can generally be divided into four categories: physical, psychological, relationship, and hormonal.

Physical reasons include many nonsexual diseases such as arthritis, cancer, diabetes, high blood pressure, coronary artery disease and neurological diseases. Think of poor sex drive as side effects of these disease processes, and often once the physical malady is remedied, the libido returns. In addition, a glass of wine may make you feel amorous, but too much alcohol can spoil your sex drive. Any surgery related to your breasts or your genital tract can affect your body image, sexual function, and desire for sex. A huge secondary cause is fatigue. The exhaustion of caring for aging parents or young children can contribute to low sex drive.

I already alluded to the role of hormones, and any major hormonal shift such as menopause, pregnancy, and breast feeding can affect desire.

There are many psychological causes of low sex drive such as anxiety, depression, poor body image, low self-esteem, and a history of physical or sexual abuse. One of the most overlooked but common causes of poor libido is stress. This can be stress related to work, finances, kids, or just life.

We all know that much of a satisfying sex life originates as much above the neck as it does below the waist; therefore, relationship issues are huge in dissecting libido malfunction. For many women, emotional closeness is an essential prelude to sexual intimacy. If you are having problems between the sheets, don’t pull the covers over your eyes!

So what can be done about this tsunami of libido lack? Obviously if there is an underlying issue, such as medications or hormone problems, they must be addressed first and often sex drive creeps back. If stress and relationship issues are paramount then talking with a counselor skilled in addressing sexual concerns can help with low libido. Therapy often includes education about sexual response, techniques, recommendations for reading materials, and couples exercises.

In women suffering from painful intercourse, vaginal estrogen may markedly improve vaginal elasticity, lubrication, and response. Testosterone, present in females at a much lower concentration than males, has a libido enhancing effect for women; however, testosterone supplementation is controversial and should be closely regulated by a knowledgeable clinician.

It is critical to remember that libido can’t be separated from the context of a relationship. Couples who learn to communicate in an open, honest way usually maintain a stronger emotional connection, which can lead to better sex.

About the Author

Ron Eaker

Popular Posts

Blog Archive

Label Cloud

Contact Us

Search This Blog

Subscribe

Popular Posts

Popular Posts