5 facts about (peri)-menopause you didn’t know!

We aren’t taught much about what happens during menopause and the few years before.

 Read on for some things you didn’t know were related to the loss of estrogen that your ovaries used to make!

1.  Vaginal dryness may be due to menopause!

You may not realize that dryness is related to the loss of estrogen. You may not get aroused as easily during sex. You may not be able to reach orgasm; orgasms are not as strong, or it takes too long and too much work to get there. Sex may even become painful. No worries, low dose vaginal hormones help treat all of these, (and you are normal if this is happening to you)! Giving back the estrogen helps the vagina lubricate. It also makes the vagina stretchy, with good blood flow, and more nerves going to it, which makes sex feel better! The good news is that vaginal hormones don’t have the same risks that go along with other hormone use. They do not increase your risk of breast cancer, heart attack, or stroke.

 2.  Menopause makes it harder to lose weight.

It is not that you are lazy or crazy. During menopause women become more insulin resistant. This means your body needs to pump out more insulin to get the same amount of glucose into the cells. Insulin makes your body deposit fat, which is not good for your waistline. Menopause leads to fat deposition around your middle instead of your hips and bust. This “apple” shape, as opposed to the typical female “pear” shape, leads to an increased risk of cardiovascular diseases like heart attack or stroke. Diet and exercise are the first step to losing weight and making your body less resistant to insulin. Some women may need the help of some of the medicines that are available to help you lose weight.

3.     Anxiety, depression and mood swings may worsen around the time of menopause.

Typically, hormone levels become erratic before periods stop. Women may feel like they are on a roller coaster ride of emotions. Also, this is the time the kids leave the home and women may be dealing with an empty nest or a lost identity. They may also be taking care of aging parents or have financial stressors. There are plenty of ways to manage anxiety, stress, or depression. Some are with appropriately chosen medicines, other times yoga or soothing apps like CALM may be all you need.

4.  Word finding difficulties, forgetfulness happens.

This can be incredibly scary for menopausal women. You can’t seem to remember why you walked into the kitchen or what task you were supposed to complete today. The good news is that brain exercise helps. Learn a new language or learn how to play an instrument. Exercise and diet also keep the brain “fresh”. Be sure to eat a healthy diet, including omega 3 fatty acids which are found in oily fish like salmon or tuna. A healthy lifestyle lowers your risk of Alzheimer’s Disease and delays the progression of Parkinson’s Disease.

5.  Low libido.

Menopause is not all about estrogen. By the time women stop having periods, their testosterone is much lower than it was in their 20s and 30s and this may lead to low or loss of sex drive. Loss of sex drive may significantly impact a women’s relationship, and couples that don’t have sex tend to grow apart. There are plenty of hormonal and non-hormonal ways to improve your sex drive.

Make sure you find a practitioner who is well versed in menopause and sexual health.

Dr. Becky Lynn is a gynecologist, menopause and sexual health specialist in St. Louis, MO.  She is licensed to practice medicine in Missouri, Tennessee and Illinois.  She she sees patients in her St. Louis office and offers telehealth consults to Illinois and Tennessee.  Call today to schedule your appointment.  (314) 934-0551 or click click here to schedule.

Vaginismus: When Your Vagina Won't Cooperate

Is your vagina uncooperative when it comes to sex?  Are you unable to have penetration or it feels like there is a brick wall in there?  You might have vaginismus.  Dr. Becky Lynn, Director of Evora Center for Menopause and Sexual Health, speaks with Megan Normille, PT and Program Director at SSM Health Physical Therapy, on the topic of Vaginismus. Vaginismus is an involuntary tight contraction of muscles around the opening of the vagina that makes putting anything in the vagina painful.

 Dr. Lynn: Hello, I’m Dr. Becky Lynn. I am a board-certified gynecologist, menopause and sexual health expert at The Evora Women’s Health.  We treat women with problems like painful sex, low libido and orgasm difficulties. We also offer a full scope plan for treating your menopausal symptoms, all of them, not just hot flashes.  Today, we are going to talk about a condition known as vaginismus, which can lead to painful sex or prevent women from having sex at all. I want to introduce you to Megan.

 Megan: Hello, I am a physical therapist with SSM health Physical Therapy and my specialty is pelvic floor dysfunction in women. I am excited to talk about vaginismus because we see so many women with this terrible problem.

 Dr. Lynn: Let’s start with what is vaginismus and what is happening anatomically. The vagina is a long hollow tube that is surrounded by muscles. Vaginismus occurs when there is involuntary contraction of the muscles that surround the vagina. Many women with vaginismus can't have penetration at all because the muscles are so contracted. I often hear my patients say "he is hitting a wall" or “he can't get in”. Many times they have seen several providers in the past and they’ve been told, “oh just relax, drink a glass of wine.” I cringe when I hear this because wine is not going to fix the problem.  Physical therapy is the first step in treating vaginismus, although not the only step.  Megan, how do you go about treating vaginismus with physical therapy?

 Megan: We start with education about the condition. We need to make sure our patients understand that it's not in their head and it's not, like you said, a conscious decision. It usually is something that has been going on for a long time. Recognizing and appreciating the frustration that women feel, and understanding that this is not something women should just power through either, goes a long way in helping our patients.

 When I work with patients, I respect what the body is going through and how the patient is feeling. We start all of the physical therapy externally.  We need to get the muscles to let go first, then we can work on stretching the muscle. We work on different ways to get the muscles to release. Sometimes that’s through diaphragmatic or belly breathing.  Sometimes it is through visualization, where we use a mirror to look at those muscles. I do a lot of education about getting comfortable with the vagina, vulva and the surrounding muscles. We talk about where those muscles are and what their functions are.

 Dr. Lynn: Will you tell us a little more about the function of the muscles?

 Megan- Basically the muscles have three primary functions. One is the “sphincter” function. The sphincters open and close and they help with bowel and bladder functions. The muscles also play a role in normal sexual functioning.  The third function is to support, to hold everything in from the bottom and that includes the internal organs and pelvic organs like the uterus and bladder. We tend to think that the muscles are either relaxed or contracted, that there is an on or off switch.  But that is not the case.  We teach our patients to try to turn down the contraction a bit so they can allow and enjoy sex.

 Dr. Lynn: One way I describe the pelvic floor muscles to my patients is to think of a human skeleton and picture the pelvis. I describe the pelvic floor musculature as a hammock that supports everything, so your organs don’t fall out the bottom when you’re standing up.You mention “diaphragmatic breathing”. What does that mean?

 Megan: Diaphragmatic breathing, also known as belly breathing, is one of my favorite techniques to teach my patients. Diaphragmatic breathing is when you breathe very deeply, high up in the ribcage. When you inhale, the diaphragm, the layer of muscle that sits right underneath the lungs, comes down to give your lungs room to expand. Then the pelvic floor comes down and relaxes just because you are breathing deeply. They work in concert.  When we take short shallow breathes, the diaphragm and pelvic floor muscles stay fixed and they can’t relax. If we can get somebody doing diaphragmatic breathing, then the pelvic floor is automatically going to be moving and relaxed. When the person inhales, the belly fills with air and then when the person exhales their belly is going to go back down.  Many times we will place hands on the belly while the patient is laying down on their back. They are in a comfortable position working on belly breathing that way.

 Dr. Lynn:  Sometimes when my patient can't get to pelvic floor physical therapy, I will recommend yoga because they teach belly breathing which relaxes the pelvic floor musculature. Yoga also strengthens your core and improves flexibility throughout the pelvis.  You also mentioned visualization as a way to treat vaginismus.  Can you tell me about that?

 Megan: Sometimes we do visualization, which is having the patient look at the tissue. This is done using the mirror. The vulva (outside of the vagina) is an area of the body we can’t see very easily and if it's been something that's painful, it's sort of scary to look at. When we google what it is or looks like, we really don’t know what "normal" is. In my practice, when I tell someone to “just relax” the muscles, it is difficult for patients to do. It is like telling someone to walk and then it makes walking more difficult.  When we say make the muscles “mushy” or “soft” or “let go” while looking at the tissue, they can understand relaxation better.

 Dr. Lynn: Do you ever use biofeedback?

 Megan: Yes, we do. In biofeedback we use stickers that go on the outside (nothing is inserted), that measure if a muscle is contracting or not.  Then we can show patients what it feels like when the muscles are contracted and what it feels like when they are relaxed.  

 Dr. Lynn How about dilator use?

 Megan: I have a love-hate relationship with dilators. I think they can be very helpful but patients need to learn how to use them or they won’t help and might make things worse. 

 Dr. Lynn: I agree. I never hand somebody a dilator and say go home and use this.

 Megan: When the muscles are still contracted, it's can be painful to insert the dilator. We want the dilator use to be pain-free. Before using a dilator, we need to get the 3 layers of muscles relaxed. We need to get the outer layers “mushy” or “let go” first, before we work on the inner layer. If those outer layers are still contracted and painful, dilator use won’t be successful in the way we want it to be.  Dilators can be very helpful, but it's usually later on in the treatment.

 Dr. Lynn:  I recommend thinking of dilators as “desentiziers”. Once my patients can relax the pelvic floor musculature, then I recommend that they try to insert the smallest dilator and gradually move up. I explain it by saying that using the dilator tells the brain that you can have something in the vagina and it not be painful. The other thing I've noticed with my patients is that it gives them confidence to try and have sex because they know they are able to have something in the vagina without pain.  If a large dilator can sit in the vagina and the patient is pain free, then they are more likely to go give penetration a try.

 Megan: With intercourse, there is a lot of movement too. We use dilators to work up to rotations and some slight in and out movements. This can bridge the gap between physical therapy and actual intercourse. I will even have the partner of the patient insert the dilator if they feel comfortable. This helps patients get them used to somebody else touching them.

 Dr. Lynn:  Right, I definitely think it's different when somebody else is touching you because you lose control, and I think that can make people very anxious. Once you lose control it becomes that much harder to do your deep breaths. I often recommend that when the woman does decide to have intercourse, that she be the one in control. She should be the one to guide the penis into the vagina, because it takes away the anxiety of being out of control and that makes a big difference.

 Megan: I talk a lot about boundaries. The patient may say to her partner "we are going to work on touching and desensitizing the external tissue", nothing further. That's the boundary that she has set. Then there's a mutual expectation of it not progressing further. Having those boundaries from the beginning can be very helpful.

 Dr. Lynn: I always learn so much when I talk to you because we approach the problem from such different angles.

 Megan: I’m curious what you tell patients about the time frame? I get asked a lot “how long is this going to take?”

 Dr. Lynn: This is a very long process and I think it's really important to set that expectation.  Having treated vaginismus over the long term for many years, I explain to patients that we take baby steps and it's not going to go away overnight. We make a little progress, then most people back up a little bit, and then a little progress forward again. Maybe they hit a stumbling block. It is baby steps forward and then a couple of steps back. But eventually, many women get past the vaginismus and are able to have pleasurable sex without pain. Many go on to get pregnant and have babies!

 Megan: We always do a little cheer when that happens so we can celebrate success with our patients. But you are right, it definitely can get better and can be successful and a good positive experience. As for the time frame, I try to be clear upfront that it is different for everybody. There are so many factors that play into it.

 Dr. Lynn: One thing that I want to say about vaginismus is that it is really important that you see a sexual medicine specialist or a pelvic pain specialist when you get the diagnosis because vaginismus can be due to several other medical conditions. It can be due to endometriosis, interstitial cystitis, irritable bowel syndrome, a history of sexual abuse or trauma, back and hip pain, and/or a lack of hormones. If you have vaginismus and let's say you found that diagnosis on the internet, and you go to pelvic floor physical therapy and nobody is treating the endometriosis or the irritable bowel, then pelvic floor physical therapy alone won’t cure the vaginismus. Only treating all of the contributing factors will. It is very important that you see someone who has knowledge in vaginismus and pelvic pain.

 Megan: I agree.  Many practitioners don’t have the expertise and that's when we hear "have a glass of wine" and other comments I like to think are well intentioned, but are not very helpful.

 Dr. Lynn: Patients get told it’s all in their head. Patients are relieved to know there's a reason they have this.

 Megan: Just the words, “you are not alone” can ease patients fears. Because of HIPAA we don't introduce patients to each other but there are so many patients out there with the same diagnosis. It's not as unusual as you would think.

 Dr. Lynn: Is there anything else you would like to add?

 Megan: I think that is about it.

 Becky- Alright, thank you for tuning in and we will see you soon! 

See this conversation on YouTube: https://www.youtube.com/watch?v=JZG9YD8-6is

 Dr. Becky Lynn is a national and international speaker, gynecologist and menopause and sexual medicine specialist.  She has been featured in Best Doctors in St. Louis, Martha Stewart Living and Self Magazine.  If you would like to make an appointment to see Dr. Lynn, call 314 934 0551 or go to her website.  Evorawomen.com.  You can even schedule a 15 minute visit just to get to know Dr. Lynn and see if she is the right fit for you.  If you have any questions, please email us at info@evorawomen.com. She is licensed to practice medicine in Missouri, Tennessee and Illinois.  She she sees patients in her St. Louis office and offers telehealth consults to Illinois and Tennessee.  Call today to schedule your appointment.  (314) 934-0551 or click click here to schedule.

Testosterone for Women: Miracle Drug or Bogus Science?

Testosterone.  That lovely hormone of desire, of sex, of muscles and power and strength.    We think of manly men with hairy chests when we think of testosterone. But did you know women have testosterone too?  They even make more testosterone than they do estrogen. Testosterone is one thing that controls sex drive in women and does a whole host of other things.  It starts to decline in your late 20s. This can contribute to low libido in women. So should testosterone be replaced? I hope to answer this question for you with answers based on scientific studies- not bogus internet marketing claims.  Let’s get started.

Does testosterone make for better sex?

If you are a midlife woman, peri or postmenopausal, then in some instances the answer is yes!  Testosterone has been shown to definitively improve several aspects of sexual functioning. Testosterone improves sex drive, arousal, helps you have more and better orgasms, and increases pleasure and responsiveness.  Who wouldn’t want all this at a time when your sex life tends to get a little dull and unsatisfying and in some women, a whole lot of work as well. When a midlife woman is suffering from low sex drive, testosterone can be used to improve it.  This is a big deal for many women because low sex drive is uber common in midlife women and many are very distressed by it. Low drive can add a lot of stress to a relationship. 

What are the benefits of testosterone?

Apart from improving your sex life, some data shows that testosterone may also help build muscle mass, improve fatigue and help with weight loss.  The data isn’t definitive though and it isn’t recommended to use testosterone for these reasons.  

What are the risks of testosterone?

There are no medicines without risks or side effects so don’t believe anyone who tells you a medicine has no risks.  Testosterone is a hormone. It gets converted to estrogen in the body. Like estrogen, it increases your risk of blood clot.  The medical term for a blood clot is deep venous thrombosis (DVT). DVTs can be quite dangerous because the clot can break away from the blood vessel and travel to your lungs and prevent you from getting oxygen.  Good news though, if you don’t have a clotting disorder, are a normal weight, don’t smoke and don’t have certain other medical conditions, your risk of having a blood clot is very low. It is much lower than when a woman is pregnant or on birth control pills.  

What about bioidentical hormones?  Do they have risks?  

Even “natural” things have risks, so don’t be fooled by the term bioidentical.  Bioidentical means that whatever you are getting has the same chemical structure as the hormones that your own ovaries used to make or are currently making. Compounded “bioidenticals” are no safer than standard prescription hormones and on the flip side, there are prescription hormones that are bioidentical.  Stick with the prescription ones. The companies that make them have to prove to the FDA that they are effective and safe. Compounding pharmacies don’t. 

What are the side effects?

When appropriately replaced, some women on testosterone will develop acne or a little bit of facial hair.  If the testosterone level in the blood gets into the male range, way too high, there can be some significant and permanent side effects like a lot of facial and body hair, deep voice, male pattern balding, and an enlarged clitoris. Your prescribing physician should be checking your blood levels to make sure you stay in the correct range.  Most women do not have these side effects.  

How should testosterone be given?

Testosterone should be given in a topical form, either a gel or a cream that gets absorbed through the skin daily.  I prescribe testosterone as a topical cream for my patients. Women put some of the cream on their calf. This mode of delivery gives a very steady blood level of testosterone and if there is a bit of local hair growth, you can just shave it off.  I don’t like the intramuscular injections of testosterone because they give you a very high dose right after you inject, then your body metabolizes it and the level goes down until your next dose when you get a whopper dose again. This creates a lot of ups and downs in your hormone levels.  Not my favorite.  

What about hormone pellets?

I don’t recommend certain hormone pellets-namely BioTe. Some of these tend to give women very high levels of hormones.  I have seen numerous women with the same blood levels of testosterone as a man would have.  At these levels, women grow beards, have deepening of the voice, male pattern balding and the clitoris grows.  These changes can be permanent. 

Also, pellets have not been studied in women in peer reviewed published medical studies.  They haven’t been proven to be any better, safer or more “natural” than anything that has been studied.  The North American Menopause Society and the American College of Obstetrics and Gynecology specifically do not recommend treatment with pellets because their safety has not been proven.  For BioTe, go to their website and check out the disclaimer at the bottom of the website. It says these are not intended to treat or cure anything! 

I will say women come to me feeling fantabulous on their testosterone pellets.  They have amazing libido! That is because they have as much if not more testosterone floating around in their blood as their male partners and maybe as much facial hair too.  Just keep in mind the permanent changes pellets may cause.

What's the best way to find out if testosterone is a good option for me?

If you are in your 40s or 50s, peri or postmenopausal, testosterone may be a good choice for you to boost your libido, barring certain medical conditions.  Make sure to see a provider with experience in treating sexual conditions. A sexual medicine specialist will also look for other factors that may be contributing to your low libido like a not-so-nice partner, depression or certain medications. Testosterone is not going to improve your libido if your partner is a jerk.  

TO SEE IF TESTOSTERONE IS RIGHT FOR YOU CLICK HERE

Dr. Becky Lynn is a gynecologist, menopause and sexual health specialist in St. Louis, MO.  She is licensed to practice medicine in Missouri, Tennessee and Illinois.  She she sees patients in her St. Louis office and offers telehealth consults to Illinois and Tennessee.  Call today to schedule your appointment.  (314) 934-0551 or click click here to schedule.

How having breast cancer affects your intimate life

Breast Cancer- that thing that turned your world upside down, breast cancer survivor.  You never thought it would be you.  No family history, you eat right, you exercise, but somehow you found a lump that turned out to be cancer. And you are young! Cancer is for old people.  But no, now you embark on the road to recovery, see the oncologist, the breast surgeon, the plastic surgeon, the radiation oncologist so you can fight this disease. You get your care and it’s done. Time to get your life back.

But no one told you what was going to happen to your intimate life!

 Did you know your breast would look funny or that you would lose sensation in your chest?  Your nipples would be gone? Did they tell you what lack of estrogen does to the vagina?  Did anyone mention that sex was going to become excruciatingly painful or you would never want to do it again? No, no and no. Because, as they should be, everyone is working on making the cancer go away for good. At the end of the day, you still have to lead your life. But should you even worry about intimacy when you should feel lucky to be alive?

 The answer is YES! Intimacy matters!  Sex Matters!

 Finding your new sexy

 Sex is going to be different now.  One of the most common issues in women with breast cancer is vaginal dryness that causes painful sex.

 Vaginal dryness

 If your breast cancer is estrogen and/or progesterone receptor positive, then the treatment to prevent it from coming back is to prevent estrogen from working or to get rid of as much estrogen as possible so there isn’t any left to stimulate a breast cancer cell to grow.  Vaginal dryness is the most common side effect of low estrogen levels. Lack of estrogen changes the vagina.  When your body is making estrogen, the vaginal tissue is thick and moist and it stretches.  It has proteins like collagen and elastin that help it stretch so a baby can fit out of it or a penis can fit into it.  It also has special cells that make moisture when you get aroused or excited.  When there is estrogen around there is a lot of blood flowing to the vagina and this makes a difference in sensation, how good sex feels. When there is minimal estrogen, the vaginal tissue gets thin and dry.  It loses its collagen and elastin so it doesn’t stretch when you try to put something in it.  This can cause a lot of pain, especially on initial penetration.  Also, there isn’t as much blood flowing to the vagina so some women say there is a lack of sensation.  

 What to do about vaginal dryness

 First of all, throw away your water based lubricants.  Some of you may have already purchased a lubricant and yes this is the first step.  Put some in your hand, put it on the outside of the vagina which is called the vulva and put some on your partner’s parts, penis or otherwise.  Invest in some silicone based lube or olive oil.  (unless you are using condoms, then you have to stick with the water based).  Water based lubes pull the moisture out of the vagina and make dryness worse. Avoid any lubes with flavors or tingly sensations.  I recommend the silicone based lubes Uberlube or Wet Platinum. 

 You can also moisturize the vagina.  Just like you use hand lotion for dry skin, you can use a vaginal moisturizer for the vagina.  There are many available on the market, but my recommendation is plain and simple, coconut oil or solid vegetable oil (Crisco).  You can use as much or as little as you prefer.  There is no right or wrong way to do this.  If you use too much, you will feel greasy or messy.  If you use too little, you won’t notice any difference at all.  Put it where you feel dry on the vulva or in the vagina.

 Lubes and moisturizers do a fantastic job at decreasing friction during sex.  They don’t do much for increasing the stretchiness of the vagina or bringing more blood flow to it.  Only low dose vaginal hormones do that.  But you thought hormones were out of the question, right?  Well, there are several national organizations like the North American Menopause Society who have evaluated the medical research about this and come up with some recommendations.  If lubes, moisturizers and other nonhormonal treatments have not worked, women with breast cancer can discuss the risks and benefits of using low dose vaginal estrogens or intravaginal DHEA (a different hormone) with their providers.  Treatment should be individualized, taking into consideration quality of life, risk of the cancer coming back and how bad your symptoms are.  Yes, you can consider the use of vaginal hormones in consultation with your cancer doctor after a thorough discussion of risks and benefits.

 Quality of life matters, relationships matter, human touch and intimacy matter.  So bring it up with your doctor.  Talk about it with your partner.  Don’t just accept sex as a thing of the past.  Find the right provider who can help you.  You need honest and accurate answers. 

 Don’t just survive. . . . . THRIVE!

 Coming soon, a discussion of low libido in breast cancer patients and survivors.  Stay tuned!

 I am a Sexual Medicine Gynecologist

Dr. Becky Lynn is a gynecologist, menopause and sexual health specialist in St. Louis, MO.  She is licensed to practice medicine in Missouri, Tennessee and Illinois.  She she sees patients in her St. Louis office and offers telehealth consults to Illinois and Tennessee.  Call today to schedule your appointment.  (314) 934-0551 or click here to schedule.

Schedule an appointment with Dr. Lynn

Check out my website for more information. 

 evorawomen.com

 Or call 314 934 0551 to make your appointment today!

Where did my 20 something sex drive go?

I was recently watching the Netflix series “You” which deals with an intensively obsessive 20 something man, falling for a somewhat clueless, innocent, sexy 20 something woman.  But it’s not the obsession that struck me(or the unusually nefarious plot), it is the crazy, throw me up against the wall, rip off my clothes and have passionate sex with me that caught my attention.  That is because in my gynecology and sexual medicine practice, I see women every day who tell me they have lost their sex drive.  Some women are desperately missing it.  They say they “want to want” again.  Others tell me they would be completely happy if they never had to have sex again in their entire life.  Had to have it?  Where do our 20 something sex drives go as we age?  Why do we lose them and most importantly, how do we get them back? 

When does sex drive peak?

Sex drive peaks in women’s early reproductive years.  Nature’s drive to find a mate and reproduce is super strong. Over time, we tend to settle down, have children, lead busy lives and our children become our main priority, right? Our spouse or partner, who we know is going to be there at the end of the day, becomes our last priority as we raise our kids and/or try to succeed in our careers. Sex lives become stale, boring, and we succumb to you guessed it-Duty Sex.

 What is duty sex? 

 Duty sex is the sex we have because our partner wants it and we do it to fulfill their needs, not ours.  Is it rip-roaring, bed-banging, need you NOW sex?  Not at all!  It is hurry up and get it over with sex.  Our partner has needs right? But what are we, as women, getting out of duty sex?  Intimacy and closeness, maybe.  Pleasure?  Not so much.  When it comes to our pleasure during sex play, we say, “oh don’t worry about me”, “you can get me next time” or “I don’t need an orgasm today”.  So we skip it, and from our standpoint, the sex is not so great.  Next time, we want to do it even less, and the sex is even less great. In fact, it is kind of bad, so we don’t want to have sex the next time and the next time and the next time.  You get the point.  Our drive tanks because in order to want to have sex, it has to be sex worth wanting!!

 Boring sex isn’t the only thing that can lower your sex drive.

 Low libido is almost never due to just one thing, like duty sex.  When I see my patients, I do a complete and detailed history to uncover anything that might remotely be contributing to low drive. If we only see and treat one thing, drive isn’t going to improve because all of the contributing factors weren’t addressed.  I ask about depression, anxiety, medicines, pain during sex, communication and relationship problems, body image, what your family taught you about sex, history of sexual trauma, partner sexual dysfunction like erectile dysfunction or premature ejaculation.  (I know I am being heteronormative here, but the majority of my patients are in heterosexual relationships).  The list is long.

 But is there treatment or should I just give up?

 YES! There is treatment.  Don’t give up.  Women may never get back to that same drive they had in their 20s but yes, they can “want” again.  My general approach to treatment is to first educate women about what is normal.  Many of us operate under certain assumptions about how sex should be, how we should be and how much sex we should want.  What is normal for one relationship is different from what is normal for another. Second, we discuss how to mitigate all the contributing factors.  For example, if the antidepressant someone is on is contributing to low libido, we discuss possibly changing it.  If the relationship needs some help, maybe some counseling is in order.  I generally recommend a good regimen of erotic reading if a patient is open to it.  The idea behind erotic reading on a regular basis is to get those neurons in the brain that think sexual thoughts firing again and again and again.  Those neurons may be out of shape, so to speak.  So go ahead, pick up that smutty novel, and exercise your erotic brain. 

 There are medicines that are FDA approved to treat low drive in women like Addyi and Vyleesi.  There are medicines that are not FDA approved for women, like testosterone, that have been shown in scientific studies to improve low sex drive in women.  They work in a variety of ways.  Each one has its own set of risks, benefits and side effects.  One may work for one woman and not for her sister or best friend.  None of them will give a woman the sex drive of a 15 year old boy reliably and usually not at all.  But for a percentage of women they work! And a good sex sex life is important to a relationship and to overall well-being. Sexual harmony so to speak!

 Stay tuned for my next blog with more information on medicines.

 Dr. Becky Lynn is a gynecologist, menopause and sexual health specialist in St. Louis, MO.  She is licensed to practice medicine in Missouri, Tennessee and Illinois.  She she sees patients in her St. Louis office and offers telehealth consults to Illinois and Tennessee.  Call today to schedule your appointment.  (314) 934-0551 or click here to schedule.

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 Check out my website today for more information. 

 evorawomen.com

 Or call 314 934 0551 to make your appointment today!

Why can't I climax anymore?

Why can’t I climax anymore?

“I just have to work sooooo hard to reach orgasm nowadays”, said my patient.  My husband thinks it is him and it’s not.  “I just don’t know what is wrong with me”. I hear this from my menopausal patients day in and day out.  They feel bad, they are worried something is wrong with them, it is causing concern in the relationship.

You can blame menopause.

Difficulty reaching orgasm or inability to orgasm is super common during menopause.  During menopause your ovaries pretty much stop making estrogen and by this time they aren’t making much testosterone either.  Both the vagina and the clitoris need these hormones to function normally.  So, reaching orgasm requires a lot more work, for some women. Some women then decide to forgo that elusive orgasm (or they fake it). “oh, don’t worry about taking care of me” my patient says to her partner.  “You can get me next time”.

The problem with this scenario is that for the woman, the sex isn’t always that great when she doesn’t get that pleasure release of orgasm.  When a woman reaches orgasm, she gets a flood of dopamine in her brain.  Dopamine is that feel good hormone, it is the one that is released if you do heroin or cocaine that keeps you coming back for more.  (NO, don’t do heroin or cocaine).  After orgasm, your body releases oxytocin, the cuddle hormone, that makes you want to curl up next to your partner.   A good orgasm is an important part of good sex.  When sex starts to become not so good, sex drive decreases too.  In order to want to have sex, it has to be sex worth wanting.

We just don’t learn about this stuff!!

 Did anyone tell you this was going to happen during menopause?  Heck, no!! Women’s sexual pleasure is a bit hush in our culture.  Well, it shouldn’t be.  All women should know that there is treatment for difficulty with orgasm due to lack of necessary hormones. Low dose vaginal hormones can be used and these do NOT increase your risk of breast cancer, stroke, heart attack or blood clot.  I repeat, no increased risk when used vaginally.  Low dose vaginal hormones bring the healthy blood flow back to the vagina.  They allow the vagina to make the cells that make moisture and they allow the vagina to be stretchy again, so sex is much less likely to hurt- another menopausal trouble, to be discussed in another blog. 

I have to mention that there are a variety of other things that can affect a woman’s ability to orgasm and the list is long.  If you are having trouble, see your doctor.  No let me change that,  see your sexual medicine doctor!

Dr. Becky Lynn is a gynecologist, menopause and sexual health specialist in St. Louis, MO.  She is licensed in Missouri, Tennessee and Illinois.  Call today to schedule your appointment.  (314) 934-0551 or Click here to schedule an appointment.. If you are not located in Missouri, Tennessee or Illinois, Dr. Lynn offers an E Health. Click here to learn more about E Health and meet with Dr. Lynn today!

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