February 2024 Newsletter | Sexual Healing and Health
My mission is to be the first woman in 4 generations to not develop Alzheimer’s Disease (AD). On my journey of discovering ways to mitigate my risk, I pass this information on to you in this Brain-Body-Health (BBH) Newsletter.
Hello BBH Citizen Scientists!
I am worried about your sexual health!
When was the last time your doctor asked you about your sexual health? Most likely never because in medical school we never learned how to talk about sex, so we didn’t. Sexual health has been taboo in our culture, and in our homes, but thankfully it is returning to be a ‘hot’🔥topic in health.
We underestimate the impact of sexual relationships on our health and the quality of our lives.
When I started BBH I wanted to know how healthy we are and how to determine our health. Did you know your sexual health is an important part of your metabolic health and overall well-being?
We’ve known for a long time that in men diseases like diabetes (DM), Atherosclerotic Cardiovascular Disease (ASCVD), and metabolic syndrome are related to erectile dysfunction (ED). The reasons for this are clear. The vessels in the penis mirror vascular health. If there is less blood getting to the penis then ED will occur. Many are unaware of this relationship. When ED arises it needs to be evaluated. Of course, we know there are many reasons for sexual problems like ED in men or genitourinary syndrome of menopause (GSM) in women. Studies suggest these same tendencies toward metabolic syndrome, ASCVD, and DM are also seen in women.
Health equity is achieved when everyone can attain their full potential for health and well-being.
When it comes to research, sexual health has been less studied because of taboos and the strong emotional overlay. Physicians are afraid to open this can of worms. The vast array of studies has not included women or people of color. Nowhere has research equity been more skewed than in sexual medicine. Take the development of Viagra-type medicines for men with little to no emphasis on the development of drugs for women’s sexual health. However, this inequity is slowly reversing in all fields addressing the need for gender and race equity. Because of this disparity and new developments, I’m going to spend the rest of this month’s BBH Newsletter addressing the sexual health of women.
A vast majority of women develop challenges to their sexual health in the years before menopause and after. Although we say menopause, it’s really not a ‘pause’. Menopause is more like a hard stop. The pause has been happening for 5+ years prior as your ovaries cause estrogen, progesterone, and testosterone levels to drop dramatically. This hormonal nose dive gives us decreased desire, vaginal dryness, anorgasmia (inability to orgasm), and urinary symptoms like incontinence and infections. These hormones have a huge impact on your sexual health and well-being. Evolution has not been kind to women. Once we can no longer procreate we are left to our own literal thinning vaginal and urinary tissues.
Just because evolution doesn’t care about female sexual health doesn’t mean we shouldn’t care about it.
Vaginal dryness, also known as atrophic vaginitis, was renamed in 2014 to genitourinary syndrome of menopause (GSM). BTW, this is not a little vaginal dryness. Think, the Sahara desert dryness. And as we age it gets worse. How much worse you ask? It can literally put your life in danger because of repeated urinary tract infections, according to Rachel Rubin, MD a specialist in sexual medicine. (See her video below)
Fortunately, we have the skills and tools to manage and trick Mother Nature into improving the quality of our sex lives. Si, se puede! (Yes, we can). Treatment with vaginal hormones prevents UTIs by 50%, improves orgasm, and eliminates pain with intercourse. Available by prescription, these hormones can be prescribed by your primary care provider. They come in low-dose inserts, creams, rings, with DHEA (another hormone), and oral forms. They are safe and effective without increased risk of cancer. GSM affects quality of life. Many men take Flomax for urinary health. Vaginal hormones provide urinary health for women that also optimize our sexual and metabolic health.
For a good laugh: here is a stenographer’s record of a courtroom testimony:
ATTORNEY: So, the date of conception (of the baby) was August 8th
WITNESS: Yes.
ATTORNEY: And what were you doing at that time?
WITNESS: Getting laid.
LESSONS FROM COACHING:
For BBH citizen scientists and coaching clients following our treatment acronym of SLEDSSSS, you may notice the addition of another ’S’ for addressing sexual health, due to the benefits bestowed on the brain! Along with pleasure, other benefits are linked to sex: like a stronger immune system, improved cognitive function, cardiovascular health in women, and lower odds of prostate cancer, along with improved sleep, stress reduction, and a cultivation of emotional intimacy. For a good in-depth read, here is a piece in the NYT exploring sex and aging.
Besides vaginal dryness, pain with intercourse (dyspareunia), and anorgasmia, the most common sexual health complaint from women is a lack of desire. The worst offenders are psychiatric medication, antidepressants, and antipsychotics. Some are better than others, but most all carry some risk of sexual side effects. In 2020 the CDC reported that antidepressant use increased with age, overall, and in both sexes—use was highest among women aged 60 and over (24.3%). Sexual health is dependent on many variables including, relationship satisfaction, body awareness, metabolic health, depression, anxiety, and sleep changes. No wonder we see this rise in antidepressants during menopause when many of these areas are being affected by drastic changes in hormone levels, as seen in the FEB 2023 BBH Newsletter. This is where an in-depth bio-psycho-social model lens of care provides a means to tease out the root cause of sexual challenges. I refer to primary care or OB-GYN to gather a good history, medical exam, and work-up with hormone testing to help shine the light on ways women might mitigate these changes and create optimal sexual health.
We know couples can maintain healthy sexual relations into their 80’s, 90’s, and beyond. Aging bodies will require creativity, patience, and a willingness to explore new territories of conversation and vulnerability. We live in a world fixated on youth and anti-aging remedies. Sex may provide an avenue for softening these cultural tenets with acceptance of our aging bodies, resulting in greater intimacy and connection to ourselves and our partners. We are lucky to have access to aids that our parents did not have, like hormones, viagra type meds, sex toys, lubricants, etc., to keep our mojos working. Remember: 'if you don’t use it you lose it'. Sex is a perfect example of neuroplasticity at work in the brain and the body. Your nervous system can be primed but once you go for long periods without sex it becomes more work than maybe you are wanting at certain times in your life. That is OK too!
Your sexual health is not about how many times you have sex or orgasm, rather it is a conversation you have with your body, partner, and health care practitioner.
If you are having symptoms of GSM, it’s time for a thorough medical check-up and pelvic exam. North American Menopause Society (NAMS) warns that GSM is a progressive condition so don’t let this go untreated! Besides your health care provider, Pelvic Floor Specialists (PFS) diagnose and treat GSM. Here is an excellent resource for PFS.
We are all on the sexual spectrum regarding frequency of activity.
So far, we have been addressing partner sexual health. Expanding our spectrum of sexual health author Betty Dobson, wrote the classic guide Sex For One. Through this intelligent, warm, and informative guide, we gain knowledge of ways to explore self-love. She is a renowned sex educator featured on Netflix’s The Goop Lab with Gwyneth Paltrow.
If you have any questions surrounding this topic, please feel free to reach out to me.
LESSONS FROM SCIENCE:
Dr Rubin 4min video about women’s sexual health.
The beneficial effects of menopausal hormonal therapy.
Bike riding can cause sexual problems in men and women.
This systematic review found that tampons, pads, and liners contain endocrine-disrupting chemicals. Here are safer alternatives, Environmental Working Group’s Guide to Personal Care Products.
REMINDER: Menopause is also a time when women’s rate of developing ASCVD begins to equal men’s. ASCVD is still the number one killer of women. Remember women’s heart attack symptoms are different than men’s. Men’s common symptoms are chest pain or discomfort. However, women may experience other symptoms that are typically less associated with heart attack, such as shortness of breath, nausea/vomiting, and back or jaw pain.
To our optimized health!
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“If you want to go FAST, go alone. If you want to go FAR, go together."
- African proverb
To our optimized health!