Search for tag: "sexual health"

Interviewer: Your partner is suddenly not interested in sex anymore. Something is wrong, but you don't know what. Is this normal? We'll find out next on The Scope.

Announcer: Questions every woman wonders about her health, body, and mind. This is, "Am I normal?" on The Scope.

Interviewer: We're talking today with Dr. Kirtly Parker Jones. She is our expert on all things women. And, Doctor Jones, we got an email today from one of our listeners and she asked, her husband or her boyfriend, she just said partner isn't feeling anymore for sex. He's not interested. She knows she is normal, but is he normal?

Dr. Jones: Okay, as a woman gynecologist, I'm not sure about my standing here on this guy thing, but as a reproductive endocrinologist, a specialist in infertility and hormone problems, the issue comes up in my practice. So let's get to the "is he normal" part. Remember, we talk about "not normal" as being what is experienced by less than 5% of people. Not normal is sort of like not very common. Women and men have the unrealistic expectation that when it comes to sex, men are always ready, willing and able, but population studies suggest that about 20-25% of men said that they are not interested in sex at some times. And that would make your man normal, meaning lack of interest in sex is common.

Now, lack of interest is more common in women than men, with about 40% of American women saying in the past year there was a period of at least two weeks when they weren't interested in sex. Now, when it comes to men and women, there is no normal when it comes to the frequency or interest, as the range is all over the map. So we can use a decrease in interest or libido as a decrease in what the man had experienced before. So the causes of decreased libido in men are largely the same as in women. And let's go through some of those.

One, lack of novelty. The frequency of sex is more a function of age of the relationship than the age of the partner; everyone knows that. Newlyweds or new relationships are run more hot than long-term relationships.

Number two, stress. For men and for women, the stresses of daily life cloud the brain and you have to have a pretty empty brain to be completely focused on sex. Depression is also common in men and women and can be a major suppressor of sexual interest.

Three, partner conflicts. Women can be pretty verbally judgmental of their partners. And an unsupportive relationship is a turn-off. If your partner is angry with you, he might be less interested.

Four, lack of sleep and kids. And they go together. Having a bunch of kids in the house, particularly young ones, can preoccupy both men and women.

Number five, poor body image. Women understand this, but men can be affected by body image issues that make them feel somewhat insecure. Yes, guys can be insecure and that may decrease their interest.

Number six, alcohol use and abuse or drug use and abuse. A little may be a relaxer in the alcohol field, but more than a little on a regular basis will turn off desire for women and men.

Number seven, medical problems and medications. Interest flags when someone isn't feeling well and some medications are directly affecting libido, such as some blood pressure medications and some ant-depressions.

And number eight, then one all women assume first and worry about the most, infidelity. Is he getting his sexual needs met elsewhere, either in reality or in virtual reality?

Interviewer: So those are the things unique to women. How about men, do they have anything unique to them?

Dr. Jones: Oh, yeah! One that affects men and women is sleep apnea, but it's more common in men than women and it can lower testosterone. And it's compounded by obesity. Second is erectile dysfunction. Women tend not to have that problem. If a man's had problems with erectile less function, it can lead to concerns about the ready, willing, and able part and make men more reluctant to initiate sex. Three, aging. Aging alone in men can decrease libido and testosterone.

Interviewer: But they don't have what many women have. They don't have menopause, right?

Dr. Jones: Well, there is something out there called andropause. Now, it's not an acute event like menopause. It's more a decline in androgens. And a decline in androgens with aging is normal, but there is this whole thing about anti-aging therapy that some clinicians out there in practice, practice medicine that is not exactly traditional medicine, where they try to "normalize" levels of hormones, including testosterone, to the level of a 20-year old, even though you're 70. Now, whether that is wise or not is another issue.

But testosterone deficiency actually isn't very common. The normal range for testosterone is large and men at the lower end of the range can have normal libido. Remember, when it comes to sex, normal is just another setting on the dryer so it's hard to talk about normal. But testosterone deficiency is not nearly as common as advertisements would make it out to be and not nearly as common as prescriptions for testosterone would indicate.

Now, they are chronic medical conditions and obesity and sleep apnea and aging that can lower testosterone, but only a few men actually have this testosterone deficiency. However, testosterone is a medical problem and can have the side effects of other medical problems. It's worth getting a test if a guy brings it up with their health care provider. By the way, a good clinician asks questions about sex as a routine part of healthcare.

Interviewer: So what's a girl to do? What's her option here?

Dr. Jones: Well, it's a touchy subject and a male partner might not want to talk about it with you or his guy friends. Being supportive in a relationship is always important unless there are some behaviors like alcohol or drug abuse that can't be supported.

Ask him if he's feeling okay these days. Tell him you miss your closeness in bed. Is he sad or mad? Does he have new worries or concerns you might help with? If he's having a sexual side effect of a new medication, ask him if he wants to talk to his doctor about it. If he isn't feeling well, has gained or lost weight, is snoring a lot, maybe he want to see his primary care provider and have a discussion. It's a difficult discussion, but be brave. Even if you might not like the answers, if this is an important relationship to you, and you care about this person, it's worth the effort.

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Dr. Jones: Listen up, this is for ladies only. Gentlemen, kids, adolescents, go listen to stuff that is just for you. We're going to talk to ladies about vaginal dryness and pain after menopause. This is Dr. Kirtly Jones from Obstetrics and Gynecology at University Utah Healthcare and this is The Scope. Guys, change the channel. Ladies, plug in your earphones.

Announcer: Covering all aspects of women's health, this is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: There are many reasons why women are less interested in an intimate sexual relationship with intercourse after menopause, but one of the most common is that sex hurts. Menopause marks the end of significant production of estrogen by the ovaries. Estrogen production is linked to egg production, so it's a pretty good thing that we stop being fertile when we get to our 50s.

One of the prime targets of estrogen is the uterus, and after menopause the uterus gets smaller and the lining gets thinner and that's a good thing. That means there's less bleeding and cramping, in fact, if it goes as it should, no bleeding and cramping. However, the uterus is just part of the reproductive tract. Reproductive tract starts at the beginning of the vagina and those tissues get thin as well and sometimes they become very thin. They stop making as much fluids and the lining of the vagina can be painful and even bleed with intercourse. It only has to hurt a couple times and then women aren't so interested anymore. So what can be done about this?

First, how common is this? In a study reported in a menopause journal, 4,200 post menopausal women from Sweden, Finland, the U.K., Canada and the U.S. were surveyed about their symptoms and their knowledge. Thirty-four percent of Canadian women experienced symptoms with vaginal thinning and 43% of women in the U.S. noted symptoms, and two-thirds of them noted that the symptoms were severe and had a significant affect on their quality of life. That's a lot of ladies.

Fifty-one percent of American women didn't know that there was a local treatment for this problem, and 63% of women with symptoms had never been treated, but 67 of those who were treated had an improvement in their symptoms.

So what treatments are out there? Well, first, there's ordinary over the counter lubricants, slippery stuff. For some women, that's enough and it is safe and inexpensive. It's made by the same material that doctors use to make an internal exam more comfortable for women.

Second and most importantly, probably, is estrogen. Estrogen can be applied locally to the vagina twice a week in the form of pills or creams and this is very effective for the majority of women. There are many different ways to apply this local estrogen to the vagina. The dose is tiny and a recent study of half a million women in the Kaiser Healthcare system were studied to see if vaginal estrogens increased the risk of uterine cancer. They compared women who filled prescriptions for vaginal estrogens with women who didn't and the rates of uterine cancer were no different.

Women with a history of breast cancer are never supposed to use estrogens and they suffer, but there's no evidence that low dose estrogens increased the risk of breast cancer. Vaginal estrogen for women who've had breast cancer is controversial, but vaginal estrogen therapy's been used for decades for post menopausal vaginal thinning and pain with a terrific safety profile.

Third, DHEA, this is a weak adrenal male hormone that can be placed in the vagina and that can increase vaginal thickness and decrease pain. The trade name is Prasterone.

Fourth, Ospemifene, the brand name is Osphena. This is a pill that can be taken orally that isn't exactly an estrogen, but it does increase the thickness of the vagina and decrease pain.

So, why don't women get treated? I think we're in sort of a "don't ask, don't tell" situation here. Post menopausal women may not bring up the subject of pain within sex and doctors don't ask, but if there's evidence that sex is part of healthy aging, then doctors should ask and they should know the safety and effectiveness of treatments and, ladies, you should speak up. Sex doesn't have to be painful.

Now you can unplug your earphones and thanks for joining us on The Scope.

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