Listen to “117: Medical Approaches to Women’s Sexual Concerns with Dr. Ashley Fuller”

Medical Approaches to Women’s Sexual Concerns

After accumulating nine years of experience working as an obstetrician and gynecologist at Swedish OB/GYN Specialists First Hill, Ashley Fuller transformed her practice into gynecology and sexual health. She claims that she was better able to pursue her passion for women’s sexual health by removing the obstetrics branch of her practice. In her practice she offers checkups, gynecological surgery, and regular exams including pap smears and STD screenings. She aims to help women with sexual and gynecological problems evaluate treatment options and make the best choices for their needs and lifestyles. 

Gynecologists are often Ill-prepared for Sexual Health Problems
In her previous practice as an OB/GYN, Dr. Fuller would have women present with sexual health problems such as low libido. While managing women’s sexual health is an important part of gynecological practice, the treatment of sexual health issues related to the vulva are not covered with any depth in residencies or medical training programs. Because of this oversight, Ashley says that when women asked her about sexual health problems, she frequently didn’t know how to help them. In an effort to fulfill this need of her patients, Ashley shifted her focus from obstetrics and gynecology to gynecology and sexual health.  

Evaluating Low Libido in Premenopausal Women
While menopause does affect libido, when a premenopausal woman presents with low libido, Dr Fuller begins by having her patient fill out the Decreased Sexual Desire Screener (DSDS), a worksheet that asks about SSRI use, possible relationship problems, painful sex, stress and fatigue, and several other common causes of sexual dysfunction in women. Ashley points out that not all of the possible causes are physical, and in those cases, she often refers patients to a therapist or sex therapist. Some causes of sexual dysfunction are physical, and in those cases, medication, hormone treatments, or other tangible interventions may be needed. The great news is Ashley tells us about libido treatment for pre- and post-menopausal women! Tune in for the details! 

How Giving Birth Impacts Libido
Dr. Fuller lists several bodily and environmental changes involved with giving birth that negatively influence libido. As physical causes go, Ashley explains that breastfeeding women often have a very dry vagina, which can cause unpleasant or painful sex, and being postpartum entails hormonal changes that can lower libido. Psychosocial factors change the relationship between partners, as newborns often require nighttime care and fail to sleep through the night, leading to parental fatigue and increased stress.  

Mental Health Influences Libido
Ashley mentions that depression and the SSRIs that treat it can both reduce libido. She looks for chronic opioid use and addiction issues, obesity, poor body image, and even poor heart health, all of which can contribute to low libido and need to be treated before hormone therapy should be attempted. 

Painful Sex
We learn that tight muscles in the pelvic floor can cause pain upon deeper penetration. When the muscular source of pain is found, physical therapy is often helpful. Ashley also suggests the Ohnut to allow for shallower penetration, and she says that women with this problem can improve with physical therapy. 

Psychological Treatment
Dr. Fuller finds that many of her patients have psychological issues that influence their pain levels. Ashley emphasizes that she isn’t saying their pain is imaginary, but she believes pain influences our psychology. “When you know something is going to hurt, she says it’s natural to tense up, but tensing up also activates the pelvic muscles, causing pain during intercourse.” The secret is to relax! 

Vulvar Pain Causes and Treatment
Ashley treats a lot of patients with vulvodynia. She says it often stems from hormone changes, especially hormone changes that appear around menopause. Birth control pills can also lead to very low testosterone levels and cause vulvar pain while some vulvar pain stems from an immune cascade where an overactive immune system attacks the vulva, causing inflammation. She warns that it can be a long path to significant relief, but she enjoys the process of treatment and is grateful for the opportunity to change her patients’ lives for the better. 

Resources for Ashley Fuller: 

More info and resources:
How Big a Problem is Your Sex Life? Quiz –
Access the Free webinar: How to make sex easy and fun for both of you:
Secret Podcast for the Higher Desire Partner:
Secret Podcast for the Lower Desire Partner:


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