#177 – Urology for Women – Dr. Lamia Gabal

#177 – Urology for Women – Dr. Lamia Gabal

Listen to “177: Urology for Women – Dr. Lamia Gabal”

Urology for Women 

Dr Lamia Gabal is a Urologist with a sub-specialty in Female Pelvic Medicine and Reconstructive Surgery. She talks about all kinds of concerns women bring to a Urologist, information about the treatment options, and how to go about it.  

Sexual issues that bring women to urologists 

Women come to urologists for various kinds of sexual concerns. While traditionally urologists were thought to be “Male gynecologists”, Dr Lamia says urologists deal with much more than that. Women come with issues of Urinary Incontinence, Urinary Tract Infection, orgasmic dysfunction, female sexual dysfunction, libido issues, and more. Many women who come with these concerns back away from having sex with their partners because of the embarrassment they feel around it. Sometimes fixing their medical problems also helps them with their sex lives. While male concerns around this subject are already well understood and treated, female sexual dysfunction has only received a “trash can diagnosis”, says Dr Lamia. There are several types of female sexual dysfunctions and each needs to be treated accordingly. 

Urologists also deal with hormonal changes and core dysfunction. Thinning of vaginal tissue as women age can also lead to sexual dysfunction. Pelvic organs prolapse after childbirth can also lead to sexual dysfunction and can be painful. 

Medical concerns that drive women away from having sex 

There’s an overlap of urologists and gynecologists in the sub-specialty of female pelvic medicine and reconstructive surgery, with each performing their roles. However, not all urologists or gynecologists specialize in the field Dr Lamia does. She categorizes the kinds of concerns patients come in by their age. While most of her patients are post-childbirth age, she also treats young women who come in with issues of painful sex which could be pelvic floor dysfunction or dyspareunia and is usually associated with sexual trauma or PTSD. Women who are of child-bearing age often come in with recurring Urinary Tract infections. Women who are getting older and are past having kids struggle with pelvic organ prolapse, urinary incontinence, and fecal incontinence. All the concerns Dr Lamia mentioned can drive women away from having sex or from having a satisfying sex life. 

According to Dr Lamia’s advice, women who experience Urinary Tract Infections that have constipation, pelvic prolapse, and vaginal atrophy (thinning of vaginal tissues) should consult a urologist.  

Where does sex intersect in terms of conversations with patients?  

As a doctor, there’s no training you get in medical school that prepares you to have these conversations about sex with your patients. It’s often one’s interest to seek out more information and awareness that leads to these conversations with patients. Dr Lamia says it’s important to talk about sex with their patients to provide better health care, it aids in understanding how it affects their body and to make important decisions. However, most doctors don’t have these conversations for reasons of not having enough time or not being comfortable enough. Sometimes because of the assumption that an older patient might not be sexually active, which should not be done. 

Pelvic Organ Prolapse – treatment options 

Pelvic Organ Prolapse commonly occurs after childbirth and is more common with vaginal deliveries. All of these factors put pressure on organs making them lean into the vaginal wall. It increases the risk of urinary incontinence, fecal incontinence, and UTIs, and the most severe case can cause kidney dysfunction. It can be treated by “Pessary” which delays or prevents the need for surgery. Surgeries like cystocele repair, rectocele repair, and slings for incontinence are also an option, but patients can expect them to be redone after 15-20 years. It can impede sexual intercourse when the patient is constipated or something else. The surgery fixes vaginal laxity caused by this which can benefit sexual intercourse for both partners. 

Treatment options for Urinary Tract Infections 

To treat Urinary Tract Infection, all the other causes of the infection has to be ruled out through either a physical exam, an ultrasound of the kidneys, or a cystoscopy. Dr Gabal explains some treatments that could help such as maintaining good sexual hygiene, treating constipation, emptying bowels regularly, consuming fiber and a lot of water, peeing before and after sex, using plenty of lubrication that isn’t “warmed or flavored” can help to reduce the infection. Using antibiotics after intercourse and using probiotics to normalize vaginal bacteria can also help. She suggests supplements like cranberry and D-mannose prevent certain types of UTIs. 

Conditions That Can Cause Sexual Pain  

Dr Lamia talks about pelvic floor dysfunction as the most common cause of dyspareunia or painful sex. It causes mild pelvic floor muscle spasm to vaginismus where the vagina doesn’t open and causes pain. To treat this, she suggests soaking in a tub, putting heat on the area, or taking muscle relaxant drugs prescribed by the doctor. Pelvic floor physical therapy is the most effective of all and is done by specially trained pelvic floor physical therapists. Post-menopausal vaginal atrophy could also be the cause. She talks about birth control as an understated cause that causes thinning of vaginal tissue and a change in PH levels causing painful sex. She recommends putting topical testosterone mixed with estrogen to treat it. 

Biography 

Dr Lamia Gabal, MD, FPMRS, is a board-certified physician who specializes in several areas of medicine, including urology and restorative surgeries. Dr Gabal has more than 20 years of experience in the field of general medicine and urology. The doctor and her staff take great pride in offering many of the newest, cutting-edge treatment options and strive to continually provide the latest in technological advancements. 

She graduated from the University of California at San Diego Medical School in 1995 and performed two separate residencies at the UCSD Medical Center. She was the recipient of the “Patient’s Choice Award” from 2011 to 2013. Currently, Dr Gabal serves residents of Southern California at Prestige Medical Group in Santa Ana, CA. 

Resources and Links:  

Website: https://www.drgabal.com/ 

Services: https://www.drgabal.com/services/ 

More info and resources:
 
How Big a Problem is Your Sex Life? Quiz – https://www.sexlifequiz.com
Access the Free webinar: How to make sex easy and fun for both of you: https://intimacywithease.com/masterclass
Secret Podcast for the Higher Desire Partner: https://www.intimacywithease.com/hdppodcast
Secret Podcast for the Lower Desire Partner: https://www.intimacywithease.com/ldppodcast
#117: Medical Approaches to Women’s Sexual Concerns with Dr. Ashley Fuller

#117: Medical Approaches to Women’s Sexual Concerns with Dr. Ashley Fuller

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. 

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#112 – Hip Injuries Can Cause Sexual Pain with Dr. Ben Domb

#112 – Hip Injuries Can Cause Sexual Pain with Dr. Ben Domb

Listen to “112: Hip Injuries Can Cause Sexual Pain – Dr. Ben Domb”

Hip Injuries Can Cause Sexual Pain

Benjamin Domb, M.D. is the Founder, Medical Director, and Orthopedic Surgeon at American Hip Institute & Orthopedic Specialists. His group pioneers advanced, comprehensive, and non-invasive treatments in a mission to cure hip pain. AHI uses Hip Arthroscopy, Robotics, Resurfacing, and Regenerative Medicine to treat hip pain in their Chicago office. Now Benjamin is reaching out to discuss the ways that hip pain can create and contribute to pain during sex. 
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#97 – Sex and Chronic Illness – Dr. Lee Phillips

#97 – Sex and Chronic Illness – Dr. Lee Phillips

Listen to “97: Sex and Chronic Illness – Dr. Lee Phillips”

Chronic Illness and Sex 

My guest is here to talk about chronic illness and how it relates to sex. Originally, there wasn’t a lot of information or resources on the subject, so to fulfill this pressing need, Dr. Lee Phillips made it a point to devote his time towards researching and alleviating some of the sexuality stressors of chronic illness. 

Lee has worked for more than 12 years as a psychotherapist; he is a licensed social worker, an educator, a sex therapist, and a prolific researcher in the sexuality realm. He brings a lot of experience and wisdom to this episode. Check it out! 

The Inspiration for his Book on Chronic Pain 

Lee says that he started a chronic pain management group through his work as a geriatric psychotherapist in Williamsburg, Virginia. This would lead to the inspiration for his subsequent work in understanding and mitigating the detrimental sexual effects of chronic illness.  

Shortly after, he was approached by a colleague and persuaded to get into sex therapy because of the impacts of chronic pain on sex and relationships. He knew he could do some good work in that facet of therapy.  He also says that he was inspired to take his own research further because there wasn’t a lot of information out there on the topic of chronic illness and pain, and how it relates to sexuality. 

 

The Various Emotions That Can Accompany Chronic Illness in a Relationship 

Lee says that some couples go through ‘crisis mode’ whenever a partner is diagnosed, but overall the emotions and dynamics vary from person to person. 

He says that it’s typically a dynamic consisting of one ‘ill’ partner and the other healthy. Occasionally relationships can “open up” as the ill partner doesn’t feel adequate enough to pleasure their partner. But even more frequently, the healthy partner teams up and doesn’t act adversarial towards the illness, but instead looks for a way to manage it together. 

And sometimes there’s actually relief after a diagnosis because it brings context to an otherwise mysterious ailment that hadn’t been understood. 

 

The Mental Aspects of Chronic Illness 

Lee says that the physical symptoms can be extreme for chronic illness, but they can also lead to severe mental health difficulties that should not be overlooked.  

A big part of his job is to try and alleviate the mental turmoil that can arise dealing with an illness. When considering getting back into as healthy a sex life as possible, he likes to take into account their sexual history and see what can be done about getting back to the same level of frequency and intimacy. This can be a good boost for overall mental health in a patient. 

 

Imago Dialogue for More Reconnection Between Partners 

He says he uses Imago dialogue therapy for his couples. One of the core principles of Imago is that we unconsciously pick partners based on the qualities of our caretakers through life. So, if there’s a lot of isolation, anger, fighting, or depression within a chronic illness relationship dynamic, he will use the Imago model as exercises to break through some of those issues. 

He says there’s a sender and also a receiver within this model. The basis of the practice is to have couples actively listen and repeat what is sent from the sender back to them. This builds the necessary rapport and reassures both partners that what they’re saying is being internalized and understood. 

 

The Importance of Seeing a Sex Therapist 

Lee encourages couples to see a sex therapist and make active strides for sexual reconnection. In addition, a sex therapist can help a couple figure out alternatives to the traditional way they’ve had sex. Because, after all, sex is so much more than just penetrative sex. There’s a whole spectrum, and a sex therapist can help illuminate this crucial aspect of sexuality to those suffering from chronic pain.  

 

Key Links for Dr. Lee 

Dr. Lee’s Website: https://www.drleephillips.com/  

His blog: https://www.drleephillips.com/drleephillips  

Instagram: https://www.instagram.com/drleephillips/  

Facebook profile: https://www.facebook.com/drleephillips  

Affiliate link for The Ultimate Guide to Sex and Disability 

More info and resources:
 
How Big a Problem is Your Sex Life? Quiz – https://www.sexlifequiz.com
Access the Free webinar: How to make sex easy and fun for both of you: https://intimacywithease.com/masterclass
Secret Podcast for the Higher Desire Partner: https://www.intimacywithease.com/hdppodcast
Secret Podcast for the Lower Desire Partner: https://www.intimacywithease.com/ldppodcast
#95 – Sherrie Palm – Pelvic Organ Prolapse

#95 – Sherrie Palm – Pelvic Organ Prolapse

Listen to “95: Sherrie Palm – Pelvic Organ Prolapse”

Pelvic Organ Prolapse 

My guest is Sherrie Palm, who is the founder and CEO of the Association for Pelvic Organ Prolapse Support. In addition, Sherrie wrote a great book called Pelvic Organ Prolapse: The Silent Epidemic that delves deeper into the subject of this episode: Pelvic Organ Prolapse or POP for short. 

Driven by Sherrie’s expertise and research on the subject, this talk demystifies the condition and shines a light on treatment options, causes, challenges, and ultimately the ways to manage the condition and live freely with it. Such an important episode that I am glad I have the opportunity to share with you. Enjoy! 

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