#181 – When Sex Hurts – Dr. Irwin Goldstein

#181 – When Sex Hurts – Dr. Irwin Goldstein

Listen to “181: When Sex Hurts – Dr. Irwin Goldstein” on Spreaker.

When Sex Hurts 

Dr. Irwin Goldstein, the founder of field of sexual medicine, joins me in the conversation about female sexual pain. He drives the talk with tons of fascinating information about sexual pain, including what are the different categories, common causes, and treatment options. 

The prevalence of female sexual pain 

Within the last month, 1/3rd of women reported experiencing sexual pain or some form of discomfort during sex, while only 2% to 7% of men reported sexual dysfunction or secondary pain.  He urges women to ensure they find the correct medical professional and find answers to their questions as he has found many women go untreated due to misdiagnosis. 

Dr. Goldstein best categorizes various kinds of sexual pain by the area it originates. The pain in the vulva is diagnosed as vulvodynia. However the vestibule is often overlooked as the source of pain, and more than 90% of the time is misdiagnosed as vulvodynia. 

Hormonally Mediated Vestibulodynia 

Dr Golstein warns against birth control pills as they have harmful side effects that can eventually affect your sex life.  He urges women to consider other birth control methods like Long-acting reversible contraceptives (LARC) – IUDs, Nexplanon and Implanon contraceptive implants, and progesterone. He further informs that The American College of Obstetricians and Gynecologists and The American Academy of Pediatrics no longer consider birth control pills as the leading method of contraception. 

Causes in Older Women and Treatment Options 

For older women over 40, the hormonal challenges of menopause are a leading cause of pain. He mentions that women go through two stages of menopause, where the first one causes low testosterone levels and the latter causes low oestrogen levels. He shares available treatment options for this. 

Other Common Causes and Treatment Options 

Among other causes, Dr. Goldstein talks about Neuroproliferative vestibulodynia, a condition where women suffer from life-long pain. Monistat is the number one medicine women use that causes neuroproliferative vestibulodynia. The only treatment option available is surgically removing the vestibule, which has an 80% cure rate and is completely non-disfiguring.  

Tune in for valuable advice that can make a huge difference in your life. 

Background 

Dr. Goldstein has been involved with sexual dysfunction research since the late 1970s. He has authored more than 350 publications as well as multiple book chapters and edited 6 textbooks in the field. His interests include penile microvascular bypass surgery, surgery for dyspareunia, sexual health management post-cancer treatment, genital dysesthesia/persistent genital arousal disorder, physiologic investigation of sexual function in men and women, and diagnosis and treatment of sexual dysfunction in men and women. 

Dr. Goldstein is Director of Sexual Medicine at Alvarado Hospital, Clinical Professor of Surgery at the University of California, San Diego, and practices medicine at San Diego Sexual Medicine. He is also Editor-in-Chief of Sexual Medicine Reviews and past Editor of The Journal of Sexual Medicine. He is a Past President of the International Society for the Study of Women’s Sexual Health and of the Sexual Medicine Society of North America. He holds a degree in engineering from Brown University and received his medical degree from McGill University. 

The World Association for Sexual Health awarded the Gold Medal to Dr. Goldstein in 2009 in recognition of his lifelong contributions to the field, 2012 he received the International Society for the Study of Women’s Sexual Health Award for Distinguished Service in Women’s Sexual Health, in 2013 he received the Lifetime Achievement Award from the Sexual Medicine Society of North America, and in 2014 he received the ISSM Lifetime Achievement Award from the International Society for Sexual Medicine. He is happily married to his college sweetheart Sue, and together they have three children and five grandchildren. 

Resources and Links: 

National Vulvodynia Association: https://www.nva.org/ 

International society for the study of women’s sexual health: https://www.isswsh.org/ 

Book: When Sex Hurts: A Woman’s Guide to Banishing Sexual Pain 

Schedule a Courtesy Call with San Diego Sexual Medicine: http://sandiegosexualmedicine.com/courtesy-call 

More info: 

Sex Health Quiz – https://www.sexhealthquiz.com 

The Course – https://www.intimacywithease.com 

The Book – https://www.sexwithoutstress.com 

Podcast Website – https://www.intimacywithease.com 

Access the Free webinar: How to want more sex without it feeling like a chore: https://www.intimacywithease.com/masterclass 

           

 

#177 – Urology for Women – Dr. Lamia Gabal

#177 – Urology for Women – Dr. Lamia Gabal

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

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: 

Training video – https://jessazimmerman.mykajabi.com/video-choice 

Sex Health Quiz – https://www.sexhealthquiz.com 

The Course – https://www.intimacywitheasemethod.com 

The Book – https://www.sexwithoutstress.com 

Podcast Website – https://www.intimacywithease.com  

Access the Free webinar: How to help your partner want more sex without making them feel pressured or obligated: https://intimacywithease.com/free-webinar 

 

#161 – Menopause – Dr. Michelle Gordon

#161 – Menopause – Dr. Michelle Gordon

Listen to “161: Menopause – Dr. Michelle Gordon” on Spreaker.

Menopause 

After having gone through menopause and being surprised by the event, Michelle discusses her journey to finding out more about it and how to make it easier for other women. She shares her experience after taking the pill, then finding out that she had a mass in her uterus thus leading her to undergo an Endometrial Biopsy. Michelle was unhappy with her body and realized that other women were probably going through the same horrific experience. 

Common Problems in Menopause 

She discusses how disruptive menopause can be especially since we are not prepared like we are for other age milestones in our lives. From her experience, externally women report weight gain and on internal issues women struggle with their ability to make decisions and encounter an identity crisis.  

Michelle notes that doctors don’t know enough to help patients and this can leave women in a worse position. She also discusses loss of libido that comes up as a very common symptom of menopause and bleeding into our relationships. Michelle explains vaginal atrophy and urethral atrophy that can come with menopause. 

The Four Pillars of Thriving in Menopause 

The key to understanding menopause is to understand hormones. Dr. Gordon discusses 4 pillars  which include science, supporting ourselves with diet, movement and the brain. 

In terms of dealing with menopause, Michelle says there is no single answer for every woman. She encourages reflection and reinvention during our menopause journeys as each one is unique.  

Links and Resources 

http://www.menopausemovement.com 

https://www.drmichellegordon.com/ 

Background 

Dr Gordon is a Board-Certified General Surgeon and founder of Gordon Surgical Group, a multi-specialty group practice in 2005. GSG serves the lower Hudson Valley of New York. 

She is also the author of Managing Menopause which you can find on her website. 

#160 – Sizzling Sex Across the Lifespan – Michael Castleman

#160 – Sizzling Sex Across the Lifespan – Michael Castleman

Listen to “160: Sizzling Sex Across the Lifespan – Michael Castleman” on Spreaker.

Sizzling Sex Across the Lifespan 

Michael Castleman is a journalist that has been writing specifically about sexuality since 2005. He is also the author of Sizzling Sex across the Lifespan, covering the good bad and ugly bits about the subject. His book contains 25 actual medical studies and is based on facts.  

Common Sexual Issues 

Poor ejaculatory control is one of his best-selling subjects and you can find his e-book ‘ The  Cure for Premature Ejaculation’ on his website. He discusses how differently men and women think about sex and provides advice for men to help improve the statistic that only 20% of women reach orgasm.  

We learn that desire difference is also a main difference with couples which is not often reported. Michael talks about sexual pain and the high number of women that suffer with it even to the extent of not knowing the medical term for it and accepting it as ‘normal.’ 

If you are experiencing tension or stress around desire discrepancy, check out my free webinar – How to help your partner want more sex without making them feel pressure or obligation at https://www.intimacywithease.com/training 

The Effects of Porn 

Michael refers to masturbation and how kids are deterred from this behavior instead of being taught to understand it and enjoy it into adulthood.  He mentions statistics that reveal 25% of the porn audience is female and despite popular belief, porn does not increase incidence of rape or disrespect of women, while teens have become more sexually responsible since pornography on the internet.  

Michael agrees that porn results in masturbation and sexual miseducation. Debunking myths, he affirms that porn does not affect men’s ability to become aroused. He mentions the refractory period and shares how this should be understood in order to manage our bodies. He discusses arousal and how it changes across one’s lifetime. 

Links and Resources 

http://www.greatsexguidance.com 

Background 

Michael Castleman is a journalist and sex counselor. Writing since 1974, he is the world’s most popular sex writer, covering sexuality, sex research, and sex therapy, helping people everywhere enjoy great sex. 

#151 – Blocks to Orgasm – Kim Akrigg

#151 – Blocks to Orgasm – Kim Akrigg

Blocks to Orgasm 

Kim joins me on this episode to discuss blocks to orgasm.  Her aim is to work with the subconscious mind to transform women.  

Listen to “151: Blocks to Orgasm – Kim Akrigg” on Spreaker.

What Blocks Orgasm? 

She delves into the root of the problem being control over women even at an intimate level and shares what these blocks actually look like.  She touches on society’s reaction to kids unknowingly exploring their bodies and being shamed for their behaviour as opposed to them being guided to understand when it’s appropriate. 

Other blocks include sexual trauma and religion which frowns upon individuals seeking physical pleasure.  

Our Minds Can Create Blocks 

Kim talks about the role our minds play when reacting to sex or orgasm. She mentions how our subconscious feeds our responses by recalling its very first sexual experience and the feelings it brought with it. This of course manifests in our daily lives and sexual encounters. 

Being aware of our personal stories around sex is key to understanding our blocks and how to fix them. This helps to distinguish between those who have blocks and those who just haven’t discovered how to reach orgasm yet. 

Rapid Transformational Therapy 

Kim tells us about a method called Rapid Transformational Therapy. The technique uses hypnosis, cognitive behavioural therapy and NLP, and it uncovers memories from the subconscious to help her clients. Dealing with the mind is crucial to helping clients as Kim emphasises. 

What to do on your own 

Kim suggests once you are open to reaching and enjoying intimacy, that you spend time on your own figuring out what you like and what works for you sexually. If you are unsure of what an orgasm feels like, Kim suggests going with whatever makes you feel good. 

If you want to work on your obstacles on your own, Kim suggests that you confront your thoughts around sex and tuning into your mind in order to figure out what is attached to your obstacle. She shares affirmations we can use and techniques that work. She reveals that repetition is the key to unlocking your pleasure. 

Background 

Kim Akrigg is the host of Kim Akrigg The Podcast and an RTT practitioner who studied under Marissa Peer. Her work focuses around using your subconscious mind to unlock your orgasm! 

Resources and Links 

Website: http://kimakrigg.com 

IG : @kim.akrigg 

We use cookies to give you the best online experience. By agreeing you accept the use of cookies in accordance with our cookie policy.