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.
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:
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
Listen to “161: Menopause – Dr. Michelle Gordon” on Spreaker.
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
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.
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
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.
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.
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
IG : @kim.akrigg
Listen to “146: What We Can Learn From People With Spinal Cord Injury – Dr. Mitchell Tepper” on Spreaker.
Sex After Spinal Cord Injury
On this episode, Mitchell joins us to discuss the impact of a spinal injury on sexual function. Having experienced this type of injury personally, he shares his journey to teaching people about sexual health being one of the first people to have a sexual health domain registered in 1996. The website was intended to help people with disabilities with their sexual health but soon became a central source of sexual health information for all kinds of people.
The Importance of Trust
Setting myths aside, Mitchell explains that people with disabilities can experience sexual pleasure, erections, etc but some have difficulty expressing themselves. After research into this, he found that people need a partner they can trust to reach the point of sexual pleasure and comfort.
A critical part of this is relearning the truth about sex, departing from the limiting physical definition to experiencing trust, safety, and connectedness. Mitchell is a testament to breaking physical boundaries with this combination. He has found that even those with disabilities below their injury region have experienced an orgasm with the proper context and approach.
Sexual Self Esteem
In other areas of his research, Mitchell tells us about the effect of how much time has passed post-injury and sexual self-esteem on sexual health. His findings also point to people having higher sexual self-esteem if they were born with their disability as opposed to people who acquired their injury. This is based on the latter group constantly comparing their past sexual performance with their current ability.
These Ideas Apply to Everyone
In his process of helping people, Mitchell explains that he helps his clients understand how their new bodies work, as this is usually overlooked or taken for granted. In addition to this, he encourages people to make use of touch, sound, and sensation to help people reach sexual pleasure.
For people that aren’t struggling with a disability but want to explore a deeper and meaningful sexual experience, Mitchell advocates sensate focus. He further explains that this builds sexual communication and advocates touching for your own sexual satisfaction, allowing your partner to provide feedback. Mitchell also finds that Tantra a meaningful technique to deeper sexual experiences. The technique has three main factors: Stop, focus, and connect, which he digs deeper into.
Mitchell’s techniques are beneficial to able-bodied and disabled people, revealing that penetration is not at all the only means to orgasm. With dozens of examples of non-penetrative orgasms amongst his findings, he shares real cases with us that shed light on this experience.
Undoing learned habits is just as huge a part of the difficult journey to experiencing sexual liberation. Incorporating play into sex is also a great way to make it less serious.
Dr. Mitchell Tepper, author of Regain That Feeling: Secrets to Sexual Self-Discovery, brings a lifetime of first-hand experience with chronic conditions and disability to his work as a Sexuality Researcher, AASECT Certified Sexuality Educator and Counselor, Coach, and self-proclaimed Prophet of Pleasure. He has a Ph.D. in Human Sexuality Education from the University of Pennsylvania and a Master’s in Public Health from Yale. Dr. Tepper worked on ground-breaking research on orgasm in women with spinal cord injuries with world-renowned orgasm researchers Drs. Beverly Whipple and Barry Komisaruk. Over the last 14 years, Dr. Tepper has turned his attention to helping wounded veterans and their partners navigate intimate relationships. His forthcoming documentary, Love After War, tells the stories of intimate partners who have won the battle for love.
Links and Resources