Physical causes – the first things to consider

• Hormone changes caused by childbirth or menopause
• Thyroid issues 
• New symptom of a chronic disease or condition 
• Pain during intercourse

Prescription drugs – many can affect sex drive (and function)

• Anti-depressants
• Anti-anxiety medication
• Birth control pills
• Blood pressure medicine

Emotional Issues – common reasons of lowered libido

• Stress (job stress for an example) workplace
• Family drama
• Issues with the relationship
• Fatigue
• Mental health problems, like depression

While there isn’t a magic potion to jump-start sex drive, some of these remedies may help.

• Erectile dysfunction medication 
• Hormone therapy – estrogen, testosterone or others
• Some anti-depressants
• Sexual lubricants, vibrators and masturbation lubricants

The good news is that a libido that’s lacking isn’t something that women simply have to live with. A solution can be as simple as asking a healthcare professional to help determine what’s at play and talk through the possible solutions. A competent expert on women’s sexual health will make the process comfortable and confidential, and on the road to feeling like yourself again.

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Keep in mind that the initial idea was to identify breast cancer at an earlier stage so it could be more treatable, and to hopefully decrease the number of late-stage initial diagnoses, thereby saving lives. Whenever effective screening programs are put in place, one result is a much higher detection rate, which can be alarming, but finding more cancers earlier is ultimately part of the goal. Eventually, medical ethics require that some thought be given to whether all of the impact of the testing itself has been “worth it” based on the outcomes achieved.

Since 1976, when screening mammography was introduced for women over 40, the detection rate for early-stage breast cancer has doubled – from 112 to 234 cases per 100,000 women. At the same time, the incidence of late-stage cancer has decreased, but only by eight percent, from 102 to 94 cases for the same size group. This vigilance in screening has also created a new dilemma. Mammographic screening has uncovered large numbers of tumors that are not, and would likely never become, cancerous. Roughly 1.3 million women – representing 31% of all breast cancers diagnosed – fall into that category.

Scientists have concluded that even though there have been substantial increases in the detection of early-stage breast cancer, the lack of a significant reduction in finding advanced stages of the disease has been disappointing. Add to that the substantial number of “false alarms” and the bottom line is that screenings have had a small effect, at best on the rate of death from breast cancer. Somehow the paradigm needs to be shifted; new techniques developed, and underserved populations screened, so we can make a consistent and meaningful impact on breast cancer mortality.

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Talk to a human. Especially on your initial call, don’t leave personal information regarding the nature of your call on a recording. Not only is it an impersonal way to approach a highly sensitive topic, it’s impossible to know whether privacy is protected when those messages are replayed. Naturally, leaving a message with simply a name and number is okay, particularly if an after-hours need arises. But during business hours and as a matter of course, patients should be able to ask and be assured that their privacy is being guarded.

Be wary of online or electronic info asks. A person’s sexual health is exceptionally private information and must be treated as such. It’s one thing to fill out an online form or register to receive information about generalized or routine health issues, but not in this arena. Patients are entitled to a higher level of private, personalized service when dealing with intensely confidential topics.

Experience really matters. Sexual health is a complicated field that requires an expert to stay current while at the same time developing an understanding of a patient’s needs that grows over time. This combination of experience and updated skill helps identify and treat problems more quickly, easily, and thoroughly.

There are many areas of medical care in which these criteria are not necessary, so efforts to streamline and standardize certain processes make sense for several reasons. But when a patient seeks medical advice from a specialist in sexual health, a higher level of personalized service and increased diligence regarding privacy should be standard. Full disclosure regarding this sensitive information is critical to resolving patients’ concerns, and any time-saving processes that could threaten confidentiality, may jeopardize a positive outcome.

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• Romantic thoughts about the object of lust can cause neurotransmitters in the brain to release the hormone adrenaline, one of the stress hormones, from the adrenal gland directly into the bloodstream. It increases the heart rate (hence the phrase “be still my heart”) and sometimes, causes sweaty palms, even trembling. These physical reactions can be strong physical evidence of high lustful interest. Being alert and attentive are signs of high adrenaline levels. We also associate all of these signs with excitement.
• Serotonin is a universal regulator. It impacts body temperature, mood, appetite and pain. Levels of serotonin are low at the outset of an exciting new attraction, and that’s why a new romantic interest can seem to take over thought processes, the “can’t get him outa my mind” It can also take away pain and feelings of hunger.
• Dopamine can produce the feeling of being almost “high on love.” It works within the brain’s pleasure centers and impacts how we respond to situations emotionally. Increased feelings of pleasure and motivation are associated with high levels of dopamine; lower levels indicate sadness.

Over time, those powerful feelings give way to a bonded attachment between lovers, and that’s when the next two hormones are ever present:

• Oxytocin has a lot to do with attachment and has become known as the “love hormone.” Blood levels of oxytocin are elevated during physical expressions of love, including sex and orgasm…and even during breastfeeding. It plays an important part in feelings of attachment and connection, and is associated with feelings of trust and comfort whether between two lovers or between a mother and her baby.
• Vasopressin is a similar substance in that it encourages bonding and attraction between long-time partners. It also plays a role in sexual arousal. Scientists are also studying whether low levels of vasopressin may have something to do with infidelity in males.

Understanding these substances and the roles they play in romantic relationships and sexual function enable a skilled provider to help patients should adjustments need to be made. It may seem unnatural to look at love through such a clinical lens, but it does help get to the heart of what may not be working in matters of the heart. If love truly does make the world go ‘round, sometimes a little nudge to get it spinning in the right direction is all that may be needed.

The post Couples’ Cocktail – The Chemistry of Attraction appeared first on James A. Simon.

The answer is an emphatic yes. It’s a bad idea. In fact, we’ve learned that the risks associated with douching can be worse than originally thought.

Remember studying eco-systems in elementary school? Maybe you collected and analyzed pond water, or watched living things grow in a terrarium. The big lesson was that there’s a delicate balance in nature required to keep all the organisms healthy and happy in their own world. That interdependence of all the required creatures in the right amounts made it all work. It’s the same principle in a well-functioning vagina. Sometimes, ordinary factors like stress, diet or a change in medication can throw off the balance. But the most direct way to destabilize your personal eco-system is to douche.

When that balance of bacteria, enzymes and acids is out of whack, a state of vaginosis can occur – which increases the risk of a secondary infection. It can also lead to catastrophic results. Studies show it can aggravate infertility, lead to miscarriage in the first trimester, or pre-term birth down the road. Pre-term birth is not only our country’s biggest cause of infant mortality – medical costs associated with it are skyrocketing. For babies that survive, asthma in children is linked back to bacterial vaginosis in the mother. Non-pregnant women may face a higher risk of cervical cancer, endometriosis and HIV.

So the next time you think about some internal tidying up, realize the delicate harmony of your own vaginal eco-system. And before you consider buying any cleaning product for it, be grateful that it’s like a new oven: magically self-cleaning.

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A study of more than 2,500 women ages 45 to 84 reported that those who experienced early menopause — either naturally or from surgical removal of the ovaries — doubled their chance of developing heart disease or stroke. This was true for women of all ethnicities.

What if I’ve had an early menopause?

I firmly believe that women who experience premature menopause should be on hormone replacement therapy (HRT) at least until age 50 — the average age of menopause. I know what you’re thinking…the Women’s Health Initiative said HRT increased a woman’s risk of heart disease and stroke. But further analysis of the data has shown estrogen doesn’t increase the risk of heart disease and may even lessen the risk for some. After menopause, the pros and cons of continuing HRT should be discussed with your physician. No two women are the same and HRT therapy needs to be individualized based on a woman’s medical history.

Heart disease is the number one killer of women

Finally, women need to know the signs of heart disease. Just as important, be sure to live a healthy life that includes a well balanced diet and daily exercise. If you’re a smoker, now’s the time to STOP.

Contributed by Lisa Larkin, MD, FACP, NCMP and James A. Simon, MD, CCD, NCMP, FACOG

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Not too long ago, I wrote a blog about a promising female libido drug — flibanserin — and the manufacturer’s decision to discontinue its development. With no FDA-approved libido drugs for women, the demand for over-the-counter sexual enhancement products is increasing.

What are these over-the-counter sexual enhancement products?

The most common OTC products that promise to enhance a woman’s sexual experience include lubricants and arousal gels. These products help increase sensation and stimulate circulation in the genitals before and during sex. Vibrators are also a popular sexual enhancement product. They help bring the user to orgasm by increasing genital sensation. Of course, there are many other options, like massage oils and nutritional/herbal supplements to name just a few.

Are these products safe?

Unfortunately over-the-counter sexual enhancement products are unregulated, and there are few clinical trials that test their effectiveness. For clinically sound sexual health information and tasteful, quality products, I recommend checking out the MiddleSexMD website.

Do these products work?

What works for some may not work for others. So go ahead and experiment. But just like with anything else, a healthy diet and regular exercise are good starting points for improving things in the bedroom.

Guest blog contributed by Lisa Larkin MD, FACP, NCMP
Dr. Larkin has been practicing internal medicine in Cincinnati since 1991. After 11 years teaching and practicing at the University of Cincinnati College of Medicine, she made the choice to shift her focus from teaching to high-quality patient care. In July 2002, Dr. Larkin opened her own practice, guided by the philosophy that she could better serve her patients’ medical needs in a smaller, more personal practice and in an environment over which she had more control.

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Ten years ago, the Women’s Health Initiative dropped a bombshell when it reported that hormone replacement therapy (HRT) increased a woman’s risk for heart disease, stroke, pulmonary embolism and breast cancer. What followed this announcement was nothing short of hysteria — millions of frightened women threw away their hormones and the medical community became extremely reluctant to prescribe hormone therapy to women suffering with menopause symptoms.

Why did this happen?

I could go into great detail about what I see as flaws in the Women’s Health Iniative’s reporting methods. But when it comes down to it, I firmly believe the Women’s Health Iniative jumped the gun and didn’t take the time to thoroughly evaluate and vet its initial findings before reporting on the estrogen-progestogen portion of the study. Further analysis by age or time since menopause tells a different story altogether, a story of little risk whatsoever for them women most likely to need symptomatic relieve, women ages 50-59. And for this, countless women will continue to pay the price, twofold. First, women will continue to suffer from the always unpleasant/sometimes debilitating symptoms of menopause. Second, the very women the study was supposed to help, those who had hysterectomies and the most severe symptoms are now at an increased risk for developing heart disease and osteoporosis. That’s right! Reanalysis of WHI data clearly show that women within 10 years from menopause who took estrogen therapy actually reduced their risk for developing heart disease, breast cancer, and fractures.

How can we make things right with the Women’s Health Iniative?

It’s time to stop living in the past. Now is the time for an independent evaluation of the Women’s Health Iniative publications to determine whether or not the data supports its original conclusions. What’s more, there needs to be an FDA advisory committee created to reexamine the black box labels on postmenopausal hormones. In particular, there needs to be a separation of advisories when it comes to estrogen only products typically used in women with a hysterectomy, and estrogen-progestogen products for women with their uterus.

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As if women with breast cancer haven’t endured enough already, they often develop painful changes in their vaginas or urethras — urogenital or vulvovaginal atrophy — as a result of their breast cancer treatment. The most common breast cancer treatments are tamoxifen and aromatase inhibitors. Tamoxifen works by blocking estrogen receptors on breast and breast cancer cells. Tamoxifen grabs that “parking space” (the breast/breast cancer estrogen receptor) so that estrogen can’t “park” there. Aromatase inhibitors are chemicals that work by suppressing estrogen production in the body. While women treated with aromatase inhibitors — Arimidex, Aromasin and Femara — tend to have more symptoms than those treated with tamoxifen, either approach can produce symptoms.

Symptoms of urogenital/vulvovaginal atrophy

The most common symptoms of urogenital or vulvovaginal atrophy include vaginal dryness, itching and irritation, painful intercourse/urination and frequent urinary tract infections. Unfortunately, these symptoms are often not diagnosed, and women continue to suffer in silence. And worse than that, even when diagnosed, symptoms are often left untreated, especially in breast cancer patients.

Don’t suffer — treatments are available

Typically, I recommend non-hormonal vaginal moisturizers/lubricants and lifestyle modifications — avoiding scented hygiene products as well as smoking cessation and stress management — to help relieve symptoms in women with a history of breast cancer. Believe it or not, regular intercourse can actually help if not too painful because the progressive stretching and increased blood flow improve a woman’s vaginal health. If none of these approaches provide adequate relief, topical estrogen therapy is a good alternative. Applied only to the affected area, a minute amount of estrogen is absorbed into the bloodstream through the vagina. Best of all, this low dose can be quite effective in relieving symptoms. It must be noted, though, that risk of breast cancer recurrence following localized estrogen therapy is uncertain. That’s why the decision to start this therapy should be made jointly with your gynecologist and oncologist.

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It’s no secret that many post-menopausal women struggle with a lack of sexual desire and the physical changes that may make intimacy difficult. Hormone production changes mean a decreased libido; and that’s the plain and simple science of it. But thankfully, that’s not the only factor in sexual appetite. For many people, the suggestion of new positions, scenarios and roles can stimulate an interest in sexual activity. In the case of Fifty Shades, the themes of domination and submission are explored, which isn’t really a new concept. It is a bit groundbreaking, however, for that kind of sexual role-playing and its impact on a relationship to be featured in something it seems that everyone is reading.

The allure of sexual fantasy has long played a part in ramped-up excitement levels, even if never overtly expressed. Therapists and other professionals have promoted role-playing for years. The difference now is that Fifty Shades of Grey has got us demanding it from our libraries and openly discussing with our book clubs.

It’s enough to make any reader (or eavesdropper of readers) curious, and that is such a positive result, especially for anyone struggling with the loss of interest in sexual activity. Think about it. And then think about it some more. Thankfully, we’re complicated creatures when it comes to intimacy. Some people may have trouble getting beyond the taboo nature of the domination/submission scenario, and that’s a shame. For my patients, especially those who have struggled in a post-menopausal sexual interest-free zone, this book may be just what they need.

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