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Melanie Cole (Host): So many women have a physical, hormonal or medical condition that may have sabotaged their sex life; yet very few women bring it up to their physicians. They may be too embarrassed to discuss it or not even quite sure who to discuss it with. My guest today, is Lori Davis. She’s a nurse practitioner specializing in sexual medicine with a focus on women’s sexual function at Cayuga Medical Associates. Lori, tell us about the field first of sexual medicine. What is that?

Lori Davis, FNP-C, NCMP (Guest): Alright, well thank you so much for having me on and giving me an opportunity to talk about sexual medicine. Sexual medicine is a newer discipline, you know sexual functioning has been something that has been treated back to antiquity; but it was really only in the 1990s that the modern medical system really kind of began to take an interest in sexual functioning from a medical perspective. Sexual medicine is a discipline that really tries to bring together all under one roof, all of the best evidence-based practice that we’ve gathered from urology, from gynecology, from psychology and to put that all under one roof and then to build upon that with additional research to begin to really come to understand how sexuality functions, how best to assess it, how best to treat it when people have distress. It’s a growing discipline. There are practitioners all over the world. There are major international conferences, journals and so it’s a great honor for me to be able to bring this new discipline to Ithaca and to offer this kind of support services for women in our community.

Host: How is overall health linked to sexual health and activity? For women especially, how is everything from our physiological health and wellbeing to our self esteem and our mental health and wellbeing attached to good sexual health?

Lori: That’s a great question. I think it goes both ways. I think there are certainly situations in which a woman’s medical and other conditions contribute to sexual dysfunction. So, you think about something like a diabetes that can cause a lack of sensation or heart issues that can cause lack of stamina or lack of circulatory flow. So, in that way, medical problems can lead to sexual dysfunction and also sexual dysfunction – sexuality is a really important component of our overall health and so having a healthy sex life feeds back into having healthy self-esteem, into having good relationships with our partners, into having strong families and also just in terms of sort of rejuvenating us and allowing for healing to take place.

Host: What are some of the main types of sexual problems that affect women, that you see and that you treat?

Lori: So, I like to think about them in four kind of categories. So, typically, I see lots of women with desire issues. I also treat women who have issues with arousal, so issues related to lubrication, issues related to orgasm and also to pain. So, there are those four different categories. I would say that sexual dysfunction in these areas is very, very common. Probably at least 43% depending on what research study you are looking at of women in America would report some type of sexual dysfunction across their lifetime. A third of women would report low sexual interest, a fourth of women would say that they have difficulty experiencing orgasm and a fifth of women would say that they have pain disorders. So, all of these things are very common, and I think that it can be difficult for patients to bring it up with their providers and difficult for providers to navigate the assessment and treatment of these disorders. I would just suggest that there is a lot of really good evidence to support some evidence-based strategies for people who are suffering with any of these problems and seeing a sexual medicine provider would be a really great way to sort of access some of this newer research.

Host: So, let’s talk about some of what’s hot. What’s going on in the area of sexual medicine right now and one of the things that I found interesting in my research was the rise in STIs in the over 50 crowd as they get divorced or move on to a new part of their life. Tell us a little bit how that works into your field.

Lori: Yeah, I mean I think that for a long time, treatment of sexuality for women and for men really focused so much on infections and on reproductive health and though as part of my work at a woman’s health practitioner, I do certainly treat infections and help women with their reproductive lives; in terms of sexual medicine, it’s really more about looking at those components like I said that about desire/arousal, orgasm or pain.

In terms of the rise in infections in that crowd; for me that just comes back to the importance of sex education which is such an important part of the sexual medicine offering and sort of allow – giving information to people about how their bodies work and about how these infections are transmitted and how to have healthy sexual relationships in ways that are safe. So, I think that in terms of bringing that education and counseling piece into the overall treatment of people’s sexual wellness is how I would relate the sexual medicine components to STIs.

Host: One of the things we mentioned earlier as far as sexual medicine and sexual health is the self-esteem factor and when you’re talking about desire issues, arousal problems; some of those can come from a woman maybe in menopause, not feeling her complete self, not feeling very pretty or attractive or any of those kinds of things that could affect desire problems or even orgasmic problems. How do you help women with that?

Lori: When I work with women – low desire is just taking it from that perspective is one of the most common problems that women have and there are so many reasons why women will have low desire. How I work with women is just begin to first hear their story. What is your version of this? What has happened in your life? What are your medical problems? What medications are you taking? Tell me about your relationship with your partner. And talk about body image as well. And then moving into thinking about like what sort of – also doing a physical exam but then moving into what sort of treatment options are available. Whether it’s looking at just providing simple sex education and education for women is often so limited in this area and so that can be a huge benefit. I have seen a lot of kind of ah ha moments with women as they start to see the like oh that’s how my body functions and this thing that I’m experiencing is normal and that can be so powerful for women as they may take this journey to try to address these issues.

I think that low self esteem and problems with relationships and intimacy, things that are barriers to intimacy, all of those things come up during the visit and they are all addressed in a sort of – in a limited perspective in the sense that I’m not a sex therapist, but I am able to provide counseling and education that can start to begin to open that door with them and allow them to make some progress and movement towards going beyond some of those concerns that they might have. And if those concerns seem to be more than that can handle in a short few sessions that can be transitioned over to a sex therapist as well.

Host: One common complaint from women is pelvic pain and sexual pain disorder. What are some treatment options out there today? Speak about when you are working with someone, some of the treatments that you can offer to help with some of these four things that you have brought up today.

Lori: Yeah. In terms of pelvic pain; we are very fortunate here in Ithaca that we have some excellent pelvic floor physical therapists and most people probably haven’t heard of pelvic floor physical therapy; but they are physical therapists that are specifically trained to work with the muscles that line the pelvic floor and most women think that this is just a Kegel exercise and it’s about tightening the pelvic floor, but for many women with pelvic pain; a component of it almost every time is going to be overly tight pelvic floor muscles. And so, a really good examination by myself, working closely with the pelvic floor physical therapists is usually a significant component of treating pelvic pain for women. Other things that go into pelvic pain that I might offer in treatment would be hormonal treatments.

Certainly, for women who have gone through menopause, they can experience symptoms of vaginal dryness and thinning of the vulva that can lead to significant pain with intercourse. And depending on their medical history, most women are candidates for some sort of hormonal treatment or use of moisturizers or lubricants that can help with dryness and atrophy. There are people who benefit from other kinds of systemic treatment, but I think that pelvic floor PT for people with pelvic pain plus treating any skin conditions with hormonal treatments are really the mainstay of working with people with pelvic pain. Of course, there are other kinds of issues that people have like interstitial cystitis or maybe they have endometriosis and they are going to have their own treatment plan, but likely also involving the pelvic PT.

Host: As we wrap up, this is such an important topic for women to hear, Lori and really something as we said at the beginning, that they are not always comfortable discussing; please give us your best advice about women and starting this discussion with their providers, explaining the symptoms that they are going through and being straightforward and honest so that they can get the help that they need.

Lori: Absolutely. I think that these conversations are really difficult and it’s also on all of us as providers to have the courage to ask the questions. It’s not just the woman who is afraid to ask; it’s often the provider who is afraid to bring it up as well. And so, I think it just really has to kind of normalize this discussion. I think this podcast is a perfect opportunity to do that, that these problems, these issues are really a normal part of being a woman and that there are treatment options out there.

I would say that if you want to talk with your provider about it, I would just suggest just being as frank as you can. The provider might initially have some discomfort around the conversation or just be sort of out of their element a little bit; but the providers have the training to be able to have these conversations with you and if you kind of open the door a little bit, I think that you will have a very receptive – a more receptive audience than it might seem initially. And the great thing now is that I think sometimes the providers have a concern about bringing up these issues because they are not maybe sure how – what they would say and how they would treat and I think the great thing now for Ithaca is that Cayuga Medical Associates has been able to bring in myself with this training in sexual medicine so now if a question comes up, there is a referral that can be made and the providers and the patients can know that like okay maybe this conversation doesn’t feel right in this setting or for whatever reason, I’d like to speak to somebody else and I think it’s very helpful to know that there is more support in the community and resources that can be accessed.

Host: And that’s the main message and thank you so much for letting the listeners know that there are resources and support in the community for sexual medicine and for women to be able to discuss this with their providers. Than you for joining us. This is To Your Health with Cayuga Medical Center. For more information please visit www.cayugamedicalassociates.org, that’s www.cayugamedicalassociates.org. This is Melanie Cole. Thanks so much for tuning in.