Her Sexual Health: Want Better Sex? Start Talking  | by Morgan Tilton

Her Sexual Health, Want Better Sex? Start Talking

Posted on Fri, Oct 19, 2018

Something bizarre happened when Emma Murray, now 23, chose a copper IUD for birth control — it’s a tiny intrauterine device that’s inserted by a doctor inside the uterus for long-term protection. Four months post-insertion, the IUD shifted during intercourse, caused a sharp pain, and fell out.

Stumped, Murray got a second IUD. A few months after the procedure, Murray was squatting in the woods, and the IUD fell out — again.

“I went back to Planned Parenthood and started asking questions,” says Murray. “We found out that my Mooncup formed a light seal around the cervix every time I inserted it.” A Mooncup is a medical-grade silicone cup that’s placed inside the vagina to capture menstrual flow. Murray explains that every time she took out the cup, it caused suction that pulled the IUD down.

Murray suspects her experience is probably more common. In the U.S., 4.4 million women from 15 to 44, who have sexual intercourse, use an IUD, reports the Guttmacher Institute. Unfortunately, one significant communication snafu has the potential to cause an unplanned pregnancy. 

“I had done all of this research on my own,” says Murray. “On the flip-side, none of the women’s health care specialists I saw inquired about why the IUD was the best decision for me.”

Start the Dialogue

Medical care providers and patients share responsibility when it comes to women’s sexual health. Excellent questions followed by openness, respect, and vulnerability go a long way, say experts, since strong dialogue can empower women’s sexual health. Such conversations, may have made a difference for Murray.

“Every week I see women who are self-conscious about the way they [read: their vaginas] look that they aren’t dating…[women] often feel guilty for being vain and live for decades without being empowered,” says Dr. Oscar A. Aguirre, an urogynecologist and founder of Aguirre Specialty Care: Pelvic Surgery and Intimate Aesthetics, The Center for Female Pelvic Medicine and Cosmetic Surgery.

Pelvic Problems

Aguirre Specialty Care

Dr. Oscar Aguirre

Pelvic complaints can negatively impact a woman’s intimacy and sexuality. Aguirre, who treats a multitude of aesthetic and functional pelvic issues, says his patients generally fit within three categories: Women ages 15 to 35, sans kids, who want to improve their vaginal appearance or sexual pleasure via procedures such as a labia or clitoral reduction; a second group is mothers with vaginal looseness, prolapse, and pelvic relaxation; and the third is women in their 60s who are experiencing vaginal dryness, painful sex, or incontinence.

“All of those women are waiting to be asked the question: How is sex?” says Aguirre.

“If you talk to patients, their doctors don’t ask them that question, because they aren’t comfortable talking sexual history and they don’t know how to help those patients.”

Aguirre says the question opens an opportunity for solutions that women never knew existed — imagine being 60 years old and reaching a sexual prime.

Eighty-percent of his patients choose to combine three treatments: the O-Shot, Geneveve, and CO2. The O-Shot — a PRP (platelet rich plasma) injection in the clitoris and vagina — increases blood flow and nerve sensation, which improves climax, orgasm, and incontinence. The Geneveve — a non-surgical vaginal laxity treatment — utilizes radio frequency to stimulate the body’s collagen formation process, which improves tissue thickness and sensation at the vaginal entrance. And, CO2 laser therapy improves moistness and tightness, says Aguirre.

Libido & Desire

For Denver-based sex therapist Dr. Neil Cannon, the most common health issue among his patient population is low libido and a desire discrepancy.

“A lot of women are pathologized by their spouses in heterosexual relationships when the woman doesn’t want ‘enough’ sex,” explains Cannon. Therein lies the problem, says Cannon, since there is no right level of desire, and everyone’s libido is unique.

“It’s not wrong that she wants sex once a monthbut it might not be enough for her partner,” says Cannon. “As a couple, they need to figure out how to close the gap or there’s consequences in the relationship.”

To find a solution, Cannon conducts a comprehensive assessment of his patients. Per Cannon’s definition, a low-level or no sex marriage is defined when the couple shares intercourse eight to 12 times per year. If she’s content, that sex frequency could be her own natural state, which might not align with her partner’s needs.

A myriad of factors can impact libido, says Cannon, such as medications, bullying or maltreatment from her partner, alcohol use, history of sexual trauma, or a biological issue, which can manifest as pelvic pain.

Dr. Shan Shan Jiang, OB/GYN

Dr. Shan Shan Jiang

Dr. Shan Shan Jiang, an OB-GYN at Consultants in Obstetrics & Gynecology at Presbyterian/St. Luke’s Medical Center, similarly notes that the most common diagnosis among her patients is hypoactive sexual desire disorder (HSDD), a lack of sexual desire that effects interpersonal relationships.

The American Congress of Obstetricians and Gynecologists reports that HSDD effects up to 13.6 percent of women from age 30 to 70 years old, and the peak incidence is from 40 to 60 years old, according to Jiang, who notes countless potential social, psychiatric, skeletal, or neurological causes.

In addition to Cannon’s list, contributing factors of HSDD include stress, psychiatric issues like depression, oral contraceptives, physical conditions caused by surgeries or menopause, muscular overuse due to exercise, or medical conditions like vulvodynia (chronic pain around the vaginal opening).

“First and foremost, clinicians need to start the conversation. Even at gynecologist visits, people don’t like to bring up low libido,” says Jiang, who asks patients about their sexual relationships. “Intimacy and sexual desire go hand in hand. Working 100 hours a week can lower desire, too. And, sometimes, someone just needs validation in order to make a change.”

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