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Healthy You

Talking About Your Sexual Health

November 8, 2016 1:00 PM with Jeffrey Albaugh

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As we grow older, we notice that our bodies work in different ways, and these changes can be confusing for people of all ages. Many are uncomfortable talking about their sexual health, but doing so can provide you with answers to common issues that may be affecting your lifestyle, and may reveal more serious issues.  If you’re in need of guidance, join Jeffrey Albaugh, PhD, APRN, CUCNS, Director of NorthShore’s William D. and Pamela Hutul Ross Clinic for Sexual Health. He will be answering questions on common sexual health issues, including dysfunction, changes in arousal, pain and dealing with sexual health issues after medical treatment.

Kathryn (Moderator) - 1:00 PM:
Our chat on sexual health is now open. You can submit questions at any time during this chat.

Kathryn (Moderator) - 1:09 PM:
Thank you for your patience. We're dealing with a small issue and will begin in a few minutes.

  Mimi (Glenview,IL) - 1:12 PM:
What can healthy post-menopausal women do for decreased libido? What are your thoughts on the pink pill? Are there any over-the-counter medications you usually recommend?
Jeffrey Albaugh, PhD, APRN, CUCNS (NorthShore)
Hi Mimi! We had some technical issues, but I am on and found your question. There are many things that impact libido; honestly, pretty much everything. Certainly sometimes people experience a post-menopausal decline in DHEA and testosterone that can lead to a decreased libido, but many other factors can be at play as well. Dopamine and oxytocin in the nervous system also impact sexual health. Relationship issues or health issues (chronic medical conditions such as diabetes, depression, anxiety, multiple sclerosis, fibromyalgia, etc..) can also impact libido. There are many different treatments and helpful things that can be done. Barry and Emily McCarthy wrote an excellent book on rekindling desire. Sometimes just re-establishing intimacy and starting over with working on what is most exciting and wonderful in terms of connection and pleasure can be helpful. More to come with my 2nd half of the answer on flibanserin (the new medication). Thanks! Blessings, Jeff Albaugh

Jeffrey Albaugh, PhD, APRN, CUCNS (NorthShore) - 1:23 PM:
I wanted to expand my answer about how desire can be treated. There is no miracle drug for low libido for women. Testosterone has been used for many years in men to treat hypogonadism and low libido, but despite excellent clinical trials, testosterone has not been approved for women. Although research shows it may benefit some women and the menopause society also supports careful use in the correct patients. It is tricky because it is a steroid and so it has pros and cons with side effects when used in women or men. The newest approved medication for pre-menopausal women with hypoactive sexual desire disorder is Flibanserin which is a medication that can decrease serotonin and increase dopamine and norepinephrine in the nervous system. It was shown to improve several domains of sexual desire over placebo. It must be taken every day (unlike on demand types of erectile dysfunction medications designed to improve blood flow). You can't drink alcohol with this medication either.

  Todd (Chicago IL) - 1:24 PM:
I have had a lack of sexual desire; I'm a 38 year old male, and this has been ongoing since age 20 with relationships, and I'm very concerned. I've tried the meds, nothing seems to work - I also went to a clinic that gave injections to use, but that didn't cure anything either. I'm not sure what to do - are there any other options I can try or types of doctors to see?
Jeffrey Albaugh, PhD, APRN, CUCNS (NorthShore)
Lack of desire is the most common complaint of men and women ages 18-59. You are not alone. Everything impacts desire! There are so many factors. There is the physical drive issues which can be related to low testosterone or shifts in dopamine or norepinephrine in the nervous system. There is the expectations and wishes, which have to do with culturally derived conceptions about sex and other thoughts and feelings about sex. Finally, there is your all the psychological factors and relationship factors that impact desire. Remember, women have a tenth of the testosterone we have and most still want sex, so it is important to know that it is not always a testosterone issue. You need to be carefully evaluated in terms of the 3 components above to determine what all may be impacting your desire and then treatments vary greatly according to what is going on exactly.

Jeffrey Albaugh, PhD, APRN, CUCNS (NorthShore) - 1:32 PM:
I have had several questions on desire problems/low libido. Low desire is the most common sexual complaint of both men and women ages 18-59 and may be even more common in older adults. There are several important factors/components related to desire including drive (that physical drive related to testosterone hormones and dopamine, oxytocin and norepinephrine in the nervous system), expectations/wishes- beliefs, feelings and values about sex, and last psychological or relational factors. Everything effects desire. Do you think about sex regularly, but not have sex regularly? That is very different from never thinking about sex at all or doing anything about it. Treatments are based completely on determining what is going on with the 3 components of desire.

  Lea (Evanston, IL) - 1:32 PM:
I'm under 30, and sometimes miss my period, and I think it's due to times of high stress. Is this normal? Can stress change the menstrual cycle, or should I be worried about something else?
Jeffrey Albaugh, PhD, APRN, CUCNS (NorthShore)
Hi Lea! Yes. So many things can impact your period and stress is certainly one. You can't really live life without stress, so what do you do? Well, many people find healthy ways to deal with stress such as regular exercise, meditation, prayer, yoga or mindfulness. It is important to regularly see your gynecologist for your pap smears and to make sure nothing else is going on. Thanks so much for your excellent question! Blessings, Jeffrey Albaugh

Jeffrey Albaugh, PhD, APRN, CUCNS (NorthShore) - 1:38 PM:
I have provided a PowerPoint handout pdf overview of sexual health on the side bar of this chat for anyone interested. Thanks! Blessings, Jeff Albaugh

  Lauren (Glenview, IL) - 1:39 PM:
How can I find a doctor who is comfortable prescribing PrEP for me? I'm uncomfortable bringing it up.
Jeffrey Albaugh, PhD, APRN, CUCNS (NorthShore)
Hi Lauren! PrEP is pre-exposure prophylaxis and can be prescribed by either a internist primary care or through a STD clinic like Howard Brown or the one at Northwestern Memorial Hospital. You don't have to see a specialist for this medication. I understand some of the stigma, but health providers are not there to judge you, but to help you. It is simply a matter of asking for it and anyone can prescribe it for you and should help you with it. We mostly treat sexual dysfunction in my clinic, but this is most often prescribed from primary care or an HIV/STD clinic (either one). For anyone who can't afford it, there is also the Core Center down in the medical district near Cook County that can help. Thanks so much for your question! Blessings, Jeff Albaugh

  Louise (Chicago, IL) - 1:44 PM:
What is a safe product to use to prevent dryness during sex?
Jeffrey Albaugh, PhD, APRN, CUCNS (NorthShore)
Hi Louise! Thanks for your excellent question! There are many things to try. First of all there are vaginal moisturizers that help with keeping the vagina moist and supple. Local estradiol therapy is a prescription form of a vaginal moisturizer that can also help with vaginal atrophy (tissue shrinkage and changes). Non-hormonal vaginal moisturizers are things such as Replens or Luvena or KY liquibeads, Sinclair Institute Organic lubricant & moisturizers. Some women also may use hyaluronic acid (hylafemme or other brands) to help with vaginal dryness. Vaginal lubricants are for friction during sex. There are many. Some popular ones are Femglide/slippery stuff, astroglide, KY, Sliquid and if trying to get pregnant Preseed. Some women really like using cocoanut oil as a lubricant or moisturizer as well. It is just a matter of trial and error until you find the ones you like best. I hope that helps! Thanks! Blessings, Jeff Albaugh

  CA (Wilmette, IL) - 1:54 PM:
I am a 41 year old healthy married woman. Are there any natural remedies to increase my chances of pregnancy without resorting to standard fertility drugs? I have not started to try yet, but might try for "one more" very soon. Thanks very much.
Jeffrey Albaugh, PhD, APRN, CUCNS (NorthShore)
Greetings and thanks for your question! There are sone things you can do to try and help things along. Some women monitor their temperature prior to getting out of bed each morning to help determine ovulation times or use ovulation kits to help predict the best time mid-cycle of menstruation when they are likely to be most fertile. You want to be generally healthy with your diet, but sometimes when women are too thin and don't have enough nutrients in the diet, they can have problems conceiving. Remember, it could also be your partner. Fertility issues can happen on either side. It sounds like you may do well with getting pregnant again and I hope things going wonderfully for you! Blessings, Jeff Albaugh

  Lisa (Gurnee, IL) - 2:00 PM:
I've been married 20 years. For the last 10 years my husband has lost all desire for sex and intimacy. He says it's not me. Yet months go by with no sex or even an attempt. His testosterone was recently checked and is in normal mid range. Why has he lost desire/arousal at such a young age 48? Can this be fixed?
Jeffrey Albaugh, PhD, APRN, CUCNS (NorthShore)
Hi Lisa! As stated earlier, desire issues top the charts with both men and women ages 18-59, so your husband is not alone. There are so many factors beyond testosterone that can impact desire. I would start with a good sex therapist/relationship counselor since his testosterone was normal. You can find certified therapists at www.aasect.org. I am a board certified urology clinical nurses specialist and a certified sexuality counselor, so you will see me listed as such. You are looking for a therapist who works on the cognitive behavioral relational side of desire to determine what is impacting his desire and also all the treatments that may be applicable. Remember, there is no magic pill, but there are things that work. Often the person without desire lacks some motivation to address the issue adding further challenges, but you can still have a wonderful fulfilling intimate life together with help. Thanks! Blessings, Jeff Albaugh

  Deborah (Evanston, IL) - 2:06 PM:
What can a woman do who has had a hysterectomy and has lost all libido as a result? I chose to not take any estrogen post-surgery and I do not want to be put on any medication to resolve this. Are there any other options available for someone like me?
Jeffrey Albaugh, PhD, APRN, CUCNS (NorthShore)
Hi Deborah! I have to get back to my clinic, but quickly... Yes. There are several treatments and options to consider carefully with an expert. There is no miracle pill, but sometimes working with a therapist on simmering and sensate focus can help. Also, sometimes I give women the studies for some supplements and they try them. I start with lower doses and work towards maximum doses described from the limited research trials available. It is important to work closely with a healthcare professional with any treatments, but the good news is there are several and people do go on to have fulfilling intimacy after treatment. Thanks! Blessings, Jeff Albaugh

Kathryn (Moderator) - 2:10 PM:
This will be the end of our chat. Thank you very much for your questions. For more information on sexual health, or to schedule an appointment with a specialist like Dr. Albaugh, contact The John and Carol Walter Center
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