Recent Sexual Health and Medicine Conferences

Communication about sexual problems with health professionals is often prevented by embarrassment or expectations of bias. Health professionals may fear being inappropriate or at risk for malpractice for mishandling communication about sexual matters with their patients. Yet the various aspects of sexual health and sexual medicine impact important areas of our lives.

The following report contains a review of topics presented at recent conferences by experts in the fields of sexual medicine and sexual health.

Infertility

Elizabeth Grill, PsyD (Associate Professor of Psychology, Weill Cornell Medical College, New York City) is concerned with infertility (involuntary childlessness) in couples. According to the U.S. Department of Health & Human Services, in about one-third of infertility cases, male infertility is the problem. Female infertility accounts for another one-third. The remaining cases are caused either by a combination of male and female problems or by unknown causes.¹ Obesity and smoking reduce fertility in both males and females.^2-5 Athletes who take anabolic androgenic steroids to improve their performance and appearance reduce their fertility.⁶ Infertility in women accelerates with age from about 5% at age 25 to about 50% at age 41.⁷

Infertile couples often exhibit anxiety, depression, or anger, which may be a cause or consequence of the infertility.⁸ Couples often feel their masculinity, femininity, or social acceptability is affirmed by their ability to have children, which adds to their distress concerning infertility.⁹ In vitro fertilization is an option for some infertile couples, but the procedure is expensive.

Bacterial Vaginosis

Sujatha Srinivasan, PhD (Senior Staff Scientist, Fred Hutchinson Cancer Research Center, Seattle) is an authority on bacterial vaginosis, the most common vaginal infection among women of reproductive age.¹⁰ At any given time, about one-third of women have this infection.¹¹ Symptoms include vaginal discharge, fishy odor, and reduced vaginal acidity. In about half of cases there are no symptoms. Why symptoms occur in some women, but not in others is unknown.¹² Bacterial vaginosis is associated with an increased transmission and acquisition of sexually transmitted infections.¹³

Douching is a common cause of bacterial vaginosis.¹⁴ Smoking is associated with bacterial vaginosis.¹⁵ Bacterial vaginosis often recurs despite antibiotic treatment, but oral treatment with the probiotic Lactobacillus crispatus has been shown to reduce recurrence.¹⁶

Effects of Breast Cancer Treatment

Lisa Larkin, MD (Owner and President of Lisa Larkin MD and Associates, Mariemont, Ohio) treats women dealing with symptoms related to breast cancer treatment. Women with no risk factors for breast cancer have a 12% lifetime risk of the disease, whereas those with a genetic disposition for the disease are more likely than not to develop breast cancer.¹⁷ Surgical removal of both breasts almost completely eliminates the extra risk of breast cancer caused by genetic predisposition.¹⁸

Many young breast cancer survivors given chemotherapy develop menopausal symptoms, including vaginal dryness, painful urination, and painful sexual activity.¹⁹ Concern over increasing cancer risk by the use of vaginal estrogens often motivates the use of non-hormonal lubricants, but these lubricants can increase the risk of infection.²⁰ The Women’s Health Initiative Observational Study showed no increased risk of cancer for women using low-dose estrogens applied as a cream, ring, or tablet directly to the vagina.²¹

Erectile Dysfunction

Sharon Parish, MD (Internal Medicine, Weill Cornell Psychiatry Specialty Center, White Plains, New York) gave a presentation on erectile dysfunction. By one estimate, the inability to achieve an erection affects 5% of men aged 40 and triples to 15% by age 70.²² Another study showed that erectile dysfunction increases with age, affecting almost 40% of men 70 and older.²³ Obesity, physical inactivity, and smoking are among the risk factors for erectile dysfunction.^24,25

Phosphodiesterase type 5 (PDE5) inhibitors, such as sildenafil (Viagra®) tend to be more effective in younger than in older men,²⁶ but can have unpleasant side effects.²⁷ Stem cell therapy,²⁴ exercise,²⁸ testosterone,²⁹ and low intensity shockwaves³⁰ may be effective treatments.

Polycystic Ovary Syndrome (PCOS)

Andrea Dunaif, MD (Professor of Medicine, Mount Sinai, New York City) is a specialist in polycystic ovary syndrome (PCOS), which she believes should be renamed “metabolic reproductive disorder.” PCOS is the leading cause of missed menstrual periods and infertility in women.³¹ Women with PCOS are commonly obese and have high blood levels of male hormones (androgens).³² Women with PCOS often experience excessive body hair and difficulty losing weight.³³

Weight loss is an effective treatment when it can be achieved. Possible drug treatments include metformin³⁴ and androgen-blockers (including hormonal contraception).^35,36 Women with PCOS often report a lack of empathy from their physicians, who may argue with them while not providing useful advice.³⁷

Older Fathers

Dolores Lamb, PhD (Vice Chair, Department of Urology, Weill Cornell Medicine, New York City) is concerned about the fact that birth rates for men under age 30 have been declining, whereas birth rates for men over 35 have been increasing. Genetic material (DNA) becomes increasingly fragmented as the age of the father increases.³⁸ On average, the offspring of a 40-year-old father have twice as many genetic mutations as the offspring of a 20-year-old father.³⁹ Miscarriage is more than twice as likely for a father over 55 than for a father under 36.⁴⁰ Children of older fathers are more likely to suffer from cancer, dwarfism, autism, schizophrenia, and other abnormalities.⁴¹

As an aside, Dr. Lamb commented that a woman in her 20s marrying a wealthy man in his 70s is unlikely to refrain from becoming a mother based on this information. In vitro fertilization with screening of embryos could be an option in such cases.⁴²

Intercourse Pain in Women (Dyspareunia)

Lindsay Phillips, LMSW (Clinical Social Worker, University of Michigan, Ann Arbor, Michigan) does psychological counseling with women who report pain during intercourse, a condition which affects 10% to 28% of women (different studies have shown different frequencies).⁴³ Just over half of women affected seek medical treatment.⁴⁴ Most women with the condition continue regular penetrative activities with a sexual partner, motivated by a desire for closeness or fear of losing their partner. Inflammation and certain contraceptives can cause the pain, but often there is no identifiable cause.⁴⁵

Men are far less likely to have pain during intercourse, and when such pain does occur, it is usually due to inflammation of the prostate or bladder.⁴⁶

Low Sexual Desire in Women

Brooke Faught, DNP (Clinical Director of the Women’s Institute for Sexual Health, Nashville, Tennessee) counsels women who suffer from distress due to low sexual desire. Nearly 40% of women in the United States report low sexual desire, but in only 12% of cases is this accompanied by distress.⁴⁷ The most common cause of distress is feeling “less connectedness” with a partner.⁴⁸ In general, sexual desire in women tends to decrease with increasing age, but associated distress also decreases with increasing age.⁴⁹

Menopause not only reduces estrogen and progesterone hormones, but androgens as well (reducing sexual desire).⁵⁰ Postmenopausal women receiving testosterone as part of hormone replacement therapy show improved sexual function and reduced cancer risk.^51,52 Intermediate rather than high doses of testosterone produce the best results. Excessive body hair was the major complaint of the women receiving the testosterone.⁵¹ The hormone oxytocin, available from compounding pharmacies, may also be beneficial.⁵³

Premature Ejaculation

Ege Can Serefoglu, MD (Associate Professor, Bahceci Health Group, Istanbul, Turkey) is a specialist in the subject of premature ejaculation. Men typically ejaculate between four to eight minutes after sexual penetration. Approximately 5% of men ejaculate in less than two minutes after penetration.⁵⁴ About 90% of men seeking treatment for premature ejaculation ejaculate within one minute after penetration.⁵⁵

In a few cases there is a readily treatable cause, such as excessive thyroid hormone.⁵⁵ Drugs can be effective, but in most cases a combination of psychotherapy and drugs produces the best results,⁵⁶ because men who ejaculate prematurely often have emotional problems. Low level of serotonin is the most well-validated cause of premature ejaculation that can be treated with drugs, but patients usually discontinue taking these drugs because of side effects (including a loss of interest in sex).⁵⁷ Modafinil, a drug used to treat narcolepsy, has shown better results.⁵⁸

Sexual Assault

Andrea Holmes, MD (Forensic Medical Examiner, Galway Sexual Assault Treatment Unit, Galway, Ireland) examines rape victims for evidence of assailant DNA and administers contraceptives and medications to prevent sexually transmitted disease. An estimated 17%-25% of women and 1%-3% of men have been sexually assaulted in their lifetime.⁵⁹ Women are more likely to report being raped than men. Of women rape victims, 16% to 25% report the incident to police, up to 30% contract a sexually transmitted disease, and 5% become pregnant. Rape by a stranger is more likely to be reported, although this is only a small proportion of all rapes.⁶⁰ Rape is the most common cause of posttraumatic stress disorder (PTSD) in women,⁵⁹ and PTSD is the most common mental health consequence of sexual violence.⁶¹

Concluding Remarks

Poor communication or lack of communication with health care professionals is a recurring theme in sexual medicine. According to one survey, fewer than 25% of people will seek help from a health professional for sexual problems.⁶²

In 2017, female students enrolling in American medical schools outnumbered males for the first time in the history of American medicine. Lack of understanding of and empathy for women’s medical problems was characteristic of medicine when the profession was almost entirely dominated by men. A greater proportion of female physicians may result in better communication of sexual problems by women.

More generally, health problems that are sexual are often taken too personally. Shame, guilt, and fear over sexual health issues that could potentially be treated can cause those problems to become chronic physical and psychological wounds.

It is my hope that this report will encourage people to have the courage to be more open about sexual issues, resulting in greater resolution of those problems.

If you have any questions on the scientific content of this article, please call a Life Extension® Wellness Specialist at 1-866-864-3027.

References

1. Available at: https://www.hhs.gov/opa/reproductive-health/fact-sheets/male-infertility/index.html. Accessed July 30, 2019.
2. Cabler S, Agarwal A, Flint M, et al. Obesity: modern man’s fertility nemesis. Asian J Androl. 2010 Jul;12(4):480-9.
3. Balen AH, Dresner M, Scott EM, et al. Should obese women with polycystic ovary syndrome receive treatment for infertility? BMJ. 2006 Feb 25;332(7539):434-5.
4. Harlev A, Agarwal A, Gunes SO, et al. Smoking and Male Infertility: An Evidence-Based Review. World J Mens Health.2015 Dec;33(3):143-60.
5. Augood C, Duckitt K, Templeton AA. Smoking and female infertility: a systematic review and meta-analysis. Hum Reprod. 1998 Jun;13(6):1532-9.
6. Christou MA, Christou PA, Markozannes G, et al. Effects of Anabolic Androgenic Steroids on the Reproductive System of Athletes and Recreational Users: A Systematic Review and Meta-Analysis. Sports Med. 2017 Sep;47(9):1869-83.
7. Vander Borght M, Wyns C. Fertility and infertility: Definition and epidemiology. Clin Biochem. 2018 Dec;62:2-10.
8. Fassino S, Piero A, Boggio S, et al. Anxiety, depression and anger suppression in infertile couples: a controlled study. Hum Reprod. 2002 Nov;17(11):2986-94.
9. Pacheco Palha A, Lourenco MF. Psychological and cross-cultural aspects of infertility and human sexuality. Adv Psychosom Med. 2011;31:164-83.
10. Machado A, Cerca N. Influence of Biofilm Formation by Gardnerella vaginalis and Other Anaerobes on Bacterial Vaginosis. J Infect Dis. 2015 Dec 15;212(12):1856-61.
11. Lewis WG, Robinson LS, Gilbert NM, et al. Degradation, foraging, and depletion of mucus sialoglycans by the vagina-adapted Actinobacterium Gardnerella vaginalis. J Biol Chem. 2013 Apr 26;288(17):12067-79.
12. Srinivasan S, Hoffman NG, Morgan MT, et al. Bacterial communities in women with bacterial vaginosis: high resolution phylogenetic analyses reveal relationships of microbiota to clinical criteria. PLoS One. 2012;7(6):e37818.
13. McMillan A, Rulisa S, Sumarah M, et al. A multi-platform metabolomics approach identifies highly specific biomarkers of bacterial diversity in the vagina of pregnant and non-pregnant women. Sci Rep. 2015 Sep 21;5:14174.
14. Bautista CT, Wurapa E, Sateren WB, et al. Bacterial vaginosis: a synthesis of the literature on etiology, prevalence, risk factors, and relationship with chlamydia and gonorrhea infections. Mil Med Res. 2016;3:4.
15. Nelson TM, Borgogna JC, Michalek RD, et al. Cigarette smoking is associated with an altered vaginal tract metabolomic profile. Sci Rep. 2018 Jan 16;8(1):852.
16. Bohbot JM, Darai E, Bretelle F, et al. Efficacy and safety of vaginally administered lyophilized Lactobacillus crispatus IP 174178 in the prevention of bacterial vaginosis recurrence. J Gynecol Obstet Hum Reprod. 2018 Feb;47(2):81-6.
17. McCarthy CM, Hamill JB, Kim HM, et al. Impact of Bilateral Prophylactic Mastectomy and Immediate Reconstruction on Health-Related Quality of Life in Women at High Risk for Breast Carcinoma: Results of the Mastectomy Reconstruction Outcomes Consortium Study. Ann Surg Oncol. 2017 Sep;24(9):2502-8.
18. Alaofi RK, Nassif MO, Al-Hajeili MR. Prophylactic mastectomy for the prevention of breast cancer: Review of the literature. Avicenna J Med. 2018 Jul-Sep;8(3):67-77.
19. Kingsberg SA, Larkin L, Krychman M, et al. WISDOM survey: attitudes and behaviors of physicians toward vulvar and vaginal atrophy (VVA) treatment in women including those with breast cancer history. Menopause. 2019 Feb;26(2):124-31.
20. Naumova I, Castelo-Branco C. Current treatment options for postmenopausal vaginal atrophy. Int J Womens Health. 2018;10:387-95.
21. Crandall CJ, Hovey KM, Andrews CA, et al. Breast cancer, endometrial cancer, and cardiovascular events in participants who used vaginal estrogen in the Women’s Health Initiative Observational Study. Menopause. 2018 Jan;25(1):11-20.
22. Feldman HA, Goldstein I, Hatzichristou DG, et al. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol. 1994 Jan;151(1):54-61.
23. Rosen RC, Fisher WA, Eardley I, et al. The multinational Men’s Attitudes to Life Events and Sexuality (MALES) study: I. Prevalence of erectile dysfunction and related health concerns in the general population. Curr Med Res Opin. 2004 May;20(5):607-17.
24. Matz EL, Terlecki R, Zhang Y, et al. Stem Cell Therapy for Erectile Dysfunction. Sex Med Rev. 2019 Apr;7(2):321-8.
25. Pourmand G, Alidaee MR, Rasuli S, et al. Do cigarette smokers with erectile dysfunction benefit from stopping?: a prospective study. BJU Int. 2004 Dec;94(9):1310-3.
26. Gareri P, Castagna A, Francomano D, et al. Erectile dysfunction in the elderly: an old widespread issue with novel treatment perspectives. Int J Endocrinol. 2014;2014:878670.
27. Wang R, Burnett AL, Heller WH, et al. Selectivity of avanafil, a PDE5 inhibitor for the treatment of erectile dysfunction: implications for clinical safety and improved tolerability. J Sex Med. 2012 Aug;9(8):2122-9.
28. Duca Y, Calogero AE, Cannarella R, et al. Erectile dysfunction, physical activity and physical exercise: Recommendations for clinical practice. Andrologia. 2019 Jun;51(5):e13264.
29. Hotta Y, Kataoka T, Kimura K. Testosterone Deficiency and Endothelial Dysfunction: Nitric Oxide, Asymmetric Dimethylarginine, and Endothelial Progenitor Cells. Sex Med Rev. 2019 Apr 12.
30. Young Academic Urologists Men’s Health G, Fode M, Hatzichristodoulou G, et al. Low-intensity shockwave therapy for erectile dysfunction: is the evidence strong enough? Nat Rev Urol. 2017 Oct;14(10):593-606.
31. Legro RS, Kunselman AR, Dodson WC, et al. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J Clin Endocrinol Metab. 1999 Jan;84(1):165-9.
32. Day F, Karaderi T, Jones MR, et al. Large-scale genome-wide meta-analysis of polycystic ovary syndrome suggests shared genetic architecture for different diagnosis criteria. PLoS Genet. 2018 Dec;14(12):e1007813.
33. Gibson-Helm M, Teede H, Dunaif A, et al. Delayed Diagnosis and a Lack of Information Associated With Dissatisfaction in Women With Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2017 Feb 1;102(2):604-12.
34. Palomba S, Falbo A, Zullo F, et al. Evidence-based and potential benefits of metformin in the polycystic ovary syndrome: a comprehensive review. Endocr Rev. 2009 Feb;30(1):1-50.
35. Corbould A. Effects of androgens on insulin action in women: is androgen excess a component of female metabolic syndrome? Diabetes Metab Res Rev. 2008 Oct;24(7):520-32.
36. de Melo AS, Dos Reis RM, Ferriani RA, et al. Hormonal contraception in women with polycystic ovary syndrome: choices, challenges, and noncontraceptive benefits. Open access journal of contraception. 2017;8:13-23.
37. Lin AW, Bergomi EJ, Dollahite JS, et al. Trust in Physicians and Medical Experience Beliefs Differ Between Women With and Without Polycystic Ovary Syndrome. J Endocr Soc. 2018 Sep 1;2(9):1001-9.
38. Wyrobek AJ, Eskenazi B, Young S, et al. Advancing age has differential effects on DNA damage, chromatin integrity, gene mutations, and aneuploidies in sperm. Proc Natl Acad Sci U S A. 2006 Jun 20;103(25):9601-6.
39. Francioli LC, Polak PP, Koren A, et al. Genome-wide patterns and properties of de novo mutations in humans. Nat Genet. 2015 Jul;47(7):822-6.
40. Frattarelli JL, Miller KA, Miller BT, et al. Male age negatively impacts embryo development and reproductive outcome in donor oocyte assisted reproductive technology cycles. Fertil Steril. 2008 Jul;90(1):97-103.
41. Kovac JR, Addai J, Smith RP, et al. The effects of advanced paternal age on fertility. Asian J Androl. 2013 Nov;15(6):723-8.
42. Schmutzler AG. Theory and practice of preimplantation genetic screening (PGS). Eur J Med Genet. 2019 Aug;62(8):103670.
43. McLean L, Brooks K. What Does Electromyography Tell Us About Dyspareunia? Sex Med Rev. 2017 Jul;5(3):282-94.
44. Corsini-Munt S, Rancourt KM, Dube JP, et al. Vulvodynia: a consideration of clinical and methodological research challenges and recommended solutions. J Pain Res. 2017;10:2425-36.
45. Pukall CF, Goldstein AT, Bergeron S, et al. Vulvodynia: Definition, Prevalence, Impact, and Pathophysiological Factors. J Sex Med. 2016 Mar;13(3):291-304.
46. Luzzi GA, Law LA. The male sexual pain syndromes. Int J STD AIDS. 2006 Nov;17(11):720-6; quiz 6.
47. Shifren JL, Monz BU, Russo PA, et al. Sexual problems and distress in United States women: prevalence and correlates. Obstet Gynecol. 2008 Nov;112(5):970-8.
48. Kingsberg SA. Attitudinal survey of women living with low sexual desire. J Womens Health (Larchmt). 2014 Oct;23(10):817-23.
49. Goldstein I, Kim NN, Clayton AH, et al. Hypoactive Sexual Desire Disorder: International Society for the Study of Women’s Sexual Health (ISSWSH) Expert Consensus Panel Review. Mayo Clin Proc. 2017 Jan;92(1):114-28.
50. Dobs AS, Nguyen T, Pace C, et al. Differential effects of oral estrogen versus oral estrogen-androgen replacement therapy on body composition in postmenopausal women. J Clin Endocrinol Metab. 2002 Apr;87(4):1509-16.
51. Krapf JM, Simon JA. A sex-specific dose-response curve for testosterone: could excessive testosterone limit sexual interaction in women? Menopause. 2017 Apr;24(4):462-70.
52. Dimitrakakis C, Jones RA, Liu A, et al. Breast cancer incidence in postmenopausal women using testosterone in addition to usual hormone therapy. Menopause. 2004 Sep-Oct;11(5):531-5.
53. Pfaus JG. Pathways of sexual desire. J Sex Med. 2009 Jun;6(6):1506-33.
54. Althof SE, McMahon CG, Waldinger MD, et al. An update of the International Society of Sexual Medicine’s guidelines for the diagnosis and treatment of premature ejaculation (PE). J Sex Med. 2014 Jun;11(6):1392-422.
55. Serefoglu EC, McMahon CG, Waldinger MD, et al. An evidence-based unified definition of lifelong and acquired premature ejaculation: report of the second international society for sexual medicine ad hoc committee for the definition of premature ejaculation. Sex Med. 2014 Jun;2(2):41-59.
56. Althof SE. Psychosexual therapy for premature ejaculation. Transl Androl Urol. 2016 Aug;5(4):475-81.
57. Saitz TR, Serefoglu EC. Advances in understanding and treating premature ejaculation. Nat Rev Urol. 2015 Nov;12(11):629-40.
58. Tuken M, Kiremit MC, Serefoglu EC. On-demand Modafinil Improves Ejaculation Time and Patient-reported Outcomes in Men With Lifelong Premature Ejaculation. Urology. 2016 Aug;94:139-42.
59. Dworkin ER, Menon SV, Bystrynski J, et al. Sexual assault victimization and psychopathology: A review and meta-analysis. Clin Psychol Rev. 2017 Aug;56:65-81.
60. Resnick HS, Holmes MM, Kilpatrick DG, et al. Predictors of post-rape medical care in a national sample of women. Am J Prev Med. 2000 Nov;19(4):214-9.
61. Jordan CE, Campbell R, Follingstad D. Violence and women’s mental health: the impact of physical, sexual, and psychological aggression. Annu Rev Clin Psychol. 2010;6:607-28.
62. Laumann EO, Glasser DB, Neves RC, et al. A population-based survey of sexual activity, sexual problems and associated help-seeking behavior patterns in mature adults in the United States of America. Int J Impot Res. 2009 May-Jun;21(3):171-8.