Gynecologist seeks answers in sexual medicine field

by Dr. Daniel Laury

I’d just stopped delivering babies. It was 2002, I had made a lifestyle change to reduce stress and the need to be on call, and instead of expectant moms, I was seeing post-menopausal women. My patients were older and I had more time to field their questions. Many were about sex.

Patients asked me about aphrodisiacs, about how antidepressants affected their libido, how to deal with intercourse pain and a host of topics once deemed too taboo to talk about. Problem was, I didn’t have all the answers.

Looking back, I recall one day of medical school lectures devoted to human sexuality - one day in four years. Not much to go on.

I knew certain medications caused erectile difficulties in men, including those commonly used to control blood pressure. I also knew certain antidepressants such as Prozac and Zoloft were capable of interfering with orgasm in both genders.

But I had to do more digging to answer poorly researched questions. Patients would describe headaches that occurred with orgasm. "Is that normal?" they'd ask. The answer: Normal, no, but common, yes.

They also brought me paperwork from the Web describing "guaranteed" cures for everything from low libido to relationship problems , asking me if they worked. Usually they didn't.

Interest is growing in sexual medicine. As a lecturer, the two topics I get invited to speak on most often are hormone therapy and human sexuality. Seniors seem more comfortable than ever talking about sex. That means doctors had better be prepared to do some homework. So that's just what I did.

An older patient of mine whose husband recently had a stroke wanted to know if they should have sex. She wondered if it could cause another stroke, how much was too much, and whether certain positions were better than others.

Much of my early research proved futile - not much existed to answer these questions. But eventually, I found answers. Intercourse is on average as strenuous as climbing three flights of stairs. So, if he was able to do that, I reassured her, then sex should be OK. In addition, I found evidence that people engaging in sex tended to live longer.

When another woman asked me about the safety of sex toys, I was surprised to find there are significant risks to certain chemicals, such as phthalates, added to some flexible toys. There's some evidence phthalate exposure may increase risk for testicular cancer, lower sperm count and lung diseases, such as asthma.

Interestingly, sex toys aren't as well regulated in this country as in Europe and Canada. I recommend shatterproof glass or stainless steel instead.

On the surgical front, patients typically reported improvement in their sex life after a hysterectomy. This could be due to reduced cyclic bleeding, no potential for pregnancy and less pain. I wondered whether certain surgical techniques weren't better than others to preserve or even enhance sexual satisfaction.

Surgery can be used to treat pelvic organ prolapse, a condition resulting from vaginal weakness. Unfortunately, repair tends to focus only on anatomical and functional outcomes - leaving sex out of the equation. I found that by tightening or loosening tissues, sex could be more enjoyable for both partners.

I'm still learning, but as I get more into sexual medicine, I feel I'm helping patients achieve happiness and improve function in an important part of their lives.

As a medical community, we're just starting to take this area seriously. General medicine is thousands of years old, but sexual medicine - no matter the age of the patient asking - is still in its infancy.

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Dr. Frank Franzese (middle) oversees a patient's radiation therapy. He helps educate patients with prostate cancer about how it affects sexual function. (Photo by Dennis Gregg)

To varying degrees, experts say, prostate cancer treatment affects sexual function in most men, including inhibiting ejaculation, diminishing libido and causing erectile dysfunction.


I am not aware of any textbook on the subject but that leaves open the option to write one! Thanks to everyone for the comments.

My experience in medical school was similar to Dr. Laury's. Is there a text book on this subject suitable for medical students to use.

I agree. This article just is scratching the surface. I'd like to know more details.

Great information - please have more articles on this subject!

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