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Question: Do I need to get my testosterone level tested?

Signed, a woman with little to no desire for sex

Of the low libido women who come to see me, roughly two or three out of twenty will have testosterone levels low enough that I identify it as a contributing factor to their low sex drive. Could that be you? It is important for you to know the answer. The list below gives you a reasonable idea if you are a woman who should get tested. Check the symptom list — If your testosterone levels are low you most likely will have at least three or four of these symptoms. It won’t just be that you have no desire for sex. Testosterone affects your whole body, so low levels affect your muscles and your mood too.

Here is the list of things that can happen when your testosterone is low:

  • You feel tired
  • You have less endurance
  • Your muscles aren’t strong, and even when you work out you don’t get much result
  • Your mood is low, and you feel a physical kind of depression
  • You are less optimistic than you used to be
  • Overall sexual touch doesn’t do as much for you as it used to–there is a dullness to the sensations in your vagina and clitoris
  • When your nipples are touched you no longer get aroused
  • Your vulva can feel as if it is burning
  • Your vagina has tears in the skin after intercourse, or can occur spontaneously
  • You will have less lubrication in your vagina when you are aroused
  • The amount of hair on your body is less, and the quality of your hair is thinner
  • You aren’t thinking about or planning for sex
  • Your memory is not as sharp as it used to be

GETTING TESTED: If you have three or four of these symptoms then ask your provider to test your levels.

Tests should include a Total Testosterone, and a Free Testosterone. SHBG (Sex Hormone Binding Globulin) will also be calculated to figure out how much of your testosterone is available for you to use, as it can be bound by this protein. If your tests show that you are deficient (below normal range) or low normal (low normal is the bottom 25% of the normal range) you may be a candidate for treatment.

More about testosterone in my book: Fanning the Female Flame

Click here to read about how PCOS can affect your sex life.

In the coming weeks, I’ll be writing about how to treat low testosterone.

Sex Doesn’t Have to be Painful

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“Treat Your Vaginal Dryness Early” are the words I would put on large billboards along I-5 and along other major highways in the US. I want to get the word out to women sooner about this common problem. Many women I see have waited months or years to seek treatment, and I cringe at the number of nights they have been in pain. Or the number of nights they are ambivalent about having sex as they face the no win choice of either “sex with pain” or “no sex”.

 

 

Treating women’s dryness early would reduce that personal pain and burning during and after sex, and it would do so much to maintain the closeness in marriages — the closeness that can wobble when this happens. So don’t wait. There is no reason to wait. Vaginal dryness, particularly menopausal vaginal dryness, is progressive. The earlier you treat it the better.

Treating dryness early would not only reduce sexual pain for women, it would also improve the capacity for arousal and the quality of the orgasms of millions of American women. On top of that it would add quality to the sexual experience of the women’s partners. As far as what it would do for relationships, well that is a lot. When a partner isn’t available for sex there is confusion, distress and sometimes a misinterpretation of the source of the problem. Treating dryness early would make this relationship chaos less.

Vaginal dryness occurs in more than 50% of women experiencing menopause. It also occurs in young women. Usually these young women are on hormonal contraceptives like the birth control pill, hormonal IUDs, and implants, or they have a hormone condition called PCOS (Polycystic Ovarian Syndrome). Significant sexual pain occurs in 10% of young women who go on the pill because of vaginal changes that occur from taking the pill. This intimate pain is quite a negative introduction to the new world of sexuality for these young women.

Whether vaginal dryness is due to the pill or menopause or other conditions, it is quickly and easily treated. Don’t wait. The symptoms of pain with intercourse or the feeling like you have a rug burn after sex, will resolve in six to eight weeks. And the treatment is safe. It doesn’t increase your risk of getting breast or endometrial cancer (links to the research on safety are included later in article).

There are multiple treatments for dryness, and there are a few new ones. Intra-vaginal DHEA is one that I reviewed in the last newsletter. More new treatments, including laser therapy, are gathering data now. Low dose minimally absorbed estradiol is still the go-to treatment for dryness. Below is the handout I give to women when prescribing this medication.


USING LOW DOSE MINIMALLY ABSORBED VAGINAL ESTRADIOL

You have been prescribed a vaginal estrogen preparation to use topically.

This prescription is to treat vaginal dryness related to loss of estrogen, or for some women it is to replace estrogen when “crowded out” by naturally higher levels of testosterone.

This is a prescription that you pick up at the pharmacy.

This medication is a low dose hormone prescription. It is different than a lubricant, and different than a vaginal moisturizer. You can think of it like a conditioner.

You do not use it before sexual activity.

The hormonal changes that occur to the vagina also affect the tissue around the opening of the vagina and the urethra (the tube that creates the passage where urine leaves your body). When a topical estrogen cream is prescribed, often the instructions are to take ½ the dose and apply around the opening of the vagina and the labia (lips) including the clitoris and clitoral hood. The other half of the medication goes into the vagina using the applicator from the pharmacy. You also can use your fingers to insert the cream internally.

If you are beginning the prescription, you will often be advised to use it daily for a week, then reducing to twice a week. It takes six to eight weeks for the tissue to get back to the thickness it had been before the hormonal change. When your symptoms are gone, you can reduce the prescription to once a week. If symptoms reoccur you can then increase again to twice a week. If you have been using it for 8 weeks and you still have dryness or pain, come back in — something else may be going on besides vaginal dryness.

Prescriptions for inside the vagina are also written for rings (Estring: this is a ring that is placed inside the vagina and releases low dose estrogen for three months) or suppositories (Vagifem or custom compounded suppositories). These methods deliver estrogen to the vagina internally. Often when a woman uses rings or suppositories internally she will still benefit from some estrogen cream applied externally around the opening of the vagina where more pressure occurs particularly with thrusting.

Compounded vaginal estrogens can be made in creams without parabens and propylene glycol and other chemicals that irritate when cracks or fissures are present, or when there is skin sensitivity. There are bio-identical options for both compounded and non-compounded prescriptions.

Vaginal Estrogens have not been shown to cause an increased risk of breast or endometrial cancer, or any other cancer. See the 2016 American College Of Gynecology guidelines here for women who have had Breast Cancer, and their use of estrogen, click here to visit.

The use of low dose vaginal estrogen and risk of stroke continues to be under study, and so far the Estring, and low dose topical creams show no increase in blood clots, click here to visit.


THE BOTTOM LINE: Don’t put up with dryness or sexual pain from dryness. Find out the cause and treat it until it is gone. There are many resources to help you be successful with this safe treatment, so if your provider doesn’t ask you, then you ask them for treatment.

Click here to read my article about why there is no better time in history to be a post-menopausal woman who wants to have a great sex life.

 

New Treatment for Menopause and Vaginal Dryness

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On July 24, 2017 the Vaginal DHEA suppository we have been hearing about for five years became commercially available. Called Prasterone, with the brand name Intraosa, it is available by prescription. It is for the treatment of sexual pain during intercourse due to menopausal changes. Prasterone (DHEA) is converted locally in the vagina into androgens and estrogens which are the hormones that restore the vaginal tissue.

According to AMAG Pharmaceuticals, there is Copay Savings Program, which lets most insured patients receive their first prescription for a $0 copay and will then pay no more than a $25 copay for each refill for the duration of the program.

The unique research news was that the hormonal effects happened locally in the vagina and did not appear to raise blood levels of estrogen or testosterone throughout the body. Even though hormone levels did not increase, this treatment is not currently approved for women who have had breast cancer, or women who have unexplained postmenopausal bleeding. You can get the prescription from your provider. The vaginal suppository is inserted daily.

Click here to read my blog post about why there is no better time in history to be a post-menopausal woman who wants to have a great sex life.