Rena Malik, M.D. - Will You Really Use it or Lose it?! Ft. Dr. Karen Tang
The conversation explores the concept of 'use it or lose it' in relation to sexual health, particularly after menopause. It is noted that lack of sexual activity can lead to changes in vaginal tissue, such as narrowing and dryness, which can cause discomfort during intercourse. However, these changes are not irreversible and can be addressed with pelvic physical therapy, dilators, and vaginal estrogen. The discussion also highlights the importance of sexual stimulation for maintaining sensitivity and responsiveness, with studies showing that vibrators can improve arousal and sensation.
The conversation shifts to the variety of symptoms women experience during their menstrual cycle, including bowel changes, pain, and mood swings. These symptoms can be exacerbated by conditions like endometriosis, which requires medical attention if they interfere with daily life. Hormonal birth control is discussed as a treatment option for managing symptoms related to ovulation and the luteal phase by stabilizing hormone levels and potentially eliminating periods. The risks and benefits of hormonal birth control are considered, including its impact on libido and the misconception that it affects long-term fertility. The discussion concludes with a critique of the pull-out method as an unreliable form of contraception, emphasizing the need for more effective methods to prevent unintended pregnancies.
Key Points:
- Lack of sexual activity post-menopause can lead to vaginal changes, but these are reversible with therapy and estrogen.
- Sexual stimulation can enhance sensitivity and responsiveness; vibrators are effective for improving arousal.
- Menstrual symptoms like pain and mood swings can indicate conditions like endometriosis, requiring medical attention.
- Hormonal birth control can manage menstrual symptoms by stabilizing hormones and eliminating periods, with minimal long-term fertility impact.
- The pull-out method is unreliable for contraception, with a high failure rate compared to other methods.
Details:
1. 🔍 "Use it or lose it": Fact or Fiction?
- Postmenopausal women who are not sexually active may experience changes in vaginal tissue quality, including narrowing and loss of moisture, which can lead to pain during intercourse.
- Interventions like pelvic physical therapy and the use of dilators can effectively increase vaginal diameter and improve comfort for those who have been inactive sexually.
- Vaginal estrogen is recommended for postmenopausal patients to enhance tissue quality and elasticity, providing a more comfortable sexual experience.
- Regular clitoral stimulation using vibrators or suction devices can improve sensation, responsiveness, and blood flow, even after periods of inactivity.
- Research shows that individuals who engage in regular sexual activity may experience fewer hormonally-related changes to their genitalia, making intercourse more comfortable over time.
2. 🔍 Pain and Communication in Sexual Health
- Addressing pain during sex is crucial rather than focusing solely on increasing sexual activity.
- Patients often report low libido due to painful sex, which needs to be addressed to improve sexual desire.
- Painful sex can lead to a lack of interest in sexual activity, as it is natural to avoid activities that cause discomfort.
- Poor communication about sexual pain can lead to misunderstandings and frustration in relationships.
- Patients often avoid discussing pain to not hurt their partner's feelings, leading to avoidance of sex.
- Open communication about sexual discomfort is essential to avoid misconceptions and improve sexual health.
- Consultations often focus on communication, not just physical treatments like hormone therapy or medication.
- Effective sexual health management involves discussing needs, concerns, and clearing misunderstandings.
- Specific communication strategies include encouraging open dialogue, using 'I' statements to express feelings, and setting aside dedicated times to discuss sexual health openly.
- Role-playing scenarios can be used in therapy to improve communication skills between partners.
- Educating both partners about pain and its sources can empower them to address the issues together.
- Using tools like communication exercises and therapy can significantly improve relationship satisfaction and sexual health outcomes.
3. 💡 Unpacking Menstrual Symptoms
- Diarrhea, butt pain, leg pain, and general pain are common symptoms around menstruation.
- Bowel function changes are common; constipation may occur before menstruation and loose stools during menstruation, known as 'period poops.'
- Prostaglandin, a hormone, causes loose stools and uterine cramps by making the bowels move faster and affecting uterine and leg nerves.
- Severe back or leg pain during menstruation may indicate endometriosis, which also causes painful periods, pain with sex, and painful bowel movements.
- Endometriosis involves tissue similar to uterine lining growing outside the uterus, causing pain and functional issues.
- Endometriosis symptoms can include diarrhea, bladder issues, and increased urgency and frequency of urination, worsening with ovulation or periods.
- Many people experience these symptoms and are told they are normal despite significant impacts on daily life activities.
- To manage these symptoms, individuals can track their cycle and symptoms to better predict and prepare for these changes.
- Consulting with a healthcare professional is recommended for severe symptoms or if endometriosis is suspected.
4. 📣 Addressing Common Misconceptions
- Women experiencing severe period-related issues should consult their gynecologist, as it's not normal to have symptoms that affect daily activities like exercising or working.
- Severe pelvic pain, often linked to endometriosis, should not be dismissed as normal period pain, and requires medical evaluation.
- Pelvic floor spasms, which can cause sharp, shooting pains known as 'lightning bolt' pains, affect both men and women and need appropriate treatment.
- Regular and severe pain during periods should be discussed with a healthcare provider to explore underlying conditions like endometriosis.
- Patients frequently report being advised to manage severe period symptoms with birth control without further investigation, highlighting a need for addressing root causes.
- Endometriosis is a condition where tissue similar to the uterine lining grows outside the uterus, causing significant pain and complications if untreated.
- Pelvic floor spasms involve involuntary contractions of the pelvic muscles, leading to acute discomfort that can severely impact quality of life.
5. 🩺 Understanding Women's Health Challenges
5.1. Endometriosis and PCOS Misconceptions
5.2. Menopause Misdiagnosis and Dismissal
5.3. Role of Male Partners in Women's Health
6. 🔄 Hormonal Changes and Their Impact
- Understanding hormonal changes throughout the menstrual cycle can help in scheduling and managing activities without unnecessary stress.
- Estrogen and progesterone, primarily produced by the ovaries, fluctuate during the cycle, affecting mood and physical symptoms.
- Cycle syncing can optimize performance but should not add stress. Awareness of hormonal phases can guide activity planning without rigid adherence.
- Progesterone increase post-ovulation can result in PMS symptoms like mood swings, breast tenderness, and bloating.
- Extreme PMS symptoms affecting daily function may indicate Premenstrual Dysphoric Disorder (PMDD), which requires medical consultation.
- The luteal phase, post-ovulation, is marked by progesterone release and common PMS symptoms, occurring between ovulation and menstruation.
- Hormonal birth control can mitigate PMS symptoms, but discussions with a doctor on risks and benefits are essential.
7. 💊 The Role of Birth Control
- Hormonal birth control methods prevent ovulation, offering treatment for symptoms related to the ovulation and luteal phase, including PMDD.
- By avoiding ovulation and the luteal phase, hormonal birth control can prevent the hormonal fluctuations that cause these symptoms.
- Skipping periods with hormonal birth control is safe because progesterone maintains endometrial health, preventing tissue build-up that could become precancerous.
- There is no long-term impact on fertility from using hormonal birth control, a myth debunked by fertility experts.
- The main risks associated with hormonal birth control involve a slight increase in the risk of blood clots and breast cancer, which are considered minimal compared to benefits.
- Patients should discuss their individual risk factors and preferences with their doctor, as some prefer to have periods for reassurance against pregnancy.
8. 🌟 Libido and Contraceptives
- Estrogen-containing contraceptives can lower testosterone levels, potentially reducing libido, although this is relatively rare.
- Progesterone-only contraceptives theoretically should not affect libido, but some women report changes.
- Trial and error may be necessary to find a suitable contraceptive method for those concerned about libido.
- Non-estrogen options, like IUDs, may be better for those experiencing libido issues with hormonal contraceptives.
- Online reports suggest some individuals experience a loss of attraction to partners after changing birth control methods.
9. 🧠 Debunking Myths about Attraction
- Claims that birth control affects attraction are largely based on small, poorly defined studies lacking substantial evidence. It is essential to distinguish between minor mood fluctuations and fundamental changes in attraction, which are primarily influenced by personality and communication.
- Concerns over birth control impacting relationships often ignore the significant risk of unintended pregnancies when reliable contraception is discontinued. Thus, scaremongering can lead to more harm than good.
- Decisions regarding birth control should weigh the balance of risks and benefits, considering that non-hormonal methods also have limitations. The choice of contraception should be tailored to individual health needs and circumstances.
- The notion that hormonal birth control universally harms relationships lacks foundation. Individual reactions vary widely, and choices should be informed by personal health and lifestyle factors.