Sexual Dysfunction
From the Show: RSC NJ - Fertility Talk
Summary:
Air Date: 8/13/19
Duration: 10 Minutes
Dr. Alan Martinez discusses how sexual dysfunction affects men and women, and the types of treatment options available.
Transcription:
Melanie Cole, MS (Host): So many men and women have a physical or hormonal or medical condition that really has sabotaged their sex life, and yet very few tend to bring it up to their doctor. My guest today is Dr. Alan Martinez. He’s a specialist in reproductive endocrinology and infertility at the reproductive science center of New Jersey. Dr. Martinez, always a pleasure to have you on with us today. Tell us a little bit how overall health is linked to sexual health and activity?
Dr. Alan Martinez (Guest): Thank you for having me on today. I appreciate talking to you, as always. Yes. When I see patients for their fertility evaluation, what we will find is that an aspect of their overall health can directly contribute to what’s going on at home and as far as their sexual life and whether they are having issues in the bedroom. So patients will often come to me and say, “Okay, I want to get bloodwork. I want to deal with all the other testing I need to do.” But we really want to ask questions and delve into what is going on with their sexual health. Because medical conditions as well as their function as far as sex can directly affect their ability to conceive.
Host: So we usually hear about sexual dysfunction in men. That gets talked about a lot. There’s commercials. We don’t always hear so much about women Dr. Martinez. So what are the types of sexual issues that effect women that you hear from them?
Dr. Martinez: So one of the most common points that are brought up when taking our medical history is either a lack of interest in sex, or hypoactive sexual disorder, or they will have physical complaints that although there is a desire to have sexual intercourse, this is either associated with pain, discomfort either before/during or anxiety and apprehension around the sexual encounter itself. So those are the two most common things that we encounter when we sit down with patients.
Host: So when you talk to them about that, and they have pain with vaginal intercourse or pelvic pain, that’s definitely a medical condition you can deal with. When you mentioned the lack of desire, and we have whacked out hormones sometimes. Certainly at different points in our cycle we have hormonal changes. How do you discuss those parts with them?
Dr. Martinez: So part of the workup, as we know, is also obtaining hormonal bloodwork for the patient. Through that, we can asses their ovarian function which can directly relate to their sexual health. So some of my patients with what we call diminished ovarian reserve, or low ovary function, can have issues stemming directly from a lack of hormones. Other patients will have an actually physical condition. Sometimes they’ve had previous abdominal surgeries. They have a condition, endometriosis, or they have other medical conditions that may contribute to actual physical pathology. Some of the patients may have issues with the way that sex is viewed, the way that any previous sexual encounters that they’ve had. Sometimes sexual trauma even comes into the picture, which can really cause a very negative impact throughout the patient’s lives.
Host: Well it certainly can. While we’re talking about this then let’s discuss men. What are some of the most common types of sexual issues that you see that effect men?
Dr. Martinez: So men will complain about having a decreased intensity of an erection. They can have an inability to maintain an erection. They can achieve an erection, but they can't complete the sexual intercourse and actually progress to orgasm, which is an issue. Most of the time we see some changes that happen as an individual gets older, but there can also be psychosocial impacts that can directly effect things. Such as one of the things that I commonly see is that when patients are trying to time out their intercourse sessions for the purposes of conception, oftentimes checking ovulation in the female and having to have intercourse at very specific intervals can really alter the sexual function from the male side. So that is the most common aspect. We try to talk through relieving their anxiety, being spontaneous, and/or if they have issues that are physiologic then we may delve into their hormones, their testosterone level. We may work directly with urologists who work on achieving and maintain erections. Sometimes that’s either done with behavioral or cognitive therapy, sexual health and counseling, couples therapy, and in some cases even medications that everyone hears about. Oftentimes, that’s not the first thing that’s jumped to. You need to look for if there’s some sort of organic cause with these patients.
Host: So once you’ve determined what the cause might be—and you mentioned medications—men have Viagra, things we’ve heard about a million times in the media. Is there something like that for women if libido is an issue? If sexual desire or interest. If there is a medication available, is it more of a drug for the mind or is there an actual physiological effect?
Dr. Martinez: There are some new medications that are coming out that help out with physiology, help out with the body. It looks like through preliminary data that these may have a benefit in women. We need to remember that often times having the female patient and/or the couple receive counseling, seeing a sexual therapist, dealing with any physiologic issues. Those are oftentimes enough to increase the interest, increase desire. So we work from the couple. Then the medicines that are out there are kind of a last resort. I think that that is one of the most important things that I don’t want patients, whether they're male or female, just to assume that a pillar of medication is going to be effective in solving the problems because oftentimes it’s multifactorial. So we try to counsel patients appropriately and get them the full workup in and determine if medical therapies may help out with regards to a specific medication.
Host: Dr. Martinez, you're so knowledgeable in so many of the aspects of sexual health and fertility. When you talk about the mental issues, does cognitive behavior therapy or sexual therapy—Have you seen in your practice that these really do work and that they do help? Because obviously either or partner can have negative self-talk and then that makes it work. It can kind of spiral out from there. What have you seen as far as results from that type of therapy?
Dr. Martinez: We’ve actually found it very, very effective in many couples. I think one of the most important aspects to remember is that fact that you mentioned which patients may retract and may not discuss this with their partner. So establishing good patient care, establishing trust with both the female and the male partner, and getting them to be honest is actually a big step. Then once they feel comfortable discussing things and we know that hey, they are not alone. This is often enough times to get them into the therapy, get the couple talking with themselves in front of professionals. It can be very effective for patients. It overall is probably the most effective is an intrapersonal relationship, being honest, and then people working together as a team rather than feeling like it’s isolated in that you're alone with this.
Host: So what is the most important bit of advice you would like couples to hear from you if one partner is fine but the other may have a medical condition or an emotional situation. Something that really does sabotage their sex life. What would you like them know about the importance of seeking out a professional, being honest as you said with their provider, and working on this so that if they are trying to conceive that all things being equal, that’s what they can try to do.
Dr. Martinez: Yes. So the most important thing is to remember that you're not alone whether you're male or female and you’re having sexual function issues. Whether you're anxious, whether the quality of the sex has changed, the frequency. The most important thing is to remain open-minded and to realize that there are several areas of intervention that can be used to help you out. I think that’s the most important thing is keeping an open mind and knowing that the physician, we are on your side. We can work with you. We can work within several disciplines, whether it’s psychologically. Whether it’s with sexual therapists, whether with infertility physicians. We all work together—urologists—to help out patients. I think that if you're open minded and you remember that you're not alone, that is one of the major keys to success.
Host: Well, I think so too. Thank you for putting it that way and really explaining something to listeners that they're not always comfortable discussing, even really with their partners. So thank you, again, for sharing your expertise and really explaining this all so very well for us. That wraps up this episode of Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey. You can head on over to our website at fertilitynj.com for more information and to get connected with one of our providers. If you found this podcast as informative as I did, please share with your friends or family. I know some people find this embarrassing to discuss but play this podcast for them because it’s really a great way to get the experts from RSCNJ—the information that they're giving us—out there to the people that you know that may have these kinds of conditions. Be sure to check out all the other fascinating podcasts in our library because there’s quite a few and they’re excellent to listen to. Until next time, I'm Melanie Cole.
Melanie Cole, MS (Host): So many men and women have a physical or hormonal or medical condition that really has sabotaged their sex life, and yet very few tend to bring it up to their doctor. My guest today is Dr. Alan Martinez. He’s a specialist in reproductive endocrinology and infertility at the reproductive science center of New Jersey. Dr. Martinez, always a pleasure to have you on with us today. Tell us a little bit how overall health is linked to sexual health and activity?
Dr. Alan Martinez (Guest): Thank you for having me on today. I appreciate talking to you, as always. Yes. When I see patients for their fertility evaluation, what we will find is that an aspect of their overall health can directly contribute to what’s going on at home and as far as their sexual life and whether they are having issues in the bedroom. So patients will often come to me and say, “Okay, I want to get bloodwork. I want to deal with all the other testing I need to do.” But we really want to ask questions and delve into what is going on with their sexual health. Because medical conditions as well as their function as far as sex can directly affect their ability to conceive.
Host: So we usually hear about sexual dysfunction in men. That gets talked about a lot. There’s commercials. We don’t always hear so much about women Dr. Martinez. So what are the types of sexual issues that effect women that you hear from them?
Dr. Martinez: So one of the most common points that are brought up when taking our medical history is either a lack of interest in sex, or hypoactive sexual disorder, or they will have physical complaints that although there is a desire to have sexual intercourse, this is either associated with pain, discomfort either before/during or anxiety and apprehension around the sexual encounter itself. So those are the two most common things that we encounter when we sit down with patients.
Host: So when you talk to them about that, and they have pain with vaginal intercourse or pelvic pain, that’s definitely a medical condition you can deal with. When you mentioned the lack of desire, and we have whacked out hormones sometimes. Certainly at different points in our cycle we have hormonal changes. How do you discuss those parts with them?
Dr. Martinez: So part of the workup, as we know, is also obtaining hormonal bloodwork for the patient. Through that, we can asses their ovarian function which can directly relate to their sexual health. So some of my patients with what we call diminished ovarian reserve, or low ovary function, can have issues stemming directly from a lack of hormones. Other patients will have an actually physical condition. Sometimes they’ve had previous abdominal surgeries. They have a condition, endometriosis, or they have other medical conditions that may contribute to actual physical pathology. Some of the patients may have issues with the way that sex is viewed, the way that any previous sexual encounters that they’ve had. Sometimes sexual trauma even comes into the picture, which can really cause a very negative impact throughout the patient’s lives.
Host: Well it certainly can. While we’re talking about this then let’s discuss men. What are some of the most common types of sexual issues that you see that effect men?
Dr. Martinez: So men will complain about having a decreased intensity of an erection. They can have an inability to maintain an erection. They can achieve an erection, but they can't complete the sexual intercourse and actually progress to orgasm, which is an issue. Most of the time we see some changes that happen as an individual gets older, but there can also be psychosocial impacts that can directly effect things. Such as one of the things that I commonly see is that when patients are trying to time out their intercourse sessions for the purposes of conception, oftentimes checking ovulation in the female and having to have intercourse at very specific intervals can really alter the sexual function from the male side. So that is the most common aspect. We try to talk through relieving their anxiety, being spontaneous, and/or if they have issues that are physiologic then we may delve into their hormones, their testosterone level. We may work directly with urologists who work on achieving and maintain erections. Sometimes that’s either done with behavioral or cognitive therapy, sexual health and counseling, couples therapy, and in some cases even medications that everyone hears about. Oftentimes, that’s not the first thing that’s jumped to. You need to look for if there’s some sort of organic cause with these patients.
Host: So once you’ve determined what the cause might be—and you mentioned medications—men have Viagra, things we’ve heard about a million times in the media. Is there something like that for women if libido is an issue? If sexual desire or interest. If there is a medication available, is it more of a drug for the mind or is there an actual physiological effect?
Dr. Martinez: There are some new medications that are coming out that help out with physiology, help out with the body. It looks like through preliminary data that these may have a benefit in women. We need to remember that often times having the female patient and/or the couple receive counseling, seeing a sexual therapist, dealing with any physiologic issues. Those are oftentimes enough to increase the interest, increase desire. So we work from the couple. Then the medicines that are out there are kind of a last resort. I think that that is one of the most important things that I don’t want patients, whether they're male or female, just to assume that a pillar of medication is going to be effective in solving the problems because oftentimes it’s multifactorial. So we try to counsel patients appropriately and get them the full workup in and determine if medical therapies may help out with regards to a specific medication.
Host: Dr. Martinez, you're so knowledgeable in so many of the aspects of sexual health and fertility. When you talk about the mental issues, does cognitive behavior therapy or sexual therapy—Have you seen in your practice that these really do work and that they do help? Because obviously either or partner can have negative self-talk and then that makes it work. It can kind of spiral out from there. What have you seen as far as results from that type of therapy?
Dr. Martinez: We’ve actually found it very, very effective in many couples. I think one of the most important aspects to remember is that fact that you mentioned which patients may retract and may not discuss this with their partner. So establishing good patient care, establishing trust with both the female and the male partner, and getting them to be honest is actually a big step. Then once they feel comfortable discussing things and we know that hey, they are not alone. This is often enough times to get them into the therapy, get the couple talking with themselves in front of professionals. It can be very effective for patients. It overall is probably the most effective is an intrapersonal relationship, being honest, and then people working together as a team rather than feeling like it’s isolated in that you're alone with this.
Host: So what is the most important bit of advice you would like couples to hear from you if one partner is fine but the other may have a medical condition or an emotional situation. Something that really does sabotage their sex life. What would you like them know about the importance of seeking out a professional, being honest as you said with their provider, and working on this so that if they are trying to conceive that all things being equal, that’s what they can try to do.
Dr. Martinez: Yes. So the most important thing is to remember that you're not alone whether you're male or female and you’re having sexual function issues. Whether you're anxious, whether the quality of the sex has changed, the frequency. The most important thing is to remain open-minded and to realize that there are several areas of intervention that can be used to help you out. I think that’s the most important thing is keeping an open mind and knowing that the physician, we are on your side. We can work with you. We can work within several disciplines, whether it’s psychologically. Whether it’s with sexual therapists, whether with infertility physicians. We all work together—urologists—to help out patients. I think that if you're open minded and you remember that you're not alone, that is one of the major keys to success.
Host: Well, I think so too. Thank you for putting it that way and really explaining something to listeners that they're not always comfortable discussing, even really with their partners. So thank you, again, for sharing your expertise and really explaining this all so very well for us. That wraps up this episode of Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey. You can head on over to our website at fertilitynj.com for more information and to get connected with one of our providers. If you found this podcast as informative as I did, please share with your friends or family. I know some people find this embarrassing to discuss but play this podcast for them because it’s really a great way to get the experts from RSCNJ—the information that they're giving us—out there to the people that you know that may have these kinds of conditions. Be sure to check out all the other fascinating podcasts in our library because there’s quite a few and they’re excellent to listen to. Until next time, I'm Melanie Cole.