Sharon Parish, M.D. discusses sexual health issues impacting women. September is Sexual Health Awareness Month and it's an important topic that impacts women of all life stages. She discusses how medical conditions, whether physical or hormonal, can impact sex life and ways that patients can bring it up comfortably with their providers.
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Sharon Parish, MD
Sharon Parish, MD is a Professor of Medicine in Clinical Psychiatry at Weill Cornell Medicine, and an Attending Physician at New York Presbyterian Westchester Division. In addition to her academic and hospital clinical responsibilities, she maintains an active faculty practice specializing in sexual medicine.Learn more about Sharon Parish, MD
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Melanie Cole (Host): Many women have a physical, hormonal or medical condition that's sabotaged our sex lives yet, very few of us bring it up with our doctors or if we do, we're not necessarily offered solutions. Thanks for tuning into Back to Health, the podcast that brings you up to the minute information on the latest trends and breakthroughs in health, wellness, and medical care. Today's special episode is part of our Women's Health Wednesday series, which features in-depth conversations with Weill Cornell Medicine's top physicians on issues surrounding women's health throughout the life course. Listen here for the information and insights that will help you make the most informed and best healthcare choices for you.
I'm Melanie Cole and today, we're talking with Dr. Sharon Parish. She's a Professor of Medicine in Clinical Psychiatry at Weill Cornell Medicine and an Attending Physician at New York Presbyterian Weill Cornell Medical Center. Dr. Parish, it's a pleasure to have you join us today. And this is a really important topic that's not often discussed really out in the open, but that's what we're going to do today. Can you give us a little background on the field of sexual medicine itself and your background in this field?
Sharon Parish, MD (Guest): Well, thank you so much for this opportunity. It's such an important topic for women and often so underrepresented in discussions about women's health and in the one-on-one doctor - patient encounter as well. So, I'm really thrilled to have this opportunity to share about the field. So, the first part of your question is what is sexual medicine or sexual health and then, how does that translate into the medical setting? Typically we think about contraception. We think about pregnancy related issues, even STDs and maybe even menopause, but kind of the last player on the list often is thinking whether there's sexual satisfaction, sexual problems, et cetera.
So, the field of sexual health for me, and I, do focus my practice, I see both men and women for sexual problems, but I do focus on midlife women, which often involves menopause; is looking at the impact of the menopausal transition and other medical conditions, health-related issues on how that might affect sexual function and sexual satisfaction.
I'm a medical provider. So, I look at the biological factors, but because it's has a far reaching impact into many domains of women's lives, I also look at the psychological, social and cultural domains and how those might affect sexual function in women.
Host: What an interesting and very important field you're in now. So, tell us how a woman's overall health could be linked to our sexual health and activity.
Dr. Parish: Sure. To start with, I think one question that often comes up is how does menopause affect sexual function? So, as women stop menstruating and ovarian estrogen, and to some extent other hormones like testosterone and progesterone change, there can be differences in sexual desire, sexual responsiveness, sexual arousal, and even problems with sexual pain, particularly having to do with the estrogen supplied to the genitals, to the vulva and to the vagina.
The specific concern that sometimes affects women is vaginal dryness and sexual pain in the menopause. That's a direct effect of changes in hormones, particularly estrogen as we age and pass through the menopausal transition.
There are other chronic illnesses that can affect sexual function. Things like diabetes, high blood pressure, even high cholesterol, this can affect vascular supply, blood flow. The medications we take, can sometimes have an impact on sexual function. And sometimes medications taken for psychiatric or psychological problems have sexual side effects.
So, that's just an example, but there are numerous other issues that can come up. I actually want to throw one more in which is sometimes treatments for cancer. When women receive a variety of treatments, for example, for breast cancer or gynecologic cancer, which can impact sexual function.
Host: So thank you for that. Now tell us then what kinds of treatments are out there? Obviously, it is based on the specific condition and situation, but tell us a little bit about how you work with women. What do you do? How do they tell you what's going on? Are some of them hesitant to say what the issue is? Is there still a feeling of self-esteem or stigma? How do you work with women Dr. Parish, to get to the root of some of these issues?
Dr. Parish: Sure. One thing that we've learned in research about how women feel about talking with clinicians about sexual function is that they really do want the opportunity to speak about these concerns and they want good information and often treatments or interventions or recommendations. Those recommendations could be counseling on lifestyle. Counseling on relationships or psychological factors or in fact, specifical medical treatments or medical adjustments to the regimen or risk factor or lifestyle modification that has a medical basis to help with these sexual problems. The problem is that women are reluctant to bring it up.
Men and women, both patients are really reluctant to bring it up because they may be embarrassed or they don't know how the clinician is going to respond, or they don't know if the clinician can help. So, I strongly recommend, and I do this in my own practice and I recommend when I teach and lecture about this or supervise trainees is to ask screening questions.
And one of the most effective strategies is to use what we call a ubiquity statement, which is to normalize and universalize sexual function changes with age or just sexual problems in general. For example, many women, I might ask, many women who are undergoing menopausal changes, are receiving treatment for cancer or are on antidepressants notice changes in their sexual function.
How about you? Or often women have questions when they come in for their annual gynecologic exam about their sexual function. How about you? So, it's an open-ended invitation, but it directs the women specifically the sexual concerns and ubiquitizes the normalness of wanting to discuss this. So, if I can leave one message for women, which is go ahead and bring it up. Your clinician wants to help you. And the message for clinicians is ask screening questions and put the woman at ease.
Now, when I do an assessment, I think I mentioned this a little earlier in our discussion. I look at the biological factors that might be the medical conditions or medications. I might do some laboratory testing. I do a psychological, or even a psychiatric assessment that's pertinent to it. I'm a medical physician. I'm an internal medicine, women's health physician, but there are questions that I'm going to ask about that context, as well as the social and cultural domain. And then I look for factors that are modifiable and amenable to intervention.
And that might be a medication adjustment. It might be treatment of a condition like a thyroid condition. And there are also, you asked about specific treatments for sexual function. So, there are specific treatments available. For vulvovaginal changes related to menopause and post-menopause there are topical low dose local hormone therapy, such as estrogen treatments. For sexual desire problems in premenopausal women, there are two medications flibanserin and bremelanotide that works specifically on the central or the CNS or brain processes related to sexual desire. There are also nonpharmacologic treatments like sex therapy, mindfulness therapy, and even recommendations like devices for improving arousal such as vibrators. Some of this is prescription. Some of these are recommendations. There is also some research supporting the use of off label testosterone in women, that's evidence-based for low sexual desire after menopause.
Host: Wow. There are so many treatment options available now, Dr. Parish, that weren't available to women just 20 years ago. We hear about Viagra for men and for women seems like there's not one single pill that can do what we would want it to do. What do you want women to know about being our own best health advocate? Knowing our bodies well enough to not be afraid to talk to our doctors about any dysfunction or pelvic pain that we're experiencing and some self-care that you'd like us to know about.
Dr. Parish: Well, I think if I could pick two things, one is that if you're experiencing a distressing loss of sexual desire, and this is a change, bring it up with your doctor because there may be a risk factor intervention, or there may be a medical treatment available for you. And that's true for both pre and post-menopausal women.
And if you're post-menopausal, the biggest complaint or concern I hear is vaginal dryness and pain with intercourse or pain with sexual activity. And there are both non-pharmacolic and there are very, very well researched evidence-based available pharmacologic, low dose hormone therapies. So ask your doctor about it.
Don't ignore the symptom. Don't live with this diminishment in your quality of life because it can get better. And there are some relatively easy to use, very accessible options, but just feel brave and bring it up.
Host: You briefly mentioned things that we can use. You even mentioned vibrators. Do you have some things that you like to recommend to women if we are kind of in that exploration phase and trying to figure out what it is, it is whether you're pre-menopausal or post-menopausal women, you know, sometimes it can be a whole new experience at that time. Is there something you really like to recommend to women that can make this all just a little bit better for us?
Dr. Parish: So, I have a few really key recommendations. One is that I think women are reluctant to use lubricants with sexual activity for comfort, and that can make a world of difference. Water-based or silicon-based depending on your preference and also compatibility with condoms, if it's necessary. Moisturizers, which are available over the counter vaginal moisture. They can improve comfort and that might change the game completely. And then I, as I mentioned already, vibrators, and, there are a variety of available on the market. They're very commonly recommended by medical and sex therapists and psychological therapists who address sexual problems.
They do help improve arousal and can be incorporated into self stimulation as well as partner sex. Sometimes lastly dilators, they're more of a medical recommendation. They can be integrated and helpful for stretching tissue after a treatment for cancer, for example, or after menopause, when the tissue might become a little tighter. So those are the four big things I sometimes will counsel women about. And it can make a big difference.
Host: So I'd like you to end with your best advice for women and our sexual health and our sexual awareness to really let us know that it's okay to talk to our doctors, to really let us know that we have to be brave. This is about us. And so give us your best advice, Dr. Parish.
Dr. Parish: One of the things that I tell all my patients is don't be embarrassed. Sexual health and sexual function, satisfaction and intimacy and relationships are very, very important. They're not a sidekick. They're extremely central to well-being, to happiness, to overall quality of life and even improving other aspects of your health.
So, if you're experiencing a distressing change, if you're experiencing pain, if you're experiencing anything that you don't understand about your sexual response, feel brave and bring it up with your clinician. If they don't have the answer, ask if they can refer you to someone who does. I think if you can do that, you'll go a long way in taking care of yourself when it comes to your sexual health.
Host: 100%, we're a whole being, we're not just one part. So, it's so important. The information you've given us today, Dr. Parish. Thank you so much for joining us. And we're so glad that you joined us for Women's Health Wednesday. We hope you'll tune in and become part of a community and a fast-growing audience of women looking for knowledge, insight, and real answers to hard questions about their bodies and their health. Please download, subscribe, rate, and review Back to Health on Apple podcasts, Spotify and Google podcast. For more health tips, please visit Weillcornell.org and search podcasts.
And parents, remember to check out our Kids' Health Cast too. I'm Melanie Cole.
Melanie Cole (Host): Many women have a physical, hormonal or medical condition that's sabotaged our sex lives yet, very few of us bring it up with our doctors or if we do, we're not necessarily offered solutions. Thanks for tuning into Back to Health, the podcast that brings you up to the minute information on the latest trends and breakthroughs in health, wellness, and medical care. Today's special episode is part of our Women's Health Wednesday series, which features in-depth conversations with Weill Cornell Medicine's top physicians on issues surrounding women's health throughout the life course. Listen here for the information and insights that will help you make the most informed and best healthcare choices for you.
I'm Melanie Cole and today, we're talking with Dr. Sharon Parish. She's a Professor of Medicine in Clinical Psychiatry at Weill Cornell Medicine and an Attending Physician at New York Presbyterian Weill Cornell Medical Center. Dr. Parish, it's a pleasure to have you join us today. And this is a really important topic that's not often discussed really out in the open, but that's what we're going to do today. Can you give us a little background on the field of sexual medicine itself and your background in this field?
Sharon Parish, MD (Guest): Well, thank you so much for this opportunity. It's such an important topic for women and often so underrepresented in discussions about women's health and in the one-on-one doctor - patient encounter as well. So, I'm really thrilled to have this opportunity to share about the field. So, the first part of your question is what is sexual medicine or sexual health and then, how does that translate into the medical setting? Typically we think about contraception. We think about pregnancy related issues, even STDs and maybe even menopause, but kind of the last player on the list often is thinking whether there's sexual satisfaction, sexual problems, et cetera.
So, the field of sexual health for me, and I, do focus my practice, I see both men and women for sexual problems, but I do focus on midlife women, which often involves menopause; is looking at the impact of the menopausal transition and other medical conditions, health-related issues on how that might affect sexual function and sexual satisfaction.
I'm a medical provider. So, I look at the biological factors, but because it's has a far reaching impact into many domains of women's lives, I also look at the psychological, social and cultural domains and how those might affect sexual function in women.
Host: What an interesting and very important field you're in now. So, tell us how a woman's overall health could be linked to our sexual health and activity.
Dr. Parish: Sure. To start with, I think one question that often comes up is how does menopause affect sexual function? So, as women stop menstruating and ovarian estrogen, and to some extent other hormones like testosterone and progesterone change, there can be differences in sexual desire, sexual responsiveness, sexual arousal, and even problems with sexual pain, particularly having to do with the estrogen supplied to the genitals, to the vulva and to the vagina.
The specific concern that sometimes affects women is vaginal dryness and sexual pain in the menopause. That's a direct effect of changes in hormones, particularly estrogen as we age and pass through the menopausal transition.
There are other chronic illnesses that can affect sexual function. Things like diabetes, high blood pressure, even high cholesterol, this can affect vascular supply, blood flow. The medications we take, can sometimes have an impact on sexual function. And sometimes medications taken for psychiatric or psychological problems have sexual side effects.
So, that's just an example, but there are numerous other issues that can come up. I actually want to throw one more in which is sometimes treatments for cancer. When women receive a variety of treatments, for example, for breast cancer or gynecologic cancer, which can impact sexual function.
Host: So thank you for that. Now tell us then what kinds of treatments are out there? Obviously, it is based on the specific condition and situation, but tell us a little bit about how you work with women. What do you do? How do they tell you what's going on? Are some of them hesitant to say what the issue is? Is there still a feeling of self-esteem or stigma? How do you work with women Dr. Parish, to get to the root of some of these issues?
Dr. Parish: Sure. One thing that we've learned in research about how women feel about talking with clinicians about sexual function is that they really do want the opportunity to speak about these concerns and they want good information and often treatments or interventions or recommendations. Those recommendations could be counseling on lifestyle. Counseling on relationships or psychological factors or in fact, specifical medical treatments or medical adjustments to the regimen or risk factor or lifestyle modification that has a medical basis to help with these sexual problems. The problem is that women are reluctant to bring it up.
Men and women, both patients are really reluctant to bring it up because they may be embarrassed or they don't know how the clinician is going to respond, or they don't know if the clinician can help. So, I strongly recommend, and I do this in my own practice and I recommend when I teach and lecture about this or supervise trainees is to ask screening questions.
And one of the most effective strategies is to use what we call a ubiquity statement, which is to normalize and universalize sexual function changes with age or just sexual problems in general. For example, many women, I might ask, many women who are undergoing menopausal changes, are receiving treatment for cancer or are on antidepressants notice changes in their sexual function.
How about you? Or often women have questions when they come in for their annual gynecologic exam about their sexual function. How about you? So, it's an open-ended invitation, but it directs the women specifically the sexual concerns and ubiquitizes the normalness of wanting to discuss this. So, if I can leave one message for women, which is go ahead and bring it up. Your clinician wants to help you. And the message for clinicians is ask screening questions and put the woman at ease.
Now, when I do an assessment, I think I mentioned this a little earlier in our discussion. I look at the biological factors that might be the medical conditions or medications. I might do some laboratory testing. I do a psychological, or even a psychiatric assessment that's pertinent to it. I'm a medical physician. I'm an internal medicine, women's health physician, but there are questions that I'm going to ask about that context, as well as the social and cultural domain. And then I look for factors that are modifiable and amenable to intervention.
And that might be a medication adjustment. It might be treatment of a condition like a thyroid condition. And there are also, you asked about specific treatments for sexual function. So, there are specific treatments available. For vulvovaginal changes related to menopause and post-menopause there are topical low dose local hormone therapy, such as estrogen treatments. For sexual desire problems in premenopausal women, there are two medications flibanserin and bremelanotide that works specifically on the central or the CNS or brain processes related to sexual desire. There are also nonpharmacologic treatments like sex therapy, mindfulness therapy, and even recommendations like devices for improving arousal such as vibrators. Some of this is prescription. Some of these are recommendations. There is also some research supporting the use of off label testosterone in women, that's evidence-based for low sexual desire after menopause.
Host: Wow. There are so many treatment options available now, Dr. Parish, that weren't available to women just 20 years ago. We hear about Viagra for men and for women seems like there's not one single pill that can do what we would want it to do. What do you want women to know about being our own best health advocate? Knowing our bodies well enough to not be afraid to talk to our doctors about any dysfunction or pelvic pain that we're experiencing and some self-care that you'd like us to know about.
Dr. Parish: Well, I think if I could pick two things, one is that if you're experiencing a distressing loss of sexual desire, and this is a change, bring it up with your doctor because there may be a risk factor intervention, or there may be a medical treatment available for you. And that's true for both pre and post-menopausal women.
And if you're post-menopausal, the biggest complaint or concern I hear is vaginal dryness and pain with intercourse or pain with sexual activity. And there are both non-pharmacolic and there are very, very well researched evidence-based available pharmacologic, low dose hormone therapies. So ask your doctor about it.
Don't ignore the symptom. Don't live with this diminishment in your quality of life because it can get better. And there are some relatively easy to use, very accessible options, but just feel brave and bring it up.
Host: You briefly mentioned things that we can use. You even mentioned vibrators. Do you have some things that you like to recommend to women if we are kind of in that exploration phase and trying to figure out what it is, it is whether you're pre-menopausal or post-menopausal women, you know, sometimes it can be a whole new experience at that time. Is there something you really like to recommend to women that can make this all just a little bit better for us?
Dr. Parish: So, I have a few really key recommendations. One is that I think women are reluctant to use lubricants with sexual activity for comfort, and that can make a world of difference. Water-based or silicon-based depending on your preference and also compatibility with condoms, if it's necessary. Moisturizers, which are available over the counter vaginal moisture. They can improve comfort and that might change the game completely. And then I, as I mentioned already, vibrators, and, there are a variety of available on the market. They're very commonly recommended by medical and sex therapists and psychological therapists who address sexual problems.
They do help improve arousal and can be incorporated into self stimulation as well as partner sex. Sometimes lastly dilators, they're more of a medical recommendation. They can be integrated and helpful for stretching tissue after a treatment for cancer, for example, or after menopause, when the tissue might become a little tighter. So those are the four big things I sometimes will counsel women about. And it can make a big difference.
Host: So I'd like you to end with your best advice for women and our sexual health and our sexual awareness to really let us know that it's okay to talk to our doctors, to really let us know that we have to be brave. This is about us. And so give us your best advice, Dr. Parish.
Dr. Parish: One of the things that I tell all my patients is don't be embarrassed. Sexual health and sexual function, satisfaction and intimacy and relationships are very, very important. They're not a sidekick. They're extremely central to well-being, to happiness, to overall quality of life and even improving other aspects of your health.
So, if you're experiencing a distressing change, if you're experiencing pain, if you're experiencing anything that you don't understand about your sexual response, feel brave and bring it up with your clinician. If they don't have the answer, ask if they can refer you to someone who does. I think if you can do that, you'll go a long way in taking care of yourself when it comes to your sexual health.
Host: 100%, we're a whole being, we're not just one part. So, it's so important. The information you've given us today, Dr. Parish. Thank you so much for joining us. And we're so glad that you joined us for Women's Health Wednesday. We hope you'll tune in and become part of a community and a fast-growing audience of women looking for knowledge, insight, and real answers to hard questions about their bodies and their health. Please download, subscribe, rate, and review Back to Health on Apple podcasts, Spotify and Google podcast. For more health tips, please visit Weillcornell.org and search podcasts.
And parents, remember to check out our Kids' Health Cast too. I'm Melanie Cole.