Your new book, Love Sex Again, addresses female sexual dysfunction. How common is it?
It [affects] 40 percent of women and 60 percent of postmenopausal women. The number one mistake [they make] is accepting sexual dysfunction as normal.
What causes it?
Number one is low libido. It may be [due to] medication; it may be depression. It may start out that you’re having painful intercourse. Then of course you’re going to have decreased libido, because people don’t want to do painful things.
And what typically causes the pain?
Sometimes it’s endometriosis, and sometimes it’s genital dryness. [If] someone doesn’t lubricate, that very often is because of hormonal issues: menopause or birth control pills. [Also] you need a good blood supply to the vagina in order to have normal lubrication, and women with diabetes and heart disease often have a decline in their blood supply in that area.
How do you fix it?
It may well be if [a woman] uses the right lubricant, she’s going to be fine.
And if not?
Women are nervous about taking hormones. [But] local vaginal estrogen is safe for essentially everyone to use. We’re using this in women with breast cancer because the systemic absorption is so low that it doesn’t even increase their blood levels beyond the postmenopausal range.
Are there any recent breakthroughs that women should be aware of?
There’s a device called InTone that reproduces what a pelvic floor physical therapist does. There are a number of new products, like nonestrogen products for treatment of vaginal dryness, [that] most women are not familiar with.
So sometimes a prescription is necessary?
Would you say to a man who couldn’t maintain an erection that he shouldn’t consider Viagra? Right now there are 25 drugs approved for male sexual health, and other than the vaginal dryness drugs, there are zero approved for female sexual health. That’s a real problem.
Any promising drugs in the pipeline?
Flibanserin has been shown in the medical literature to have an impact on female libido. It is going back to the FDA [for approval] in a couple of months.
You say that most doctors are not up on these solutions. Why?
[Knowledge] is highly variable depending upon where somebody trains. At Northwestern, [sexual health] is not a part of the residency. I’m trying to change that. It sadly all comes down to funding.
Your book is incredibly thorough. I mean, you have a section on kosher lubes and on vajazzling.
Some of that I put in just to have fun.