Promising Treatments for Women's Intimate Health

So I wrote a book for Women's Health regarding hormone replacement therapy. It's called Testosterone. Strong enough for a man, but made for a woman. And the real, you know, messaging was that it's not just estrogen, progesterone, it's also testosterone is your key component to your healthy aging. When you go through menopause, you're not working anymore and you start getting more disease, more weight gain, more thinning of the bones, your brain gets older faster, you get more cardiovascular disease, more wrinkles. We restore a lot by basically regenerating you by using a pellet of testosterone and estrogen and some progesterone. And when we have patients getting this done, it's usually about every four months, three. I'm sorry, three months, they're getting their hormone pellet, they feel better, everything is working better, energy is better, mood's better, skin's better, look better, hair is typically better. And we don't really address this enough that we should. But we need to talk about sexual health. So a big part of when we think about hormone replacement in a woman is sex and your libido and your ability to have an orgasm or enjoy sex. And things happen such as dryness and decrease orgasm and what can we do? So a lot of things we've been doing over the last 20 years, they've evolved tremendously. I'm going to go through those and if you're not comfortable hearing about these, go ahead and turn this off. So the one thing we do commonly is a vaginal rejuvenation with something called intimalase. And this is a laser device made by Fotana. We have them and it goes inside the vagina with almost like a little like a, like a dildo sleeve. And the laser goes inside of it and it causes the tissue to regenerate. And we see improvement of urinary incontinence, improvement of urinary incontinence and improvement of vaginal moisture. And the tissue gets more friction so there's more sensation, so it makes the tissue younger. So that's, that's the one thing. And if you are interested in that, that's something we do in our offices in Livonia and Shelby. Number two is using some kind of a hormone cream on your genitalia. So estrogen in the form of estriol. Estriol is a non stimulating hormone, meaning it doesn't stimulate the growth of your uterine tissue. It's good for moisture and vaginal sensation. And if somebody has dryness and it's not quite working with the hormone replacement you can go on estriol cream. I love using it for that. Then there's testosterone gel. So testosterone gel is usually like a 0.1 or 2% on the, on the external genitalia. Increases your sensitivity and your ability to have an orgasm. So those are ways to approach it from using hormone replacement. There's something we call screen cream, scream cream. It is something like something called ergotomine. It's kind of a theophylline or aminophylline and sometimes use a form of cialis. And it causes blood flow to improve to the area. Sensation improve in the area. And women have orgasms typically faster or more often multiple orgasms. If you had that in the past, you don't have as much more. And if you had a hard time having an orgasm makes it happen faster and easier. There's a sublingual pill you can put in of Viagra and oxytocin that allows women to have orgasms easier and faster. Very inexpensive, last probably parts of it last about an hour and other parts last about 20 hours. So you have to be really good with timing. There is something that's called, there's a trademark name the O shot and that is using platelet rich plasma or platelet rich fibrin into the clitoris. Now we don't use the O shot. I don't have that trademark. It belongs to another doctor. But that's what it is. It's basically a common word now referring to injecting platelet rich plasma or platelet fibrin into the clitoris which the other ones with the creams you're using it before sex. With the OSHA you're doing it to last for you know, a year or whatever. And increases blood flow to the clitoris. Doesn't make it bigger. It does temporarily because you're putting something in there but. And it hurts a bit. So we put a numbing cream on first. But the so called osha, the PRF and the clitoris improves the clitoral sensation, the ability to have a clitoral orgasm. The G spot shot or the G shot. I wrote a blog on this back in 07. It's still the most popular blog out there on this Very really interesting. I'm not sure why anybody's looking it up but that's a common thing to consider is the G spot, that's a vaginal orgasm. And it was first described by Dr. Matlock in the early 2000s using collagen. Now we use a hyaluronic acid, something like juvederm or Rebanese. We put three syringes into the G spot, which is right inside. If you see where your urethra is at, it's just about a half an inch behind that. And you put three CCs in, you have more G spot sensation, a better ability to have an orgasm. And interestingly, a doctor done an autopsy on women who were dead, obviously autopsy. And based on if they had vaginal orgasms or not. And the women that did not have vaginal orgasms had a very thin, thin G spot pad, but the same number of nerve endings as women that did have vaginal orgasm that had a thicker pad. And this led to ultrasound studies and others to see that, okay, when that pad's thinned out, you have less vaginal orgasms. So the woman that's had vaginal orgasms in the past, and now it's not happening as easy. The G shot is a good option. Now, in the past, 15 years ago, I would tell a woman, if you've never had a vaginal orgasm, this will not work. Now it's proven wrong by patients that asked me to do it anyways. It's just not consistent. It's not consistent. So if you've had vaginal organs in the past, this probably will work. Clitoral orgasms, the O shot will work or PRF will work, and you could do them both. So there's something called clitox. So Botox or Xeomin, actually, they use xeomin into the clitoris. And the exact mechanism is not understood, but it's been well described where you put 50 units of a toxin. Neurotoxin, Xeomin was the one studied. And it somehow affects the autonomic, say, sympathetic versus parasympathetic nervous system. And a lot of people would describe, like, a man might say, I can't get an erection when I'm nervous. And I think about it, I can't get erection. And a woman might say, I can't get clitoral orgasm when I'm thinking about her or nervous. And somehow this turns off this sympathetic tone that makes the parasympathetic system work better. And I think there's some other mechanism as well that Botox into the clitoris lasts about six months or so. And that tells us there's really a lot of other options. I really think about patients that are going through hormone replacement, which I feel that every woman who's in menopause should consider hormone replacement. A big disservice to our women's health in the last hundred years. Probably the biggest one was we stopped using hormone replacement as a routine in women in menopause. That was a standard of care. And this study came back in 2000, 2004 and sort of shift shot that down. It was totally misunderstood. Now we're understanding that we should not have abandoned that practice. They subjected a lot of women to a shorter lifespan. But hormone replacement therapy is step one then based on the condition vaginal or clitoral orgasms. Is there vaginal laxity? Is there urinary incontinence, Is there dryness? There are solutions for all these things that can lead to a better quality of life. Potentially better relationships just make you feel more confident. So don't be afraid to ask your provider about those things. And I'm going to list them out again because there was a lot. So vaginal rejuvenation, we use the Fotana. There are other devices on the market that work quite well. So I wouldn't say there's one that's the best, but when I bought our machines in 2015 there was really limited choices and Fotana was the best. I'd say that it's still the top one right now, but there's other that would meet it so you don't have to do it full time. There's other options. The topical estriol cream I like for vaginal dryness better than estradiol because it's non stimulating to the uterus. So estriol cream, excuse me, 3% topical testosterone gel to apply to the external vulva like the clitoris and the lips for that something you'd put on say before sex, an hour or so before sex. Whereas the vaginal estrella you can put on any head. And then there is the sublingual cialis oxytocin combination. A few hours before sex there is the screen cream which is something you get compounded. Your doctor can order that for you. And it's a standard name scream cream. All the compounding pharmacists know what's in it. And then there is the clit tox, the clitoris toxin, the O shot that's called Oshot trademark name that we use PRF into the clitoris and the G spot shot or the G shot which is a filler into the G spot that is done by your provider. So those are options for you. And you know, if you're having some sexual concerns, you have that discussion with your provider and we have a lot of options for you. That's really something that maybe doesn't get brought up all the time. It might be a little embarrassing. Somebody comes in with their pellet. Hey, how's your sex? It might feel weird, so bring it up to your provider. And they're very knowledgeable about it, so thank you.