Out from under the covers
Women and men have become equals in the home and the workplace, but a public acknowledgment and acceptance of female sexuality still lags behind. To open up a frank discussion of this important and often misunderstood health area, BeWell spoke with Leah S. Millheiser, MD, FACOG, IF, a clinical assistant professor of obstetrics and gynecology who practices at Stanford Hospital & Clinics and Lucile Packard Children’s Hospital.
How would you define sexuality?
Sexuality is a combination of several factors: the degree of sexual attractiveness, the quality of sexual function and the sum of a person’s sexual behavior and tendencies (and the strength of those tendencies).
Are there stages?
Yes: sexuality is very fluid, and changes throughout life. Sexuality spans kids who aren’t aware of what they are doing/experimenting … to women in their 90s.
Is there a difference in how society deals with female versus male sexuality?
Unfortunately, yes. In many ways, America is still puritanical in its views about women and sex. Presidential candidate Bob Dole can be on a TV commercial for Viagra during dinner time, but a commercial for an over-the-counter treatment to improve female sexual arousal can’t be shown until after 11 p.m.
What affects a woman’s sexuality?
- A woman’s hormonal makeup (which can vary throughout life)
- Medications (birth control, SSRIs, beta blockers and medications for breast cancer, etc.)
- Psychosocial stressors, including relationships, work or home stress, kids, and body image
- Nerve function and blood flow
What can a woman expect to happen when she has a baby?
In the first six months, a woman should expect:
- Altered body image: women often don’t like their body when pregnant or after delivery, and this decreases sexual activity
- Increased incontinence (leaking of urine)
- Pain from tearing
It is important to note that these conditions all improve within the first six months.
A woman can expect a couple of other factors to be more variable:
- Breastfeeding lowers estrogen and testosterone and can cause vaginal dryness
- Lifestyle changes in the home: couples are learning to adjust to having a baby in the house and become less carefree
Is sexuality impacted by perimenopause or menopause?
Women between the ages of 20 and 40 have a 50% drop in testosterone. Accordingly, women will notice a decline in desire that is not just about work, kids, etc. Rather, it is truly a biological process. Testosterone does not necessarily correlate to libido; psychological factors are also involved.
The number one complaint from women during this time is vaginal dryness and lower libido. Without addressing this condition, it will not improve, but instead may continue to wax and wane depending on what is happening in the woman’s life. Male partners may also experience their own function issues (erectile dysfunction).
What is the current clinical consensus on hormone use?
At the end of the day, the doctor will look at the individual woman and her symptoms. Physicians typically will not prescribe hormones without moderate to severe symptoms, such as hot flashes or vaginal dryness. Not every woman is a candidate. Hormones are not the enemy anymore.
What about sexuality later in life?
A recent study showed that 50% of seniors are sexually active, which includes kissing, touching, oral sex and masturbation. Men are more active than women, but this is likely because women don’t always re-partner after the loss of a partner. We often remain sexually active until we die.
How can female sexual health and wellness improve?
There are two FDA-approved drugs for female sexual dysfunction: Premarin vaginal cream and Osphena. Both are for the treatment of dyspareunia caused by postmenopausal vaginal atrophy. We hope the FDA approves more novel drugs for both pre- and postmenopausal women, especially for the treatment of low libido, which is the most common type of sexual complaint in women.
Interview conducted by Julie Croteau and edited by Lane McKenna Ryan.
Sex differences in medicine