Tampa Obstetrics, Fertility & Gynecology

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Adam S. Levine, M.D. recently finished his fellowship in reproductive endocrinology and infertility within the department of gynecology and obstetrics at the Johns Hopkins University School of Medicine. His areas of expertise include reproductive endocrinology, infertility, assisted reproductive technology, reproductive surgery, pediatric and adolescent gynecology, and menopause.

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sexuality

Q:     Four months ago I gave birth to a very large baby boy (9 lb., 13.1 oz.) I was given an episiotomy during the birth. Although I was told at my six-week post-partum checkup that the incision was completely healed, I have experienced severe pain at the incision site every time my husband and I have tried to make love. Is this pain normal? Will it go away by itself? How long do my husband and I have to wait for it to go away?
A:   During pregnancy a woman's body undergoes several changes. One of these changes is a gradual relaxation between the ligaments and tendons of the pelvis. The ligaments and tendons maintain the bony pelvic architecture. This relaxation occurs so that a baby may pass through the birth canal between the pelvic bones. A 9-lb,13.1-oz. baby is fairly large, and an episiotomy was probably made in this case to facilitate a safe delivery.
   There are two different types of episiotomy; mediolateral and midline. Both can be different sizes as necessary. Usually both types of episiotomy heal within 2 to 6 weeks. However, in some cases the superficial incision (skin surface) appears completely healed, while the underlying, deeper incision may still be in the process of healing. The pain experienced during sexual intercourse may occur as the episiotomy continues to heal or as the physiologic changes that occurred during the preceding 9 months of pregnancy resolve. Typically, most women experience either minimal or no pain within 6 weeks. In any case, severe pain should be evaluated by an obstetrician-gynecologist.

Q:    I recently heard a discussion on a TV talk show about testosterone ointment cream for women. It seems that this cream is applied vaginally and supposedly restores sexual desire. My doctor prescribed it for me, but we are unsure of the amount to use, as well as how often to use the drug for it to be effective. Can you also tell me if there is any research being done on this cream?
A:   Libido is the technical term for sexual desire. There is some evidence to suggest that a woman's libido is influenced by the amount of androgens (male hormones) in her blood. After women become menopausal, androgen levels decline, which may result in a decrease or loss of libido. Libido may also be adversely affected by falling estrogen (female hormone levels).
   Unfortunately, there is no well-established treatment for improving libido. Some have tried to improve libido by administration of androgens in a variety of ways, including pills (methyltestosterone or DHEA) or topical administration (ointments or creams). However, the most common reason to use topical testosterone (a type of androgen) preparations is to treat abnormal labial skin conditions. Further, there is only a limited amount of data available that supports the use of androgens in any form for improving libido. Since the data is so limited, there is no recommended dose or amount to use. In this case, consultation with a Reproductive Endocrinologist may be helpful. S/he can recommend a dose and route of administration, as well as possibly referring you to an ongoing study.

Q:   Just read your article on Claratin. I used it and felt that it caused impotence. After I stopped using Claratin everything returned to normal. Have you heard of this before?
A:   Yes. Impotence is defined as the inability to satisfactorily achieve or maintain a penile erection to permit penetration and ejaculation. Claratin along with many other antihistamines (allergy preparations) and pharmaceutical products (blood pressure medications) is associated with impotence. In some cases, a simple modification of the dose, such as using it every other day instead of every day, may improve the symptoms. In others cases, changing medications is most effective. Men with new onset impotence that is not related to a new medication should seek a medical evaluation.

Q:   In the last three months, I have lost more than 20 pounds on a calorie-controlled diet. I am thrilled with the results, but I have lost my sex drive. Could you please let me know if this is typical? I have stopped getting my period, and although my doctor is monitoring me, I would like to know if the hormone imbalance could have negatively affected my libido?
A:   It is difficult to fully answer your question without more information. Generally, any reproductive age, sexually active woman who stops having regular menses (technically referred to as amenorrhea) should be evaluated by a gynecologist. The first thing that should be established is whether or not she is pregnant. There are many different conditions that can cause a woman's menses to temporarily stop. Some of these conditions may also result in a decrease in libido. Significant physiologic stressors (such as a 20-pound weight loss over a short time) can potentially result in amenorrhea.

Q:   I am a 24-year-old female who became sexually active 9 months ago. Sex has always been painful. I stopped taking birth control pills two months ago, because I thought that was the problem, but I still have pain, burning and itching. I constantly feel dry. Test results for infection came out negative twice. I am on asthma medication. (Slo-bid, Accolate, Ventolin Inhaler, Flovent, Intal, Atrovent). Could this be causing my problem?
A:   Painful sexual intercourse is technically referred to as dyspareunia. It may result from a variety of different conditions. One common cause of dyspareunia is vaginitis. Vaginitis generally arises from infectious causes such as bacteria or yeast. Vaginitis may also occur as a result of an allergic reaction to soaps, laundry detergents, or other personal hygiene products. Dyspareunia may also occur in women who have pelvic inflammatory disease (sexually transmitted diseases such as gonorrhea or chlamydia that may cause an infection in the uterus or fallopian tubes), endometriosis (a condition where the lining of the uterus grows outside the uterus and causes pain), psychological issues or other dermatological (skin) conditions.
   A pelvic examination by a gynecologist in conjunction with a "wet prep" (a microscopic examination of vaginal secretions) or vaginal and cervical cultures (looking for infection) should be able to detect many of the underlying reasons for dyspareunia.
   Oral contraceptive use is not a common cause of dyspareunia. In fact, oral contraceptives are used by many practitioners to treat dyspareunia. Because of the risk of sexually transmitted diseases (HIV, gonorrhea, chlamydia, and syphilis), condom use is commonly recommended in addition to oral contraceptive use.
   A possible side effect of some asthma and allergy medications is reduced vaginal secretions. This may result in vaginal dryness and ultimately painful sexual intercourse. Since the use of these medications is important, it may be more advisable to treat the vaginal dryness. Any of the over-the-counter vaginal lubricant preparations may be used. It is important, however, to read the information that is provided with the lubricant to be sure that it can be used safely with condoms. Information about specific lubricants may be obtained from a physician or a pharmacist.

©1999 Tampa Obstetrics, P.A. All rights reserved. All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician before starting a new fitness regimen.

Q: Four months ago I gave birth to a very large baby boy (9 lb., 13.1 oz.) I was given an episiotomy during the birth. Although I was told at my six-week post-partum checkup that the incision was completely healed, I have experienced severe pain at the incision site every time my husband and I have tried to make love. Is this pain normal? Will it go away by itself? How long do my husband and I have to wait for it to go away?	A: During pregnancy a woman's body undergoes several changes. One of these changes is a gradual relaxation between the ligaments and tendons of the pelvis. The ligaments and tendons maintain the bony pelvic architecture. This relaxation occurs so that a baby may pass through the birth canal between the pelvic bones. A 9-lb,13.1-oz. baby is fairly large, and an episiotomy was probably made in this case to facilitate a safe delivery. There are two different types of episiotomy; mediolateral and midline. Both can be different sizes as necessary. Usually both types of episiotomy heal within 2 to 6 weeks. However, in some cases the superficial incision (skin surface) appears completely healed, while the underlying, deeper incision may still be in the process of healing. The pain experienced during sexual intercourse may occur as the episiotomy continues to heal or as the physiologic changes that occurred during the preceding 9 months of pregnancy resolve. Typically, most women experience either minimal or no pain within 6 weeks. In any case, severe pain should be evaluated by an obstetrician-gynecologist.
Q: I recently heard a discussion on a TV talk show about testosterone ointment cream for women. It seems that this cream is applied vaginally and supposedly restores sexual desire. My doctor prescribed it for me, but we are unsure of the amount to use, as well as how often to use the drug for it to be effective. Can you also tell me if there is any research being done on this cream?	A: Libido is the technical term for sexual desire. There is some evidence to suggest that a woman's libido is influenced by the amount of androgens (male hormones) in her blood. After women become menopausal, androgen levels decline, which may result in a decrease or loss of libido. Libido may also be adversely affected by falling estrogen (female hormone levels). Unfortunately, there is no well-established treatment for improving libido. Some have tried to improve libido by administration of androgens in a variety of ways, including pills (methyltestosterone or DHEA) or topical administration (ointments or creams). However, the most common reason to use topical testosterone (a type of androgen) preparations is to treat abnormal labial skin conditions. Further, there is only a limited amount of data available that supports the use of androgens in any form for improving libido. Since the data is so limited, there is no recommended dose or amount to use. In this case, consultation with a Reproductive Endocrinologist may be helpful. S/he can recommend a dose and route of administration, as well as possibly referring you to an ongoing study.
Q: Just read your article on Claratin. I used it and felt that it caused impotence. After I stopped using Claratin everything returned to normal. Have you heard of this before?	A: Yes. Impotence is defined as the inability to satisfactorily achieve or maintain a penile erection to permit penetration and ejaculation. Claratin along with many other antihistamines (allergy preparations) and pharmaceutical products (blood pressure medications) is associated with impotence. In some cases, a simple modification of the dose, such as using it every other day instead of every day, may improve the symptoms. In others cases, changing medications is most effective. Men with new onset impotence that is not related to a new medication should seek a medical evaluation.
Q: In the last three months, I have lost more than 20 pounds on a calorie-controlled diet. I am thrilled with the results, but I have lost my sex drive. Could you please let me know if this is typical? I have stopped getting my period, and although my doctor is monitoring me, I would like to know if the hormone imbalance could have negatively affected my libido?	A: It is difficult to fully answer your question without more information. Generally, any reproductive age, sexually active woman who stops having regular menses (technically referred to as amenorrhea) should be evaluated by a gynecologist. The first thing that should be established is whether or not she is pregnant. There are many different conditions that can cause a woman's menses to temporarily stop. Some of these conditions may also result in a decrease in libido. Significant physiologic stressors (such as a 20-pound weight loss over a short time) can potentially result in amenorrhea.
Q: I am a 24-year-old female who became sexually active 9 months ago. Sex has always been painful. I stopped taking birth control pills two months ago, because I thought that was the problem, but I still have pain, burning and itching. I constantly feel dry. Test results for infection came out negative twice. I am on asthma medication. (Slo-bid, Accolate, Ventolin Inhaler, Flovent, Intal, Atrovent). Could this be causing my problem?	A: Painful sexual intercourse is technically referred to as dyspareunia. It may result from a variety of different conditions. One common cause of dyspareunia is vaginitis. Vaginitis generally arises from infectious causes such as bacteria or yeast. Vaginitis may also occur as a result of an allergic reaction to soaps, laundry detergents, or other personal hygiene products. Dyspareunia may also occur in women who have pelvic inflammatory disease (sexually transmitted diseases such as gonorrhea or chlamydia that may cause an infection in the uterus or fallopian tubes), endometriosis (a condition where the lining of the uterus grows outside the uterus and causes pain), psychological issues or other dermatological (skin) conditions. A pelvic examination by a gynecologist in conjunction with a "wet prep" (a microscopic examination of vaginal secretions) or vaginal and cervical cultures (looking for infection) should be able to detect many of the underlying reasons for dyspareunia. Oral contraceptive use is not a common cause of dyspareunia. In fact, oral contraceptives are used by many practitioners to treat dyspareunia. Because of the risk of sexually transmitted diseases (HIV, gonorrhea, chlamydia, and syphilis), condom use is commonly recommended in addition to oral contraceptive use. A possible side effect of some asthma and allergy medications is reduced vaginal secretions. This may result in vaginal dryness and ultimately painful sexual intercourse. Since the use of these medications is important, it may be more advisable to treat the vaginal dryness. Any of the over-the-counter vaginal lubricant preparations may be used. It is important, however, to read the information that is provided with the lubricant to be sure that it can be used safely with condoms. Information about specific lubricants may be obtained from a physician or a pharmacist.