Mar 13

Sex, Weight and Self after Baby

   For all the Ask Dr R queries about getting your self and your life back after childbirth…

The beauty of motherhood and womanhood lies in the balance

      Losing Baby Weight

Many women look back at their pre-baby clothes convinced they will never wear them again, but there is hope, because most do regain a pre-baby contour within 3-6 months, and some as early as 6 weeks.  Taking care of a newborn takes a lot of energy.  Energy burns calories.  Breast feeding also helps burn calories by revving up your metabolism to provide nourishment for the baby.  Most women do just fine with a healthy diet and getting as much rest as possible. If you have a choice between making dinner and taking a nap, take the nap.  Order take-out or let your spouse cook. Avoid bingeing on comfort foods-they will make you feel better but they also trigger fat production.  Breast feeding moms are usually extremely careful about eating healthy so that the breast milk is the best it can be, and this healthy focus helps them lose the weight they gained with the pregnancy.  Also, light weight-bearing exercise is good for new mothers, particularly exercises that strengthen your core back and abdominal muscles. I don’t advise aerobic exercise, which very likely will increase your fatigue.  We’re talking weights, resistance training and flexibility work. Postpartum is a good time to do yoga, floor Pilates, or basic gym calesthenics.  Even 15 minutes a day can help get your shape back.

          Loss of Libido

The big L.  While some women feel more sensual after the baby is born, for many women the combination of physical and emotional fatigue, sleep deprivation and fluctuating hormones flip the “red hot mama” switch to the “off” position. Breastfeeding also suppresses hormones, putting lactating women into a mini-menopause type situation, with a resulting suppression of the menstrual cycle, transient vaginal dryness and a reduction in clitoral sensitivity.  When these normal, healthy and temporary changes occur full blast, a woman may feel like her libido has been amputated.  Believe it or not, this is nothing to worry about, because it all comes back in full as the baby starts to sleep through the night, weans from the breast, and menses resume.

–     Time for Romance        

          Welcome to motherhood.  And fatherhood for that matter.  Parenting is a two sided coin; taking care of the children and taking care of your relationship.  Both you and your mate need to remember that your relationship a priority.  Children like to see their parents happy, so don’t fall into the “everything we have, everything we do is for and with the children” trap.  After the first few newborn months, get your life back into grown–up balance. Bring in a babysitter, get dressed and go out.  Leave the kids with relatives and take a weekend for yourselves every 4-6 months.  They won’t need psychotherapy if someone else changes their diaper or takes them to soccer practice once in a while.  It’s like the oxygen mask instructions on airplanes- you can’t rescue the kids until you rescue yourself.  Ignore the cranky-type fussing and crying, because you are teaching them one of the most important lessons they will need to be the best parents they can be for your grandchildren.  Some of that fussing and crying is a test to see who’s really running the show in your home.  Let there be no contest. Take each other as seriously as you take your parenting.

          Painful Sex

          Before you have a go at sexual intimacy, check with your clinician (doctor, midwife, physician assistant, nurse practitioner) taking care of you.  If you had stitches, sex has to wait until all the sutures dissolve.  If you didn’t have stitches, sex has to wait until the uterus is back to normal.  Even if you had cesarean, hormonal changes may make the vaginal skin temporarily thin and dry with poor spontaneous lubrication.  Breast feeding may delay the return of normal skin elasticity and lubrication even further.  Sexual lubricants may be all you need to take care of pain caused by vaginal dryness.  If that doesn’t work, talk to your clinician about using topical estrogen cream on the labia and clitoris until your menstrual cycle resumes.  Estrogen cream, applied in small doses with your fingertip, can work magic on vaginal skin elasticity, spontaneous lubrication and clitoral sensitivity.



Content copyright protected on date of online post publication. Content herein does not represent medical advice. 


Dec 13

Obstetric Fistula: an eradicable blight on women’s lives. Let’s end it.


UNFPA campaign to end obstetric fistula invites you to change the world.

Dec 01

Maternal Mortality in Niger & Fashion International de la Mode Africaine 2011

Fashion Internationale de la Mode Africaine

FIMA 2011

It was a pleasure to return to Niamey, Niger, this trip by far the most fashionable, sponsored by internationally renowned designer Alphadi and his innovative wife Kadidja, along with United States Ambassador Bisa Williams and the First Lady of Niger, colleague Dr Malika Issoufou Mahamadou. Promoting health and wellness along with creativity, fashion, beauty and the power of the African Diaspora, Fashion Internationale de la Mode Africaine 2011 made a clear statement – Health is Beautiful.

The Fashion Internationale de la Mode Africaine whirlwind of creative genius is the brainchild of haute couture designer Alphadi, whose dedication to the promotion of African fashion transcends the political landmines and traditional dogma of Nigerien culture, sparking debate in his country and awe in the world of international fashion.

Women’s Health

Committed to promoting health and wellness along with creativity and couture, FIMA 2011 invited 3 American physicians, Dr. Emily Nichols and her husband Dr. Jonel Daphnis – specialists in internal medicine and adult/pediatric emergency medicine, and myself – specialist in urogynecology and obstetric fistula repair. It was a pleasure to reconnect with colleague and expert fistula surgeon Dr. Abdoulaye Idrissa, connecting his work at the National Hospital in Niger with the newly minted Cure Hopital au Niger run by Dr. Gary Roark, and a tragedy to see the women suffering fistula waiting for surgical repair at the National Hospital no longer permitted to live on the hospital grounds, relocated instead to a garbage dump across the street from the hospital, camped out in a shared sisterhood of sorrow, resilience, patience and hope.

Dr. Gary Roark of CURE Hopital au Niger and Dr. Abdoulaye Idrissa of Hopital National, Niamey Niger


Obstetric Fistula

Obsetric fistula patients living in garbage dump next to hospital, Niamey Niger 2011

While these women gave permission to show their faces, the picture chosen is one that preserves anonymity, both for their privacy rights and to highlight the non-anonymous rag tents fenced with garbage in the background. In this place of filth and feral cats they have camaraderie, belonging and hope that was lost to them in their lives of exile as totally incontinent obstetric fistula sufferers living on the margins of their communities. As of my last mission to Niamey in 2005, these women were permitted to live on hospital grounds while waiting for surgery and after discharge from hospital while securing arrangements to return home. New hospital rules do not permit overnight stays unless you are in a hospital bed. With no half-way house option, these women now live across the street from the hospital, in sight of the side-entrance, in an open air garbage dump.




Maternal Mortality

The prevalence of obstetric fistula is difficult to know with certainty, typically extrapolated from the maternal mortality data to which it is closely related. Niger, for many years running, lays claim to the worst maternal mortality rate on the planet, at 1:7 risk. Compare this to maternal mortality in developed nations at 1:4000, and the difference between the two is simply obscene.

Obstructed Labor, Death and Disability

One great contributor to maternal mortality is obstructed labor. Without ready access to trained clinicians during labor, or EmOC (emergency obstetric care), women in obstructed labors lasting for 3, 4, 5 days and some up to a week, have 2 possible outcomes- maternal death, or maternal survival with severe damage to bodily function, including vaginal fistula causing constant incontinence of urine or stool, severe foot drop from pelvic nerve compression, uterine infection resulting in infertility, and vaginal fibrosis precluding sexual function, usually in some combination of miseries and almost always associated with a stillborn infant. Can you imagine the trauma, depression and anxiety these women suffer?

In developed nations we call this obstructed labor “failure to progress”, preventing the stillborns, fistulas, nerve damage and vaginal destruction with cesarean section performed according to accepted standards of care. For women living in remote rural areas of poor nations, access to such care does not exist. Women labor alone, or with a local lay-midwife with no formal training.

Access to emergency obstetric (EmOC) care allows any woman of any age and condition to be delivered safely, to be able to count on her own survival and that of her baby. Reduce maternal mortality through EmOC and watch obstetric fistula disappear, watch neonatal survival improve, just as occurred in the States and Europe with the advent of ready access to Cesarean delivery made possible by the then novel application of Ether anesthesia in the late 1800’s. Some 200 years later, the pregnant women of Niger are living as did women worldwide in 1850, in fear of their lives and the lives of their unborn babies with every single pregnancy every single time.

Taking care of the women takes care of the children, takes care of the men, takes care of the community and creates a new future full of hope and possibility for the country. Right now, as this post occurs, the pregnant women of Niger would be safer in DR Congo, in Somalia, Sudan, Bangladesh, Pakistan or Afghanistan. And all of these women in all of these developing and middle income countries can only dream of the safety and optimal mother-child outcomes enjoyed by their sisters lucky enough to live in wealthy nations where antenatal care and routine access to EmOC has nearly obliterated the constant threat of pregnancy-related death and disability.

With this initial collaboration of Nigerien and American doctors, the First Lady of Niger, the US Embassy and the creative genius of the House of Alphadi FIMA 2011, we look forward to the day when the women of Niger can rest assured that they, their daughters and grand daughters will bring forth future generations in comfort, in safety, in health as a birthright for mother and child.

FIMA 2011 Touareg Haute Couture – Niamey Niger

Content is copyright protected on date of online publication. Content herein does not represent medical advice. To learn more about pelvic floor disorders such as fistula, pelvic organ prolapse, dropped bladder, dropped uterus, hysteropexy uterine resuspension, vaginal laxity, rectocele, postpartum rehabilitation, vaginal rejuvenation, labiaplasty, vaginoplasty, Kegel exercise or incontinence please visit other posts in this blog and the Urogynics website at

Sep 06

Pelvic Organ Prolapse Surgery and Graft Complications 1950-present

Vaginal prolapse surgery with synthetic and non-synthetic graft material –

Concerns about the use of graft material, particularly Prolene mesh, continue to mount after the most recent FDA warning on mesh in vaginal surgery.  These diligent authors from Michigan, Texas, Massachussetts, Washington State, New Mexico and Israel combed the international medical literature in all languages from 1950 to present, looking for data on adverse events when graft material is used at the time of vaginal prolapse repair. Three common problems, erosion (graft eroding through the vaginal skin so that it is palpable to touch and/or visible to the examining eye), granulation tissue (“proud flesh” commonly found in wounds as they heal inside and outside of the body), and dyspareunia (painful sex) were the key factors under review.

Granulation, Erosion, Dyspareunia and Prolapse Organ Prolapse Surgery with Graft Materials

What they found is that rates of each of the three complications did not differ between synthetic (such as non-absorbable Prolene or absorbable  Vicryl mesh) vs non-synthetic (such as porcine [Surgisis] or bovine [Xenform] or human cadaver-based) graft material, and that reportage with regard to sexual problems was so spotty and incomplete that it was difficult to figure out if women with sexual pain after surgery had sexual pain before surgery with the problem persisting after reconstruction, or whether it was clear that the surgery definitely caused the dyspareunia (sexual pain).

Of the more than 2000 mauscripts considered, less than 200 were included and most did not report on all three of these possible complications. In more recent years, the reportage tended to be consistent with our modern-day concerns, as one might expect the case to be.

Bottom line: there are no guarantees. Grafts reduce prolapse recurrence rates, but come with their own set of headaches.


To mesh or not to mesh?

Synopsis for the Journal of Sexual Medicine from original manscript published in the July 2011 issue of the International Urogynecology Journal:

Abed H, Rahn DD, Lowenstein L, Balk EM, Clemons JL, Roberts RG

Incidence and management of graft eriosion, wound granulation and dyspareunia following vagianl prolapse repair with graft maeriasl: a stematic review.

Int Urogynecol J (2011) 22:789-98.

This metanalysis reviewed global data published from 1950-2010 from papers  reporting adverse events after vaginal prolapse repairs using graft materials. 2260 citations were identified using Medline search terms including vaginal or uterine prolapse, rectocele, surgical mesh, cystocele, and similar pelvic  floor terms. After review of each, data from 196 manuscripts was included in this analysis. Graft erosion was reported in 110 studies (10.3%) with similar rates for synthetic and biologic grafts.  Diagnosis of erosion occurred between 6 weeks and 12 months. The most common risk factor for erosion was concomitant hysterectomy, as well as patient age, smoking and diabetes, surgeon experience, and use of T incision of vaginal skin during dissection. Granulation tissue as reported in 7.8% of the 16 papers reporting on this outcome in series using a single type of graft material. While not statistically significant, the reported rate of granulation was higher with biologic graft material than with synthetic/permanent graft material (9.1% and 6.8%, respectively). Spontaneous resolution of granulation tissue and resolution with suture removal and silver nitrate treatment were reported treatment options.

Dyspareunia was reported in 71 papers with overall incidence of 9.1%, rates similar between synthetic and biologic grafts, with risk factors including posterior repair and mesh erosion. Listed treatments included vaginal estrogen cream and excision of eroded mesh. The authors point out that many of these studies did not limit reportage to sexually active women, nor make clear whether the painful sex was persistent or de novo. They also remind the readers that dyspareunia is known to occur with native tissue repairs also, operations where no graft material of any sort is used. The authors go on to report that most of the studies did not including what proportion of women sere sexually active, how may had pre-existing sexual dysfunction and how many benefited from improved sexual function. They state that as more studies use the validated quality of life Pelvic Organ Prolapse / Urinary Incontinence Sexual Questionnaire, the quality of  data on the impact of pelvic floor surgery on sexual function will improve in accuracy and clinical relevance.

Content is copyright protected on date of online publication. Content herein does not represent medical advice. To learn more about pelvic floor disorders such as fistula, pelvic organ prolapse, dropped bladder, dropped uterus, hysteropexy uterine resuspension, vaginal laxity, rectocele, postpartum rehabilitation, vaginal rejuvenation, labiaplasty, vaginoplasty, Kegel exercise or incontinence please visit other posts in this blog and the Urogynics website at



Aug 29

Female sexual function and vaginal surgery

Vaginal Prolapse Surgery, Vaginal Contour and Female Sexual Function

This is another manuscript I reviewed for the Journal of Sexual Medicine, published by colleagues from The Mayo Clinic in the International Urogynecology Journal July 2011 issue. These authors looked carefully at the possibility of change in vaginal contour resulting from pelvic organ prolapse surgery with regards to female sexual function. They measured vaginal length and width before, immediately after (patient still in the operating room under anesthesia, case finished), and 6 months after surgery. The women completed a validated questionnaire for prolapse, incontinence and sexual function in women called the PISQ-12 before and 6 months after surgery. In summary, vaginas were a bit shorter and a bit narrower after surgery, and sexual function quality of life questionnaire scores did not change, nor did sexual satisfaction or lack thereof correlate to vaginal measurements either before or after surgery.  This helpful study will no doubt be repeated in various fashion as we in the field of urogynecology do our best to adhere to the mandate of “primum non nocere” (first, do no harm).

Once you’ve done this:

Childbirth - good thing they're so cute

You might need this:


Cutting & Sewing - 2 darts and a dash of facing, voila!

To get back to this:


Anatomy in 3-D - the vagina in relation to the rest of you

Journal summary:

Ochhino JA, Trabuco EC, Heisler CA, Klingele CJ, Gebhart JB.

Changes in vaginal anatomy and sexual function after vaginal surgery.

Int Urogynecol J (2011) 22:799-804

The authors enrolled 92 women undergoing vaginal reconstruction prolapse surgery in study including pre- and post-surgery completion of a validated sexual function questionnaire (PISQ-12) and in measurement of vaginal contour before, immediately after, and 6 months after surgery in order to determine whether changes in vaginal length and caliber correlate to changes in sexual function. All but one of the women was white. 72.8% were menopausal and 16.3% had undergone one prior prolapse operation. 47.8% were sexually active before surgery with a preoperation PISQ-12 score of 33.5. Pre-operation vaginal length was 10.4 cm on average with mean caliber 3.2 cm. Some women had intentional coning (narrowing) of the top of the vagina to correct excessive laxity and some did not – those undergoing coning (N=14) were evaluated separately from those who did not (N=78) for post-op vaginal contour measurements.

Immediately after surgery while still anesthetized, vaginal length of women with no coning was reduced to 7.9 cm with caliber 3.0 cm while coned patients measured 6. 8 cm length with caliber 2.8 cm. At 6 months postop, the no-cone women measured 8.7 cm length with 2.8 cm caliber while coned women continued to measure 6.8 cm length with .2 cm caliber.

74 women completed the PISQ-12 prolapse-incontinence-sexual function questionnaire at 6 months post-surgery, with 52.6% sexually active. Only 34 sexually active women completed the questionnaire before and after surgery, and in this group no change in score was demonstrated (33.4 vs 34.7). Further, no correlation was found between pre0operation score and vaginal length or caliber or between post operation score and vaginal length or caliber. The authors did not comment on the drop-out rate for questionnaire completion. They point out that, according to this data in this first study to look at changes in vaginal contour as correlates to sexual function, changes in vaginal dimensions does not seem to affect sexual function in women who were sexually active before and after the pelvic organ prolapse operation.

Level of evidence: III Count: 325 words

Content is copyright protected on date of online publication. Content herein does not represent medical advice. To learn more about pelvic floor disorders such as fistula, pelvic organ prolapse, dropped bladder, dropped uterus, hysteropexy uterine resuspension, vaginal laxity, rectocele, postpartum rehabilitation, vaginal rejuvenation, labiaplasty, vaginoplasty, Kegel exercise or incontinence please visit other posts in this blog and the Urogynics website at



Aug 22

Ask Dr R: painful sex- perineoplasty?

Painful sex after menopause

Hello Dr. R,

I am a 51 year old that has pain upon entry, visited my doctor and he is suggesting a perineoplasty, is that the same procedure as a Fenton’s?  Is there anything else that wouldn’t be as invasive? I do not want to take hormones and I am not ready for my sexual life to be over.  Once the opening is loosened up a bit it doesn’t hurt as long as I use a lubricant. Would this be a senario for a perineoplasty?  Thank you so much!


Painful sex (dyspareunia) after menopause is best treated with a dose of creativity - rush not to the knife!

Dyspareunia: perspective from a urogynecologist

Hello L,

Without examining you, it is impossible to know if a perineoplasty is your only treatment option for painful sex (dyspareunia). I strongly suggest you seek second opinions from urogynecology specialists in your area, which you may locate through American Urogynecologic Society. Therapies may include vaginal estrogen, dilators, pelvic floor physical therapy, pelvic floor electrical stimulation, valium vaginal suppositories, or some combination there-of.  You may consider perineoplasty and Fenton’s to be synonymous for this indication. Keep us posted…

Dr R


Content herein does not represent medical advice. To learn more about pelvic floor disorders such as fistula, pelvic organ prolapse, dropped bladder, dropped uterus, hysteropexy uterine resuspension, vaginal laxity, rectocele, postpartum rehabilitation, vaginal rejuvenation, labiaplasty, vaginoplasty, Kegel exercise or incontinence please visit other posts in this blog and the Urogynics website at

Aug 15

Labia minora: anatomy and sex

Labiaplasty, cosmetic gynecologic surgery, female sexual function and anatomy of the female vulva

Vulvar anatomy circa 1798. Some things never change. Thank goodness...


Every two months I report for on scientific manuscripts in the recent medical literature for the Journal of Sexual Medicine that pertain to female sexual function. In an anatomic study of vulvar anatomy published in the journal of the American Urogynecologic Society, scientists took a close look at the microscopic goings on of labia minora. The controversy over labiaplasty and other forms of cosmetic gynecologic surgery rages on, with proponents on both sides claiming “fair” and “foul” in equal measure.

The clitoris has erectile function

Unless you believe in the G-Spot orgasm and are of the opinion that there is a difference between “internal/vaginal” and “external/clitoral” orgasms for women, you’re probably in agreement with most physiologists and anatomists that the female orgasm emanates from the clitoris, the organ in the body with the highest density of sensory nerves and an intense erectile response to sexual stimulation. That’s right, ladies. Your clitoris gets a woody every time you have an orgasm, or even get aroused.  The role of labia majora and labia minora in this erectile and orgasmic function is so poorly understood it’s almost criminal. Seriously – do you know how much is understood about male sexual function and role of erectile tissue in a man’s sexual pleasure? They’ve written books about it. An entire pharmaceutical industry is making $$bajillions catering to it. Courses are taught, books are written, Medicare PAYS FOR IT (all of it) right down to the fancy shmancy-est of prosthetic penile implants.

Labia minora: high density of nerve function and blood flow

So this study took a look at the micro-anatomy of labia minora. Few studies have reported any meaningful data on labiaplasty’s (surgical reduction of labia minora) impact on sexual function. There is one study by a renowned cosmetic genital surgeon who reported that out of 166 women undergoing combined labiaplasty and clitoral hood reduction, 38 reported better sexual pleasure and 9 reported a worse, or a negative impact on sexual function, from the procedure. This raises the question that it may be possible for genital cosmetic operations done to improve sexual function may actually have the opposite effect…

Being that the subjects in this particular study were all cadavers, evaluating sexual function was not possible. But the researchers did find a high density of nerve fibers on both the outer and inner surfaces of labia minora in all specimens, in addition to a high density of blood vessels, in excess of that needed to maintain the skin of the labia, indicating a high likelihood that the blood vessels of the labia minora play some role in the sexual response and possibly in the engorgement and erectile function of the clitoris, although these points remain to be proved in studies on live women.

Remember, one study does not an absolute fact make. This area of gynecologic surgery is in evolution, and this anatomy study is one important contribution to that body of literature that will permit, over time, for meaningful conclusions to be made.

Here’s the summary to appear in the Journal of Sexual Medicine sometime this fall:

Ginger VAT, Cold CJ, Yang CC.

Structure and innervation of the labia minora: more than minor skin folds.

2011 Female Pelvic Medicine & Reconstructive Surgery  17:4, 180-3.

Eight fresh cadaveric vulvar specimens were fixed and stained to report the histologic features of the labia minora with regard to female sexual function.

Labia were highly variable in appearance. Labia minora were thin in relation to majora, and in some cases fused. No labia minora contained fatty component, as do the labia majora. After fixation and histologic staining, the inner labum minus were found to be  covered by a basket-weave keratin type dermis.. The substance included numerous vascular structures surrounded by connective collagen and no smooth muscle, thereby making the labia minora vascular tissue non-erectile.  Elastin was abundant, as were neural elements with no difference in distribution of neural elements between the lateral and medial sides of the labia minora. There was a central core of neural elements long the length of the labia, traveling alongside vascular structures to form the neuro-anatomic substrate where sexual arousal results in labial engorgement. Neural elements were sparse with in the labia majora.  Histologic images are included to illustrate these findings. The authors go on to comment on genital labioplasty done for aesthetic or functional reasons, reiterating that reports of diminished sexual responsiveness are documented in at least one series of 166 women undergoing labiaplasty and clitoral hood reduction, where 9 reported negative effect on sexual sensation in contrast to 38 reporting improved sexual sensations.  They note that among reports on labia minora structure, very little mention is made of possible function. They comment that the specimens obtained for hits study were likely, but not know for certain, to be from menopausal women in which degenerative changes would have been present and that despite this, a high density of neural and vascular elements were found in the labia minora of the specimens evaluated.  They finish by stating that “Biochemical and molecular studies may further elucidate (the labia minora’s) role in the female sexual response,… which are specialized vascular structures with densely distributed neural elements providing anatomic substrate for changes observed during sexual arousal”.

Content herein does not represent medical advice. To learn more about pelvic floor disorders such as fistula, pelvic organ prolapse, dropped bladder, dropped uterus, hysteropexy uterine resuspension, vaginal laxity, rectocele, postpartum rehabilitation, vaginal rejuvenation, labiaplasty, vaginoplasty, Kegel exercise or incontinence please visit other posts in this blog and the Urogynics website at

Jul 19

Female Sexual Dysfunction and Androgens: The Real Deal


Just because you’ve gone through menopause doesn’t mean sex—and the DESIRE for sex—should stop.

Ten years ago, a sex study published in Journal of the American Medical Association found that 43% of women suffer from sexual dysfunction at some point…compared to just 31% of men.

To be fair, and clear, the conclusions drawn from this study continue to be hotly debated since publication, as many in the healthcare profession raised concerns about the medicalization of women’s sexuality and the integrity of this study’s conclusions, which many specialists consider exaggerated.

That said, many women find the age related decrease in sexual urges disturbing and distressing.

Traditionally, a woman reporting problems with libido finds herself thwarted in her efforts to restore prior sexual appetites, as the medical profession is notorious for telling women they have to “live with it”.

Male and female symbols

Testosterone is good for girls AND boys

Despite this, the only FDA-approved treatments for problems between the sheets—Viagra, Cialis, and Levitra—target men.

This is why Procter and Gamble introduced Intrinsa, a testosterone patch medication designed to treat female sexual dysfunction, or FSD, caused by natural reductions in testosterone as women approach age 50. Low testosterone can affect libido and sexual arousal.

FSD involves any condition involving the inability to become or remain aroused during sex, the inability to achieve an orgasm,  and/or the presence of pain during intercourse. Not all of these symptoms are due to testosterone deficiency. The symptoms of FSD are often more prominent during hormonally vulnerable periods, like menopause or during lactation and breast feeding. Menopause can occur naturally with age, or abruptly when a woman’s ovaries are removed surgically.

Intrinsa is targeted at women who have undergone the menopausal transition and who are suffering sexually as a result of the age-related, inevitable drop in testosterone levels. Intrinsa  is a clear, egg-shaped patch which adheres to the skin on a woman’s belly that works by releasing small, controlled amounts of testosterone into a woman’s bloodstream.

Testosterone is a “masculine” sex hormone which is produced by a woman’s ovaries and adrenal gland. A woman’s testosterone level drops with most with birth control pills, and always with natural or surgical menopause. By age 45 or so, most women’s testosterone levels have decreased  by 50% from peak levels in the mid-20’s!

The theoretical clinical benefit to increasing serum levels of testosterone in the blood is to  reduce libido and arousal symptoms of FSD. Being a patch, Intrinsa CAN cause side effects, such as rash, redness, itching, and irritation at the patch site.

More importantly, testosterone is a powerful hormone, to be used with the greatest of caution and fastidious monitoring. More is NOT better! Because testosterone is a male sex hormone, overdosing may cause extremely troubling and potentially irreversible side effects such as: deepening of the voice, an increase in facial hair, enlargement of the clitoris, weight gain, cardiovascular conditions and hair loss.

Despite Intrinsa’s promise to effectively treat sexual dysfunction, however, the US FDA rejected the medication in 2004, citing a need for more studies. As a result, Proctor and Gamble took Intrinsa to Europe, where it is available by prescription. If you want to try Intrinsa, clear it with your doctor and hop the red-eye. Otherwise, women in the States suffering arousal disorder-type sexual dysfunction can talk to their gynecologist about diagnosing and treating androgen deficiency syndrome…a fancy term for “low testosterone”, that may be treatable with off-label applications of currently available hormone preparations on this side of the pond.


Jul 13

Pregnancy, Prolapse and Cesarean on Demand

Cesarean on Demand

More women than ever before are showing up at the hospital in labor and asking for a cesarean section.

According to the National Institutes of Health, the rate of c-section delivery has increased 40% since the mid-90s, a trend reflected in these NIH summary statements:

Between 1996 and 2007, the C-section rate rose by 53 percent, with similar rises seen among all age, racial and ethnic groups, according to the report released Tuesday from the U.S. Centers for Disease Control and Prevention’s National Center for Health Statistics, which used birth certificate data to arrive at this conclusion.


After a slight dip in the late 1990s, C-section rates began marching relentlessly upward again. The pace of the increase has accelerated since 2000, with the overall rate surging from 23 percent to 32 percent in 2007

That translates to about one in four American babies being born via cesarean section.

So why has “cesarean on demand” become so popular?

One frequent reason is today’s mom-to-be believes avoiding a vaginal birth will reduce her risk of incontinence and pelvic organ prolapse down the road.

Pelvic organ prolapse is a condition that occurs when a woman’s bladder, rectum, or uterus shifts from its proper location, and moves into the vaginal canal.

But giving birth via cesarean section is NOT NECESSARILY the 100% protection from protection that some women think it is.


Pregnant woman

If only we came with zippers

Pelvic Organ Prolapse and Pregnancy

There’s new research on this topic, reflected in a new study published in the International Urogynecology Journal that examined the impact of a woman’s first pregnancy on pelvic support and found that less than one year after giving birth via c-section without labor, 21% of women experienced moderate organ prolapse and 5% of women who had cesarean deliveries experienced severe prolapse.

Since cesarean delivery did not necessarily prevent prolapse, the study’s authors suggest that simply BEING PREGNANT can increase a woman’s likelihood of prolapse, regardless of delivery mode!

This coincides with data showing that 50% of women who have borne children will experience prolapse at some point,  compared with 30% of ALL women, including women who’ve never been pregnant.

It IS important to note that women who gave birth vaginally DID experience higher rates of prolapse, according to the same Urogynecology Journal study.

But are these numbers significant enough to warrant cesarean on demand?

Maternal and neonatal mortality, uterine rupture, placenta previa & obstetric hemorrhage

Maternal mortality rates from cesarean are THREE TIMES higher than in vaginal delivery, according to Obstetrics and Gynecology.

Moreover, Birth magazine reported that babies are more than twice as likely to die when delivered via cesarean.

Knowing this, it makes sense NOT to opt for c-section delivery unless there is a legitimate medical reason for the best health of the mother or the baby.

Once the uterus heals from cesarean, future pregnancies are at risk for uterine scar separation, called uterine rupture, that can be deadly for the baby, and for problems with placenta previa, where the placenta is low and can hemorrhage at any time, further risking the life of the baby. Uterine rupture and obstetric hemorrhage are two good reasons to take cesarean section very seriously.

Thinking about elective cesarean section? Be a smart mother – make a wise choice with your obstetrician.

For a video on this topic, visit video on the truth about childbearing and cesarean on demand

Content herein does not represent medical advice. To learn more about pelvic floor disorders such as fistula, pelvic organ prolapse, dropped bladder, dropped uterus, hysteropexy uterine resuspension, vaginal laxity, rectocele, postpartum rehabilitation, vaginal rejuvenation, labiaplasty, vaginoplasty, Kegel exercise or incontinence please visit other posts in this blog and the Urogynics website at

Jul 07

Vitamin D and Women’s Health

The Center for Disease Control attests that at least 77% of American adults don’t get enough Vitamin D. And while that’s bad news for everyone, it’s often WOMEN who suffer most.

Image of a woman taking a vitamin D pill

Vitamin D - good for bones, prolapse, incontinence, autism, ...

Vitamin D is involved in regulating up to 2,000 different genes in the human body.

Considering that this amounts to 10% of our makeup, it’s disturbing that so many adults are D deficient.

Recent research shows that women in particular should be concerned about getting adequate levels of vitamin D.

A study at Boston University School of Medicine recently found that pregnant women who are vitamin D deficient are FOUR TIMES more likely to require delivery by cesarean section.

Similarly, the risk for both preeclampsia, which is dangerously high blood pressure, and pre-term labor, is significantly increased when a mom-to-be is lacking the nutrient.

And risks from a mom’s D-deficiency extend to an infant, as well.

Vitamin D is important for the proper development of a fetus’s brain, and it’s a significant factor in preventing respiratory infections and wheezing after birth.

Vitamin D deficiency is also being investigated as a potential culprit in the development of autism!

Low levels of the nutrient can also make it more difficult to conceive a pregnancy in the first place, according to findings reported in the American Journal of Clinical Nutrition.

And even if you’re not trying to conceive, researchers at Creighton University in Omaha found that women who get adequate amounts of vitamin D are up to 60% LESS likely to get breast, skin and lung cancer.

Plus, multiple studies have linked vitamin D deficiency in women to mood disorders such as premenstrual syndrome, seasonal affective disorder, major depressive disorder, and non-specific mood disorder.

Postmenopausal women should be aware that low levels of the nutrient may lead to osteoporosis, or thinning bones.

Women of all ages with vitamin D Deficiency are more likely to suffer urinary incontinence and pelvic organ prolapse.

No matter what your age or stage of life, ensure that you’re getting enough of this VITAL nutrient by asking your doctor to test your blood levels.

Women who are deficient may benefit from a daily supplement or increased sun exposure.

To learn more about essential vitamins and minerals, check out this video on Vitamin D and Womens Health, courtesy

Content herein does not represent medical advice. To learn more about pelvic floor disorders such as fistula, pelvic organ prolapse, dropped bladder, dropped uterus, hysteropexy uterine resuspension, vaginal laxity, rectocele, postpartum rehabilitation, vaginal rejuvenation, labiaplasty, vaginoplasty, Kegel exercise or incontinence please visit other posts in this blog and the Urogynics website at


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