Sexual health is an important part of health and wellness, but it can be uncomfortable to discuss with your healthcare provider. But for Sandy Clatanoff, 56, starting the conversation was the key to unlocking a better quality of life.
Sandy first noticed sexual health symptoms, specifically pelvic organ prolapse, in 2019. Pelvic organ prolapse is a condition where weakened pelvic muscles — including the vagina, bladder, uterus and rectum — can sag and, in severe cases, bulge onto a nearby organ or outside of the body. Sandy also began to experience pain with sex and low sex drive (low libido).
Sandy saw her local gynecologist, who misdiagnosed the issue and prescribed treatments that didn’t relieve her symptoms. Then, Sandy met with her primary care provider, who referred her to Atrium Health.
Pelvic organ prolapse surgery
Sandy was referred to Dr. Erinn M. Myers, a female pelvic medicine and reconstructive surgeon at Atrium Health Women's Care Urogynecology & Pelvic Surgery. Dr. Myers diagnosed Sandy with rectal prolapse and performed surgery to correct the issue.
“When the prolapse first happened, I was embarrassed,” says Sandy. “But as soon as you walk in the door at Atrium Health, everyone is so nice and makes you feel comfortable.”
Though the surgery was successful at correcting the rectal prolapse, Sandy continued to experience undesirable symptoms, including low libido (sex drive).
“Sex wasn’t nearly as painful after I had the surgery, but I just didn’t care if I ever had sex again,” she says. “When I was intimate with my husband, I loved it, but I had no desire. I thought I was stuck like that.”
Treatment options for low libido in women
Myers referred Sandy to Rachel Murray, a board-certified women’s health nurse practitioner at Atrium Health Women's Care Sexual Health with an additional certification from the North American Menopause Society (NAMS).
Sexual health issues can be caused by a variety of factors, but are often related to hormonal changes and menopause, so treatment typically works with hormones to improve symptoms. Sexual function can also be affected by:
- Depression
- Anxiety
- Relationship problems
- Poor body image
- History of sexual abuse or trauma
- Stress
- Pregnancy and breastfeeding
- Substance use disorders
- Heart and vascular disease
- Diabetes
- Neurological disorders or nerve damage
- Chronic conditions like liver or kidney failure
- Cancer
- Medication side effects
“Generally speaking, women start to see a gradual drop in testosterone around age 35 and over time, that can have an impact on libido,” says Murray. “Studies show approximately 40% of women in the United States struggle with painful sex. As many as 84% of women have genitourinary syndrome of menopause, which can cause vaginal atrophy. When this occurs, vaginal tissue breaks down and this puts them at risk for pain, urinary tract infections (UTIs) and vaginal infections.”
For low libido, medications like testosterone and flibanserin (an antidepressant that can treat hypoactive sexual desire disorder) can help increase spontaneous sexual desire. There’s also an injectable medication women can use for planned desire as well as ointments and creams to help with symptoms of painful intercourse.
“When I met with Rachel, it was such a relief,” says Sandy. “I found out all of my symptoms could be fixed. She understood what I was talking about and everyone in the office made me feel so comfortable. It was like a huge weight was lifted off my shoulders.”
Murray prescribed testosterone cream to be applied to the skin once a day and flibanserin, an oral medication.
Sandy noticed an improvement in her symptoms within a month or two.
“I thought I would never get a lot of pleasure out of sex again, but now I do,” she says. “Anybody can. That’s why I’m willing to talk about this.”
Why women shouldn’t be afraid to talk about sexual health
“Sexual medicine is uncomfortable for some women to talk about because it is unfortunately still stigmatized,” says Murray. “In school, women are taught how to prevent pregnancy, but aren’t taught what a healthy sexual experience should be like.”
Sexual health has a significant impact on a woman’s quality of life.
“Having sexual health issues can increase a woman’s risk of anxiety and depression, decrease sexual satisfaction, and impact their relationships,” says Murray.
When to talk to your healthcare provider about sexual health
If you experience sexual health symptoms for three to six months or more, talk to your primary care provider or gynecologist. Sexual health issues in women can include:
- Low sex drive
- Pain during intercourse
- Vaginal dryness
- Difficulty becoming aroused
- Difficulty achieving orgasm
“People are so happy when they come to our office and with their outcomes,” says Murray. “They didn’t know there was anything they could do, so many women struggled in silence and felt isolated, but there are evidence-based treatments that can help.”
If you’re unsure how to broach the topic of sexual wellness with your provider, Murray recommends saying something like, “I have some sexual health concerns today. Would this be an appropriate place to talk about it or can I have a referral to a sexual medicine specialist?”
Sandy is an advocate for speaking up, even if you’re embarrassed or nervous.
“I want women to know that this isn’t the end and these issues can be fixed,” she says. “Rachel was able to help me get my sex drive back. I feel fantastic and my husband is happy. Rachel is a miracle worker.”
Learn more about Atrium Health Women's Care Sexual Health.
