Download Women`s Sexual Health Health Radio September 24, 2007 Hilda

Women's Sexual Health
Health Radio
September 24, 2007
Hilda Hutcherson, M.D.
Lisa Martinez, R.N./J.D.
Please remember the opinions expressed on Patient Power are not necessarily the views of Health Radio, our
sponsors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care
from your own doctor. Please have this discussion you’re your own doctor, that’s how you’ll get care that’s
most appropriate for you.
Introduction
Andrew Schorr:
Hello. This is Andrew Schorr. Welcome once again to Patient Power on HealthRadio
Network. Thank you so much for being with us. You know, so often we talk about very
serious health concerns. They dominate your life. I'm a leukemia survivor so when I was
diagnosed with that all I thought about was how am I going to beat the cancer. If you're
diagnosed with a chronic condition like multiple sclerosis or rheumatoid arthritis or you're
told you have diabetes, you say, Oh, my god, what am I going to do? And you're focused
on the treatments and trying to live as well as you can. Well, where was your life before
this? You had things you enjoyed. You had hobbies. You had relationships, hopefully,
and if you did have relationships part of that relationship that's normal and healthy is
having a sex life. And that's very important to all of us. And, you know, it's still
important even if you have a health concern. Actually, it's part of healing and enjoying
the life you have. So it's about time that Patient Power talks about that, and so we have
two experts joining us today where we can do that. There's a conference coming up and
it's really something that's essential in our lives, and whether you've had a health concern
in the past or there's one you're dealing with now, it still can be part of your life.
So I want you to meet Lisa Martinez. Lisa is executive director of the Women's Sexual
Health Foundation. And also Dr. Hilda Hutcherson, who is an obstetrician/gynecologist.
She's an educator, author. She's at Columbia University Medical Center. She's a clinical
obstetrics and gynecology professor there, and she's also director of Gynecologic Teaching
Associates. So first of all, Lisa, thank you for joining us from Ohio today.
Ms. Martinez:
Thank you. It's a pleasure to be on your program.
Andrew Schorr:
Thank you. And Dr. Hutcherson, thanks so much. I saw you on the TODAY show the
other day, feel like I know you. Thank you for joining us too.
Dr. Hutcherson:
Oh, it's my pleasure.
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Addressing Intimacy Issues with Your Doctor
Andrew Schorr:
So, Lisa, I want to start with you. So you have your foundation. How come? You know,
it would seem like sex is pretty natural and people just proceed and they don't need a
foundation for it. Why is it even an issue? Why does it need to be talked about more?
Ms. Martinez:
Well, what we found was for example those who have had cancer 90 percent of patients
who have had cancer have problems with intimacy, and yet no one is really addressing
those issues with them. And what we heard from women was the fact that they didn't
know how to bring up the topic and, when they did bring up this topic with their
healthcare provider many times their healthcare provider really didn't have the education
or the background to assist them. And we were hearing this over and over again. I have
a nursing background, and at that point we decided we needed to start a foundation to
bridge the gap between healthcare providers and women to educate them and to help
everyone understand that there are solutions, there's help out there and really not to give
up on this area of their lives.
Andrew Schorr:
Now, Dr. Hutcherson, I want to ask you more about it as an obstetrician/gynecologist. It
would seem like, though, that's basic to being an obstetrician/gynecologist. Obviously
you're doing pap smears and pelvic exams, and you're helping women who want to have
babies and then go on with their lives or looking out for various conditions that come up.
But isn't sex part of the natural discussion? Why is there a gap?
Dr. Hutcherson:
Well, one would think so, but when you look at the education that doctors receive in
medical school oftentimes sex isn't part of the curriculum. At many, many schools
students may get one lecture or two lectures on sexuality, if they're lucky, during the four
years that they are in medical school. And I can tell you when I was a resident here at
Columbia we never had a single talk about sex and sexuality. We talked about the
consequences of sex. We talked about pregnancy, of course, we talked about sexually
transmitted infections, but we never talked openly about sex and sexuality and about
sexual pleasure and the importance of a healthy sex life for women.
Importance of a Healthy Sex Life
Andrew Schorr:
Now, just to expand upon that a little bit. I suggested I think when I said that it's a
natural part of life and it's part of good health, and Lisa and I were just talking a minute
ago about acknowledging people may have a health concern they've lived with that has
dominated their life. Why is sex part of being healthy?
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Ms. Martinez:
Well, sex is natural, and it's a natural part of being human. I view it as a health, it's
really a health issue. And it's about your heart. We know that when you're having
satisfying and active sex life that it strengthens your heart and it boosts your immune
system and it decreases anxiety and stress and depression. So it has a lot of health
benefits that we don't really talk about in healthy women, in women who don't have
health issues. And then when you go to women who do have health issues where an
active sex life is still an important part of who they are and makes them feel good, there's
even less talk for those women with their physicians about the importance of continuing
this healthy sex life.
Andrew Schorr:
So, Lisa Martinez, you have a conference coming up, and I know Dr. Hutcherson is
speaking at it as well. It's at Columbia in New York. Why the conference, and what would
be the key message of it?
Ms. Martinez:
Well, what we want women to know is, first of all, if they have had medical conditions or
even emotional issues that have impacted their sexual health and intimacy that they can
reclaim that part of their life if that's what they really desire to do. So this is really about
empowering women to ask questions to discover the right solutions for themselves and to
talk to their doctors. And that's what we want to do. We want to empower women to be
able to address these issues with their physician. Sadly, we just did a survey at the
Women's Sexual Health Foundation, an international survey, and the results indicated that
less than 9 percent of women are asked routinely during their annual exam whether or
not they're having any sexual health or intimacy problems. So this conference is really to
help women understand that they're going to have to advocate for themselves.
Andrew Schorr:
And often women are the last to do that. If they are in a relationship they advocate for
their partner, their spouse, their kids, and with so many health concerns it comes last. I
know I have done programs on migraine headache. It took a long to get women to say,
Oh, by the way, I've been having these terrible headaches, after you've taken care of little
Johnny or my concern about my husband. And then they put sex it seems even lower.
It's like it's a bonus, but they don't talk about it. You must be frustrated as a healthcare
professional, Lisa, that it doesn't get discussed.
Ms. Martinez:
Well, the women who we've spoken with, many of them are so devastated. I mean truly
they want solutions. They want to know where to turn. There's a certain sadness when
they articulate their concerns, and it is frustrating. It's frustrating for even those
healthcare professionals who are experts in the field who ultimately see these women
because many times women who are looking for help will bounce from one doctor to
another doctor to another doctor perhaps more often than not because that particular
physician hasn't been trained.
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Andrew Schorr:
Right.
Ms. Martinez:
So it's not unusual for women to see six to eight physicians before they find the right
physician.
Andrew Schorr:
Well, we're going to talk a lot more about it as we continue our discussion about sexuality,
helping women get what they deserve. It's all coming up as we continue our discussion
on Patient Power. We'll be right back.
Regaining Sexual Intimacy After Cancer
Andrew Schorr:
We're back on Patient Power and HealthRadio Network as we continue our discussion
about sexuality and how can we really for women get back to a full life even if you have
had a health concern. Dr. Hutcherson, let me ask you. So a woman goes to her
gynecologist and maybe she had an experience where she was told they needed to be
treated for cancer or she needed some kind of gynecologic surgery, whatever it is she
feels changed. And the whole idea of her sexuality goes in the background. Maybe she
doesn't even have the confidence in who she is as a woman to feel good about herself.
How do we get her back to that place where we say, You know what? This can be
restored for you. You can go on. How does that happen, because I'm sure you have had
many women in that situation.
Dr. Hutcherson:
Oh, yeah. Absolutely. And most of the time the women don't feel comfortable just
coming out and asking the question. And so when I talk to doctors I tell them that it
behooves them to bring the topic up because most women have this in the back of their
minds even though they may not ask. The reason is they're afraid of how the doctor is
going to react to the question because discussions about sex and sexuality is still rather
taboo today, and so when you go to your doctor who really is a stranger although you
may trust this person it is very difficult to bring that topic up. And often women are
waiting for the doctor to say something, and if the doctor doesn't say anything then that
conversation never takes place. So what I say to women when I travel around is to view
your sexuality as a very important part of your life and a natural and healthy part of your
life.
So if you're coming in with a medical problem and you need to have surgery or you've
been given a diagnosis of cancer or diabetes or any diagnosis, that, sure, first you're
going to deal with coming to grips with that medical problem first, but then you do need
to have the confidence to ask those very important questions about your sexuality with
your doctor and expect that your doctor is going to give you good answers to your
questions.
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Ms. Martinez:
And you know one tip that I give women, I will often tell them to say, this is important to
me, Doctor, and I want to ask you a question about intimacy as it relates to, for example,
chemotherapy. How will chemotherapy impact intimacy with my husband because this is
a very important issue for me and for my husband. And I think if you couch it in those
terms, doctors take it pretty seriously now.
Asking the Important Questions
Dr. Hutcherson:
Doctors do take it seriously, but some doctors just aren't equipped with the information
and the knowledge to impart to patients. And sometimes they will just kind of brush it
aside because they don't have the information. And I don't think that women should stop
there because often they will stop there and say, Oh, perhaps I shouldn't have asked that
question. But instead of stopping there if the doctor does not feel comfortable they can
either ask the doctor for a referral to someone who would feel comfortable talking to them
about sex and sexuality or do their homework and find someone else who can talk to
them about the issue, but don't just drop it.
Andrew Schorr:
This is a pretty important discussion. We're visiting, by the way, with Lisa Martinez who is
executive director of the Women's Sexual Health Foundation. They have a website. It is
twshf.org. And then also we're visiting with Dr. Hilda Hutcherson, who is an
obstetrician/gynecologist, educator and author. She's at the Columbia University Medical
Center in New York City. She has a website too, and that's drhilda.com, drhilda.com.
Let's continue our discussion. So here's from a man's point of view and that is when my
wife was pregnant I worried a lot about intercourse and hurting her or hurting the baby.
If a woman has breast cancer surgery and she has a breast removed, I might feel, you
know, I maybe went through it with her, all the treatments and was there by her side and
so again worried about her being fragile. Or my wife might feel if, god forbid, she went
through that, but if she did, she'd say, Oh, my god, I had a breast removed. I don't feel
good about myself and I don't look good to my husband. How do you deal with that?
Who wants to take that one, or both of you?
Ms. Martinez:
I'll take it and then Hilda can certainly go from there. I think, first of all, the couple, they
need to discuss this, their concerns. They need to have the conversation. But also any
time you have a breast removed there are body image issues, but if a woman happens to
be on chemotherapy or on tamoxifen or one of the aromatase inhibitors she could have
vaginal dryness too. And there are solutions for that. There are over-the-counter
solutions such as water0based or silicon type lubricants. There are vaginal moisturizers
that are available over the counter, nonprescription. There are some other products, such
as Zestra that can help a woman with arousal difficulties. And then if it's still a problem
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she should really talk to her doctor about potential vaginal estrogens. And depending on
the kind of breast cancer some oncologists are fine with that, and others may say, you
know, perhaps that's not the direction that that particular woman should go.
But there are lots of options. I think it first starts with talking one-on-one as a couple
about the concerns, and if it really is very, very difficult they may need to even get the
assistance of perhaps a counselor to help them.
Andrew Schorr:
Dr. Hilda?
Dr. Hutcherson:
I love it when the couple comes in, when it's not just the woman who comes in to see me
but she brings her partner as well because then we can have this conversation. It makes
it so much easier for them. Because I will throw out the issues. I will throw out the
issues about body image, say a woman who has had a breast, one or two breasts
removed, and we talk about the fact that she is not her breast. She is still a whole
woman. And then the husband will pitch in about his feelings about the change in her
body, and we can have this nice conversation between the three of us. It takes some of
the pressure off of the couple to do this on their own.
And then we talk about some of the issues as far as sexuality. As Lisa said, the vaginal
dryness is a big issue, and it causes painful sex. So not only is the husband concerned
about hurting her in the area where she's had the surgery but now he's concerned about
hurting her when they have intercourse because she's having pain. So we can really talk
about those issues. We can come up with solutions. I can leave the door open for the
women and her husband, her partner to contact me if there are any other questions that
come up in the future. And I absolutely agree with Lisa that sometimes you need a
therapist. I'm a gynecologist, and I can do only so much. Sometimes a couple will need
a therapist or a counselor to help them get through this difficult time.
Andrew Schorr:
Now, we got a question about just this. It refers to what you were talking about, Lisa,
about lubricant. So let's ask either one of you. Joyce writes in from Atlantic City. She
says, "Is it okay to use VapoRub as a lubricant, or is Vaseline the safest route?" Lisa?
Ms. Martinez:
I wouldn't use VapoRub at all. And then Vaseline can be problematic, but I'll let Hilda,
Dr. Hutcherson address that.
Dr. Hutcherson:
Yeah, the VapoRub is going to cause some severe burning and pain when used as a
lubricant. And Vaseline is okay but not if you're using a condom because it's oil based
and can degenerate a condom so it's not effective. For a couple who's not concerned
about sexually transmitted infections or pregnancy you can use Vaseline, but there are
much, much better lubricants out there now. There are a large number of water-based
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lubricants that you can buy now at CVS or Duane Reade or whatever pharmacy you have
in your community. It's amazing the number and the variety that you can get at your
local pharmacy. Or you can go online and buy all types of water-based lubricants that
last longer. They're more like your natural secretions than Vaseline and can be wonderful
additions to your sex life.
Andrew Schorr:
Okay. Well, there's some guidance for Joyce.
We're going to take another break and when we come back we'll be taking more of your
questions as we continue our discussion about sexuality and sex on Patient Power. We'll
be right back.
Andrew Schorr:
Andrew Schorr back on Patient Power on HealthRadio network broadcasting from sunny
Seattle today. And we have with us Lisa Martinez who is joining us from Ohio. Where are
you in Ohio today, Lisa?
Ms. Martinez:
Cincinnati.
Andrew Schorr:
Cincinnati. I love Cincinnati, and I've been over to Newport on the levy, and I've been all
over around there. Lisa is the executive director of the Women's Sexual Health
Foundation. And then we have with us Dr. Hilda, Dr. Hilda Hutcherson who you may have
seen on the TODAY show or other programs on TV and she writes a column. What
magazines are you in, Dr. Hilda?
Dr. Hutcherson:
I'm in Essence and Glamour.
Dr. Hutcherson’s Book: What Your Mother Never Told You About Sex
Andrew Schorr:
Okay. So our listeners may well have come across that. And you have some books too.
What are some of your books they may have seen?
Dr. Hutcherson:
Well, the first book is What Your Mother Never Told You About Sex, and that was one of
Oprah's favorites. And Pleasure: A Woman's Guide to Getting the Sex You Want, Need
and Deserve.
Andrew Schorr:
And that's what we're talking about today. And then, Lisa Martinez, you have a
conference at Dr. Hilda's institution. What's the reason for this conference, and tell us
just a little bit more about that before we dig into questions today.
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Ms. Martinez:
Well, the conference is October 5th. It's on a Friday in New York City at Lerner Hall. And
the main purpose really is to empower women. This is a conference for women to attend.
We have international speakers on the topics of women's sexuality, and it's an opportunity
really for women to understand and learn about solutions concerning any problems they
may be having with intimacy, whether it's from menopause or medications or diabetes or
cancer or even your day-to-day stressors in life. And we're going to have an opportunity
also for them to talk to the faculty and ask questions. So we think it's the first of its kind
in the US for women.
Andrew Schorr:
Thank you, from all of us, and I think my hat is off to you and I think it's great that you're
doing it and that it's out there publicly and it can be discussed. So now we've got
questions people want answers for. Are you ladies ready?
Dr. Hutcherson:
Yes.
Andrew Schorr:
So here's one, and actually I have to say it's been a concern in our family. This is from
Heather in Colorado. And there's a concern about urinary tract infections, I take it after
sex. So, Dr. Hilda, what is the most effective way to prevent that or lower your risk of a
UTI and carry on an active sex life?
Dr. Hutcherson:
Yeah. There's a reason why some women get UTIs or urinary tract infections after sex,
and that's because the actual act of sex always pushes bacteria up into the bladder in
women. We have this little short urethra, the tube that goes from the bladder to the
outside. It's very short in women so all women get bacteria into the bladder, but not all
women get infections. Some women are more prone to getting infections when they get
this bacteria in the bladder.
So what I say to women is you have to urinate before sex, you urinate after sex, and you
drink a lot of fluid in the hours after sex so that you can flush out this bacteria in your
bladder. You also want to be very, very healthy, taking your vitamins, eating well, getting
sleep, all those things that make you healthy so that your body can take care of these
bacteria after you have sex.
Andrew Schorr:
Okay. This is another question from Heather she asked, and it relates probably to a
concern about infection as well. She says, "What's the truth about anal sex? Is it
harmful?"
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Dr. Hutcherson:
That's a great question and one that many women are afraid to ask, so I'm happy that
someone did ask that question because there's a lot of misconceptions about it. Yes, it is
safe when done properly. And there are right ways of doing it and wrong ways of doing it.
I think if someone is going to do this the man and the woman have to do on the same
page. They have to understand the anatomy. They have to know that there's no
lubrication in the anus so you have to use a lot of lubrication, and you have to take it
very, very slowly. And if a woman is having pain that means that something is wrong,
and she needs to communicate that with her partner who then stops and readjusts to
make sure that there is no damage. But it is a safe way of having sex.
Andrew Schorr:
Okay. Here's a question from Willamina in Los Vegas, and she wants to know when is the
best time of the month to have sex to get pregnant and is it the same for all women. So
Dr. Hilda, are you the right one for this?
Dr. Hutcherson:
Yeah, I think so. Lisa, you can pitch in too. But, basically, you want to start having sex
five days before you expect to ovulate. So people think that you need to have sex on the
day of ovulation. That may be too late because when that egg comes out you want the
sperm to already be sitting there in the fallopian tube waiting for the egg. The way you
determine when you're going to ovulate or release this egg is you have to mark down
your period every month and then count back from the first day of your period, 15 days.
That would be the day that the egg was released, and then count back about five days
before that, and then that would be the day that you should start having sex.
You can also look at your mucus too. When you get that stringy egg white like secretions,
vaginal secretions, that means that that's your fertile time.
Does Sex Drive Increase or Decrease with Age?
Andrew Schorr:
Okay. Let me see. We've got another question that's come in, and I'm glad we can talk
about this frankly too. I think it's really important. Here's a question from New York City
from David. And Lisa, you may be a good one to take this. His female partner is almost
40 and she's warned him, if you will, that at that age her sex drive is likely to increase
dramatically and that he better be prepared.
Ms. Martinez:
Prepared?
Andrew Schorr:
And he said to her, he said, Well, I've questioned her as far as, well, what do you think
you're going to need to satisfy this upcoming, and he put it in quote, urge, and her
answer is many vibrators. Now, he says, "I'm not a jealous man, but I'm wondering
about it though and any insight would be appreciated." Lisa, want to try that?
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Ms. Martinez:
Well, I'm just kind of curious what their life is like now if she's anticipating this change.
You know, I think you sort of have to go with the flow. Her sex drive may increase. It
may not. So again I think the couple needs to be open to all the possibilities. And it
sounds a little bit like and this is just my opinion, I'm not a counselor, a little bit like
she's pushing him a tad. And I'm not so sure that's fair to him.
Dr. Hutcherson:
Well, it is true, though, that some women when they get to 40, that perimenopausal
period, their libido does go up. And she's probably heard from some of her friends that
it's happened to them.
Andrew Schorr:
I'm hearing it in my house too, yeah.
Dr. Hutcherson:
And it does happen to some women that when they get around 40 what is happening is
that the estrogen level starts to decrease, and when the estrogen level starts to decrease
you get a decrease in these binding proteins. And the decrease in these binding proteins
causes your free-floating testosterone, that male hormone that we think causes an
increase in desire, to increase. So your free-floating testosterone increases. So for some
women all of a sudden they want to have a lot of sex. They want to have sex every day.
Now, the problem is if you're 40 your husband is probably a little bit older, and their libido
starts to go down at the same time. It's like a cruel joke, you know.
Andrew Schorr:
They may just be tired.
Dr. Hutcherson:
Or they may be tired. So what's she's saying to him is, I'm going to want it every day,
maybe twice a day because I've heard this from my friends, and I understand that you
may be tired and you may not want it as much as I do so is it okay for me to get a
vibrator. Is it okay? And my answer would be, Sure, it's okay. Her using a vibrator does
not mean that she's replacing her husband. She's just kind of supplementing, and I think
he should just let it be.
Andrew Schorr:
Okay. I'm fascinated by the answer, and I'm living it so.
Dr. Hutcherson:
You're living it.
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Andrew Schorr:
There you go. But it sounds healthy, and I'm really delighted we can have this discussion.
So, David, there you go. You're a fine man and your partner, you know, that's where she
is, and that's okay too. And it's communication.
Dr. Hutcherson:
And it won't last forever. That's the unfortunate part.
Ms. Martinez:
Yeah. And I know it's easy to say you shouldn't feel threatened. If he's feeling a little bit
of that, again, I think he needs to talk about that with his partner and kind of have the
conversation.
Andrew Schorr:
Yeah. It comes down to communication in so much of this. It really does.
Here's a question from Nancy in Illinois. She says, "I'm a woman in my late 20s, and I've
always had a problem not getting wet enough during sex, even during orgasm. Is this
normal for a woman, and is there anything I can do to change this.
Ms. Martinez:
I have a real quick question. Dr. Hutcherson, could that be due to birth control pills
possibly too?
Dr. Hutcherson:
Oh, sure. It could be due to birth control pills, antidepressants, antihistamines. A lot of
medications can cause vaginal dryness. But it's also true that some women just don't
make as much lubrication as other women. Some women complain that they have too
much, and then you have other women who say they don't have enough. It doesn't mean
that there's something wrong with you. That's normal for you. If you're not taking any
medications and you're attracted to your partner, so it's not a matter of just not being
interested, then that's normal for you, and you have to feel comfortable using a lubricant.
Often women will say to me, Well, I don't want to use a lubricant because that's not
natural. What's he going to think? He's going to think I'm old and dried up. No. This is
okay. It's okay for you to use a lubricant, and you incorporate it into your foreplay with
your partner. Make him a part of it, so it's not like you're running to the bathroom to put
it in but you're actually allowing him to place it on you and to place it on himself.
Andrew Schorr:
I think what you said earlier really tells it all when you said if you go to the pharmacy now
there are wide range of lubricants. Well, there wouldn't be all these products if a lot of
people weren't making use of them. So if she worries is this normal just know that those
things are going off the shelves and that a lot of people have use for them, but it's part of
normal life.
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Dr. Hutcherson:
That's right.
Ms. Martinez:
Absolutely. And one other comment I want to make, you know, we hear from women
who will say, Well, I tried a lubricant that didn't work. Well, sometimes you have to try a
second or third type. So just because the first brand didn't work don't give up because
the third one may do the trick for you.
Dr. Hutcherson:
Yeah, they are so different, the lubricants, and I tell women to get a variety of different
lubricants and to use them and to ask their partners even what's his opinion of the various
lubricants but to keep trying until you find one that works for you.
Andrew Schorr:
Okay. Very good point. Now here's a question from Denise who's in Kentucky. She says,
"I'm a 21-year-old female. I have never had sex, and I have no desire to right now. Is
that normal?"
Dr. Hutcherson:
Do you want to tackle that, Lisa?
Ms. Martinez:
Well, I mean I think it depends on where she's coming from. If she's comfortable with
that I think that's fine, but if she's concerned about it she may want to talk to her doctor
about that.
Dr. Hutcherson:
Also I would also say to her that for women sometimes you don't have spontaneous
desire, and a question would be if she's in a situation down the road and she has a
partner and her partner approaches her is she open to responding to that rather than
having spontaneous desire. So for some women spontaneous desire just doesn't happen.
They don't think about it, but if they have the right partner and he or she approaches her
she's more open to becoming sexually active at that time.
Andrew Schorr:
Right. I think she probably was writing in because she does have a concern about it and I
think that's great advice.
Dr. Hutcherson:
No, it's normal for some women not to have spontaneous desire.
Andrew Schorr:
Yeah, when the time is right and the right person.
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Dr. Hutcherson:
Right.
Sexual Desire After a Traumatic Experience
Andrew Schorr:
Now, here's another question from New York. We're getting a lot of New Yorkers today,
Dr. Hilda, so maybe some of these people are even in your practice. But Marcy writes in
and she says, "Several years ago - "and this is terrible," my mother was raped, resulting
in severe trauma, and when she visits the doctor it's difficult for her to get pap smears.
What resources are available for women who have been sexually assaulted in going in for
checkups?" And her doctor actually told her he wasn't comfortable speaking with her
about how she should overcome this fear of intimacy. What should she do? Sounds like
counseling could play a role, but what would you say?
Dr. Hutcherson:
Oh, counseling certainly. She needs to have counseling. But she also needs to find a
doctor who is sensitive to her problem, her issue. This is very, very significant. A rape is
a major life trauma, and you just don't get over that overnight, and going to a
gynecologist is maybe somewhat similar to how she felt when she was raped. But there
are doctors who will take the time and be very, very sensitive with the woman and talk
her true the exam and make it possible for her. But I certainly that therapy is important
as well.
Ms. Martinez:
And there are some very good therapists in the New York area too, so she's lucky from
that perceptive.
Andrew Schorr:
I had a girlfriend, actually, who had been raped and, yeah, she had a lot of issues to work
through to be able to accept that intimacy again. And I imagine again going to the doctor
is very private and you have to feel comfortable. But getting the pap smears is
important, right, Dr. Hilda?
Dr. Hutcherson:
Absolutely. It's so extremely important because cervical cancer is a preventable cancer.
Women who go religiously every year and get their pap smear can totally prevent getting
cervical cancer. Getting your pap smear and if you're over 30 getting the HPV test, which
is a separate test from the pap smear. The pap smear and a HPV test if you're 30 or over
can totally protect you from getting cervical cancer.
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Andrew Schorr:
Right. I have to put in one little commercial here too. I've been learning because I do a
lot of cancer programs that they're seeing a fall-off in older women getting
mammograms. It's sort of mammography fatigue. So, ladies, stay on that. Your pap
smears, your annual mammograms are so important. But let's continue our discussion
about sexual issues.
This one came in from someone who saw you on the TODAY show, Dr. Hilda. Susan from
New York writes in. She says, "I read all your books, saw you on the TODAY show. My
question is after making love to my husband sometimes his ejaculation burns after sex.
This has never happened before. Is this because of changes in my body? Is it natural?
We've never had children and is this my body's way of telling me something?"
Dr. Hutcherson:
There are a couple of things that could be going on. If she's very dry when she has sex or
she dries out before it's over she may be getting little minor cuts in her vagina or
abrasions in her vagina so when he ejaculates that can burn a little bit because she's got
this raw surface area. So she needs to make sure that she's well lubricated or she's using
a water-based lubricant.
The other thing she needs to look into is what is he eating and what medications is he
taking. Because anything that he eats or drinks or smokes or any medications that he's
taking will come out in his ejaculate. So if he's eating something or taking a medication
that is causing an allergic reaction in her that may be the problem.
Andrew Schorr:
Okay. Yeah, that's something I worry about. If something feels different are they just
natural changes or is it something wrong.
Dr. Hutcherson:
Right. And you have to feel comfortable going to your doctor and saying, this is
happening to me. And oftentimes women don't feel comfortable going to their doctors
and asking these very important questions.
Ms. Martinez:
And I have one comment. If your doctor doesn't take it seriously you may need to find a
new doctor.
Dr. Hutcherson:
Absolutely.
Ms. Martinez:
You shouldn't hesitate doing that.
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Andrew Schorr:
I say that in so many hotel concerns and I think recognizing that sex is a natural and
healthy part of life you need to be able to talk about that with your provider and not be
ashamed about it. They shouldn't be uncomfortable about it.
Here's another question from New York City. Maria writes in, "I am 54 years old. I was
told that I should continue use contraception until 12 months after my last period." Now,
remember, she's 54. "I went nine months without a period and then had another one.
Does this mean I have to start counting all over again for 12 more months before I can
stop using contraception? It's hard for me to believe that I could become pregnant at this
point." And she says, "I know there have been news stories about women in their 50s
giving birth, but what are the chances really of an unintentional pregnancy at my age, 54?
My youngest child was born 32 years ago, and I'm really tired of three decades of
worrying about contraception."
Dr. Hutcherson:
Yeah, I totally understand, but, yeah, she has to start all over again. It has to be a
continuous year of no menstrual cycles. Now, the chances of getting pregnant at 54 are
small, but they're not zero. There was a case a year or two ago of a woman who was 55
who had a natural pregnancy. It wasn't IVF or any heroics. It was a natural pregnancy
so it can occur. And she does need to protect herself. Does she need to take birth control
pills? No. Can she use just a spermicide that you buy over the counter? I would say yes
because that's enough protection I think for her at the age of 54. But I don't think that I
would just chance using nothing at all.
Andrew Schorr:
Wow. You can tell the fatigue of all this.
Pete writes in from New Jersey. He says, "I have a problem while having sex in that," he
says when he inserts his penis into his girlfriend's vagina his sperm comes out within
minutes, "so I cannot fulfill sex." So he's wondering what he should do. It sounds like
premature ejaculation.
Dr. Hutcherson:
Yeah. There are things that can be done. The first thing I would say is to see a urologist
to have an examination to be checked out completely to make sure you're healthy and all
of that because I think that men need to do that anyway. But the second thing I would
say is to see a sex therapist because that can be done to make men last a little bit longer.
So I would see a urologist and a sex therapist.
Understanding Sex as a Fulfilling Part of Life
Andrew Schorr:
Okay. I want to just sum up a little in the last couple minutes we have. So, Lisa
Martinez, your foundation, and again website is twshf.org, you've got your conference
coming up shortly in New York City and I imagine the information is all on the website.
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What do you want people to know is the bottom line, whether they've had a health
concern or not, as far as sex being a healthy and fulfilling part of their life into their
sunset years.
Ms. Martinez:
Well, first of all, if you want to reclaim intimacy I believe you can. Part of it is talking to
your doctor, educating yourself, going to really good websites, such as ours, also
attending the conference that we're putting on and really exploring ways to reclaim that
intimacy that you believe you want to regain and to not give up on that. And talk to your
doctor about it, and if your physician can't help you then you really do need to find a
physician who can because there are physicians out there who can help you. You really
should not give up at all.
Andrew Schorr:
And Dr. Hilda Hutcherson from Columbia University, I know you work hard not just in
educating the public but in educating healthcare professionals so that both sides of this
dialogue can happen. Everybody is sort of primed for it. But it sounds like it's so
important.
Dr. Hutcherson:
Oh, absolutely. And I'm starting with the medical students and really educating them
about the importance of sex and sexuality and trying to get them to the point where they
can talk openly and honestly with their patients about sex. And there's so much guilt and
shame not only with women but also with the healthcare providers and the doctors, and
I'm try to go make a difference for all women.
Andrew Schorr:
I want to thank you for your books and your dedication to this and also your dedication to
minority health too.
Dr. Hutcherson:
Thank you.
Andrew Schorr:
These are so important, and I've really been delighted to have you on Patient Power. Will
you both come back some time?
Ms. Martinez:
I'd love to.
Dr. Hutcherson:
Absolutely.
Andrew Schorr:
Okay. Well, thank you so much. So this has been I think a very important discussion.
We'll have more about sex, sexuality. It's a part of health where whether you've had a
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health concern to really make that so much a part of your life. And we know from surveys
too that as people get older it remains important to them. So we'll continue to help you
and connect you with leading experts like Dr. Hilda Hutcherson from Columbia University,
Lisa Martinez with the Women's Sexual Health Foundation.
Andrew Schorr thanking you for joining us today. Remember, knowledge can be the best
medicine of all. Have a great day. Andrew Schorr signing off.
Please remember the opinions expressed on Patient Power are not necessarily the views of Health Radio, our
sponsors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care
from your own doctor. Please have this discussion you’re your own doctor, that’s how you’ll get care that’s
most appropriate for you.
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