The Vagina Dialogues with Dr. Anita Sadaty: Intimacy, Arousal and Sexual Health
Show Snapshot:
Want to maintain tip-top sexual health, vibrant intimacy, and self-care for down there as you age? Of course, you do. You’re fifty, not dead. We welcome back Dr. Anita Sadaty, an expert on gynecology and women’s hormonal health, who coaches us on how to care for our lady parts, libido, and pelvic floor. Plus, we dive into biggies like bladder health (spoiler – you SHOULD be able to sneeze without wetting your pants), why some of you are doing those Kegels all wrong, and fun stuff like Yoni Eggs and sex toys.
In This Episode We Cover:
1. Three factors that affect women’s sexual health and arousal as you age.
2. Why sex is often more painful, less pleasurable after menopause.
3. How to have a better orgasm.
4. Non-hormonal vaginal moisturizers versus hormone therapy.
5. Over-the-counter fixes to combat dry vagina and increase blood flow (a key ingredient for orgasm).
6. Are you a good candidate for Estrogen or DHEA?
7. Why to consider non-invasive vaginal rehabilitation therapy.
8. You may be doing your Kegels all wrong.
9. Biochemistry, your brain and arousal.
10. Working with your partner to create positive sexual experiences.
11. A surprising sex drive superhero.
Quotable:
When a patient says to me, ‘I really have no sexual interest anymore.’ My first question is, ‘Is sex painful?’
Around the late forties, early fifties, there is a significant impact on women's sexual health. There are about 42 million women over the age of 50 in the U.S. and probably close to 30% say that low sexual desire is a problem in their life. And there's fully another 10% of women, about 4 million, who can be diagnosed with a clinical disorder called hypoactive sexual desire disorder.
Snackable Smarts:
A trifecta of factors can affect women’s sexual health and libido as they age: physical, psychological, and hormonal.
Around the transition time, in the late forties, early fifties, there is a significant impact on women's sexual health. There are about 42 million women over the age of 50 in the United States and close to 30% say that low sexual desire is a problem. And there's fully another 10% of women, about 4 million, who can be diagnosed with a clinical disorder called hypoactive sexual desire disorder.
As we age, and have a hormonal decline and less estrogen, we see changes in the vaginal tissue, as the vagina becomes thinner, less elastic, with less collagen and elastin. There's less lubrication and also less blood flow. We can have pain, even burning, during sex. There's also less blood flow to the clitoral area and orgasm can be difficult, diminished or frustrating.
If you are experiencing pain or burning, the first thing is you definitely need to have a doctor’s exam. Is it dryness? Could it be an infection? Could it be fissuring? Sometimes women end up developing microscopic tears. Identify what’s at play so it ca addressed and fixed.
The first line of therapy is often non-hormonal vaginal moisturizers. Choose moisturizers that contain natural products versus chemicals. Hyaluronic acid, a non-hormonal treatment for skin designed to increase moisture thickness and resilience, can be very effective if used also with a lubricant.
The workhorse for treating vaginal dryness, burning and painful intercourse caused by estrogen-deficiencies are hormones, estrogen or DHEA, which is an adrenal hormone that turns into estrogen in the cells.
You can also consider non-invasive rehabilitation therapy like the Femi Lift and the Votiva. These are lasers and radio-frequency devices used by gynecologists to stimulate collagen and elastin formation.
Exercise your vagina with Kegels but be sure you are doing them correctly. Squeeze the muscles as if you are cutting off the flow of urine, or better yet, as if you are holding in a fart. Biofeedback devices like the Kegel Smart Device and the Evie Trainer can help you learn to do better Kegels.
Hormones not only affect physical changes, but they are also all over your brain. You have thousands of receptors for estrogen and progesterone and testosterone in the brain, as well as receptors for things like cortisol and stress hormones. Stress hormones, medications for depression or anxiety, and low testosterone can all reduce libido. Dopamine can improve libido, and the excitatory response.
Ideas for improving libido include introducing novelty into your sex life, prioritizing good communications with your partner and good sleep hygiene is a sex life superhero. Studies show women have greater arousal after a good night’s sleep.
Nitric oxide is an over the counter chemical mediator in the body that is responsible for vascular blood flow ad can improve arousal and libido.
Low testosterone is a problem for many menopausal women. Symptoms include decreased libido, increased weight, slowing of metabolism, decrease in muscle formation, increased depression and anxiety symptoms, increased irritability and impatience. Increased issues with focus and concentration. Testosterone therapy can be a fix.
Bladder urgency symptoms are also extremely common in childbirth and later in life which can impact daily living. Consider working with a pelvic floor therapist. Other fixes: achieve optimal weight as being overweight can stress the bladder, certain medicines like diuretics can stress the bladder, talk to your doctor. And avoid common bladder irritants such as caffeine, carbonated and citric beverages, and alcohol.
Bottomline: For optimal sexual health and bladder health as you age, schedule a visit your physician. Write out all of the issues that you have, do your research, ask the doctor what they find helpful in their own practice.
Word of Mouth. Anita’s Product Pick:
For both sexual dysfunction and any feelings of discomfort in the vaginal area or for orgasm issues, I would be remiss not to mention the value of sex toys. They are fabulous for improving blood flow and sensation.
More Resources:
Anita’s previous appearance on A Certain Age:
When Toxic Rage is the New Hot Flash
Episode Links:
Lovehoney sex toys
Follow Anita:
Anita’s Website
Anita on Facebook
Anita on Instagram
Transcript
Katie Fogarty (00:07):
Welcome to A Certain Age, a show for women on life after 50 who are unafraid to age out loud. I'm your host, Katie Fogarty.
The most downloaded episode of Season One of A Certain Age was our very first show. When Dr. Anita Sadaty joined me to talk menopause, toxic rage, and navigating this natural life transition with your vibrancy and wellness intact. That show hit a nerve. Listeners are still talking to me about their own experiences with toxic rage and menopause's other maddening side effects. I am so delighted to welcome Dr. Anita Sadaty back to the show, not to talk rage, but to talk love, sexual health, intimacy, arousal, and self-care down there. Welcome back, Anita.
Dr. Anita Sadaty (00:52):
Thank you, Katie. So happy to be here again.
Katie (00:55):
I'm really, really excited. I think we talked about this, all February long we're going to be exploring love from a variety of angles. And I really am thrilled to have you kick off this month because women and women's sexual health really needs to be at the center of this conversation, right? Not on the sideline, not taking a backseat, which is too often the case. So, as we dive into love, intimacy, and self-care, what do you think women should focus on and pay attention to in order to maintain sexual vibrancy and wellness?
Anita (01:24):
That's such a great question. You know, it's so interesting that you say this should be at the forefront because so many times in my practice, what happens is, you know, we'll be sort of finishing up an exam or an office visit, and my hands on the doorknob to go out. And then all of a sudden, "Uh, one more thing." And that's when, and that's when the question comes up. It's something that even women nowadays just feel very uncomfortable talking about or bringing up to their doctor, or maybe because they don't even feel like there are solutions to what they're experiencing. So, to begin with, I'd say that around the transition time, certainly in late-forties, early-fifties, there is a significant impact on women's sexual health. So, just to give you kind of what that impact is epidemiologically there are about 42 million women over the age of 50 in the United States and probably close to 30% do say that low sexual desire is a problem in their life. And there's fully another 10% of women, about 4 million, who can be diagnosed with a clinical disorder called hypoactive sexual desire disorder.
Katie (02:37):
Wow.
Anita (02:37):
So, it's not really small potatoes. It's very obvious why this kind of thing is going to happen. But more on three different levels. Like, you can look at, for example, physical factors that are gonna impact libido and interest. You can also look at psychological factors and then just generally hormonal reasons, why women are going to experience either a decline in interest, desire. Also more difficulty with orgasm and sexual pleasure.
Katie (03:09):
So, wow. There's really like a trifecta of issues that are at play here. Talk to me about the physiological component of that. Let's start there. What does that look like in terms of women's sex drive as they age?
Anita (03:25):
The first thing, when someone says to me, you know, "I really have no sexual interest," and in some cases it may not even bother them anymore. Like they'd rather curl up with a good book or a Netflix series, but obviously their partner may feel a little differently about that. And so, the first question is, "Is sex painful?" You know, does it not feel the same? And so, we want to kind of focus on the vaginal health, see what's going on there. So, once we have some hormonal decline, we start noticing changes of this lack of estrogen in the vaginal tissue. The vagina becomes thinner, less elastic, there's less collagen and elastin. There's less lubrication and also less blood flow. So, on top of more pain potentially, more burning is another symptom that a lot of patients complain about. There's also less blood flow to the clitoral area and so orgasm can become a lot harder and it's very frustrating. So, those are all things that you can say as a blanket statement are going to be related to the lack of estrogen.
Katie (04:33):
Okay. So, is this just affecting the vagina or does it like affect the vulva or other areas of a woman's body?
Anita (04:41):
Yeah, no, absolutely. It's also something that's going to affect the outer genital area, the clitoral area, vagina, the bladder. So, I mean, just as unfortunately we may notice, there is a little bit of an increase in wrinkling and sagging skin after menopause. Well, unfortunately this leads to a saggy vagina in some cases. But luckily there are a lot of great things you can do about that.
Katie (05:07):
All right. Well, like what? Tell us.
Anita (05:08):
So, the first thing is you definitely need to have an exam. You know, this isn't something I think telemedicine alone should be used for. You need to have an exam to figure out, okay, why is it that I may be feeling discomfort or downright pain? You know, is it dryness? Could it be an infection? Could it be fissuring? You know, sometimes women because of dryness end up developing microscopic tears. And these are things that really need to be addressed and fixed.
Katie (05:37):
So, I love that you just said, "addressed and fixed." I want to just be clear. This is fixable, right? This is not something that we people have to put up with and endure.
Anita (05:45):
Oh my gosh. A hundred percent. And there are so many ways that you can do it. So, when we talk about estrogen being at the forefront of why these conditions happen, a lot of women will say, "I really am not interested in dealing with hormones." I'm concerned about them. I'm worried about using them. I'm worried about breast health, whatever it is. If they have family history of breast cancer, sometimes there's sort of a big "X" across estrogen. But the first line of therapy is going to be non-hormonal vaginal moisturizers. Now, there are several out on the market over the counter, but what I prefer are moisturizers that contain more natural products. A lot of the over-the-counter stuff like Replens, for example. It's a very common moisturizer. It has a lot of chemicals that are just not ideal to be putting in the vagina. It's almost like putting in your mouth. The tissue is very similar, so whatever you wouldn't want to put in your mouth, you know, you don't want to put in your vagina. So, the first thing is something like hyaluronic acid, that's a non-hormonal treatment and that's the same thing we put on our skin to try and increase moisture thickness resilience. So, that can be very effective if used also with a lubricant.
Katie (07:01):
Now, is that over the counter? Or do you have to work with a doctor to get that type of...hydrochloric? I can't even...
Anita (07:06):
Hyaluronic acid. Yeah. It's a mouthful. It is actually is it is over the counter, but as a physician, you can also use a compounding pharmacy to put together different little concoctions for patients that have hyaluronic acid, that have vitamin E, that have coconut oil, natural binders. And so it's a really nice option to use something like that if you don't want to use hormones. But the workhorse for treatment for vaginal dryness and burning and painful intercourse related to estrogen deficiencies, of course, going to be hormones. So, estrogen or DHEA, which is an adrenal hormone that turns into estrogen in the cells, both of those are highly effective. The only thing is that you do have to use it sort of on a continuous basis. You have to start out using it every day for a couple of weeks, and then you need to increase it to twice a week, ongoing.
Katie (07:57):
Well, okay. And so, it's these non-hormonal lubricants, it's estrogen. Are there other fixes for the physiological aspect to dry vagina and painful sex? Tell us.
Anita (08:12):
What I think is the most interesting and encouraging to me, it's a no-brainer to consider using non-invasive rehabilitation therapy. There's a CO2 laser device called the FemiLift. And there's a radio-frequency device called the Votiva. There are several others on the market, but these are treatments that your gynecologist can perform if they have them in their office. These guys actually stimulate collagen and elastin formation.
Katie (08:41):
Wow.
Anita (08:41):
Yeah. And they also can improve the pelvic floor tissue. It can create more support under the bladder to help with urgency, urinary frequency, and incontinence. It helps with spontaneous lubrication, it improves the blood flow.
Katie (09:00):
That sounds like maybe it's dangerous. Do we actually want spontaneous lubrication?
Anita (09:08):
Exactly. Work will not be getting done today, but it's really something amazing. Because you just have to do initially three treatments and then once a year. This is for the woman who really doesn't have time to be focused on throwing things in her vagina every night. I mean who can do that? There are too many creams and applications going on.
Katie (09:31):
We have a very crowded bathroom shelf. We can't squeeze more stuff in. So, that's cool. It's nice that these kind of fixes that you only need to do maybe three times a year exist.
Anita (09:41):
Or once a year.
Katie (09:44):
Or once a year. That's even better. One and done. I'm there for that. So, tell me also, is there anything that you can do... When you said pelvic floor and sort of building muscles? Is there anything that we can do in terms of exercise? You know, can you exercise your vagina? Is that even a thing?
Anita (09:59):
That is such a thing.
Katie (10:00):
Okay. All right.
Anita (10:02):
There are whole Facebook groups devoted to this. So, there are a few devices, and a lot that are over the counter that women should look into, especially if there's a concern about tightening. There's a lot of relaxation that can happen after pregnancy and childbirth. So, there are ways to kind of rehab the vaginal tissue and the bladder. There are three devices. I think they're kind of interesting. One is called the Kegelsmart Device. So again, talking about, do you have anything else to do all day? It's a small device that you put in the vagina and it vibrates intermittently to signal you to squeeze…
Katie (10:44):
Wow.
Anita (10:44):
...around the device.
Katie (10:46):
So, do you use this all the time? Or just when you're exercising?
Anita (10:49):
You can use it for a certain period of time, but I guess theoretically you could keep it in all day and squeeze away. But you have that. And then they even have devices that give you biofeedback. So, there's an app, it can connect to your app, and it can tell you how you're doing. Like, how is the squeezing going? So, there's a little bit of biofeedback with other devices called the Elvie.
Katie (11:13):
So, and how do you spell Elvie?
Anita (11:16):
Elvie. E-L-V-I-E. Yeah. So, Kegelsmart and Elvie are two devices that I think are really interesting. And then you can really take it up a notch with a patient device called the intensity electrical stimulation device. So, this is more of a probe that goes in the vagina and it will actually release an electrical stimulation to cause a contraction.
Katie (11:40):
Wow.
Anita (11:41):
Yeah. So, you don't even necessarily have to do any work.
Katie (11:44):
Is this like childbirth contraction or just like, like a sit-up contraction?
Anita (11:49):
Absolutely. No, absolutely not.
Katie (11:51):
Define contraction. I have three kids. I have been there. I'm not sure that I want contractions again.
Anita (11:58):
So basically, what we're thinking about, is just trying to tighten the area. So, kind of almost to make the vagina feel smaller as opposed to pushing out. So, it's something that I actually do recommend that you work with your doctor to make sure that when you do the “Kegel”, which is pelvic floor muscle contraction, that you're doing a correctly. I find a lot of women, I'd say 70% of the time, they're doing the exact opposite of what you want to have happen.
Katie (12:25):
What?! Wait. Wait. Okay. I need to know about this. Because when you think about vaginal tightening, you think Kegels. And you think about like bladder, you think Kegels. Have we all been doing it wrong?
Anita (12:38):
I hope not. But unfortunately, when I actually test patients in my office to say, "Okay, so we're going to do the Kegel, we're going to do a contraction. Let me see. I have my fingers in the vagina. And I said, "Okay, now, now do it." And they're literally pushing my fingers out. And I'm like, no, no, no.
Katie (12:53):
That's the wrong direction lady. So, tell us. Like what should we be...? Can you walk us through? Just verbally?
Anita (13:00):
I kind of can. It's kind of graphic. But what you want to think about is actually as if... So it's squeezing as if you want to hold urine in, not release. Or even better is if you wanted to hold a fart in. That's the direction…
Katie (13:16):
Oh! So you need to be committed. You have to be super committed.
Anita (13:20):
Super committed, super laser-focused.
Katie (13:24):
Pretend you're on a first date, and you do not want to be farting.
Anita (13:30):
Right.
Katie (13:30):
All right ladies...
Anita (13:32):
And chilli is on the menu.
Katie (13:32):
Oh my God. Oh my God. So funny.
Anita (13:35):
Yeah. But that's where other devices, like weighted balls and they even have something called a Yoni Egg, which is this beautiful kind of egg-shaped gemstone that you can actually put in the vagina and you need to hold it in. So, you'll know if you're doing it wrong. If your egg drops to the floor and shatters.
Katie (13:53):
If your egg rolls away, get yourself to this Kegel device ASAP.
Anita (14:01):
Exactly. Exactly.
Katie (14:03):
That's so cool. All right. I'm intrigued. I'm going to look this all up, and I'm going to link to them in the show notes. Because I love that there's literally an app for that. Like there's that whole joke about, "There's an app for that." There are apps for Kegels. That's like we live in the 21st century for sure.
Anita (14:20):
No, it’s amazing. It's amazing.
Katie (14:22):
So psychological, you mentioned that's all. So, now that we've got our eggs and like we know how to improve our Kegels, how do we address the psychological components to sexual health and intimacy as we age?
Anita (14:35):
So, the other aspect with psychology around the transition time is that we talked about how hormones can affect physical changes. But hormones are also all over your brain. You have thousands of receptors for estrogen and progesterone and testosterone in the brain, as well as receptors for things like cortisol and stress hormones. So, it's not just the sex steroids that can affect the brain and psychology. It's also related to stress hormones. Also, what is your neurochemical balance there? So, serotonin, we think about that when we think about serotonin, most people think, "Oh, that's the feel-good brain chemical." You know, that's what a lot of medications try to increase when you're treating somebody for depression or anxiety. The SSRIs for example. But the problem is that high serotonin, believe it or not, actually reduces libido.
Katie (15:32):
Wow. Yeah. That's so weird. Because I thought serotonin was like that happy hormone. So, why does it reduce libido?
Anita (15:39):
So, the why is a good question. I don't know why but in studies serotonin absolutely can reduce libido. And it's borne out by studies of women who are placed on SSRI medications like Zoloft and Prozac, Celexa, Lexapro. These are all SSRI. They stimulate an increase in serotonin in the brain. And it's very well known that these medications actually increase the potential for difficulty with orgasm and also are well known to decrease libido.
Katie (16:14):
Wow.
Anita (16:14):
So, the why is not clear, the neurochemical that's really helpful for libido is more like dopamine. So, that's kind of the thrill-seeking excitement, you know, kind of daredevil. That's a really different type of feel-good. It's more excitatory though.
Katie (16:32):
So, how would you increase your dopamine then to improve your libido as you age? Give us some tools.
Anita Sadaty (16:40):
So, when we talked about psychology, dopamine is going to increase in the setting of things that are novel and different and excitatory. And so, one of the things that I think that women need to understand is that as we hit that transition time when you have a lack of novelty or uniqueness in a situation...
Katie (17:05):
Like when you've been married for a long time?
Anita (17:08):
Right! Like that. Anything like that, if it's sort of this sameness, it doesn't work for women. So, there was a really interesting study that I had read about in The New York Times where they compared men and women who were given images of sort of like the socially sexually appropriate attractive partner, sort of the same photos. And they did functional MRI imaging. So, this is to see if they could see areas of the brain related to desire and arousal lighting up. And what they found was, that over time you could show a guy the same image over and over and over again. And they still get like lighting the areas of interest. With women it went down like over time, that response just went down.
Katie (17:56):
So fascinating. Because I like would have thought it was the opposite, honestly.
Anita (18:00):
Nope. Which is why it doesn't matter how old you are or what kind of shape you're in. Your husband is going to chase you around the room no matter what, you know. So, that's kind of the good news.
Katie (18:13):
That's hilarious! Oh my God. But like the bad news for us. So, what would a woman who's feeling, You know, I mean, I guess we could come up with all sorts of things that a woman might do, but from a medical perspective, if a patient's coming in, I'm not saying that you're recommending that they find new sex partners and that they dress-up. If you were to talk to a patient, what would your advice be around increasing dopamine and managing sameness in terms of libido?
Anita (18:41):
Yeah, that's a fabulous question. So, these are definitely some tools that you can use to try to combat the...I don't want to use the word monotony, but the monotony of what the sexual experience may have may become. So first of all, you certainly want to make sure that your relationship quality is good. You know, if there are issues, I mean, I remember writing a blog post about this, and if I've said it once I've said it a thousand times if you find your partner repulsive, you're not going to want to have sex. It doesn't have to be repulsive but it can be...if there is some conflict that's going on, it's really hard to then translate into a positive sexual encounter leader. So, working on how you guys communicate and wanting to be with each other and not being angry or irritable or having any resentment. So, that's obviously the first thing. The second thing is good quality sleep. There are studies that show in women who get a really good night's sleep, the next day, they have much more interest in sex.
Katie (19:44):
That is fascinating.
Anita (19:46):
Yeah. Yeah. So quality sleep is huge. The other thing is obviously focusing more on foreplay. So, there's a lot of studies that show that women, maybe less than 18% of women can actually orgasm with intercourse. They actually more, 30-40% are going to orgasm with clitoral stimulation. So, you know, not skipping that part. It's kind of, don't go straight for the goods. Kind of work on that. And there are some interesting ways to do that, especially since one of the things that happen with menopause is that arousal is a little more difficult. The stimulation, because blood flow goes down, and collagen and elastin go down, you need more to achieve orgasm or to achieve a quality orgasm, which also can sort of shift. And so, I recommend for women who are in that situation, two things. One is look at using some nitric oxide supplements. Because nitric oxide helps to improve blood flow.
Katie (20:48):
So, what is nitric oxide?
Anita (20:49):
Nitric oxide is a chemical mediator in the body that is responsible for vascular blood flow. So, it's important for a lot of things. It would be helpful for someone with high blood pressure to relax the blood vessels there. It's great for women that have Raynaud's Phenomenon that have cold hands and feet. It's great for kidney disorder. It's awesome for arousal and libido.
Katie (21:12):
So, is this again, something that you get through a doctor or is it over the counter?
Anita (21:16):
This is over the counter. They're two over-the-counter companies that I like. The products, one is called Berkeley Life Nitric Oxide. And the other one is Neo40. Those are two oral ones. One is a capsule, one is like a chew. And you just do two of them a day. And patients are coming back for it all the time from my office. They're loving it
Katie (21:38):
Yeah. I mean the quality of your orgasm…people are probably scarfing them down.
Anita (21:44):
Sign me up!
Katie (21:44):
I'm going to get those from you after the show too so I can put them in the show notes, so people can explore that for themselves as an option. So, you said there were two things: the nitric and then what was the second one?
Anita (21:56):
Did I say two? Oh well, let's see. Nitric oxide. Oh, the other thing actually was related to women who are on antidepressants that increase serotonin. One thing you could try to do is to see if working with your doctor, if it may be appropriate to switch your medication to something like Wellbutrin, that actually does increase dopamine.
Katie (22:18):
Ah.
Anita (22:18):
And as a matter of fact, there are some practitioners who will treat women with like categories of sexual dysfunction with Wellbutrin, regardless of the presence of anxiety or depression, because it does boost dopamine.
Katie (22:33):
Yeah. It's so important for any woman who's listening to this. Who's thinking, "You know, I need some of these interventions," to educate themselves about what's possible. Have a conversation with your doctor, because I love the way you started the show, by saying that, you've got your hand on the doorknob, you're exiting the room, and the woman is like, "And one more thing. My sex life!” So, I think that people that's important to encourage people to know that it doesn't have to be that way. If there are things that have changed, if there are things that you were wish were different, or better, that you should be having conversations, not just with your partner, but with your doctor as well. That there is help.
Anita (23:14):
Yeah, absolutely. This is not this merits more than a-hand-on-the-door-knob conversation. This is a separate visit that you should schedule with your physician. And write out all of the issues that you have, do some research behind it. See what the doctor finds helpful in their practice. What would they recommend given what they're talking about? Get a thorough exam to see where the issues are. There's so much to do. I mean, you can also work with practitioners like pelvic floor physical therapists. For example, if there's beyond just dryness or estrogen-related deficiency, there could be pain syndromes. There could be nerve neuropathy issues. So, it's not just one thing. There are so many layers to it and it deserves a focused visit with your doctor.
Katie (24:02):
That's such great coaching. Women are really good about making appointments and checking boxes for their family members, maybe nagging their spouse, but to really put your own sexual health front and center...you know I feel like I need to stop talking to you and go make some appointments right now. But we are going to keep going.
So, I know we've touched on hormones a little bit. Have we covered hormones or is there more for people to learn about hormonal interventions that can help with sexual health post-menopause.
Anita (24:39):
That's perfect because I didn't want to forget this. So, hormone therapy or not hormone therapy, but hormones in general, as we talked about have, have a huge impact on the brain which some people argue is the biggest sexual organ for women, is their brain. Thousands of receptors, right? The thing is that what a lot of women don't realize is that testosterone, which we think of as a male hormone is critical for sexual behavior. So, women have testosterone; women continue to make testosterone even after menopause. So, even though the ovary has stopped making estrogen and progesterone, it's still making testosterone. But the issue is that sometimes that loss, the testosterone may not be adequate. It may actually fall as we age and that can be horrendous for sexual interest and response. So, checking your testosterone level with your doctor would be really helpful.
And what most menopausal societies recommend, is that if you have symptoms of testosterone deficiency, which I'm going to get into in a second and your blood levels are in the lower 25th percentile of the range—it doesn't have to be out of range, it just has to be on the lower end of the range—if that's coupled with low testosterone symptoms, you're a candidate to consider testosterone therapy. And if I tell you what testosterone therapy may help with, you're going to be wanting to sign up for that too.
Katie (26:12):
Tell us.
Anita (26:12):
The symptoms are going to be obviously decreased libido, increased weight around the middle in particular, and a slowing of metabolism, decrease in muscle formation, increased depression and anxiety symptoms, increased irritability, and impatience. Increased issues with focus and concentration. So, it's such an important, critical sex hormone, and women don't even sometimes realize that they have it. That they have testosterone or they need testosterone. So that, to me, is like a game-changer if you're an appropriate candidate.
Katie (26:51):
So, I feel like every single woman who's listening is thinking, "I have low testosterone issues." Or is this simply COVID and shelter-in-place because everything that you ticked off, I was like, "You've been talking about my last 11 months. Is it testosterone or all the banana bread I’ve been making?”
Anita (27:11):
Is it the bottle of wine every night, or is it testosterone? Well, it's related. Because your ability to manage and handle stress is going to be reduced when your hormones are not normal. And just to even back up from there. So, testosterone. Big, big game changer also really helpful with orgasm frequency and intensity. So that's another thing but just backing up to hormone therapy. So, I think women got really the real short end of the stick back in 2002. At that time, there was a large study called the Women's Health Initiative that came out. Huge study that was actually looking to see if hormone therapy would reduce the risk of cardiovascular events. Because there was a lot of data and research that showed that hormone therapy could reduce your risk of heart attacks and things like that. So, that's what the study was actually looking to achieve. Unfortunately, what ended up coming out prematurely.
Anita (28:12):
So, they actually stopped the study early. Because they found there was an increased risk of breast cancer in certain groups using hormone therapy. Now, the sad thing about this study is that that then pulled the rug out from women in terms of considering that. Or for doctors even prescribing that because of concerns about breast cancer risk. But now years later, the study has been really not torn apart, but it's been investigated and there are so many reasons why epidemiologically, it was so flawed to make that determination early.
First of all, the study wasn't powered to look at breast cancer risk. The second thing is that the average age of women in this study was over 64. When you look at women between the ages of 50 and 59, which is your prime hormone replacement therapy category group of women. Those women in certain situations actually had a decreased risk of breast cancer and they definitely had a decreased risk of cardiovascular disease. So, the whole fear around considering hormone replacement therapy for the majority of women, I'm not saying it's for everyone, but for the majority of women, this is a huge consideration, because that in some cases really changes the way you experienced menopause.
Katie (29:33):
That is absolutely fascinating. Because even though I feel like my knowledge around what's appropriate testosterone levels is astonishingly lacking, considering it's my own body, and I should be knowing these things. I do know that there is that concern about hormone replacement therapy and breast cancer that has been widely and extensively covered in popular magazines and media that I consume. And I had no idea that there was second-guessing around this concept. So, you know again, it just goes to show that you should be talking to your doctor. You've got to keep yourself up to date on what's happening with medicine. So, thank you for bringing that up.
I love how you also talked about the fact that the study there were, you know, they were looking at older women when it was really younger women that would benefit from this. And so there was just sort of a mismatch between who was being studied and who was going to be benefiting. So, that sparked a question in my mind, which I've had, which is, you know, is there a difference? And we know we've talked about vaginas aging, and as we age, but is there a difference in vaginas sort of broadly for women who have had children and women who have not? Because not everyone is listening is a mother or a biological mother. Is there a difference between the two types of vaginas?
Anita (30:53):
Well, it's interesting because actually there are opposite problems that can end up happening in women who have never had a vaginal delivery versus women who have. So, even though there's a lot of overlap with some of the symptomatology like dryness and burning, and painful intercourse. Where it can start to diverge is that if things go on for long enough, if you kind of ignore those early symptoms, then what happens is the vaginal canal can actually become smaller and tighter. But the problem is where are you starting from? So, if you're starting from a vagina that has never had a vaginal birth, that shrinkage is horrible. It makes it impossible to accommodate anything in there. You know? So that's a sort of a separate issue that can happen.
On the flip side, women who haven't had vaginal deliveries are much less likely to have bladder issues, bladder or rectal incontinence issues. So, in some ways, they're a little bit more protected against that. Not that's not a get out of jail free card fully because there are women who've never had vaginal deliveries that still have incontinence issues and overactive bladder issues. But in general, you're certainly far more protected than women who have had vaginal deliveries and multiple vaginal deliveries. Because that can impact the support structures around the bladder. So, you know, at least if you've had vaginal deliveries, you're less likely to have that. You know, I can't accommodate anything in there. You're more likely to have bladder issues as well. So, there's definitely a difference between how women can experience those changes.
Katie (32:39):
Okay. That is so interesting. So, we're nearing the end of our time here. But I do want to explore a little bit more about bladder issues. Because you know sexual health, self-care for your lady parts, I'm using all these silly euphemisms, but it's beyond just sex. It's beyond sex with a partner, it's beyond intimate self, where you are able to have sexual pleasure on your own. But it's really sort of beyond sex. It's about keeping your life, your lifestyle, to be able to have urinary continence and stuff. Tell us what's normal, what's abnormal, and what people should be doing or thinking about to make sure that they're living a well, vibrant life.
Anita (33:24):
Yeah. So, I mean, just to give you a sense. The feminine incontinence pad industry is probably like a billion-dollar-a-year industry. So, this is not a small problem. Upwards of a third of women after childbirth experience incontinence issues. More than that, probably I'd say 40-50% experience urgency, incontinence, or frequency. Bladder urgency symptoms that really can affect and impact their life and their daily living if you're constantly looking for a bathroom.
Katie (34:00):
So, I'm just laughing, because I'm always like that. When I go to the movies, when I did pre-COVID, I would always sit in the aisle. I'm like I got to get up in the middle of the movie. We all know that.
Anita (34:11):
I'm with you, I'm with you. I need the aisle seat on the plane. You know, of course. So the first thing is that you are not alone if you have this issue. The second thing is that there are, there are some basic things that you want to make sure are in place before we move on to sort of step two. So, step one is, do you have normal body weight? Because unfortunately, if you are overweight, the pressure on the bladder will increase the risk of incontinence episodes and bladder urgency, and overactive bladder episodes. The second thing is, are you on medications that might increase the risk of urinary symptoms like blood pressure medications or diuretics, or anti-diabetic medications? So, there are a lot of things that will end up that you're taking for other health issues that will impact the bladder. The third thing is, are you someone who consumes a lot of bladder irritants? So, what I mean by that is that the bladder can get irritated very easily by some substances that we drink or eat. The top three are going to be coffee or tea, anything that's caffeinated, and alcohol.
Katie (35:23):
I knew you were going to say that.
Anita (35:24):
Sorry.
Katie (35:26):
And I'm not happy.
Anita (35:29):
I do not accept that. I do not accept that.
Katie (35:31):
I just want to be clear. I like wine.
Anita (35:35):
I don't know why I wouldn't have imagined. Who doesn't? Let's just say that. Who doesn't? So, alcohol is a huge bladder irritant, unfortunately. Citrus beverages. Anything that's sort of acidic, even Vitamin C. So, in this COVID time, everybody's downing Vitamin C. Which they should. It's amazing protection for COVID. But it can be a bladder irritant in certain amounts. So, that may be something you want to look into and carbonated beverages that are more than three.
Katie (36:05):
Well, I am happy to stop drinking orange juice.
Anita (36:09):
And how much of that are you drinking?
Katie (36:12):
Not that a lot, but, but I'm eliminating it from my diet.
Anita (36:16):
Okay. That sounds good.
Katie (36:17):
Anita, this has been absolutely so amazing. I'm just excited. I was taking so many mental notes. I'm going to put all your recommendations into the show notes because I know that women listening to this episode are really going to benefit as they think about how to care for their body and what they understand as what's possible. Before we wrap up, I want to ask, I mean, you shared so many wonderful tips, but is there something that you really want to leave our listeners with, that they should know about?
Anita (36:45):
Gosh, I mean, there's a lot of things. I think one thing I did not mention of course, which I think I would be remiss not to mention is that certainly for both sexual dysfunction and any feelings of discomfort in the vaginal area, orgasm issues, I would be remiss not to mention the value of sex toys. So, and they all have unbelievably cute names. I mean, things like the Loki, Lily, Lilo, Siri, I mean, that's cute two-syllable words, but it is it's fabulous to improve again, blood flow to the area, sensation. It's something to bring into the relationship as well. And, I think that also just sort of brings in, be open with your communication about what you want and what your needs are. And, I mean... Be honest. I think that most partners want to know what they can do to help here. So please, that's a big thing. Is to not be embarrassed, not feel self-conscious, this is really important. So, that's one thing we didn't get into, but I would say that's important to include.
Katie (37:58):
I love it. You're going to have to come back for season three and then we'll dive more into that. Okay. How could our listeners keep following you and all your wonderful tips and advice on women’s...
Anita (38:10):
So, my website is full of a lot of my ponderings, DrSadaty.com. I have a section on my website called Share the Health. And that's where I post a lot of my tips and blog posts. Also, I'm on Facebook at Redefining Health Medical, that's my office. And on Instagram as well at @drsadaty. I do have a newsletter. So, if you guys actually go onto my website, I'd be happy to have you join my newsletter and we just send out information on all kinds of women's health.
Katie (38:48):
Perfect. Thank you so much, Anita.
Anita (38:50):
Thank you so much, Katie.
Katie (38:52):
This wraps A Certain Age, a show for women over 50, who are aging without apology. Join me next week when I talk self-love with Christine Marie Mason, the founder of Rosebud Woman, which offers a line of luxury plant-based intimate wellness products.
Special thanks to Michael Mancini Productions who composed and produced our theme music. See you next time. And until then: age boldly, beauties.