9 Things Your Doctor Won't Tell You About Your SexABILITY

PHOTO: Dr. Lauren Streicher, associate clinical professor of obstetrics and gynecology at Northwestern Universitys Feinberg School of Medicine.
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Dr. Lauren Streicher says women of all ages are eager to talk about what she calls their “sexABILITY,” if only doctors would just ask.

In preparation for a segment on ABC’s “Nightline,” the Chicago gynecologist and a film crew randomly approached women on the streets of New York, targeting mostly women in their 40s and 50s, shattering the myth that women are hesitant to talk about their sexual health.

“Not one woman turned us down,” said Streicher. “Here’s the way I started: ‘The last time you went to your doctor, did he ask you about your sex life?’ One or two said, ‘yes,’ but all the others said, ‘No, I wish they had.’”

“It’s a huge issue,” she said. “The scientific literature doesn’t bring it up. Doctors are limited by time and they are not really comfortable. Women may be intimidated by a male doctor or think [their problem] is not important enough – and doctors are not bringing it up.”

Streicher has written a comprehensive guide to help women solve the medical problems that are “sabotaging” their sex lives in her new book, “Love Sex Again.”

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As a clinical associate professor of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine, she has launched a campaign to publicly address sexual dysfunction in women for whom she says nearly half, intercourse is “uncomfortable, unpleasurable and even painful.”

"Sexability – I love that word – is not just about vaginal dryness, but the ability to have sex,” said Streicher, who writes the blog, “Midlife, Menopause and Beyond.”

“I was seeing so many women come in for general consultations and had thrown their sex lives out the window because they were told things like ‘use a lubricant’ and it didn’t help,” she said. “Doctors say vaginal dryness is a normal part of aging, but oh my god, it’s an easy fix and no one is given the information – it’s really pathetic. There are 55 million post-menopausal women and no one is helping them.”

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But sexual dysfunction is not just the domain of older women, according to Streicher. Women of all ages face medical issues that can impact their sex lives.

The biggest sex destroyers are hormone issues caused by post-menstrual stress, infertility, pregnancy, birth, conceptions and menopause; stress; excess weight; lack of sleep; and medical challenges such as arthritis, cancer, depression, diabetes, heart disease, inflammatory bowel disease; and other gynecological problems.

Not only does Streicher give women permission to talk about their sexual concerns, but she provides medically approved and widely available solutions, as well as a list of websites and organizations to help women get more information and sexual products.

“There is a real disconnect between information that is available and what is being told to women,” she said. “Women desperately need this information and their own doctors aren’t helping them.”

What should a healthy vagina look and smell like and how can a woman keep her pH levels normal? What’s the difference between vaginal lubricants? How can a pelvic physical therapist help a woman achieve orgasm? What prescription drugs affect libido? Are vibrators just for women with partners?

She deals with every imaginable topic with empathy and humor. “Is your heart going to be able to take fabulous sex and orgasms?” she asks, reminding readers the late New York Gov. Nelson Rockefeller died having sex with his mistress.

ABC News senior medical contributor and gynecologist Dr. Jenn Ashton said Streicher’s book, which hit bookstores last month, is “well-written, thorough and comprehensive.”

Ashton said 40 to 50 percent of her female patients are affected by dyspareunia (painful intercourse) and low libido.

“It is definitely true that women don't ask their doctors about sex, and doctors don't ask their patients,” said Ashton. “I ask every patient about their sex lives, and only feel uncomfortable when I feel that my patient is having a problem that I can't help her with. Also, the female sexual cycle is so much more complex than that of a man, that there can be numerous issues that contribute to poor sexual function in women, and these can require different diagnostic and therapeutic approaches.”

Some of the advice in Streicher’s book – specific recommendations for lubricants and other over-the-counter products – a woman can buy without seeing a doctor. Other recommendations require a doctor’s prescription. Streicher also gives women a “script” to bring up the topic with their doctors and how to ask for help.

Here are nine things your doctor may not have told you about sex:

1. You can hire a “personal trainer” for your vagina. Pelvic floor therapy can strengthen the muscles to make sex less painful and offer the “pleasure-boosting power” of kegel exercises.

2. Vaginal dryness can be corrected with “safe and effective solutions” beyond lubricants. Estrogen-based products can actually reverse vaginal atrophy.

3. Incontinence affects 30 percent of all women, says Streicher. “Women may cough or sneeze and lose urine. Some find they pee when the penis is in the vagina or when they have an orgasm. It’s horrifying, so they don’t go there.” Pelvic floor therapy can help, but so can a brand new FDA-approved vibrator device that a woman can use at home. Some even come with clitoral stimulation and can help with orgasm.

4. Women with disabilities can also have pleasurable sex.

5. Single women without partners have needs, too. “Most doctors assume if you are single, you are not having intercourse,” said Streicher, who has recommendations for sex toys.

6. Cancer patients can be helped. Chemotherapy and radiation can destroy a woman’s sex life, as can surgery after pelvic and colon cancer. “Doctors can counsel them back in to the game with local vaginal and estrogen products.”

7. Diabetes can cause nerve damage that can kill a woman’s ability to have an orgasm. Clitoral neuropathy can affect blood flow. “Even if he has the fastest fingers in the West, it’s still not enough,” she said. Vibrators, topical botanicals and even suction devices in clinical trials, can help.

8. Common dermatological conditions like lichen sclerosis, which affects the vulva, can make sex painful, but these conditions can be treated with soothing creams that are “life-saving,” she said.

9. Flibanserin, a drug currently in clinical trials and before the FDA for approval, can help a subset of women rekindle sexual thoughts and urges.

“The libido is complex,” she said. “If a woman has pain with sex or no libido or hates her husband, this won’t help her.” But for those who have pain-free, pleasurable sex and orgasms, [Flibanserin] works on the he neurotransmitters in the brain to bring back “sexual fantasy and the urge to have sex.”

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