When Your Vagina’s in a Phunk

by Lauren Streicher, MD

Any woman who has ever watched a celebrity flip her shiny hair in a TV commercial knows how vitally important it is to use a pH-balanced shampoo. No one knows why, (I certainly don’t) and I would refer you to your hairdresser for more information. When it comes to the importance of vaginal pH, however, I’m an expert.

PH refers to the vagina’s acidity level. A vaginal pH of 3.5 - 4.5 indicates that there is a perfect amount of good bacteria (lactobacilli), and no overgrowth of the bad bacteria that can cause odor, irritation and sometimes infection.

At its extreme, the result of too much bad bacteria is bacterial vaginosis (BV). BV, not yeast, is the most common cause of abnormal vaginal discharge, accounting for 40 to 50% of cases. But it’s not just about an irritating discharge. Women with BV are at risk for many more serious medical conditions including preterm delivery, post-hysterectomy infection, and an increased tendency to acquire STD’s such as gonorrhea and chlamydia. They also have an increased risk of pelvic inflammatory disease and subsequent infertility.

In addition to being uncomfortable and dangerous, BV can be really expensive. Ask any woman who has gone to the drugstore and invested $50 in anti-yeast medication only to find that the irritation, odor and discharge are still there. By the time she sees her doctor, gets a test for BV, and pays for her prescription, one episode of BV can cost hundreds of dollars. As if that weren’t enough, it comes back 30% of the time.

So, what makes pH rise higher than 4.5? There are a surprising number of triggers that can upset the vaginal ecosystem:

  • Menstruation: Blood has a pH of 7.4, so during your period, vaginal pH becomes elevated.
  • Tampons: Since they retain the fluids that cause pH to increase, tampons can contribute to the problem, especially if you “forget” a tampon and leave it in too long.  
    • Intercourse: The pH of semen is 7.1 to 8.
    • Douching and cleansers: Any vaginal infusion of water or other fluids can affect vaginal pH. The pH of water is 7, and fragrances and perfumes can also irritate the vagina.
    • Menopause or pregnancy: These are times where hormones fluctuate, which is associated with elevated pH.

    Many women who suffer from recurrent BV infections find that their period or intercourse is the event that sets them in motion time after time. Some women ask how something as natural and normal as menstruation or intercourse can cause a problem since women are intended to have periods and sex? The answer is, while most women’s bodies can tolerate this period of pH elevation, in some women, even a slight imbalance can tip the scales, causing a funny odor or a much more serious problem.

    How can you keep things in balance? I am not going to suggest that you stop having sex or using tampons! I consider tampons to be one of the top 10 inventions of the 20th century, right up there with sliced bread. Theproduct that can restore and/or maintain normal pHwhen things are "off" is RePhresh™ an an over-the-counter vaginal gel. Any persistent odor, dischargeor irritation however does require a trip to the gyne.

    Next time you are shopping for a new shampoo, don’t forget that your hair is not the only thing that needs to be pH-balanced, especially if you visit your gynecologist more often than your hairdresser.  

    Posted on doctoroz.com4/03/2012 |

    Gyno Myth: Yogurt on a Tampon for Yeast Infections

    by Lauren Streicher, MD

     

    I’m a big fan of yogurt and eat Greek yogurt with blueberries, sliced almonds and a dash of honey almost every day for breakfast. But yogurt on a tampon to prevent or cure a yeast infection? This comes up time and again in women’s magazines, on the Web and on TV. Hate to say it, but no! Never! Don’t do it!

    Yes, lactobacilli are good for your vagina, but the strain of lactobacilli in yogurt is not the same strain of lactobacilli that populates a healthy vagina. Multiple studies have shown that putting yogurt in the vagina does not work. (Some studies have even shown that there are yogurts that claim to contain lactobacilli and may not have them at all.) For those women who say, “It worked for me!” guess what? Self diagnosis of a vaginal yeast infection is more often incorrect than correct. One study even showed that women were correct in their self-diagnosis of yeast infection only 34% of the time and 15% of the time; there was no infection at all (no doubt, these are often the situations in which believers have found yogurt on a tampon to work). Also keep in mind that the most likely culprit of an abnormal discharge is bacterial vaginosis, a common but lesser known kind of infection with similar symptoms to a yeast infection that has nothing to do with yeast.

    So if you have that awful, itchy feeling, a cottage cheese discharge and you are fairly certain a yeast infection is the cause, by all means try one of the over the counter antifungal medications intended to treat yeast infections. If you want to keep the right balance of lactobacilli in your vagina, try an oral probiotic such as Pro-B that has the correct strains of lactobacilli that might help prevent a yeast infection, but won’t do anything to cure it once it’s there. But with bacterial vaginosis and other infections or issues that may be stirring up trouble, you just may have to bite the bullet and make a trip to the gynecologist to see what’s up down there because soaking a tampon in yogurt and putting it in your vagina is nothing more than a waste of a perfectly good yogurt.

    7Originally published2014 doctoroz.com

    Freezing Eggs: Most Women Glad, but Wish They Banked on it Sooner

    by Lauren Streicher, MD

    If pregnancy is years away, the perfect solution would seem to be to simply store your eggs until you are ready to use them. Every day I have patients that inquire about freezing eggs in order to increase the possibility of conceiving if life circumstances put pregnancy on hold.

    While freezing embryos (an egg that has been fertilized with sperm and is at an early stage of development) is very successful, and has been an option for years, the technique of cryopreservation of unfertilized eggs, until recently was not routinely recommended since in many cases a thawed egg was not always a viable egg . In the last few years however, the technology of egg freezing (and thawing) has dramatically improved, and while not always a guaranteed success, is the best option for someone who doesn’t have sperm in their life, and would like to increase the chances of a biologic baby down the road. The big question is always timing.  Most women are not thinking about freezing their eggs when they are in their twenties. By the time someone is considering it (usually in their late thirties or early forties), egg quality is already sub-optimal.

    A 2013 Belgium survey asked women one year after they froze their eggs, if they were glad they did, and if they intended to use them.

    In this study,

            75% of women said they believed they were less likely to use the frozen eggs than at the        time they had them retrieved.

    34% said they were unlikely to use their frozen eggs.

    96.2% said they were glad they froze eggs,would recommend it to others and would do it again.

    70.6% however wished they had done it at a younger age when there was a better chance of a healthy egg.

    So back to timing. While the number one predictor of fertility is age, there is a significant variability in ovarian aging which make some women infertile at 35, and others still going strong at 40.

    Anti-Mullerian Hormone, (AMH) isprobably the best way, way to evaluate someone for ovarian reserve…essentially how good your eggs are, and how long they will be functional.

    AMH is secreted by cells from follicles in the ovary. Follicles are only present if healthy eggs are still around. AMH declines with age as the “good” egg pool declines and is completely gone after menopause. Unlike other hormones used to measure fertility, AMH doesn’t vary through the cycle and can even be measured by a blood test even in women who are taking birth control pills. While AMH is considered to be a reasonably reliable way to know what ovarian reserve is there, there is not consensus as to what the lowest “OK” level is. In general, if AMH is above 0.5, there is good ovarian reserve.

    So even if you are not going to use it, a little money in the bank can be a good idea. If you have the money, your AMH is still high, and youdon’t mind going through hormonal stimulation and egg retrieval, egg freezing is currently the best option to stop the clock. The best time to consider it, however, it is long before you will likely, if ever, need it.

     

    Originally published Jul 10, 2013 EverydayHealth. Edited Sept 2, 2015

    Eliminate Fibroids and Eliminate an Incision

    by Lauren Streicher, MD

    Most women with troublesome fibroids either just put up with a monthly flood until they go through menopause, or end up with a hysterectomy. uBt there is anoutpatient, no-incision option that many women are not offered, and not aware of: hysteroscopic myomectomy.  

    But first, some background: Fibroids, the most common gynecologic tumor, are present in the uterine wall in up to 70% of women. In most cases, fibroids are too small to create symptoms and, if found, can be ignored. It’s not just size, but the position of the fibroid that predicts who is going to have issues. As any good real estate agent knows, it’s all about location, location, location. And there’s no worse location than fibroids that actually grow into the cavity of the uterus. These are the fibroids that cause the “change the tampon every hour” heavy periods that not only are miserable to deal with, but also can result in anemia. But sometimes your uterus doesn’t need to be sacrificed in order to make it stop.

    Myomectomy is an alternative to hysterectomy that surgically removes fibroids and leaves the uterus behind. Most women that undergo myomectomy get an abdominal incision and require a six-week recovery. Hysteroscopic myomectomy is an underutilized uterus-sparing technique that removes problematic fibroids without an incision. This procedure is performed as an outpatient, takes less than an hour, and requires essentially no recovery.

    Here’s how it works: Most women are familiar with dilatation and curettage (D & C), a procedure in which the cervical opening is made slightly larger in order to put an instrument into the uterine cavity to scrape away the lining of the uterus. It would be nice if a simple D & C could eliminate fibroids, but scraping the lining of the uterus to remove a fibroid is like raking leaves and expecting to remove the boulder in the ground. D & C’s are useful for evaluating bleeding, but are not really meant to treat the bleeding.

    When I perform a D and C, it is always accompanied by hysteroscopy in which I slide a slender scope with a camera and light attached to it through the cervix in order to see what’s going on inside the uterus. If a fibroid is present, I insert a small instrument through the hysteroscope to cut the fibroid into small pieces, a process known as fibroid resection or morcellation. The small pieces of fibroid than are easily removed. The patient goes home that day, fibroid-free. Hysteroscopic morcellation does not have the same issues as uterine morcellation performed during laparoscopy. During hysteroscopy the fibroid fragments  stay inside the uterine cavity  prior to removal.  In the rare instance that  an unknown cancer is found, it will not spread to other places. 

    Even in the right hands, not every woman is a candidate for hysteroscopic myomectomy. The fibroid has to be the right size and the right location. Sadly, for those that are candidates, the biggest hurdle to this procedure is finding a surgeon to do it. Too many gynecologists still do not offer hysteroscopic myomectomy to their patients.

    If you have fibroids and have been told that hysterectomy is your only option, it is worth asking your doctor if you are a candidate for hysteroscopic myomectomy. If he or she doesn’t seem familiar with the procedure, or doesn’t offer it, a second opinion is in order.

    2/27/2012 doctoroz.com

    Can a Hysterectomy Make You Look 10 Years Younger?

    by Lauren Streicher, MD

    Have you ever known someone that took time off from work to recover from a hysterectomy and returned looking younger and really well rested? She of course said that getting rid of her bleeding fibroids did her a world of good. The truth is, she may have taken advantage of the downtime from her surgery to have a few other things taken care of. Like her face, breasts and protruding belly. For many women, a medically indicated operation is the ideal time to sneak in some bonus surgery.

    Very few women are thrilled about having a hysterectomy. Even when they know that it is medically the right thing to do, it’s often difficult psychologically. Having a hysterectomy, more than any other type of surgery, stirs up all kinds of troublesome emotions … getting older, end of potential fertility, and for some, the beginning of menopause. Planning a cosmetic procedure that you’ve always secretly wanted is a way to turn things around. You may be losing your uterus, but at least you’re gaining a flat stomach and perky breasts.

    I am frequently asked, half-jokingly, to do a tummy tuck "while I am there." Most women are surprised to hear me reply, “You don’t want me doing your tummy tuck, but I can get a plastic surgeon involved.”

    If it’s something you have always wanted to do, there are actually a number of advantages to having a plastic procedure at the same time as a necessary surgery.

    Cut the Cost!

    By the time you add the price of the surgeon, anesthesia, operating room, recovery room, drugs and hospital stay, it’s no surprise that it’s usually only the rich and famous who can afford those little nips and tucks. But, if a plastic procedure is done at the same time as a hysterectomy, it means that the only out of pocket cost may be the surgeon’s fee and possibly the expense of additional operating room time.

    Paying for cosmetic surgery is only part of the financial obstacle for women who cannot justify or afford to take time off work. But, if you are already taking time off to recover from a hysterectomy, there’s no additional lost revenue.

    No One Has to Know….

    It’s easy to keep your tummy tuck a secret when you’re recovering from major abdominal surgery. A facelift is a little harder to hide, so your best bet is to tell potential visitors to stay away for at least a week. If some well-meaning do-gooder does show up with a turkey noodle casserole, be prepared to give a creative reason to explain why you need to wear sunglasses and a big-brimmed hat with your pajamas.

    There’s Always a Down Side

    Before you schedule your facelift, tummy tuck, liposuction, breast augmentation, and oh, by the way, hysterectomy, there are some negatives to consider.

    Cosmetic surgery is still surgery, and every operation has the potential for complications. By adding an additional procedure, you are also adding the potential for additional problems.

    Also, it’s going to hurt more. An outpatient laparoscopic hysterectomy usually results in minimal pain. Adding a tummy tuck adds a large abdominal incision along with post-op belly pain and tightness that makes it pretty difficult to stand up straight for a few days. But, that’s simply the price you pay for a belly you can bounce a quarter off of.

     

    11/10 2010 doctorOz.com

    5 Things Your Doctor Didn't Tell You About Sex

    By Lauren Streicher, MD

    If you are like 97% of women, your annual visit has come and gone and for the third year in a row, despite the fact that your doctor asked you if you had any other concerns or questions, you just couldn’t bring yourself to spit out that one question you really wanted to ask. You just wish it wasn’t up to you to bring up that you can't have an orgasm , sex hurts like hell and what about that funny odor? No wonder you have no libido and no little pink pill is going to fix it.

    Well, problem solved.  Sex Rx: Hormones, Health, and Your Best Sex Ever, speaks to women about the physical, hormonal and medical aspects of maintaining all aspects of peak sexual health with up to date information (OK, the now out of date libido section says that flibanserin might get approved! humor, and best of all, no stirrups.

    The goal of Sex Rx is help you achieve “SexABILITY,” my term for the ability to enjoy fulfilling, exciting sex by working with, if not overcoming, your body’s unique challenges. Just because you didn't get a solution to your problem at your last doctor visit doesn't mean there isn't one.

    For example, did you know…

    1. Your diabetes may be getting in the way of your ability to have an orgasm. Your doctor asked about decreased sensation in your feet, but he or she didn’t mention that your clitoris might also be a little numb from vascular or neurologic changes that commonly occur with diabetes.

    2. Your vibrator won’t mess with your pacemaker. No way do you want to tell your cardiologist that you are terrified that sex with your regular partner “Bob” (AKA Battery Operated Boyfriend) will cause a pacemaker malfunction. Rest assured, clitoral or vaginal vibration will not unpace your pacemaker.

    3. Your birth control pills can dry up your vagina. You know that menopause is years away, yet lately, even though you are totally in the mood, your vagina is more like the Sahara desert than the waterfall it used to be. While it’s not typical, around 3 percent of the population has this distressing side affect from hormonal contraception.

    4. A headache with an orgasm may be a sign of a serious problem. You mentioned your bad headache to your doc, but neglected to mention that, oh, by the way, the really bad headache is simultaneous with an orgasm.  That’s one you want to check out sooner rather than later since 4 to 12 percent of patients with a sub-arachnoid hemorrhage report that a severe headache at the time of climax was their first indication of a problem.

    5. The recurrent vaginal infections may be because you use Vaseline as a lubricant.Vaseline makes your chapped lips feel so much better that it stands to reason it would be the perfect product to keep your other lips moist as well. Unfortunately, Vaseline has been shown to double the chance of bacterial vaginosis, the most common cause of odor and irritating vaginal discharge.

     Sex Rx speaks to all women who struggle with physical or hormonal issues related to sexual function — menopause, incontinence, stress, chronic lack of sleep — as well as medical conditions such as heart disease, diabetes, cancer, and more. No it won't help you fix your broken relationship, but it will help you fix your broken vagina.

    Updated August 21, 2015. Original published Apr 9, 2014 EveryDay Health

    48 Hours of All About Addyi

    Just returned from New York where I spent 2 crazy days doing interviews to discuss the FDA approval of Addyi, the first medication for the treatment of low libido in women. Arrived at midnight on Monday and got up at the crack of dawn to get some badly needed professional help with my makeup. Started the day  with a piece for NBC Nightly News  (taped for 1 hour and they used one sentence- oh well) and then raced over to ABC to appear by satellite with Christine Tressel for  ABC News in Chicago.  Dashed  over to Fox News to tape for affiliate stations all over the country.  I was in Duane Reade buying an extra large bottle of Visine when I got a call  to go back to ABC to tape a piece to air the next morning   for Good Morning America . This was the point that I was really glad I had my Tieks foldable flats in my bag. The official announcement was finally made late Tuesday evening thatthe FDA said  "Yes!" and within minutes a  New York Times piece  I was interviewed for was posted. Not to be outdone by the New York Times, I immediately  posted my piece on Everyday Health.  (Yes, I wroteit in advance, "just in case") . The BBC asked me to appear on their show, but I had to decline since I had no access to Skype (theirNY studio was closed for the night) and I was already settled in with a friend sipping a crisp rose.

     Wednesday my e-mail was going crazy (an assistant, car, driver and personal stylist would have been nice) , but the good news was that the false eyelashes that my fabulous NY makeup artist had applied the day before, were still intact. (Thanks Tovah!)  Of course,  the first order of business was to get on the phone to  do an interview with Andrea Darlas and Steve Cochran for WGN radio. Took a break  and had lunch with Marlaine Selip, the former Executive Producer of Windy City Live, who now lives in New York. She told me I was doing OK, but that my bangs were messy on Good Morning America. Moments later I got a text from  Cindy Petrasso, also formerly of Windy City Live, who informed me my bangs were messy on GMA. Thanks guys. Now I know what is important. Fixed my bangs and went over to the Affiliated Press to tape a segment  for national distribution.

    The best part of the day  (other than shopping the sale rack  at Bergdorf's) was  CNN where I did an interview with the fabulous Richard Quest... officially the man I would most like to be seated next to during a dinner party! Had a blast with him. Love, love, love  his voice. On the way to the airport did interviews with a few magazines. Hit the American lounge where they have private telephone booths (who knew?), the best yogurt covered pretzels and had an on air chat with  my friends Roe Conn and Anna Davlantes for WGN. Hope the crunching wasn't too obvious. Finally made it home where I waited in line for 30 minutes at O'Hare to get a taxi. So hungry I bought an airport turkey sandwich. (Desperate people do desperate things) Explained to the taxi driver that this was a great day for women because they would now want to have sex. He drove me home very fast .

    Addyi AKA "Female Viagra" Gets FDA Approval!

    The FDA approval  of Addyi marks an important day in Herstory. I chatted about it on ABC Nightly  News. My article on Everyday Health is an everything you  want to know guide . Talked to the New York Times about what this will mean for women.  GMA this morning! Lots more to come!

    FDA Agrees: Now Is the Time for Women’s Viagra

    EveryDayHealth.com June 2,2015

    EveryDayHealth.com June 2,2015

    “I’m just not interested in sex anymore.”

    “I don’t think about sex.”

    “I miss feeling sexual.”

    Welcome to my office.

    Of all the sexual problems my patients report, the loss of libido is by far the most common. The medical term for lack of lust is hypoactive sexual desire disorder, or HSDD: an absence of sexual thoughts, fantasies, or desire for sexual activity that causes distress or interpersonal difficulties. The last part is really important.

    Not every woman who has zero libido cares or is motivated to do something about it. But millions of women do care, either because they find this loss of libido personally distressing or disinterest in sex has sabotaged a relationship or marriage.

    It is perfectly normal to not want to have sex with a guy who smells like the zoo and with whom you don’t even want to be in the same room with much less share a bed. It is perfectly normal to not want to have sex if it is excruciatingly painful. But the woman with HSDD loves her partner, and things work just fine physically, but her libido switch is simply in the off position.

    What Keeps Libido Strong

    The biological cocktail for an intact libido includes not only hormones such as estrogen and testosterone, but also neurotransmitters that determine how often women think about, and desire, sex. While many neurotransmitters make a contribution, the essential ones are dopamine, norepinephrine, and serotonin.

    Dopamine is all about desire. It’s dopamine that creates that feeling of “I want sex, I need sex, and I can’t stop thinking about sex.” Serotonin is all about keeping desire under control so you can stop making love long enough to go to work and do the laundry.

    It’s all about balance — enough dopamine to want sex, and enough serotonin so we don’t want it all the time.

    So essentially, HSDD is a biological problem. Currently, there are no FDA-approved medications to help women who have HSDD.

    This week, the FDA is taking another look at flibanserin, a promising drug that has been shown in multiple scientific studies to help women with HSDD, but was turned down by the FDA in the past. Experts have been invited to speak at a public forum to explain why flibanserin should — or should not — get the FDA nod of approval. I will be one of the experts in Washington on June 4th to step up to the mic and explain how flibanserin works on the brain to increase dopamine and decrease serotonin levels. I will also emphasize that flibanserin is not for everyone. Flibanserin will not help, and should not be prescribed for,  the woman who has a dysfunctional relationship, painful intercourse, or a hormonal imbalance.

    Approval of this drug has become controversial and in many ways has become a political issue rather than a medical issue. Many “experts” claim that HSDD is not real, but is a made-up condition so pharmaceutical companies can sell drugs. Yes, HSDD, like other female sexual problems is real, and I am offended that 26 drugs have been approved for male sexual health and none for women, other than to alleviate vaginal dryness.

    5 Myths About HSDD That We Need to Debunk

    Here are the facts to balance out the fiction:

    Myth 1: HSDD is not a real medical condition.

    There are more than 13,000 medical publications about HSDD dating back to 1977. Not to mention that anyone who has spent time in my office knows how real it is.

    Myth 2: It is an exaggeration that there are 26 drugs approved for male sexual health.

    Actually, there are 41 if you include generic drugs for men. But 26 is the number of unique medications.

    Myth 3: Sexual problems are mostly due to interpersonal, psychological, or cultural/social issues.

    Yes, all of those things are important, and a therapist or change of relationship is often the fix. But biology is also key. Science has shown that activity in the brain is different in women who have HSDD. It is clear that an imbalance of neurotransmitters is at fault. No amount of talk therapy is going to correct a biological imbalance.

    Myth 4: Flibanserin doesn’t work.

    Women receiving flibanserin in clinical trials reported a 53 percent increase in sexual desire, as measured by the Female Sexual Function Index (FSFI). Adjusted for placebo response, there was a 37 percent increase. This was a meaningful response for the women in the trial.

    Myth 5: Flibanserin has too many side effects to justify giving it to healthy women.

    There were more than 11,000 women in the flibanserin clinical trials, and they reported no serious side effects. Some women experienced fatigue, nausea, or sleepiness. In contrast, there were only 3,000 men in the Viagra trials, they had  serious side effects such as cardiovascular problems, visual changes, and a drop in blood pressure. Not to mention, men get to choose if they want to take a risk and take a drug to enhance sexual desire!

    Women’s sexual health problems are real and deserving of research and development of new drugs. Flibanserin will not solve every sexual problems, but it will treat low sexual desire in a meaningful way and make a difference for millions of women. So stay tuned. I am optimistic that the FDA will not allow bad politics to trump good science.

    UPDATE: Since this post ran, the advisory committee to the FDA panel voted 18 to 6 to recommend that flibanserin be approved. It was an exciting day speaking before the committee, and I was honored to be part of the process in a very small way. Many experts spoke, and to say the discussion was lively would be an understatement.

    The FDA still must gave final approval before the drug will be released, and certain conditions must be met to ensure safety. But this a huge victory for women and a clear indication that the FDA appreciates that there is an unmet need.

    PHOTO CREDIT: Meriel Jane Waissman/Getty Images

    Could Waxing Boost Your Libido?

    By Lauren Streicher, MD

     

    Your head is not the only place on your body that reflects hair fashions. Today, genital hair styles range from completely natural, to a neat trim, to a totally bald Brazilian. While some women remove hair for religious reasons, others say vulvar baldness increases sensation during sex and feels “more hygienic.” Most young women say they simply prefer the way it looks and regard removing genital hair as no different than shaving legs or armpits.

    Age, socioeconomic level, race and religion are all variables that have been associated with the choice of pubic hair style, but is there an association of groomed pubes and sexual behavior?

    The general perception is that someone who goes to the trouble, expense and sometimes pain of hair removal is more likely to be in a partnered relationship than just because they want to look nice in the locker room, but no one had specifically studied the association between specific sexual activities and genital-hair removal.

    Until now, that is. In 2013, researchers from Indiana University conducted a study of 2,400 women between the ages of 18 and 68 to determine if shaving and waxing correlated with sexual interest and sexual behavior.

    They looked at diary entries for 49,000 days and found that on the days that someone removed hair, they were far more likely to report sexual interest and engage in specific kinds of sexual activities. Interestingly, while age was a factor (young women were the most likely to remove genital hair), contrary to other reports, there was no association between hair removal and ethnicity, race or educational level.

    So, did hair removal occur because the women anticipated sexual activity and were “preparing,” or did hair removal make someone “feel sexier” and choose to engage? Hard to say since the researchers did not take it to the next step and ask why someone removed hair on a particular day.

    As far as being “more hygienic,” there is no reason to think that is the case. In fact, a study released in March 2013 suggested that the irritation from hair removal was potentially responsible for the increase in vulvar molluscum contagiosum, a sexually transmitted virus that causes a skin eruption.

    So remove it if you desire, but keep in mind that burns from wax that is too hot, ingrown hairs and unattractive red bumps are all possible consequences. And whether you wax, shave or laser, keep in mind that pubic hair is there to decrease friction during intercourse, so don’t be surprised if suddenly rug burn and chafing become an issue.

    First published 7/12/13 doctoroz.com

    Bleeding After Menopause? Don’t Go With That Flow!

    by Lauren Streicher, MD 

    It’s always disconcerting to have unexpected vaginal bleeding, but it’s particularly unsettling when it occurs years after your uterus and ovaries have closed for business and you no longer possess a pad or a tampon. It’s not just about making the midnight run for sanitary products, it’s that stomach-dropping fear that “blood equals cancer” that causes women to spend hours searching the Internet for reassurance. In spite of the fact that most women imagine the worst, in the majority of cases, postmenopausal bleeding is not an indication of anything serious.

    So, if you see red and you’re not supposed to  … what next?

    The first step is to determine where the blood is coming from. Blood on the toilet paper can be coming from the vagina, rectum or bladder, and while it seems as if the source should be obvious, it’s not always easy to know. When in doubt, put a tampon in (you may have to borrow one from your daughter). If the tampon stays white but there is blood in the toilet bowl, it’s most likely coming from the rectum or bladder and a visit to your primary care doctor is in order.  

    The best time to see your gynecologist about abnormal vaginal bleeding is while you are bleeding so we can determine not only where it’s coming from, but also how heavy it is. Your description helps, but I have learned over the years that one woman’s spotting is another woman’s hemorrhage. Many women are hesitant to be examined while bleeding, but as I overheard my nurse once say to one of my patients who was reluctant, “Don’t worry. Here, everyone either arrives bleeding or leaves bleeding.” Not exactly how I would have phrased it, but somewhat accurate nonetheless.

    So, short of cancer, what causes most postmenopausal bleeding?

    A bloody vaginal discharge is commonly due to dryness and thinning of vaginal tissue from lack of estrogen. Vaginal infections such as yeast or bacterial vaginosis are another culprit.

    Bleeding originating from the cervix can occur if there is a benign cervical polyp or cervical inflammation. Many sexually transmitted infections can cause cervical bleeding; if there is a new partner in your life, it is a good idea to be screened for chlamydia, gonorrhea and trichomonas. Cervical and vaginal cancers can also cause bleeding, but are less common.

    Abnormal bleeding from the cavity of the uterus is caused by hormonal imbalances, benign growths such as polyps or fibroids, pre-cancer or cancer. An ultrasound combined with a sample of tissue from the inside of the uterus will generally identify the problem. Years ago, a surgical dilatation and curettage was the only way to obtain tissue. Now, a quick office procedure is usually performed in which a thin flexible catheter is threaded through the cervical opening into the uterine cavity.  The catheter has a suction device on it such that a tiny amount of tissue can be aspirated and sent to the lab for analysis. Most uterine samples yield reassuring results, but on occasion uterine cancer, the most common gynecologic malignancy and the fourth most common cancer to occur in women, is detected. 

    Since uterine cancer is usually diagnosed in its early stages  (when a woman first experiences abnormal bleeding), there is a high cure rate. In fact, the five-year survival for women diagnosed with a Stage I cancer is 96%. 

    While the overwhelming majority of abnormal bleeding is not an indication of uterine cancer, DON’T put off that trip to your gynecologist … and DON’T wait for the bleeding to stop!

    Originally published 6/07/2011 doctoroz.com

    Why Would Your Doctor Recommend a Vibrator?

    by Lauren Streicher, MD

     

    “Edna, are you all right?” My 70-year-old patient was looking at me blankly and finally burst out, "Did you really  just say I  should buy a vibrator?”

    Actually, that is exactly what I had told her, and if you have never entered the wonderful world of vibrators, dildos, and erotica, you may want to give it some thought. And while you may think it odd that this slightly unorthodox recommendation comes from a board-certified gynecologist on faculty at a major medical school, it’s not so strange.

    Historically, vibrators were originally not sexual items that women bought for themselves, but medical devices used as treatment by doctors during Victorian times. This gradually fell out of favor, and by the 1970s, scientific publications stated that vibrators were harmful and never to be used by “normal” women. Twenty years later, attitudes began to shift again and polls showed that many women, while they didn’t own a vibrator, were “interested.” Interest turned into practice, and by 2004, almost half of American women had at least tried one.

    Fast forward to today. Vibrators are routinely used, and as a physician and sexual health expert, there are a number of situations and medical conditions that prompt my recommendation to use a vibrator.

    Reach Orgasm
    Many of my patients have never had an orgasm.   Ever. They expect to have an orgasm during intercourse, and when it doesn’t happen, they are not only at a loss, but also often feel like there is something wrong with them. It was Sigmund Freud that set the stage for the notion that women should expect to have vaginal orgasms. This myth was propagated until the more realistic (and scientific) team of Kinsey and Hite reported in 1953 that “sexual intercourse is an extremely inefficient way to stimulate the clitoris.”

    According to recent scientific studies, only about 5-10% of women are able to reach orgasm with vaginal intercourse. The rest require digital, oral, or other form of clitoral stimulation. But for many normal women, the intensity of a vibrator is the only way they are able to climax.

    Enhance Arousal
    As women’s hormones decline, very often so does sensation. Many post-menopausal women find that achieving an orgasm becomes a lot more difficult.  In addition, medical conditions, such as diabetes cause nerve damage requiring more intense stimulation to achieve the same effect.

    Spice Up a Stagnant Sex Life
    Face it – spending years with the same partner can get a little boring. As I once said on The Dr. Oz Show, “If you have cornflakes for breakfast every day for 30 years, you get to the point where you don’t even want breakfast any more. If one day a chocolate chip  pancake   shows up on your plate, suddenly breakfast is a lot more appealing.”

    Partner Issues
    This is actually one of the most common reasons women buy and use a vibrator. Many women have no partner, or have a partner that is physically incapable of intercourse. Sometimes men who suffer from erectile dysfunction avoid intimacy knowing that they can’t follow thorough. They are thrilled and relieved to find a way to pleasure their partner without intercourse.

    It’s not surprising that a 2009 scientific study found 52% of women reported not only having used a vibrator but having increased sexual satisfaction as a result. And far from being something that is used only for masturbation, vibrators were used by couples 80% of the time.

    So next time you ask your doctor for a prescription to help your sex life, don’t be surprised if he or she gives you the address of the local erotica store. If you bump into Edna, be sure and ask her how things are going and tell her she is overdue for her annual exam.

    Originally published Jan 30, 2013 doctoroz.com

    Uterine Cancer: Beating the Odds

    By Lauren Streicher, MD 

     

    Most women are surprised when I tell them that endometrial (uterine) cancer, not ovarian cancer, is the most common gynecologic malignancy and the fourth most common cancer in women. The reason uterine cancer is not the first to come to mind is that since most uterine cancer is diagnosed in its early stages, comparatively few women die from it. Five-year survival for women diagnosed before the cancer has spread is 95%.

    Abnormal bleeding is usually the first sign of a problem, which is why irregular periods, heavy bleeding or constant spotting should never be ignored. Any bleeding in a postmenopausal woman should be evaluated. The majority of abnormal bleeding is not an indication of cancer, but still needs to be checked out.

    A sample from the lining of the uterus (no cutting involved!) is performed in the doctor’s office to detect pre-cancerous or cancerous cells. A Pap test, on the other hand, detects abnormal cervical cells and does not screen for uterine cancer.

    Most uterine cancers occur because there is a hormonal imbalance that results in an abnormal buildup in the cavity of the uterus. In a normal menstrual cycle, women produce estrogen, which thickens the uterine lining. Ovulation, or the monthly release of an egg, triggers the production of progesterone, which prevents the uterine lining from getting too thick. If someone isn’t ovulating, the lining of the uterus gets blasted with estrogen but without the progesterone to balance it out, the potential for cancerous changes increases.

    The only thing better than early detection of uterine cancer is to prevent it from developing in the first place. Here are 5 steps that can reduce your risk:

    Lower Your Weight to Lower Your Risk
    Fat cells produce estrogen, which is why obesity is thought to be one of the primary reasons endometrial cancer rates are increasing in the US. Women who are obese are more than three times as likely to get endometrial cancer.

    A Pill a Day …

    Every woman knows that taking birth control pills helps prevent pregnancy, but taking oral hormonal contraception for at least 12 months also decreases the risk of uterine cancer. The longer you take them, the more your risk is reduced – taking them for three years or longer may reduce risk by a whopping 30 to 80%. This protection may last for 15 years after pill use is discontinued.

    Choose an IUD
    Birth control pills are not the only type of contraception that reduces uterine cancer. The progestin in the Mirena™ intrauterine device also keeps the lining of the uterus from building up. Mirena IUDs are now used to treat a pre-cancerous condition called hyperplasia.

    Pick Your Progestin

    It has been known since the 1970s that taking estrogen therapy without adequate progestin increases the risk of uterine cancer almost tenfold. If you are taking estrogen for relief of menopausal symptoms (and have a uterus), it is crucial to take an appropriate progestin to protect the lining of the uterus. Compounded progestin creams have not been shown to offer adequate protection. The progestin molecule is too large to be absorbed well through the skin, which is why the FDA approved progestins used to balance estrogen therapy are in pill form.

    Question Your Kin
    Many women have heard of BRCA gene mutations that are associated with breast and ovarian cancer. But BRCA is not the only genetic mutation. Families with a Lynch mutation are not only at risk for colon and stomach cancer, but also have a 20 to 60% chance of developing uterine cancer as opposed to approximately 3% in the general population.

    originally published 11/14 2013 DoctorOz.com

    Incontinence: It Can Ruin Your Sex Life

    By Lauren Streicher, MD

     

    For the approximately 30% of adult women who suffer from involuntary loss of urine, they are not just afraid to laugh, sneeze, cough or run without wearing a diaper or a pad – they are also afraid to have sex. In fact, close to 30% of women with incontinence report that sexual activity causes them to lose urine … a libido killer if there ever was one.

    If like many women you go into avoidance mode and your partner never knows your “headache” is because you really just don’t want to pee on him, not because you don’t want to have sex with him, it’s good to know that there are better solutions.

    Kegel exercises, while commonly recommended, rarely completely alleviate the problem but may be helpful if performed correctly.

    Sling procedures are minor surgical procedures that elevate the bladder neck to prevent leakage. While highly effective for stress incontinence (the kind that makes you lose urine when you cough laugh or sneeze), some women prefer not to have surgery.

    Pelvic-floor muscle training, along with behavior modification and biofeedback with an experienced pelvic-floor physical therapist, are also highly effective, but relatively few women have access to a personal pelvic-floor physical therapist.

    InTone is a  use at home  device that can help strengthen your pelvic floor and eliminate or greatly reduce incontinence. This silicone device, which you can obtain from your doctor and use at home, is placed in the vagina and inflated in order to assure comfortable (but close) contact with the vaginal walls. During brief therapy sessions, a gentle electrical stimulation (the appropriate level is determined in the doctor’s office) occurs which enables strengthening of pelvic floor and bladder muscles. A hand-held control unit provides voice coaching and visual biofeedback. The results are impressive.

    The point is: Incontinence is common, but common is not the same as normal, and there are a number of options to go from diapers to dry. It’s a matter of starting the conversation with your doctor to say, “This is important to me and I want to do something about it” instead of just accepting it and letting it ruin your sex life.

    Sexual function is complex and whether the issue is incontinence, pain, dryness, loss of libido or the inability to have an orgasm, the solutions are not one-size-fits-all any more than one speculum fits all! My book, Sex Rx, is  a comprehensive look at all the things that can sabotage one’s sexual health, and more important, how to fix it. In addition, you will see how you compare to other women when it comes to sexual practices and sexuality. So, please take 5 minutes to participate in my SexABILITY survey.

    Originally published 8/26/13 doctoroz.com

    When No Period Is No Problem

     

    By Lauren Streicher, MD

     

    When the pill was first released for use as a contraceptive in 1960, it was prescribed to include a hormone-free week in order to ensure a normal menstrual period. The scientists that invented the pill felt that in spite of the nuisance factor, maintaining a normal menstrual cycle would make women comfortable taking this new form of contraception. The truth is, there is no medical benefit to that week off, and there are a number of advantages (beyond wearing white pants without fear) to skipping the pill-free days and instead take an active pill up to 365 days a year.

    The obvious benefit is that no period means no cramps, no menstrual headaches,  and no making a midnight run to buy tampons! Women who are anemic from heavy periods may particularly benefit. Eliminating the hormone-free week also dramatically decreases the chance of an inadvertent pregnancy that can occur if a new pack of pills is started late. The idea of eliminating periods by taking pills continuously is not a new concept. For over 20 years gynecologists have recommended continuous rather than cyclic use of birth control pills to eliminate painful menses in women with endometriosis. What’s new is the notion that menstrual suppression is an option driven by patient preference and convenience rather than medical indication.

    Many women, when asked, think it is unnatural and unsafe to not bleed monthly, which is why the majority of women who use hormonal contraception take three weeks of hormones followed by four to seven hormone free days to bring on a menstrual period. While a monthly period may seem “natural,” what nature really intended was for women to be pregnant or nursing as much as possible and have relatively few periods. Consider that prehistoric women experienced only 50 menstrual cycles in a lifetime (due to shorter lifetime and increased rate of pregnancy) as opposed to the approximately 450 menstrual periods experienced by most women today.

    With the average woman spending over 2,000 days of her life bleeding, it’s no surprise that according to a Harris poll, a majority of women would eliminate or decrease the number of their menstrual periods if safe to do so.

    Currently, many new forms of hormonal contraception are packaged this way, and the expectation is that this trend will continue. I predict our granddaughters will want to hear about the “olden days” when women who were not trying to get pregnant still got a period.

    So if you take birth control pills, try skipping the hormone-free days. People who use a NuvaRing may also be able to skip the ring-free week and replace one ring with another after 3-4 weeks.

    Buying those extra couple of packs every year can be expensive, but you can more than make up for it in the money saved in pads, tampons and pain medication!

    Origianlly published Jan, 2014 DoctorOz.com

    A Positive Pregnancy Test is Not a Baby

    A Positive Pregnancy Test is Not a Baby

    By Lauren Streicher, MD

    The beauty of Facebook is that you never feel alone when you have hundreds, thousands, or even millions of 'friends" who are there for you 24/7. So it is understandable that Mark Zuckerberg, the father of Facebook, (and a wanna be actual father)  has gone public with the news that he and his wife had  three  miscarriages prior to her current healthy pregnancy. And as anyone who has experienced  the excitement of a positive pregnancy test followed by a miscarriage is painfully aware, a positive pregnancy test doesn’t always translate to a baby nine months later.

    When the Rabbit Dies

    Today even women who flunked high school chemistry can find out they are pregnant by testing their urine in the privacy of their own bathroom within minutes of a missed period. Contrast that to the 1950’s, when women waited until the physical signs of pregnancy confirmed their suspicions. The  “rabbit test” was available, but not frequently done, since the test was performed by injecting a rabbit (or frog, or mouse) with urine from a pregnant woman. The rabbit was then” sacrificed”  (the politically correct scientific way of saying “murdered”) in order to check for changes that occur in rabbit ovaries after being injected with  a pregnant woman's urine.  

    By the 1960’s, rabbits no longer had to lose their life in the name of confirming pregnancy, and  today women not only learn they are expecting without having to go to the doctor, but  are able know  months before they can no longer zip their jeans. And, it is natural to want to alert your dearest "friends" via Facebook, that a baby is on the way the minute the faintest of faintest blue lines is discernable.   But stop the presses… Since significant numbers of pregnancies miscarry , even in young healthy women, it’s a good idea to wait prior to informing the immediate world.

    Yes, Even Young Women Miscarry

    Most women are aware that miscarriage rates are high in older moms, but are  shocked to learn that the pregnancy loss rate is as high as 1 in 5 pregnancies in young women. It is actually much higher, but most miscarriages  are undetected because they occur before  a missed period. In fact, even in a young woman, less than 50% of eggs that are fertilized make the journey down the tube, implant, and successfully grow into a baby.

    Miscarriage rates, primarily because of a genetic abnormalities, increase with maternal age.  Under age 30, pregnancy loss ranges from  10 to 20%, by age 45, 80% of pregnancies miscarry.

      When a pregnancy loss does occur, the question is always, “why did this happen and could anything have been done to prevent it?”  Unfortunately, the majority of miscarriages cannot be prevented, even if the cause has been determined.

    While  the most common cause of miscarriage is a pregnancy that is genetically abnormal even normal pregnancies are sometimes lost.  If a uterus has an abnormal shape , fibroids, or a lining that is not “welcoming” to a growing fetus implantation is sometimes sabotaged.

     Does Bed Rest Prevent Miscarriage?

    Despite your grandma's  advice that staying in bed will prevent a miscarriage, there is no evidence that doing so will make a difference. Avoiding playing tennis or having sex  (Sorry Grandma) also doesn’t matter. Since most pregnancies that miscarry are because of genetic or other abnormalities, a change in activity simply will not influence the outcome. You can't shake a good pregnancy loose.

    So back to the original question…when do you alert the media? Most  women, even if they are only five minutes pregnant, assume that it is obvious to even the most casual acquaintance and see no need to  keep this change in status private  for minutes, much less days, weeks, or. gasp… months?

     But, if you are planning on having pre-natal genetic tests it makes sense to wait for those results. It is always a difficult painful decision to terminate a desperately desired pregnancy.  It is even more difficult when you have told the immediate world that you are expecting.

     Even if you are not having genetic testing, the only people that you should tell you are pregnant in the first couple of months are  those people  you would confide in if you were to lose the pregnancy. If that includes all your Facebook friends, so be it. But don't say I didn't warn you. Once the pregnancy is a "go", post away, and as the Zuckerbergs have done, it's nice to let  women that have experienced a miscarriage know  they they are not alone, even if it is not posted on Facebook.

     

     

     

     

     

    Men Reveal Their Biggest Bedroom Turn Offs

    by Lauren Streicher, MD

     

    No one is more self-critical than a woman who is about to expose herself (literally) to a new sexual partner. Time and childbirth are not kind to the hips and thighs and many women spend hours obsessing about cellulite and saggy breasts. Too many women avoid intimacy altogether because they are so self-conscious of their less than perfect bodies.

    I have news for you. With few exceptions, he doesn’t notice and he doesn’t care. How do I know? I asked.

    Last year over 3000 men and women took my SexAbility Survey and answered questions about sexual response, preferences and habits. Most of the survey answers are in my book, Sex Rx, but one question did not make it to the book. I asked the guys, “What is your biggest turn off during sex? “As you can imagine, there were all kinds of comments, (tattoos, peasant like night attire, dandruff) but two general themes kept popping up:

    Theme 1: The over whelming majority of remarks were not about the size or shape of a partner’s breasts, thighs or belly, but were about hygiene. That’s right, responses to “what turns you off” were dominated with statements like, “if she smells bad”, or ”if she has bad breath.” And then there was my favorite comment – ” a smelly forest is no fun to play in.”

    Theme 2: The second largest number of gripes from the men had nothing to do with appearance, but rather with a lack of response on the part of the woman during lovemaking. The guys complained that women would too often “lose focus,” “drift away,” “not participate,” “not reciprocate” “not react,” or even worse, ”fall asleep.”

    So, did you get that ladies? You don’t need to wax your legs, highlight your hair and liposuction your thighs to make him happy. Simply take a shower and brush your teeth. If there is a persistent vaginal odor despite meticulous hygiene, get to your doctor and find out why. Above all, let him know that you like what he is doing. Show a little enthusiasm – reciprocate!

    I can already hear your comments. “Are you kidding? What about his bad breath? His gross toenails? The fact that he expects me to have an orgasm just because he has walked in the room? Or worse, doesn’t notice or care if anyone other than him has an orgasm!”

    So now it’s your turn. When I did the first SexAbility survey, I never asked the women about what repelled them about the men in their beds. I thought only women would read Sex Rx and didn’t need that advice. Well I was wrong. A lot of guys are reading Sex Rx  (forward thinking guys that want to understand women) and they are dying to know what they are doing wrong. So take a few minutes to take this survey  about the things that turn you off the most. Next blog, I will reveal your answers.

    Origianlly published 7/03/14 doctoroz.com

    Incontinence: Can It Kill You?

    By Lauren Streicher, MD 

     

    Involuntary loss of urine is embarrassing, inconvenient and distressing, but the one thing I have always assured my patients is that it is not a life-threatening condition. Recently, my perspective on that has changed.

    One of my patients mentioned to me that she had just recovered from a hip fracture that required a lengthy hospitalization and surgery. I asked her how she broke her hip and she replied, “I fell down at home.” That’s not unusual. In fact, most hip fractures occur from falls at home. She then said, “Actually, I never told anyone else, but I will admit to you that I was rushing to get to the bathroom and didn’t quite make it. I slipped on my urine and fell.”

    I wondered how many other home falls were due to incontinence and did a little digging.


    I found a number of studies that confirmed the association between urinary urgency, incontinence and falls that result in fracture including a 2013 article in the Journal of Clinical Nursing that showed that these often occur in elderly women living at home. It’s impossible to know exactly how many women fracture their hip running to get to the bathroom. Just as my patient didn’t report the reason for her fall, many women probably don’t report the reason for their fall to medical providers. Millions of women, especially older women, live with urinary incontinence. While we can’t know for sure how many falls every year result from rushing to the bathroom, the numbers are likely very high.

    This is no small issue. There are 54 million people with osteoporosis in the United States. About one in three people who fracture their hip will die within a year of the fracture. In spite of the prevalence of the problem, most women do not report their incontinence. The reasons vary from embarrassment to assuming that a leaky bladder is a “normal consequence of aging.” Unfortunately, about half of women that do report leakage to a health-care provider are inadequately treated. Pads and diapers are commonly recommended, but they should be thought of as a means to manage–not treat–incontinence.

    Know that there are many options available for treating your incontinence. You can have relief now, whether it’s with surgery, medication, pelvic-floor physical therapy, or an electrical stimulation biofeedback device, without waiting until you are older to do so. If your primary-care doctor or gynecologist does not offer options, consider seeing a urogynecologist.

    While it is important to prevent and treat bone loss, preventing falls is equally important. If you are one of those women that gets that sudden “gotta go” feeling and then dashes, make sure there is a clear path between the bed and the bathroom. And then make an appointment to see your doctor.

    Origianlly published 11/14 2014 doctoroz.com

    Pain for Pleasure? The O-Shot

    by Lauren Streicher, MD

    You have to study for the test to get the “A,” prepare the meal to enjoy eating it, and lift those weights to get fabulous toned arms. No pain, no gain. One of the few exceptions to that rule is having orgasms. Not only are orgasms predictably pleasurable, but also the getting there is half the fun.

    Unless that is you need to get a shot in your vagina or a surgical procedure in order to achieve orgasm. That’s why when I first heard about the O-Shot, my reaction, like many others’ was, you get a shot WHERE????

    Up to 25% of women have an orgasmic dysfunction, which is defined as the persistent or recurrent delay or absence of orgasm following a normal sexual excitement phase. The list of reasons this might happen is long and includes medications, hormone issues, medical problems or relationship issues. Studies also show that if you or your partner are depending on intercourse alone or need a map to the clitoris, it’s unlikely to happen.

    Enter, the O-Shot. The O-Shot is not a drug. It’s a procedure performed in a doctor’s office in which your own blood platelets are injected into vaginal tissue. The theory proposed by the inventor, Dr. Charles Runels is that platelets naturally attract your own stem cells to the injected area, and according to his website, “generate healthier and more functional tissue in the areas of sexual response in the vagina (G-Spot, O-Spot, Skene’s Glands, urethra, and vaginal wall).”  This is the same technique used by Dr. Runels when he invented the Vampire Facelift.

    In addition to claiming to improve your sex life, The O-Shot also promises to “cure” urinary incontinence (when you accidentally leak when laughing, coughing or exercising).  It’s true that many of the same women who have difficulty achieving orgasm also have problems with involuntary loss of urine, since weak pelvic floor muscles can be responsible for both problems.

    While some women are thanking their doctors for bringing the zest back into their bedrooms with the O-shot, most gynecologists aren’t on board. There simply has not been adequate research to prove its safety and effectiveness for either orgasmic dysfunction or incontinence. It may well work, and it may be safe, but the studies have not been done.

    The O-shot isn’t the only procedure some women are enduring in the quest for a decent orgasm. A machine where you simply push a button to climax is in development. There is a slight down side. This device requires surgery in order to implant a cigarette pack size generator into your buttocks. Oh, and there would also need to be electric contacts surgically inserted into your spinal cord. The remote control sends a signal to the implant, which then stimulates the nerves with electrical impulses to trigger an orgasm. I could be wrong, but I just can’t see women standing in line to surgically implant electrodes into their spinal cord and a box in their butt in order to have remote control orgasms. The inventor, however, who is starting clinical trials, expects to have no trouble getting women to sign up since women “currently endure more painful operations to enlarge their breasts.” Huh?

    I am not diminishing how frustrating and upsetting it is for women who have lost the ability to orgasm, but there are a number of easier ways to achieve this pleasure than plunging a needle into your vagina, or having spinal surgery. (The details are in my book, Sex Rx)

    One interesting alternative is a  device called Intensity that exercises and tones pelvic floor muscles combined with clitoral stimulation. And here’s the interesting part… many of the doctors that administer the O-Shot recommend that their patients use Intensity as well. So before you plunk down $1200 or more to get platelets injected into your vagina (no, insurance does not cover it, and yes it does need to be repeated) you might want to invest in an Intensity ($230 and it’s yours forever) to get the desired affect. No pain… and great gain.