Sexual Dysfunction – Dryness / Laxity / Incontinence / Lichens
Dr. Finkelstein specializes in treating incontinence, vaginal dryness, lichen sclerosus, vaginal pain, laxity, prolapse, and cosmetic labia issues. The ability to have enjoyable sex is an important part of both one’s physical and emotional health. So when sex is generally unenjoyable it’s a huge problem that is both personally frustrating and potentially debilitating to one’s relationship with their spouse or significant other. Some women sadly report lifelong “anorgasmia”, meaning they have gone their entire lives being physiologically unable to enjoy sex the way they would like, never having experienced orgasm during intercourse with any sexual partner. Other women, in some sense even more tragically, report “acquired” sexual dysfunction, meaning a once very enjoyable sex life has been disrupted to where they no longer enjoy it. Chronic pain from endometriosis, adenomyosis, or even large fibroids can disrupt the sex life. These women are mostly bothered by deep penetration pain. Certain sex positions may be simply intolerable while other positions are ok. Alternatively, “superficial dyspareunia” – a term that refers to pain at the vaginal entrance – is associated with certain vaginal infections, dermatologic inflammatory conditions such as lichen sclerosis, and is overwhelmingly common in women approaching or past the menopause due to “atrophic vaginitis”. Atrophic vaginitis are age-related changes in the vulva and vagina that lead to chronic dryness, narrowing (sometimes profoundly) of the vaginal entrance, chronic urinary problems, and a saggy appearance to the labia that some women find unsightly and embarrassing. Vaginal prolapse is another problem that can disrupt sex. Women may complain of pain related to bulge discomfort. There may be embarrassment due to the vaginal appearance, or due to leaking urine during sex. Or it may just be a matter of vaginal gape – a widened vaginal opening from prolapse often interferes with the friction of intercourse, leading to complaints from the woman or her male partner of finding it difficult to feel each other well during sex. Some women have chronic sex pain due to a poorly repaired episiotomy, or as a complication after vaginal mesh placement, or an overtightening of the vagina in a prior surgery. Whatever the issue, you do not have to live that way. Solutions are available. Sometimes a corrective surgery is what is needed. In other cases, medical-based therapy is the way to go. There are many options to choose from. Among the more wildly popular and promising recent advances in sexual medicine that are minimalist, effective, and safe with very low side effect profile are the Thermiva radiofrequency therapy and biologic injections that deliver growth factors and anti-inflammatory properties – probably the most known example today being the PRP based O-shot (O for orgasm).