Life Extension Magazine®
Doctor taking notes at sexual health and medicine conferences

Issue: Oct 2019

Recent Sexual Health and Medicine Conferences

Presentations at recent conferences by experts in sexual medicine included infertility, erectile dysfunction, older fathers, intercourse pain, bacterial vaginosis, polycystic ovary syndrome, premature ejaculation, and sexual assault.

Scientifically reviewed by:  Dr. Gary Gonzalez, MD, on January 2020. Written By Ben Best, .

Ben Best
Ben Best

Communication about sexual problems with health professionals is often prevented by embarrassment or expectations of bias. Health professionals may fear being inappropriate or at risk for malpractice for mishandling communication about sexual matters with their patients. Yet the various aspects of sexual health and sexual medicine impact important areas of our lives.

The following report contains a review of topics presented at recent conferences by experts in the fields of sexual medicine and sexual health.


Elizabeth Grill, PsyD
Elizabeth Grill, PsyD

Elizabeth Grill, PsyD (Associate Professor of Psychology, Weill Cornell Medical College, New York City) is concerned with infertility (involuntary childlessness) in couples. According to the U.S. Department of Health & Human Services, in about one-third of infertility cases, male infertility is the problem. Female infertility accounts for another one-third. The remaining cases are caused either by a combination of male and female problems or by unknown causes.1 Obesity and smoking reduce fertility in both males and females.2-5 Athletes who take anabolic androgenic steroids to improve their performance and appearance reduce their fertility.6 Infertility in women accelerates with age from about 5% at age 25 to about 50% at age 41.7

Infertile couples often exhibit anxiety, depression, or anger, which may be a cause or consequence of the infertility.8 Couples often feel their masculinity, femininity, or social acceptability is affirmed by their ability to have children, which adds to their distress concerning infertility.9 In vitro fertilization is an option for some infertile couples, but the procedure is expensive.

Bacterial Vaginosis

Sujatha Srinivasan, PhD
Sujatha Srinivasan, PhD

Sujatha Srinivasan, PhD (Senior Staff Scientist, Fred Hutchinson Cancer Research Center, Seattle) is an authority on bacterial vaginosis, the most common vaginal infection among women of reproductive age.10 At any given time, about one-third of women have this infection.11 Symptoms include vaginal discharge, fishy odor, and reduced vaginal acidity. In about half of cases there are no symptoms. Why symptoms occur in some women, but not in others is unknown.12 Bacterial vaginosis is associated with an increased transmission and acquisition of sexually transmitted infections.13

Douching is a common cause of bacterial vaginosis.14 Smoking is associated with bacterial vaginosis.15 Bacterial vaginosis often recurs despite antibiotic treatment, but oral treatment with the probiotic Lactobacillus crispatus has been shown to reduce recurrence.16

Effects of Breast Cancer Treatment

Lisa Larkin, MD
Lisa Larkin, MD

Lisa Larkin, MD (Owner and President of Lisa Larkin MD and Associates, Mariemont, Ohio) treats women dealing with symptoms related to breast cancer treatment. Women with no risk factors for breast cancer have a 12% lifetime risk of the disease, whereas those with a genetic disposition for the disease are more likely than not to develop breast cancer.17 Surgical removal of both breasts almost completely eliminates the extra risk of breast cancer caused by genetic predisposition.18

Many young breast cancer survivors given chemotherapy develop menopausal symptoms, including vaginal dryness, painful urination, and painful sexual activity.19 Concern over increasing cancer risk by the use of vaginal estrogens often motivates the use of non-hormonal lubricants, but these lubricants can increase the risk of infection.20 The Women’s Health Initiative Observational Study showed no increased risk of cancer for women using low-dose estrogens applied as a cream, ring, or tablet directly to the vagina.21

Erectile Dysfunction

Sharon Parish, MD
Sharon Parish, MD

Sharon Parish, MD (Internal Medicine, Weill Cornell Psychiatry Specialty Center, White Plains, New York) gave a presentation on erectile dysfunction. By one estimate, the inability to achieve an erection affects 5% of men aged 40 and triples to 15% by age 70.22 Another study showed that erectile dysfunction increases with age, affecting almost 40% of men 70 and older.23 Obesity, physical inactivity, and smoking are among the risk factors for erectile dysfunction.24,25

Phosphodiesterase type 5 (PDE5) inhibitors, such as sildenafil (Viagra®) tend to be more effective in younger than in older men,26 but can have unpleasant side effects.27 Stem cell therapy,24 exercise,28 testosterone,29 and low intensity shockwaves30 may be effective treatments.

Polycystic Ovary Syndrome (PCOS)

Andrea Dunaif, MD
Andrea Dunaif, MD

Andrea Dunaif, MD (Professor of Medicine, Mount Sinai, New York City) is a specialist in polycystic ovary syndrome (PCOS), which she believes should be renamed “metabolic reproductive disorder.” PCOS is the leading cause of missed menstrual periods and infertility in women.31 Women with PCOS are commonly obese and have high blood levels of male hormones (androgens).32 Women with PCOS often experience excessive body hair and difficulty losing weight.33

Weight loss is an effective treatment when it can be achieved. Possible drug treatments include metformin34 and androgen-blockers (including hormonal contraception).35,36 Women with PCOS often report a lack of empathy from their physicians, who may argue with them while not providing useful advice.37

Older Fathers

Dolores Lamb, PhD
Dolores Lamb, PhD

Dolores Lamb, PhD (Vice Chair, Department of Urology, Weill Cornell Medicine, New York City) is concerned about the fact that birth rates for men under age 30 have been declining, whereas birth rates for men over 35 have been increasing. Genetic material (DNA) becomes increasingly fragmented as the age of the father increases.38 On average, the offspring of a 40-year-old father have twice as many genetic mutations as the offspring of a 20-year-old father.39 Miscarriage is more than twice as likely for a father over 55 than for a father under 36.40 Children of older fathers are more likely to suffer from cancer, dwarfism, autism, schizophrenia, and other abnormalities.41

As an aside, Dr. Lamb commented that a woman in her 20s marrying a wealthy man in his 70s is unlikely to refrain from becoming a mother based on this information. In vitro fertilization with screening of embryos could be an option in such cases.42

Intercourse Pain in Women (Dyspareunia)

Lindsay Phillips, LMSW
Lindsay Phillips, LMSW

Lindsay Phillips, LMSW (Clinical Social Worker, University of Michigan, Ann Arbor, Michigan) does psychological counseling with women who report pain during intercourse, a condition which affects 10% to 28% of women (different studies have shown different frequencies).43 Just over half of women affected seek medical treatment.44 Most women with the condition continue regular penetrative activities with a sexual partner, motivated by a desire for closeness or fear of losing their partner. Inflammation and certain contraceptives can cause the pain, but often there is no identifiable cause.45

Men are far less likely to have pain during intercourse, and when such pain does occur, it is usually due to inflammation of the prostate or bladder.46

Low Sexual Desire in Women

Brooke Faught, DNP
Brooke Faught, DNP

Brooke Faught, DNP (Clinical Director of the Women’s Institute for Sexual Health, Nashville, Tennessee) counsels women who suffer from distress due to low sexual desire. Nearly 40% of women in the United States report low sexual desire, but in only 12% of cases is this accompanied by distress.47 The most common cause of distress is feeling “less connectedness” with a partner.48 In general, sexual desire in women tends to decrease with increasing age, but associated distress also decreases with increasing age.49

Menopause not only reduces estrogen and progesterone hormones, but androgens as well (reducing sexual desire).50 Postmenopausal women receiving testosterone as part of hormone replacement therapy show improved sexual function and reduced cancer risk.51,52 Intermediate rather than high doses of testosterone produce the best results. Excessive body hair was the major complaint of the women receiving the testosterone.51 The hormone oxytocin, available from compounding pharmacies, may also be beneficial.53

Premature Ejaculation

Ege Can Serefoglu, MD
Ege Can Serefoglu, MD

Ege Can Serefoglu, MD (Associate Professor, Bahceci Health Group, Istanbul, Turkey) is a specialist in the subject of premature ejaculation. Men typically ejaculate between four to eight minutes after sexual penetration. Approximately 5% of men ejaculate in less than two minutes after penetration.54 About 90% of men seeking treatment for premature ejaculation ejaculate within one minute after penetration.55

In a few cases there is a readily treatable cause, such as excessive thyroid hormone.55 Drugs can be effective, but in most cases a combination of psychotherapy and drugs produces the best results,56 because men who ejaculate prematurely often have emotional problems. Low level of serotonin is the most well-validated cause of premature ejaculation that can be treated with drugs, but patients usually discontinue taking these drugs because of side effects (including a loss of interest in sex).57 Modafinil, a drug used to treat narcolepsy, has shown better results.58

Sexual Assault

Andrea Holmes, MD
Andrea Holmes, MD

Andrea Holmes, MD (Forensic Medical Examiner, Galway Sexual Assault Treatment Unit, Galway, Ireland) examines rape victims for evidence of assailant DNA and administers contraceptives and medications to prevent sexually transmitted disease. An estimated 17%-25% of women and 1%-3% of men have been sexually assaulted in their lifetime.59 Women are more likely to report being raped than men. Of women rape victims, 16% to 25% report the incident to police, up to 30% contract a sexually transmitted disease, and 5% become pregnant. Rape by a stranger is more likely to be reported, although this is only a small proportion of all rapes.60 Rape is the most common cause of posttraumatic stress disorder (PTSD) in women,59 and PTSD is the most common mental health consequence of sexual violence.61

Concluding Remarks

plants growing in a beaker

Poor communication or lack of communication with health care professionals is a recurring theme in sexual medicine. According to one survey, fewer than 25% of people will seek help from a health professional for sexual problems.62

In 2017, female students enrolling in American medical schools outnumbered males for the first time in the history of American medicine. Lack of understanding of and empathy for women’s medical problems was characteristic of medicine when the profession was almost entirely dominated by men. A greater proportion of female physicians may result in better communication of sexual problems by women.

More generally, health problems that are sexual are often taken too personally. Shame, guilt, and fear over sexual health issues that could potentially be treated can cause those problems to become chronic physical and psychological wounds.

It is my hope that this report will encourage people to have the courage to be more open about sexual issues, resulting in greater resolution of those problems.

If you have any questions on the scientific content of this article, please call a Life Extension® Wellness Specialist at 1-866-864-3027.


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