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Sex with Dr. Jess


August 24, 2017

Sexual Health Questions Answered

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The brilliant Dr. Jessica Shepherd (@JShepherd_MD) joins Jess to talk about vaginal health and answer a few sexual health questions from listeners. If you have questions you’d like us to answer, send them our way! We love to hear from you.

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This podcast is brought to you by Desire Resorts

Rough Transcript:

This is a computer-generated rough transcript, so please excuse any typos. This podcast is an informational conversation and is not a substitute for medical, health or other professional advice, diagnosis or treatment. Always seek the services of an appropriate professional should you have individual questions or concerns.

Sexual Health Questions Answered

Participant #1:
Hello out there. And welcome to another episode of the Sex With Dr. Jess podcast. I am Jessica O’Reilly, your friendly neighborhood psychologist, and my goal is to provide you with with accurate sciencebased, information and insights that will help you to have happier relationships and a more fulfilling sex life. However, you define that, and I want you to feel great about yourself, to love your body, to embrace your desires and everything that comes with them. Now, today’s show is all about sexual health, and it’s brought to you by Desire Resorts, one of my favorite places to visit down in Mexico. You can Tan nude, meet new, exciting people from all over the world, and it’s couple’s only clothing optional. Check them out at Desire Resorts. Now, today, I am really thrilled to have Dr. Jessica Shepard with me as a guest. And Dr. Shepherd is an obstetrician gynecologist and director of Minimally Invasive Gynecology at the University of Illinois at Chicago. She specializes in endometriosis fibroid and minimally invasive surgical approaches to gynecological diseases and much, much more. We met about a year and a half ago in Toronto working on an event, and she’s brilliant, lovely. She’s beautiful, which doesn’t matter, but I can’t not think about that. So Jessica, Dr. Shepherd, thank you for being with us. Absolutely. I think we have a lot more in common than that. We have same first name. We have Jamaican heritage. We’re Canadian. I mean, we’re both doctors. I don’t know how much more I can get than that. That’s awesome. Yes. And you’re a medical doctor, so you can answer a ton of questions that I just don’t have any background on. So today we’re going to be answering questions from my Twitter followers, from some of our listeners about sexual health and sexual challenges. But before we do, I came across an article and of course. Oh, boy. Yeah. It was plastered all over my Facebook. And here’s the headline, Vaginas Absolutely Need Sex or the Waste Away Study. My first reaction is one who wrote that. And two, can I visit them and talk to them about vaginas and just how awesome vaginas are and why they really are in the wonderful powerhouse of the body, which is the pelvis. And that is absolutely not true. It’s not necessarily the opposite, but to say that it would waste away. I think that’s for lack of a better term, that’s not so nice to say that about the vagina, but there are definitely ways to keep it vibrant, but it doesn’t necessarily mean if you don’t use it, then it’s going to go away, right? I mean, you asked who wrote it. Maybe that’s the answer in and of itself. This is The New York Post we’re talking about. So one of the pieces of the advice I found in the article suggests that if cells don’t get enough oxygen, they cannot eliminate waste from the tissue, which can cause inflammation that leads to problems. Such as vaginal atrophy. And of course, they’re connecting us to sex, saying, if you don’t have the sex, the vagina is going to run into trouble. So what is the relationship between sex and vaginal health? So the relationship really is vagina is very forgiving as far as what the vagina is able to withstand and withhold. And if you think about it, children commend it through the vagina. So I think that the vagina is very elastic as far as elasticity, it’s full of connective tissue. Now, we do know that after menopause, it’s not so much that the cells don’t necessarily aren’t being used. It’s more so that the estrogen that’s being released from the ovaries is going to be significantly less. And that’s when you see that you’ll have that drop. So what happens after that drop in the estrogen is that you’ll see that the tissue starts to change. And so when the tissue starts to change, that’s when you’ll notice that you have a little bit of dryness in the vagina, sometimes it’s not as elastic or flexible as we like to call it. But that doesn’t necessarily mean that you can’t use it. So that’s a big difference. We do have lots of ways to help women kind of use the vagina and help it out a little bit after menopause. And whether that’s with lubrication. I’m a big advocate of lubrication. Whether that’s hormone replacement therapy to give you back that estrogen, obviously, you need to talk to your doctor about that before you would choose that one. And also pelvic physical therapy. Exercise is also great. Diet is a big part of how your body responds internally. And so there are so many things in ways that we can change our lifestyle and medications that we may want to take that can help the vagina and not let it waste away because it’s not going to waste away. I know this is like the powerhouse of our body. I can’t imagine another organ in any gender’s body that can do what the vagina does. I mean, it’s very multi fauceted. It does so many things. So there’s nothing we can do sexually that will make our vagina waste away. Is that accurate? That is accurate? Definitely. I have people who think that again when we’re talking mainly about penis size for penile vaginal intercourse is that sometimes it can be too big and traumatized. The vagina that usually comes with the degree of intensity of how you have sexual intercourse. So sometimes women can present to the office and they might have a laceration because they had a little bit of rough respects. But to say that the vagina is going to completely stretch out juicy penis size. Typically, we don’t see that happen. The vagina is very forgiving. If you think about childbirth after a baby passes through the vaginal canal and that birth canal, it really does go back down to the initial size. Maybe not exactly. But very close. So again, the vagina is very forgiving it’s very powerful. And I encourage women also to not feel after menopause that they can’t use it. I think sometimes there is an idea that after menopause, you shouldn’t be having sex anymore and you can’t have sex anymore. But it’s quite the opposite that we want you to be very sexually happy and have adequate and very good sexual health even into your older years. Right. So that could mean not having sex or that could mean having sex every single day. And either way, you’re exactly. Yes. You mentioned diet. And that’s a really interesting. So can you tell me a little bit about what we should be eating, what we shouldn’t be eating because I don’t think people associate what they eat with vaginal health. Yeah. Absolutely. I think what we put in our bodies is what we put out. And so what we have shown in studies is that a diet that is very highly inflammatory. So that’s going to be foods that are going to be processed, your fast foods, your foods with a lot of sodium preservatives and also foods that have white flour, white sugar, and also those are going to promote a lot of inflammation in the body. And so when you have inflammation inside the body again, that’s going to affect your increase in vaginal infections, such as yeast infections, bacterial vaginosis. And so a lot of that sometimes relates to how you treat your body inside is what it’s going to put out. And so I have had women who come with whether it’s chronic yeast infections or chronic bacterial vaginosis infections, we can treat it with medication, but some women actually can get it what we call recurrently. And that means just over and over again. And a lot of these patients that I see, I’m like, let’s work on your diet and see if we can change that and change some of the outcome that we have. And many of them come back and say, you know what? This is great. I started decreasing all those white flour, white sugar, processed foods in my diet, maybe taking some more probiotics. Keifer is also a good food source that can decrease inflammation in the body. And they do see changes. So lifestyle has a lot to do with vaginal health. Okay. Excellent. All right. Well, I have some questions now that I have you here. I have some questions from some of my followers that I’d love to ask you. So I’m going to start with a tough one. I mean, this one says we have some bad news. My wife was diagnosed with cancer, throat cancer. She’s 60. She’s never smoked. She’s very fit and beautiful. We’ve had a great sex life over the years. And the doctor says that the cause of the stroke, cancer could possibly be HPV. I remember it goes on to reference Michael Douglas talking about this and that the doctor sees more and more of this now, how prevalent is it? Do we know that it is HPV from oral sex and is my sex life changed forever? What can we do? That’s a great question. I’m so sorry to hear of that diagnosis, but I definitely think that even patients who have a cancer diagnosis, one can still partake in sexual intercourse and activity and have very healthy sexual relationships. Now, when we talk about throat cancer specifically for this question, HPV, what we do know is that HPV in general, the virus is a leading cause of cancer. And so we have started to see an increase in, not necessarily significantly, in autofringeal cancers, which would include throat cancer. And now we are seeing that HPV can be a cause of those cancers. Now, if that’s directly related to oral sex, an oral intercourse, as far as contracting the HPV virus. Yes, there is an Association with how the HPV virus would be transmitted in some of those cases. But we see that also in cervical cancer, cervical cancer. Hpv is the leading cause of cervical cancer, which is why we do the PAP Smear for screening and also anal cancer as well. So for men who have sex with men, you will see or women who have anal sex who partake in anal sex. Also, we have noted that anal sex HPV would be the leading cause. So it’s more so that the virus is very carcinogenic and can cause these types of cancers. So, again, with any penetration in oral anal or vaginal penile, you also will see those types of cancers being caused by HPV as well. Do we have any screening for throat cancer? I remember talking to a dental hygienist students who said they were even being trained to look for symptoms in the back of the mouth and throat. So there are really good ways to look for the throat cancer for those students who look for it for symptoms. Maybe people come in with complaints. Obviously, there are ways that we can look for it. But if there’s actual screening test, there’s not right now. And what we do know is it can come through the you can do HPV what we call typing cotesting with the PAP smear, but we haven’t really delegated one for the throat as of yet. So obviously, as we start to see, more numbers increase, then we’ll start to I’m sure that we’ll start to work on a way to screen for that. And so what are doctors doing when they look in our throats? Would they be looking for symptoms of I don’t know. Yes, they would be looking for signs. Typically, if a patient has a complaint or if a patient States that they are taking primarily in oral sex, that may be a good reason to look for any signs, but usually it will be based on symptoms. That’s not a routine annual screening that we do to look for throat cancer. For someone who says that they do partake in oral intercourse insects. But there are ways that if someone comes in with a specific complaint, then yeah, that’s something that we would definitely ask them if they partake in and then start to look for possible signs and symptoms that may correlate the oral sex to possible throat cancer. Okay. Is our sex life changed forever? Can they still have oral sex? Do you have any thoughts on that? So when we think about viruses, they have multiple strains. And when we say strains, it’s pretty much just same virus, very different types. For lack of a better term, they wear different coats, so they have different coating, same kind of person. So again, we have to know what the particular type or strain of HPV. It was that the patient may have been exposed to, but typically, when someone has a cancer, usually that means they’ve already had some of the more what we call carcinogenic types of HPV and been exposed to that, obviously, because now it’s progressed into a cancer. So with that being said, it does not mean that they cannot have oral sex. But it may be a good time to think about if you want to again protect yourself and wear condoms for that type of sex, because you don’t want to increase your risk of being exposed to other strains of the HPV virus. Right. So it’s a risk for her as well. This is something we don’t talk about enough. And even when we do talk about it, people don’t tend to want to use condoms and other barrier methods for oral sex. And I don’t know if you’re seeing a rise in throat cancers, as this doctor reports via his patient here. But do you think, as we see an increase in cancers related to HPV, people will consider more seriously using condoms for oral sex? I think that’s definitely something that would be more of a public health issue in the sense that it requires more education from the public health standpoint that if we do start to see a significant rise in for cancers, then we, as a medical community, need to take that responsibility to them, educate, and also for ways in the private sector to find ways that are creative to provide barrier methods that people again would want to use. So it’s kind of combined. If we see an increase in those numbers of throat cancer and knowing that it’s HPV related, we need to start educating. We need to start opening the conversation and the dialogue with patients so that they know that this is a potential risk that they take when they partake in oral sex. And so with that risk. Also, what are ways that we can decrease those possibilities of transmitting the HPV virus, which would be with really creative ways to come up with various methods. So if anyone’s listening and there’s an entrepreneur, that may be something that we would love to see on the market is something that’s specifically for oral sex and some type of barrier method. Right. Okay. Perfect. Thank you. Now I have some more questions. These ones may be a little bit more straightforward. So this one says, I used to love sex. This is from a 45 year old woman, this woman I used to love sex. But ever since I lost my job, I find it painful. How do I get my groove back? That’s a great question. So what we do know is libido, which is our desire to initiate sexual activity or have sexual fantasy or thoughts can be decreased when you have something significant and traumatic happening in your life, such as loss of a job, a divorce, loss of a loved one. And so with that comes a decrease in the ability to think of things that would be pleasurable, which would fall into the range of sexual intercourse. And so typically, what we like to recommend to patients when they have some of these issues is to really again, sit back and think, what are the causes that they may have that may have caused this particular decrease in desire, and also when they have thinking about maybe individual therapy, individual therapy that they can have with a therapist that might help them get to that level where they feel better about themselves and better about their relationships with their partner, and that they will feel delighted to have sex even in the midst of going through a traumatic time in their life or something that doesn’t make them feel very good about themselves. So really, it’s really multi focus when you think of the way to deal with that. Again, working specifically with the psychotherapy of that individual to get them to a better point where they feel that they can have a desire in sex. Right. And this seems to be common. So they’re talking about painful sex starting after some sort of a big life shift or traumatic experience. And so the body can psychologically. Yeah. The body responds to those things very much so in stressful times, you’ll see that you’ll have different ways and that the muscle is tense, is not relaxed. And when you see that happen, that can be directly, because when you think about sex, actually, it’s very connected to our brain and how we’re thinking we’re head spaces. And so when someone is significantly down or depressed have some signs of depression, the pelvis is going to know that, and it’s going to respond accordingly. And so you’re going to see a decrease in possibly lubrication the way that the muscles respond to sex. And then you might have some tightening, intense areas or moments that it’s not going to respond to the sexual course, as we call it, during sexual intercourse. So again, the muscles can be very tight. Sometimes I send patients who have had a long course of pelvic pain related to some type of issue that’s going on in their life to a pelvic physical therapist. I love sending patients to pelvic physical therapist because they work with the patient on their muscles in the pelvis. There’s so many muscles in the pelvis, and they really pinpoint where those areas are and how they can help that patient get back to more relaxation in the pelvis and having great sex life. Awesome. Yes. Pelvic floor therapist. I think everybody should have access to one. And I don’t know about you, but I am learning so much from them, and there seems to be new information every year because ten years ago, the prevailing advice was just, hey, do Kecos. And now we know that most of us shouldn’t even be doing Kecos, right. I think we have gotten to the point where we overdo them, and then we haven’t learned how to relax the muscles now, so we’re very much building them up, but we’re not relaxing them as well. You run into that with PAP Smear exams that you have difficulty insertion for some people who are hypertonic or tense down there. Absolutely. We have patients who have had maybe history of sexual abuse are very uncomfortable with their PALPAs in general. And we will definitely see that manifested during the PAP Smear. Some patients I have to really talk to ahead of time before we do the actual speculum exam in the room and then work our way towards that. I find having a discussion before it, letting the patient know exactly what we’re doing throughout the exam and having them relax and think of something that is so stressful before we actually insert the speculum. And that’s very helpful that we have a conversation about it before and through the whole exam so that they feel comfortable and they don’t mind having the metal speculum or the plastic speculum placed inside. But I do see that quite often tense vaginal and pelvic muscles during an exam. Yeah, that makes sense. All right. I’ve got one more quick question. I know that we have to let you go. This person says I have no problem with sex. I love it. But after sex, my vagina hurts. Why might this be? Is there anything I can do? I’m already using Luke. There are multiple reasons why. And the difference is that pain or discomfort discomfort sometimes can occur after sexual intercourse, and that’s not necessarily a bad thing. There are a lot of during orgasm. Again, you have a shift in how your vaginal muscles respond to that. And you can have some what we call cramping or tensing of the muscles in that area. And how long does it last? Is it pain or discomfort that lasts for a short period of time or a long period of time? And for women who have a long period of time where they have pain after intercourse, and that’s something that we need to again evaluate in the office, possibly with ultrasound on a bimanual exam and just getting an idea and appreciation of what might be going on in their vagina. So we have patients who may have endometriosis, which is a pelvic pain disorder, and it’s estrogen related, but we could actually do a full show on Endometriosis. It’s so complex, but that could be a cause another time, another time. Yes. But in endometriosis, that may be in the vaginal walls. That’s why they may have pain after sex. And some women have what we call vulva dinner, so that’s increased hypersensitivity of the vulva and that’s the outer portion of the vagina. But that, too, can be affected by sexual intercourse as well. Okay. Now I know that you have what I really appreciate your time. I have dozens of questions that I would love to have you answered another time. Having said that if you could just leave people with one piece of information that would improve their physical sexual health, is there something you’d like them to know? Yeah. I think that’s being empowered by their body and feeling comfortable with themselves, I find that a lot of sexual disorders have to do with again, overall health, how they feel about themselves when I say health, not necessarily health is their blood pressure. Okay. But overall health, meaning emotional psychosocial health that also plays a big part in how they respond sexually. So much goes into sex and sexual health. It’s not just penis vagina, and that’s it. There’s so much more that goes around that. And I really encourage patients to be willing to talk to their provider about any issues they’re having with sex so that they can feel comfortable. That’s a really good point, because it can be hard to advocate on your own behalf as a patient if you’re absolutely comfortable talking about this. But some doctors can’t even say vagina. You know, I had a doctor called my vagina, my lady parts three or four times a few months ago. Oh, my goodness. I hate hearing that. Yeah, we have to learn to stand up as patient. So, Dr. Shepherd, thank you so much for being with us. We really appreciate it. We’d love to have you back again. Definitely to talk about endometriosis and what the best practices are today in 2017, because Endometriosis group and I see their stories of pain and heartache and how it interferes with even their ability to go to work. So that would be a great topic to cover. I think it encompasses so much of pelvic health, but I would love to have a discussion with you on Endometriosis, and I’m part of a lot of support groups as well to help patients, so we can definitely invite them to be part of the conversation and get some Twitter activity during that conversation. Okay. Wonderful. Thank you again for being with us, folks. Thanks for tuning in. This is the at sex withdoctorjeffodcast. Follow us. And Dr. Shepard, where can they find you? Oh, they can definitely find me on Twitter at J. Shepard, S-H-E-P-H-E-R-D underscore, MD on Twitter and Jessica Shepherd, MD on Instagram and her Viewpoint dot com for the website Perfect. We’ll make sure we share those links. Thank you all and have a great day. Bye.