Maria Uloko, MD, Author at Grand Rounds in Urology

Maria Uloko, MD

University of California, San Diego

La Jolla, California

Disclosures:

Maria Uloko, MD, is a urologist who specializes in the treatment of female sexual dysfunction, female sexual pain, low libido/desire, regenerative ED treatments, advanced erectile dysfunction, symptomatic menopause, atrophic vaginitis, urologic prosthetic surgery, Peyronie's disease, and hormone therapy. Dr. Uloko has expertise in providing gender-affirming care to transgender and nonbinary patients.

Dr. Uloko is an assistant professor at UC San Diego School of Medicine, she is involved in training medical students, residents, and fellows in urology and sexual health.

Dr. Uloko completed a fellowship in comprehensive sexual health with a focus on prosthesis/reconstruction at San Diego Sexual Medicine and Scripps. She completed residencies in urology and general surgery at the University of Minnesota Medical School in Minneapolis and earned her medical degree from the University of Missouri - Kansas City School of Medicine.

Dr. Uloko is a strong advocate of improving the quality of life of her patients by providing a comprehensive, compassionate, and inclusive approach to often stigmatized subjects. She believes in empowering her patients to take ownership of their sexual health by providing a shame-free space to ask questions and share their stories. She seeks to close gaps in care disparities and implement systems that promote diversity and inclusivity.

Talks by Maria Uloko, MD

Common Drug-Induced Sexual Dysfunction in Men

Posted by Maria Uloko, MD | Jul 2023

Maria Uloko, MD, discusses symptoms, causes, and treatments of post-finasteride syndrome (PFS) and post-SSRI sexual dysfunction (PSSD) in men. She begins by defining PFS, noting its controversial status in urology. Dr. Uloko outlines PFS symptoms, including depression, suicidality, and anxiety. She explains that these psychiatric symptoms often worsen when medical professionals dismiss them as results of finasteride use.

Dr. Uloko then considers the incidence of PFS, emphasizing the need to study PFS in the treatment of male pattern hair loss and highlighting the NIH’s inclusion of PFS in its 2015 list of Rare and Genetic Diseases. She discusses how 5-alpha-reductase inhibitors cause PFS, later evaluating the results of androgen deprivation in animal models as well. This leads Dr. Uloko to highly recommend validating patient concerns. She completes her discussion of PFS by advocating for a biopsychosocial approach to treatment, noting the importance of medication cessation and educating patients.

Dr. Uloko proceeds by discussing PSSD in men. She first reviews PSSD and its symptoms, noting that the prevalence of persistent sexual side effects following SSRI discontinuation is unknown. She lists common SSRIs and explains their use in treating depression and premature ejaculations. Dr. Uloko then discusses how discontinuation of the drug can increase serotonin activity. She explains how serotonin negatively affects sexual factors, signaling PSSD’s mechanism of action. Dr. Uloko transitions into a discussion on the pathophysiology of PSSD and explores the debate surrounding this topic. She then focuses on PSSD treatment, proposing that urologists utilize a biopsychosocial approach and address correctable factors. She concludes her discussion by emphasizing the need for patient validation and further research on PFS and PSSD.

Primer on Testosterone Therapy for Women: Treatment of HSDD

Posted by Maria Uloko, MD | Jun 2023

Maria Uloko, MD, discusses testosterone therapy for women with hypoactive sexual desire disorder (HSDD). She explains that people with HSDD have higher rates of impaired body image, low self-confidence and self-worth, relationship stress, depression and anxiety, and increased healthcare costs.

Dr. Uloko shares the Basson Model of Sexual Motivation and emphasizes there is no “quick fix” for low libido. Dr. Uloko advocates a biopsychosocial approach that incorporates the biological, psychological, and social aspects that can affect HSDD. She explains the importance of patient education and therapy as well as medication treatments like flibanserin and testosterone.

Dr. Uloko emphasizes that testosterone is not FDA-approved for women, and it remains challenging to dose women appropriately. She cites studies that conclude testosterone, either alone or in concert with estrogen therapy, can be effective and safe for the treatment of HSDD. Dr. Uloko states that symptomatic improvement takes approximately 12 weeks, and treatment should be discontinued if no improvement occurs within six months.

Dr. Uloko then concludes that HSDD is a common but multifactorial condition for women with significant detriment to quality of life. She re-emphasizes the importance of a biopsychosocial approach to diagnosis and treatment that may include treatment with testosterone therapy.