Sexual Dysfunction Archives

“Just Drink a Glass of Wine” and Other Things Doctors Get Wrong About Sex Med

by Kelly J. Casperson, MD | Dec 2024

Kelly J. Casperson, MD, discusses the complexities surrounding female sexual health, addressing both societal misconceptions and medical gaps. In this 21-minute talk, she emphasizes that sex education, even for medical professionals, has been inadequate, with little attention paid to female anatomy.

Casperson highlights the medical community’s oversimplification of female sexual dysfunction, dividing it into issues of desire, arousal, orgasm, and pain. She critiques the cultural tendency to prescribe medications for low sexual desire without first addressing lifestyle, relational dynamics, and patient understanding of their own sexual health.

In her discussion on treatments, Casperson points out the challenges women face in getting access to effective therapies for sexual dysfunction. Additionally, Casperson addresses misconceptions about menopause and the effects of declining hormones on sexual and urinary health.

Care Considerations for the Man on ADT

by Alejandro R. Rodriguez, MD | May 2024

Alejandro R. Rodriguez, MD, discusses the management of metabolic, cardiovascular, and other side effects of Androgen Deprivation Therapy (ADT). In this lecture, Dr. Rodriguez highlights common side effects of ADT as a treatment, including:

Bone-Density Loss
Cardiovascular Disease
Diabetes and Other Metabolism Changes
Sexual Dysfunction

For each of these conditions, Dr. Rodriguez presents management strategies that can be used by physicians, patients, and members of the patients’ care team.

Interviews with Icons: Mickey Karram, MD

by Neil H. Baum, MD | Apr 2024

Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, interviews revolutionary urogynecologist, Mickey Karram, MD, on topics ranging from urogynecological cosmetic surgeries to robotic pelvic reconstruction. Dr. Karram is an internationally renowned urogynecologist and pelvic surgeon, widely considered to be a pioneer in the field. He has co-authored several of the leading textbooks and reference books in the study of Urogynecology, in addition to publishing over 200 peer-reviewed articles in medical journals.

In this interview, Dr. Karram shares his insights on:

Fostering Collaboration Between Urology and Gynecology Specialists
Urogynecological Cosmetic Procedures
Female Sexual Dysfunction
The Use of Robotics in Pelvic Reconstruction
The Future of Pelvic Reconstruction

Interviews with Icons: Sue and Irwin Goldstein

by Neil H. Baum, MD | Dec 2023

Grand Rounds in Urology contributing editor Neil H. Baum, MD, interviews Sue and Irwin Goldstein, MD, on their influential roles in the field of sexual medicine. Dr. Goldstein has authored over 360 publications and his contributions have significantly shaped the study of sexual health, while Sue has played a vital role in pioneering research on female sexual dysfunction, culminating in the establishment of the International Society for the Study of Women’s Sexual Health (ISSWSH) in 2000.

They discuss the groundbreaking impact of Viagra, as well as the evolution of women’s sexual health as a recognized discipline. Sue highlights the prevalence of female sexual dysfunction, shedding light on issues like sexual desire problems and the underreported concern of pain, affecting 43% of women. Dr. Goldstein addresses challenges faced in sexual medicine, citing issues related to knowledge, information, and finances. The Goldsteins’ unique approach involves extensive patient interaction, including in-depth interviews and testing, underlining the necessity of time to advance the field.

The two also detail the ‘orgasm gap,’ with Sue discussing the International Society for the Study of Women’s Sexual Health’s ongoing work to understand and address orgasm-related issues, and Dr. Goldstein sharing insights into physiological pathways related to pain and orgasm.

Sue details common conditions urologists can address in women, such as genitourinary syndrome of menopause (GSM), hypoactive sexual desire disorder (HSDD), and pain, emphasizing the crucial role urologists can play in menopause management.

Both Goldsteins advocate for urologists’ involvement in women’s sexual health, recommending participation in the ISSWSH events. They express commitment to training residents and fellows, encouraging interested individuals to reach out for opportunities.

Common Drug-Induced Sexual Dysfunction in Men

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.