Re: Postpartum sexual dysfunction
From: D. Ashley Hill, M.D. (dahmd@cfl.rr.com)
Mon Nov 5 19:55:32 2007
Thanks, Joanne.
As a follow through, I've looked at every reference I can find and have
identified the following: several conditions can cause decreased
clitoral blood flow, including atherosclerosis and estrogen deficiency.
Treatment is not well researched, but some advocate estrogen therapy, or
viagra, or mechanical therapy such as the Eros device or similar (a type
of clitoral pump). Interestingly, the patient had her first visit with
a pelvic floor physical therapist (who has worked wonders with several
of my patients) and reports a 40% improvement (at home, in case anyone
wonders) in clitoral sensation after a few sessions of anterior
"vesicouterine fascia manipulation" with the therapist. I also have her
using topical estrogen BID. It's an interesting problem. As to
Joanne's comments, although I agree with what she wrote, I believe this
patient has an organic cause. Thanks again,
Ashley
At Sun, 4 Nov 2007, Joanne Bulley, MD wrote:
>
>This may not be related to anything anatomical or neurologic.
>
>This may be related to the total disconnect between when it means to her
>(and her family of upbringing) to be a "Mother" and the meaning of
>"being sexual"
>
>There are plenty of reasons for this disconnect. Helping her be BOTH a
>Mother AND a Lover may be what is needed.
>
>Add to the societal aspect of all products being "sold" with sexual
>innuendos - overt or subtle - EXCEPT for merchandise that has to to with
>"motherhood" - think about the commercials you see for frozen dinners /
>housecleaning products or diapers - the women are fully clothed - never
>showing cleavage etc. Add to that much upbringing that makes moms
>asexual.
>
>How much "free" or "personal" time does she have? Does she work 40 +/-
>hours per week AND keep track of all the needs of the baby / child care
>/ grocery shopping / husband's needs? If she is the one where the "buck
>stops" at home - having the 36 hour a day job of mom / wife /
>housekeeper AND works outside the home - then her sexual needs may have
>just gone into hiding to give her a bit of respite.
>
>I sure see this click with a lot of women I care for. I remind them
>they need "self time" for that sexual being to wake up. Sexuality can't
>be "left" for the last thing after a full day's work and
>responsibilities when there is no energy left. You know - totally
>exhausted worrying about tomorrow - brush the teeth and the ONLY thing
>desired is (hopefully) 6 or 8 hours of sleep and only sleep! The couple
>needs to create new way of communicating to create a sexual relationship
>as parents as compared to the "we can do it anytime" during courtship
>and living together / early marriage without kids.
>
>I think the claim that there is absolutely no sensation whatsoever
>without any known trauma to the periclitoral area is a key to the
>diagnosis.
>
>May need counseling if a session of 30 or so minutes with her gyn
>doesn't help reach the cause and outline a path for change. Book a
>consultation for review separate from the regular exam.
>
>Joanne
>
>At Sun, 4 Nov 2007, D. Ashley Hill, M.D. wrote:
>>
>>Listers:
>>
>>30-something presents for care 12 months after an uncomplicated,
>>spontaneous vaginal delivery of 7.5# baby after 1 hour second stage
>>without operative delivery with complaints of anorgasmia since delivery.
>>She had a midline second degree laceration repaired with vicryl. There
>>was no anterior lacerations or hematomas. Prior to delivery she
>>reported a satisfying sex life with no difficulty achieving sensation
>>and orgasm with self- or partner-stimulation. Now she feels clitoral
>>"numbness," cannot achieve orgasm regardless of technique, including
>>vibrator usage, and notes that she no longer has any clitoral
>>engorgement. Prior to delivery she "always had clitoral engorgement."
>>There is sometimes pain with clitoral stimulation but no generalized
>>vulvar pain. Her libido is intact and she wants to get back to her
>>normal sex life.
>>
>>Exam reveals normal female anatomy. The pudendal distribution appears
>>grossly normal compared to light touch elsewhere, and the
>>bulbocavernosus reflex seems appropriate (although how would you
>>quantify this)? There are no pelvic masses.
>>
>>I don't know if there is any value to pudendal nerve testing, because I
>>don't think anyone knows what the numbers mean from that test. Does
>>anyone have experience with this or with Viagra or similar for female
>>patients? Any other thoughts? Thanks in advance,
>>
>>Ashley
>>
>>--
>>D. Ashley Hill, MD
>>Division Director, Dept. of Obstetrics and Gynecology
>>Florida Hospital Orlando
>>Medical Director
>>Loch Haven Ob/Gyn Group
>>235 East Princeton Street, #200
>>Orlando, Florida 32804
>>http://www.lochhavenobgyn.com
>>
>>Please understand that due to time constraints I am unable
>>to answer any personal emails, therefore they will receive no response.
>>
>>These comments are general educational comments and should not
>>be construed as specific medical advice. The best person to
>>answer your health care questions is your physician or other
>>health care provider. Thank you very much.
>>
>--
>Joanne Bulley, MD, FACOG
>Solo gyn
>Keene, NH USA
>
--
D. Ashley Hill, MD
Division Director, Dept. of Obstetrics and Gynecology
Florida Hospital Orlando
Medical Director
Loch Haven Ob/Gyn Group
235 East Princeton Street, #200
Orlando, Florida 32804
http://www.lochhavenobgyn.com
Please understand that due to time constraints I am unable
to answer any personal emails, therefore they will receive no response.
These comments are general educational comments and should not
be construed as specific medical advice. The best person to
answer your health care questions is your physician or other
health care provider. Thank you very much.
