Re: Postpartum sexual dysfunction
From: Cesar Molina (cemolar777@gmail.com)
Wed Nov 21 08:21:48 2007
she is in lactation and the high levels of prolactin decrease the libido.
Then the sexual response is decreased to, difficulting all the "sexual
fisiologic cascade"; furthermore the new situation of a MOTHER. He have to
be patient and increase more and more the creativity and choice the exactly
momento to intercourse.
2007/11/6, D. Ashley Hill, M.D. <dahmd@cfl.rr.com>:
>
> 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.
>
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