Vaginal dryness (atrophic vaginitis) can lead to painful intercourse. Usually the result of decreased hormone levels and aging, atrophic vaginitis causes changes in the vaginal tissue, decreased lubrication, painful intercourse, and hence a low interest in sex.

Medications can be toxic to sex drive. Depression and anxiety medications, known as SSRIs and SNRIs (examples are Prozac, Zoloft, Effexor, and Cymbalta) classically decrease interest in sex and ability to achieve orgasm. Oral birth control pills decrease Testosterone, lowering sexual desire. Other examples of medications that are toxic to your libido are: over-the-counter anti-histamines like Benadryl, opioid pain medications like Percocet and Vicodin, B-blockers which treat blood pressure and heart conditions, and Benzodiazepines like Valium and Xanax commonly taken for anxiety. Our goal is to minimize/eliminate the need for these medications when possible by using natural alternatives.

Genital mismatch (defined as the increased diameter of the vaginal canal, often in conjunction with decreased size of the erect penis) is extremely common as sexual partners age. Childbirth, weight gain, chronic straining (from constipation or difficulty with urination), and pelvic injury (often from pelvic surgery) results in vaginal laxity, also known as Vaginal Relaxation Syndrome. Weakening of the muscles that support the pelvic organs causes prolapse, or a “dropping down” of the uterus, vagina, bladder and/or rectum. In addition to causing issues with bowel and bladder control, vaginal relaxation can lead to decreased stimulation and pleasure during sex, especially if a partner’s penis has also decreased in size due to the aging process.

Lifestyle factors can also interfere with libido. Lack of sleep, lack of excess, poor diet or increased stress can interfere with intimacy. Depression/anxiety and weight gain can change your comfort level with your body and sexuality can negatively impact interest in sex.

Other gynecologic concerns can play a role. These include: dyspareunia (chronic painful sexual intercourse), lichen sclerosis (a condition that causes changes in the appearance of the skin of the vulva, results in chronic itching, pain, and scarring of the vulvar tissue), vulvar vestibulitis (a chronic pain syndrome possibly linked to chronic yeast, bacterial vaginosis, or HPV infection), other vaginal infections, or heavy, prolonged menstrual bleeding.

Fortunately, there are now several options, both hormonal and non-hormonal, available to help improve vaginal dryness and elasticity of the vaginal tissue. Often several modalities will be necessary to achieve non-painful, pleasurable intercourse. As discussed above, bio-idential hormone replacement, through pellets and creams is a mainstay for treatment. Non-hormonal options which patients have found to be extremely beneficial are the O-shot^® and FemiLift^®. The Orgasm Shot uses Platelet Rich Plasma to improve vaginal lubrication, improve tissue elasticity, and increase clitoral sensitivity. The Intima^® uses a fractional CO2 laser to restore vaginal tone, flexibility and shape. An added benefit is decrease in stress incontinence, or leaking with coughing, sneezing, laughing and exercise.

As described above,FemiLift^® laser can be used for vaginal tightening, while the Priapus Shot^® can improve erections and size of penis for male partner. Other options for treatment include surgical procedures, when necessary, to address organ prolapse, especially when leading to bowel and bladder dysfunction.

An overall evaluation of general health, including cortisol levels/adrenal function, insulin resistance, and thyroid testing when appropriate, to aid in weight management and optimization of energy.

Specific treatment of any gynecologic concerns which may interfere with a healthy libido, especially chronic infections and lichen sclerosus.

Improvement in sensitivity of the clitoris, intensity of orgasm, and lubrication of vagina through the O-shot^® will not help with libido, but will improve pleasure and sexual satisfaction.