Approximately forty percent of American women experience some form of sexual concern during their lifetime. This is more than the number of men, women, and children with all types of diabetes combined! Unfortunately, this common condition often goes underreported and undiagnosed. Regardless of the cause or type, you don’t have to suffer! At Haven Center, we can help you feel better.
Low Sex Drive
Hypoactive Sexual Desire Disorder (HSDD)
Characterized by a lack of spontaneous sexual desire or fantasy, HSDD is one of the most common types of sexual dysfunction. Multiple factors, including rigid upbringing, previous sexual assault, or even partner-related sexual issues, can lead to this condition. Many treatments exist for patients with HSDD, including counseling, sex therapy, and medication.
Sexual Aversion Disorder
Sexual aversion disorder is characterized by symptoms such as nausea, shortness of breath, or extreme revulsion in response to sexual stimuli, or even the possibility of such activities. This condition often stems from negative sexual experiences or negative thoughts/guilt about sexual activity. Treatment is therapy-based, and may include journaling or anti-anxiety medications.
Female Sexual Arousal Disorder (FSAD)
Female sexual arousal disorder is a condition characterized by either a loss of lubrication, difficulty maintaining lubrication with sexual activity, or a decreased sensation of being aroused (turned on). There are multiple causes of FSAD, including an exaggerated anxiety response, high blood pressure, diabetes, previous pelvic trauma, or hormonal deficiencies. Treatment is based upon identifying the causative agent and includes counseling, medication, or arousal aids.
Persistent Genital Arousal Disorder/Genito-pelvic Dysesthesia (PGAD/GPD)
Persistent Genital Arousal Disorder/Genito-pelvic Dysesthesia is a condition characterized by unwanted feelings of arousal which are often painful, occur completely outside of sexual activity, and are disturbing to the patient. Classification of this disorder is based on the originating location of the symptom, such as the genitals, the spinal column, or brain. Treatment is often multidisciplinary, and may include medication, counseling, physical therapy, and surgery.
Pain with Sex
Vaginismus is a condition characterized by spastic, painful contractions of the muscles at the entrance of the vagina. Many women with vaginismus experience anxiety about any type of vaginal penetration, and will have symptoms arise during gynecologic exams, insertion of tampons, or sexual activity. Current therapy for vaginismus involves desensitization, counseling, muscle relaxers, and physical therapy. The Pacik Multimodal Botox Program under Anesthesia has been successful in eliminating symptoms in over ninety percent of patients undergoing the procedure.
Dyspareunia, or painful intercourse, is a condition that has many different causes. It may occur with initial penetration, deep penetration, or both. Many non-gynecologic conditions can cause painful intercourse, including interstitial cystitis, pelvic floor spasms, and diverticulitis. Treatments revolve around finding the specific cause of the pain, and include modalities such as counseling, physical therapy, medication, or (rarely) surgery.
Pelvic Floor Dysfunction
Pelvic floor dysfunction is an overarching term that encapsulates disorders of the pelvic floor and includes conditions such as pelvic pain, incontinence, and pelvic organ prolapse. Diagnosis is made via physical exam, although certain types of pelvic floor dysfunction may require further testing such as muscle conduction studies or ultrasound. Treatment for this condition is dependent on the type of dysfunction, but includes physical therapy, therapeutic injections, medication, or surgery.
Difficulty with Orgasm
Female Orgasmic Disorder (FOD)
Female Orgasmic Disorder is a condition that manifests as either difficulty obtaining orgasm, and/or adverse reactions after orgasm, such as nausea, vomiting, or headache. FOD is often caused by hormonal dysregulation in the brain, medications like anti-depressants or hormonal contraceptives, or problems related to sensory stimulation in erogenous areas. Various treatments for orgasmic dysfunction exist, although relatively few studies have been conducted on their efficacy. Counseling, hormonal therapy, and medication have all been used to treat female orgasmic disorder.
Pleasure Dissociative Orgasmic Disorder/Orgasmic Anhedonia (PDOD)
Pleasure Dissociative Orgasmic Disorder (PDOD), also known as Orgasmic Anhedonia, is a condition characterized by the knowledge that one is having an orgasm, but without any pleasurable feeling from that event. A fairly rare condition, PDOD is thought to be associated with problems in the brain’s pleasure center – the limbic system. This may be due to hormonal imbalance, head trauma, or chronic medical problems. Treatment is often multifactorial, combining psychologic, physiologic, and pharmacologic therapies.
The term vulvovaginal disorders refers to a series of conditions that affect the tissues of the vulva (external genitalia) and the vagina (internal genitalia). These conditions may be inflammatory, infectious, or reactive in origin. Although they are very common, vulvovaginal disorders are frequently misdiagnosed. They can range from mild to severe, and encompass a variety of concerns from yeast infections to gynecologic cancers.
Chronic Yeast Infections
Vulvovaginal yeast infections are often characterized by itching, abnormal discharge, and irritation of genital tissue. These infections are most commonly caused by the fungus Candida, and are diagnosed via culture or microscopy. Chronic yeast infections can be challenging to cure, as effective treatment regimens are often complicated and may require a series of multiple medications.
Vulvar Skin Conditions
Vulvar skin conditions are a collection of skin disorders that affect the external female genitalia. Itching is by far the most common symptom, but patients may also have pain with intercourse, burning with urination, or a sensation of rawness. It is common for vulvar skin disorders to be confused as sexually transmitted infections, so it is important that patients receive a thorough exam and biopsy to be correctly diagnosed. Treatment involves medication such as steroids or biologics, as well as lifestyle changes.
Pudendal neuralgia refers to nerve-related pain originating from the pudendal nerve. On the vulva, this pain is often felt around the clitoris and/or perineum, but can also manifest around the anus. Common causes include sacral trauma, pelvic floor spasms, childbirth, and straddle injuries that may occur from riding a bike or horse. Diagnosis is based off of clinical examination and treatments vary depending on the root cause of the pain.
There are many different causes of pain in the clitoris. Infection, trauma, and vascular issues, such as clitoral priapism (a persistent erection of the clitoris), can lead to debilitating discomfort. One such cause, clitoral adhesions, are common, and can result from an infection underneath the clitoral hood due to trapped debris such as pubic hair, dead skin cells, or toilet tissue. A thorough exam, often including vulvoscopy, is necessary to properly diagnose the root cause of clitoral pain. Treatment is based on removing the offending agent through surgery or medication.
Chronic Vaginal Discharge
Although some vaginal discharge is very normal, patients with excessive amounts of chronic vaginal discharge often complain that it affects their quality of life. This may be due to an abnormally strong odor, a sensation of irritation, or requiring consistent use of pads or liners. Possible causes include infections, hormonal changes, and certain medications. Treatment often requires microbial testing to determine if an infection is present, followed by dietary changes, supplements, or medications.
Vulvodynia and Vestibulodynia
Vulvodynia and Vestibulodynia are painful conditions that affect the vulva and vaginal vestibule, respectively. They are often caused by hormonal, inflammatory, or nerve-related issues, and can be present for many years before patients seek care. Diagnosis is made with a thorough exam of the painful area, and often involves blood work and testing for bacterial infection. Treatment is dependent upon the underlying cause of the pain, and can include hormone therapy, topical nerve/pain medication, or surgery.
Lichenoid disorders of the vulva are a group of inflammatory skin conditions that often present with intense itching as well as changes to skin pigmentation. These include lichen simplex et chronicus (LSC), lichen sclerosus (LS), and lichen planus (LP). LSC is considered a type of eczema of the vulva, and while bothersome, is not life-threatening. LS and LP, on the other hand, can progress to cancer if not properly treated. As such, it is very important to have biopsy confirmation of the disease and treat aggressively with medication.
Vulvar itching can have numerous causes such as infections, inflammatory or allergic reactions, and nerve-related conditions. While the itching itself may be simply bothersome, the underlying condition may prove to be more serious. Thus, it is important to fully investigate the cause of the itching in order to make an accurate diagnosis and prescribe proper treatment.
Did you know that in the United States alone, over half of the entire population uses some form of hormone therapy? At Haven Center, we believe in an individualized approach to hormone therapy, basing our recommendations off of your specific health goals, preferences, and laboratory findings.
Physiologic menopause is defined as the absence of regular periods for more than one year. Surgical menopause occurs when the ovaries are removed prior to the onset of physiologic menopause. It is very important to note that menopause is not a disease, though the associated symptoms can substantially impact quality of life. These symptoms commonly include hot flashes, night sweats, mood swings, and vaginal dryness. Treatment often takes the form of hormonal and non-hormonal medication, counseling, and dietary and lifestyle changes.
Primary Ovarian Insufficiency (POI)
Primary Ovarian Insufficiency (POI) is an autoimmune disease that causes the onset of menopause prior to the age of 40. Previously known as Premature Ovarian Failure, or premature menopause, POI is often found in women who have additional autoimmune diseases, such as Lupus or Type-1 Diabetes. Symptoms are similar to physiologic menopause, and include hot flashes, mood swings, and vaginal dryness. Women experiencing POI should receive hormone therapy to reduce the occurrence of menopause-related complications such as osteoporosis, Alzheimer’s, dementia, and heart disease.
Insulin is a hormone that is produced in the pancreas in response to sugar (glucose). When glucose levels rise, the pancreas releases insulin to help move glucose into cells, where it can be utilized for energy. If there is too much insulin, however, insulin resistance can occur. If this happens, glucose is pushed into a storage form for “a rainy day,” which leads to weight gain. As this cycle continues, other complications of this inappropriate storage will occur, such as elevated cholesterol, high blood pressure, and eventually, the development of diabetes.
At Haven Center, we customize a treatment plan for each patient depending on their goals and the severity of their condition. We are fortunate to be able to offer two new drug therapies in our office that are specific for the treatment of insulin resistance.
Genitourinary Syndrome of Menopause (GSM)
Genitourinary Syndrome of Menopause (GSM) is a result of hormonal deficiencies in the female reproductive tract and surrounding tissue. Previously known as vulvovaginal atrophy, GSM is now the preferred name for a collection of symptoms including vaginal dryness, painful intercourse, recurrent vaginal infections, recurrent urinary tract infections, and regression or shortening of genital structures. Up to seventy-five percent of menopausal patients will experience symptoms associated with GSM which are often progressive in nature. Treatment includes either local or systemic hormone therapy, vaginal moisturizers, and lubricants.
Menstrual-related Mood Disorders (PMS/PMDD)
Menstrual-related mood disorders such as Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD), encompass a wide variety of emotional health concerns that correlate with changes in the menstrual cycle. Symptoms of these conditions overlap and may include irritability, depression, anxiety, and fatigue. In the case of PMDD, however, they are often more severe, and patients may report suicidal or homicidal ideations. Both disorders demonstrate an improvement in symptoms after the onset of menses. Diagnosis is based off of a thorough history of symptoms as well as menstrual charting. Treatment is often centered around minimizing hormonal fluctuations, and can also include antidepressants and counseling.
The following topics and conditions often correlate with sexual medicine and/or vulvovaginal disorders. As such, they are addressed at the Haven Center.
In addition to world-class subspecialty care, we also provide exceptional routine gynecologic care at Haven Center. We offer well-woman exams, Pap smears, and breast exams, as well as providing diagnosis and treatment for PCOS, endometriosis, abnormal bleeding, and more – all in a spa-like, comfortable environment.
LGBTQ+ Affirming Care
According to the Gay and Lesbian Medical Association (GLMA.org) “studies show that lesbian, gay, bisexual, transgender and (LGBT) populations, in addition to having the same basic health needs as the general population, experience health disparities and barriers related to sexual orientation and/or gender identity or expression.” At the Haven Center, we are knowledgeable about and sensitive to the unique needs of the LGBTQ+ population. All patients at our clinic receive the same level of exceptional, affirming, inclusive, and respectful healthcare, regardless of sexual orientation or gender identity/expression.
Sexual Function Across the Cancer Continuum
Sexual medicine for patients who are undergoing, or who have completed, therapy for cancer is a very complex and often misunderstood practice. Not only is treatment data limited, but most patients and providers are unaware that many options exist to support healthy sexual functioning. Whereas previous generations of cancer survivors were told that they were no longer candidates for hormone therapy, new medications and treatments have been shown to be safe and effective in this population.
We recognize that past experiences may have a long-lasting effect on mental and physical well-being. Trauma is associated with many sexual conditions and may contribute to vulvovaginal disorders as well. As such, we utilize traumasensitive language and trauma-informed care principles throughout our practice.
At the Haven Center, we utilize multiple forms of analgesic therapy to reduce or eliminate pain associated with in-office procedures and routine gynecologic exams. In addition to relieving discomfort, these tools can lower procedural anxiety as well. With our nitrous oxide sedation system, we can provide rapid-onset pain and anxiety relief that clears the bloodstream within minutes, allowing our patients to drive themselves home after the procedure. We also utilize numbing creams, distractionary techniques, and other modalities to improve the overall patient experience.
Pediatric and Adolescent Gynecology
Pediatric and adolescent gynecology refers to the medical and surgical management of gynecologic concerns in patients under 18 years of age. It requires specialized evaluation and examination techniques to reduce the possibility of trauma associated with a gynecologic exam. Not only is our office uniquely suited to ensure that even the youngest patients feel comfortable and receive the highest level of care, but we are the only gynecologic provider in the region to offer multiple forms of adjuvant pain and stress-relieving therapy.