Let's talk about sex: FAQs from patients to the GP
By Dr. Aparna Hegde,
Cosmetic & Integrative General Practitioner, Educator A5M & ACAAM, Advisory Panel Member A5M
MBBS, FRACGP, MPH & Tropical Medicine, Dip Aviation Med, ACAAM
Q: Do you need it?
Q: What is normal?
The average Australian couple has sex once to twice a week. My rule of thumb – get concerned if the frequency of sex is either taking up so much time that it is interfering with work and social life such as with sex addiction or so little that it is negatively impacting on relationships or sexual function if the person is single.
I often use the quote "use it or lose it". Sexual function should be exercised in a similar fashion to your muscles and brain to maintain the health of the genitals. The link between the mind and body for arousal and the physical changes that accompany arousal to climax and the "happy hormones" that are released should be practiced at least twice a week in men and women to effectively maintain sexual function.
In older men and women who lose interest in this aspect of life for reasons such as loss of a partner or hormonal changes, the decline in sexual organs accelerates due to the lack of "exercise". In men, the resultant erectile dysfunction and low testosterone can lead to low mood, increase in visceral fat, decrease in lean muscle mass and a host of adverse health issues. In women, there is thinning and dryness of the vaginal lining that can cause discomfort and recurrent urinary tract infections.
Q: What can go wrong?
In men, premature ejaculation, decreased libido and decreased sexual function are the common presentations I deal with as a GP that can be easily addressed. The first and most difficult step for men seems to be to acknowledge there is a problem and to seek help.
In women, decreased libido, discomfort with sexual intercourse, vaginal dryness and laxity would be the most frequent presentations. I find women tend to discuss these issues during the Pap smear or routine well woman checks and as with most health issues are more open to addressing them than men.
Q: What treatments are available?
Couples counselling can be used to identify and address any psychological concerns that are impacting on sex in relationships. Any significant health issues such as low testosterone levels or vascular disease should be excluded when there are difficulties in sexual function such as low libido. In men, medication is used to address premature ejaculation as well as erectile dysfunction which is defined as difficulty achieving and maintaining erection.
New treatments such as extracorporeal low shock wave therapy and platelet rich plasma also have good evidence to address erectile dysfunction.
I recommend Rosie King's book "Where did my libido go?" to women who present with low libido. It is easy to read and has practical suggestions that all women can incorporate as well and has good feedback from my patients. There is a medication called flibanserin nicknamed the "pink pill" (Viagra is known as the "blue pill") that is being used in the US for low libido but it despite the hype, the results have not been positive and it is doubtful it will be approved for use in Australia. The use of HRT, topical oestrogens, laser treatments as well as platelet rich plasma for vaginal rejuvenation and better sexual function are used as treatments in women with good effect.
If you are a healthcare practitioner or doctor interested in learning more about reproductive health, we have a workshop this November in Melbourne entitled "A multi-functional approach to Men's health issues", scroll to the top of this page and use the event link to register for the workshop.
A5M Member price $550 | Non-member price $600 - workbooks & catering included.
Published by A5M with permission from the author
Dr Aparna Hegde can be found at Azure Medical in Perth, WA.
She is a UWA (1994) graduate who has specialised in General Practice and Aerospace Medicine. Aparna completed her certification in Anti-Ageing Medicine with A5M in 2017 (ACAAM). She has a special interest in Women's Health, she is experienced in the use of bio-identical hormones and supplements to restore normal physiology. Aparna was in the RAAF full time for 11 years and is still in the specialist reserves.
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