When Women Lose Their Libido: Lessons from Rachel Bilson’s ‘Isn’t That Crazy?’ Moment

Dr. Amber Klimczak and Dr. Beverly Reed discuss the orgasm gap that Rachel Bilson educated us about. They discuss low desire as well as their recommendations and new treatment options available. Watch this (Season 3, Episode 13) on Youtube or listen on your favorite podcast platform to Two Peaks in a Pod.

https://www.youtube.com/@peakfertility

https://podcasts.apple.com/us/podcast/two-peaks-in-a-pod/id1694248202

Transcript

0:06

Hi, I am Dr. Beverly Reed. And I'm Dr. Amber k Clack. And we are two two peaks in a pod. A pod. Well, welcome back everybody. Today I wore red because we have an extra spicy topic for today. Oh, I didn't even think about that. Remember how I was offended because I asked, um, chat GPT about our podcast and they said, well, they said we did do a good job for a very dry topic, so let's. Spice it up a little bit. Yeah. Fertility is not a dry topic. Oh, yes. Yes. And um, and so let's talk about something a little spicy. So I hear you have a celebrity to tell us about. Yes. Um, who maybe had some issues with the spiciness going on, right? Yes. Okay. So do you know who Rachel Sen is? I do, yes. Okay. She's beautiful. I think she has the dark hair. She's dark hair. I think she's so gorgeous. Cute. Um, and I really like one show that she's in. I feel like this is not as. Well of a known show, but I watched it all like binge watched it Hard of Dixie, have you heard about this? No. Uhuh, she's like a little family medicine doctor in a small town. Oh. She like goes back, I think it's like where her dad lived or something. Gosh, she takes over his practice. I really, it's like very Hallmark movie ish. Oh my gosh. How cute. Okay. You need to watch that. But the one I was thinking of, wasn't she on some kind of, I mean, it's been a while. Some, some kinda like OC show something. Yeah. She was on the oc. I think that's what she's most famous for. But Heart of Dixie recommend highly. Yes. Dix. Okay. Perfect. Perfect. Okay. Um, but I love her and I guess so she talks about something really interesting mm-hmm. That I think our patients often encounter. Mm-hmm. And sometimes, you know, you feel kind of alone in the world of infertility. You feel like maybe you're the only person that's. Going through things, feeling a certain way. Mm-hmm. Um, but she kind of talked about this disparity mm-hmm. Um, in the frequency of sexual climax between males mm-hmm. And females. Mm-hmm. Right? Mm-hmm. Okay. Especially like heterosexual encounters. Yeah. And she called this the orgasm gap. Mm-hmm. And so I guess this is kind of a well-known phenomenon, right? I think all of us women. Probably understand and know this, we didn't need a fancy term for it. Right. But the idea is that 95% of the time men are orgasming with every sexual encounter. Mm-hmm. Right? That's like mm-hmm. That's gold. Yes. Right. So not fair. Right. Standard. That's not like, that's not equivalent for women. Yeah. And they say that only 65% of women mm-hmm. Report doing so. Mm-hmm. I actually feel like that's high. Yeah, sure. I mean, don't you think? Yeah, totally. Yeah. 'cause that's, that's self-reported. Like I feel like also women sometimes aren't even open enough to say no. Maybe it's like even lower than that. Right, right, right. Um, and so I do feel like this is an interesting topic for fertility because unfortunately. Women, you know? Mm-hmm. Women's orgasm isn't necessarily an essential part of getting pregnant. Right. That's true. But it's essential for the guy. Right. And so it may be that you're out there struggling with fertility and are, you're kind of dissociating. Mm-hmm. Your sexual encounters with, from. Pleasure. Yeah. And more so it's just work, right? Yeah. Work, work, work. Your timing ovulation, you have to get together at a perfect moment is probably gets to the point where it's not very enjoyable. Totally. Well, it does remind me too, and I think I've brought this up to you before, is um, a lot of times I'll see a couple for a new patient consult and they'll kind of have some uncertainty. I don't know if I came to see you too soon, like. We've only been trying this amount of time or whatever. Let's say they say, well, we've only been trying, trying for a year or something, right? Mm-hmm. And then inevitably the guy will chime in and he said, well, I told her it's too soon. I think we just need to be having more sex. Enjoying the, trying always say that, you know? And I'm like, you know, and here they've been timing and let's say they had sex. Twice during the fertile window, we know that should be enough. Yeah, right. Yeah. But like from the male perspective, they're like, well, hey, we can get more in that window if we just keep trying it. We're gonna get there. Right? Yeah. Meanwhile, the women are like, please, yeah, get him off of me. But I think you bring up a really good point too, because maybe just women. In general may have this gap, but I do feel like when you have infertility, I can understand how maybe you can almost have an attachment of some of the negative feelings of infertility with having sex too. Right? If it has become to feel like a chore, you ha you are timing it. You have to force it to happen at certain times. I can understand how in the long term, even if you got pregnant and had a baby after that. That may be a link with your brain that really might need to be explored or kind of recited in a way so that you don't have that kind of negative feeling. Maybe that comes up whenever it comes to sex as well. Yeah, absolutely. Mm-hmm. Such a good point. Mm-hmm. Yeah. I know we always talk about health, infertility, and fertility. Journeys can change you. Yeah. You know, for the long run. So sometimes once you're even, um, at a good point in your journey, you have to reflect and see if you need to maybe go through some things to recover. Yeah. You know? Yeah. So I saw a really sweet couple the other day. Mm-hmm. Um, you know, they've had a long journey and they're, you know, kind of making decisions on what to do next and they actually feel really happy with what they're gonna be trying next. Um, but it was sweet because, um, the. Partner, he said, well, didn't you have one more question you wanted to ask? You know, and she said, oh, yes. Okay. Well, I did wanna mention, you know, I love my husband so much. He's so handsome, he's so great, but I just never wanna have sex ever. And she's like, it's not personal towards him, but like it. Is there anything you can help me with? And I did kind of feel bad as a doctor because I do think sometimes I'm so focused on infertility that maybe I'm not paying attention to some of these other things. So I was just curious, is this something you're seeing in your practice and kind of how would you be able to best help your patient, um, with these things? Yeah. Oh my gosh. And like. Kudos for her for speaking up. Yeah, it's, I think that that's actually a really hard thing to admit. Yeah. With your partner standing next to you. Totally. That's a really good point. Yeah. Yeah. Mm-hmm. Mm-hmm. Um, 'cause that's, I mean, that's a really candid conversation. Yeah. Um, I would just say maybe your patient's listening or there's other patients out there. Mm-hmm. You're not alone. Right. So we do have a lot of data to show. So there's, you know, a fancy word for the results of a lot of studies is a meta-analysis and systematic. Systematic reviews basically that summarize all the studies that are out there. And it does show that women with infertility are at increased risk of sexual dysfunction. So you are not unusual if you're feeling this way. So absolutely, it can be lots of different things. It says, um, sexual dysfunction, particularly with issues with lubrication, orgasm, and satisfaction domains, which makes perfect sense, right? Because especially when that sexual encounter is maybe rushed or. Forced, or, you know, more frequent than you're ready to do. All of those things pop up. Um, so I think that that absolutely, this is a common thing to have sexual dysfunction. And then when you look into other types of sexual dysfunction, there's a disorder called hypoactive sexual disorder, which is the number one. Sexual disorder that's out there that exists and it's basically exactly what your patient's describing. Mm-hmm. Just not having any libido. Right. And not being interested in having sex at all. Right. Mm-hmm. Mm-hmm. Um, so I think that this is absolutely something that can be a risk factor, right. In fertility's a risk factor for this happening. Um, and then, you know, kind of interesting vice versa. Mm-hmm. Sometimes the subgroup of patients that ultimately end up struggling with infertility. Could be linked to sexual dysfunction, right? Mm-hmm. So could sexual dysfunction be a risk factor for infertility? And we know this, right? Yes. Because we see this a lot. There's really two conditions that pop up into my mind when I think about this. Yes. One of the first one is when you have painful sex, the fancy word for that is DYS Premia. Absolutely. That can be. Sign of endometriosis. Yes. And we know endometriosis can lead to infertility. Mm-hmm. So it is a risk factor. Mm-hmm. The other thing that we see a lot in our practice, just by nature of our practice, is another condition called vaginismus. That's where those muscles just immediately, immediately contract and tighten up. Mm-hmm. Um, really with a sexual encounter or other things like GYN exams. Mm-hmm. That can make getting pregnant really hard. Absolutely. So, um, you know, there are things that I think could put our patients into this risk category. Oh, absolutely. And, um, I think too, it's almost a protective me mechanism for some people. Um, so imagine if you've got endometriosis and you don't know it. You have intercourse and it's painful, right? So your brain only wants to protect you. So your brain says, well, I don't wanna do that again. Right? And so then actually sometimes you can also get vaginismus because your muscles learn to squeeze to try to keep anything out of the vagina. And then your brain says, gosh, let's just lower the desire. So that this is just not an issue that we have to deal with. Right. Um, and so I, I do think in some cases it could be all connected together, and I think that's helpful from the patient standpoint to again, have some validation of, you're not alone. There is a reason for this. It's not that you, there's a relationship problem or, or anything like that. Um. And, um, even just knowing that I think can give you some comfort, right? Because really I think the key is when you're trying to understand is something wrong? A big part of it is maybe you have low desire and it causes you distress. Mm-hmm. Right? Because, you know, do you ever hear that question of like, how many times a week should you be having sex? Right? Yeah. Like, and you'll hear. So many different answers, but maybe the right number will be different for different people. Really, at the end of the day, does each partner feel happy with it? And nobody's in distress, right? I think the biggest issue becomes if either partner is not getting to where they wanna be, and if that's causing distress to themselves or even to each other, or to the relationship, um, as a whole. Yeah, absolutely. I mean, we even learned about that in med school, right? Mm-hmm. It is. If you and your partner only wanna have sex once a year and you're both happy with it, yeah. That's fine. That's up to them. Yeah. Yeah. It works. Mm-hmm. So, um, absolutely. But I, you know, going back to some of these things c that can be happening. Mm-hmm. We do have some advice and recommendations for you. Mm-hmm. Um, so if you're listening and maybe you're thinking this is something that's. Going on with me, you can ask yourself, okay, is there any aspect of this that could be painful? Right. Or I'm having issues with these. So some of the tips may be for discomfort, right? Can be due to vaginal dryness and things like that. Mm-hmm. Sometimes we're messing with your hormones. Some of the medications we can give you can also cause vaginal dryness. Yeah, dryness. And make it uncomfortable. Um, so some recommendations would be pelvic floor therapy. I'm such a huge proponent of pelvic. Or therapy actually, just physical therapy in general. Yeah. I recently did just regular physical therapy and I loved it. Yeah. So I think these people are really, really talented. Mm-hmm. Um, I think the problem is you have to commit to it and you have to keep doing it. Yeah. You know? Yeah. Um, physical therapists and public. Floor therapist, they'll give you some exercises and modifications to do. Mm-hmm. And I do think it helps when you actually go there and do it with them. 'cause I'm not great about continuing on my own. That's true. I don't dunno about you. Yeah. You know, it's kinda like having a personal trainer. Right? I totally see that. Yeah. Yeah, yeah. Um, so my advice would be kinda learn what they're doing there and then try commit to still doing it. Mm-hmm. But I think it can be extremely helpful. Yeah. Um, I think everyone out there has probably heard of lubricants, right? There are certain lubricants. That, um, if you're trying to conceive, you might wanna consider more so, 'cause some of them can maybe be detrimental to sperm, but I always recommend lubricants with every sexual encounter. Mm-hmm. I think it really can make a difference because if you struggle, things are painful. Right. That can really help. Mm-hmm. Um, one thing that you might not have heard of as frequently vaginal moisturizers. So you can use vaginal moisturizers. Daily or a couple times weekly. This is almost just like putting lotion on, right? Mm-hmm. Similar concept, but the moisturizers can help so that you're more ready in the, in the moment. Mm-hmm. Right. Yeah. So you're not feeling really, um, d dry and irritated. Mm-hmm. Can I just make a comment about the lubricants? Mm-hmm. Because, um, so I'm a big fan of the Egg Whisperer. Mm-hmm. If you aren't following her, you should. Mm-hmm. Um, one of my favorite episodes that she did is they took sperm. Like live sperm. And then they added all the different lubricants to see what is the best lubricant for sperm. Yeah. Right. And what they did find is probably the best for fertility is no lubricant. Mm-hmm. But if you're gonna use a lubricant, that's when those fertility, um, friendly lubricants come in. And I think it's an important distinction to make because sometimes when you see those fertility friendly lubricants. People are under the impression of like, okay, if I use a lot of this lubricant, that that is then gonna help the sperm in some way. Yeah. Um, and it's not that, it's just that it is not as negative for the sperm as some of the non fertility. Good point. Lubricants. Too. And so if you are trained to get pregnant and you're in your fertile window and you're using lubricant, use a fertility friendly one, but two, probably use it more sparingly, um, in an attempt not to get as much in the actual semen or anything like that. Mm-hmm. Yeah. Yeah. And it can just be messy. That's true. It's hard to clean up. Yes, yes. That's right. That's right. Um, the other recommendation that we, um, recommend for our patients, I think I both of us do this quite a bit, is just vaginal dilators at home. Mm-hmm. Especially if you are struggling with vaginal mis, because that's just exposure therapy basically. There's some great ones just even on Amazon now. Yes. I love that Amazon has. VA vaginal dilators now, like I'm so old. I was here before Amazon and it was hard 'cause patients would say, where do I buy these vaginal dilators? Mm-hmm. They were hard to even find, but now you can get the prime shipping. You can have dilators by tomorrow. Yeah, I know. In indiscreet packaging. I mean, no one knows what you're ordering from Amazon. It's in a brown package. Totally. Yeah. Yeah. Yeah. So I think the dilators are great and you can combine those with the lubricant as well, right? Just start super small. Mm-hmm. Maybe do it, you know, two times a day, once a morning, once at night, maybe like five, 10 minutes, leaving your dilator in. And over time you should be able to achieve a higher level, um, of dilation, which ultimately may be able to help you tolerate, um, penetration with less pain, um, as well. Mm-hmm. Um, okay. Now, you know, I'm a little bit crunchy. I'm a little bit granola too, because. I love like all the natural things to talk about too. Mm-hmm. Right. So one of the things I'll ask my patients first is like, okay, are you sleeping? Mm-hmm. Are you eating healthy? Yeah. Are you exercising? Right. I mean, and we all know we're supposed to do those things and we all try to do those things, but sometimes we're not. And I think it makes a lot of sense if. Our brain is thinking, well, gosh, if you're not getting sleep right now, if you're not eating healthy right now, it's probably not prioritizing sexual desire and thus reproduction, right? That's kind of how mother nature works is you've gotta be able to take care of yourself before you can take care of a baby. And so, um, I would say there is good data to show that all of those things can really, um, factor in and improvement on those things would likely help as well. Yeah. Such a good point. Mm-hmm. Um, and then you're a big one on alcohol too. Yeah. Heard about alcohol. No, I know. That's actually a really good point too. Um, I'm like, don't gimme certain alcohol. No, I think that's interesting because I think a lot of times when people picture a romantic evening mm-hmm. There's probably alcohol involved. Mm-hmm. Right. Um. And alcohol can cause sexual dysfunction for both men and women. Um, and I think people are often surprised, especially for men too, as they get older, it can really contribute to, um, erectile dysfunction. Um, it can contribute to men who are unable to, um, ejaculate as well, which is obviously a fertility issue too. I've had a patient before, she said, Dr. I'm exhausted. My husband goes for an hour. It hasn't happened yet. Oh gosh. You know, he was like, help me. You know? Um, and sometimes those things, um, can be related, uh, to alcohol use as well. So I, you know, when people ask me how much to drink, I call myself the fun crusher, and I say, you know what? Nobody should ever drink alcohol. We know it causes at least seven different types of cancer. But I do realize that's a bit extreme. Mm-hmm. You're the nicer doctor I know, because I have a hard time recommending things to my patients that I can't stick with if I don't get my Friday night margarita. Like I'm an unhappy person, but, but I think you would agree. Um, at least moderation. Yeah, absolutely. Not at all. Or moderation. Right. I think the relationship between alcohol and just sexual encounters is very interesting. Yeah, actually that's true. Yeah. I mean, there is even data to show heavy alcohol use in women as associated with hypoactive sexual disorder. Mm-hmm. As well. Mm-hmm. Yeah, because that's one of the treatments that they talk about for that. Mm-hmm. Just. I think sometimes we don't realize how much you could potentially be drinking. Right. Yeah. Because we Americans, we really do like to drink. Mm-hmm. At least my age, Americans. Yeah. I've been told that Gen Z doesn't like to drink. Oh, that's right. You're right. You're right. See, I'm in with the younger girl. Yeah. Yeah. You're hip. You're hip. I know. Should we say the other day, what you said yesterday, Dr. Kay, um, we were talking about a patient who was 36. Yeah. And I said, she's so young. And you said, that's young. I'm like, yes. It better be young. If you think that's old, then what am I? Well, this just was making me feel better though. No, I was just Because you're 36. Yeah. I was like, this is great. That's, you're like, wow. You think I'm young? Yeah. I was like, this is, this is really good news. I'm like, you better be. Um, yeah. But apparently Gen Z, they're all, well, I think they are. They often do other mind altering substances other than alcohol. Well, that's true, but that's a good. Point too, right? Yeah. Because other mind altering substances can affect, um, sex in many different ways too. Um, marijuana can also contribute to, um, lower testosterone in men and, um, and can contribute to a lot of sexual dysfunction there as well. So it's, you're right. Not just. Alcohol, but many other things, um, can factor in and mm-hmm. And I am just again, the fun crusher. Stay away from it all. Just be natural. Um, yeah, totally. So, um, wanted to chat a little bit more just about hypoactive sexual disorder mm-hmm. And our patient population too. So there is an interesting study, um, from fertility and sterility, which is kind of like our Bible, right? Yeah, totally. Yeah. Fertility and sterility is like the. Biggest fertility journal that pretty much everyone reads. And they did an interesting study just in terms of how infertility and sexual dysfunction with hypoactive sexual disorder are related. Mm-hmm. And so I thought this one really stood out to me. Mm-hmm. Because they looked at women, um, who said their desire prior to going through infertility testing and treatment mm-hmm. Was adequate. Okay. In the past. Okay, so 93% of women that were surveyed said in the past it was adequate. Yeah. Then after, right? Mm-hmm. They have gone through all this, almost 20% said their level of sexual desire had decreased. Mm-hmm. And of that 20%. Almost 17 said it predated the onset of infertility, and 82% said it occurred while they were struggling to conceive. So it is really interesting, like I think that you could have been chugging along through your whole life. Yeah. Not really had any issue. And then boom, infertility just kind of knocks you on your ass. Yes. And then you have this. This absolutely hypoactive sexual disorder. Yeah. Um, and to your point, I think sometimes you get stuck in this cycle mm-hmm. Even after maybe you've had success with your fertility. Yeah. So I think it can be really challenging. Yeah. Um, hypoactive sexual disorder is really something that I think more people are talking about. Mm-hmm. Um, and more treatments are arising for it. Mm-hmm. Um, I think one of the most effective treatments for it is cognitive behavioral therapy. Mm-hmm. Or CBT. Mm-hmm. Um. This is a type of therapy that is used for lots of different disorders. Yeah. But what I like about CBT and what I explained to my patients who asked me about it just in general, is mm-hmm. It's not just talk therapy, right? Mm-hmm. Mm-hmm. I'm not saying go land someone's couch with a counselor and just tell them about like, everything you ate that day and like, you know, all of your gossip from the day. Right. These people, these counselors and therapists mm-hmm. And psychologists are trained mm-hmm. To give you very specific tools mm-hmm. That you can apply to your daily life mm-hmm. To break the cycle. Mm-hmm. Mm-hmm. And I think it's really helpful. Mm-hmm. And it's so effective. Mm-hmm. Um, and this is a type of therapy that you can really apply to different things, but for hypo sexual hypoactive sexual disorder, it's extremely effective. Hmm. And I do think that so much of this, like you're saying, is you get caught in this. Um, just kind of routine, right? Mm-hmm. And so they give you some different things to help break it up. Um, so I thought that that was, you know, really? That's great. Yeah. I didn't realize how impactful it is. That's awesome. I think we'll have to maybe find some local people to refer to mm-hmm. Who can offer that kind of treatment, because, you know, I love that as, again, liking more natural things. I would consider that to be natural. Mm-hmm. It's something that you can do while you're conceiving. It's. Not a medication. I do feel like sometimes doctors can be admittedly very quick to give you a pill to just fix it, right? Mm-hmm. Um, this may involve more for work, but I, but I like the concept of you're not having to take anything. Right. Um, but also too, it's probably a good time to just pause too, because I feel like when maybe patients may talk to other friends or something like that about, um, what a common thing or common advice that everybody gives. Mm-hmm. You should get your hormones checked. Oh, yeah. You know? Mm-hmm. What do you think about that? Do you think checking the hormones is important in this circumstance? I kind of have some thoughts going either way about it. Mm-hmm. But what do you think? Um, I would say it depends. Mm-hmm. Honestly. Mm-hmm. The vast majority of, of women with hypo hypoactive sexual disorder, or other sexual dysfunction. Mm-hmm. Probably your hormone levels are gonna come back. Normal. Yeah. Right. Mm-hmm. Um, and I don't even like to say normal because it just depends. Yeah. Right. Yeah. When they're checking it, people checking your hormones mm-hmm. That aren't endocrinologist, probably just don't know how to interpret them anyways. Yeah. But I think it's unlikely to lead to some magical, low level that you need some supplementation from. Mm-hmm. Okay. In in less, in very rare cases. Yeah. Right. Yes. Rarely. I can think of some conditions where it might pop up, you know, showing mm-hmm. Some things Yeah. On your hormone levels. Yeah. Yeah. But I think we women, we think about our hormones like that, and we think, I'm not feeling like myself. My libido's low. It must be my hormone. Yeah. You know? Right. And then that leads to wanting to have them checked. Yes. So I can definitely understand the thought process. Yeah. Yeah. But speaking as a reproductive endocrinologist mm-hmm. I think that's very unlikely to actually lead you down a road to correction. Yeah. Like, I don't think you'll actually get much of an answer or, um, really a treatment based off of that. Yeah. Yeah. I agree. Um, you know, I think if I have a patient who's having a period every single month, that is usually a good indicator to me that her pituitary is. Stimulating her ovaries and her ovaries are feeding back to her pituitary that that loop is intact. I'll say if I had a patient who's not having periods or they're very irregular, um, I do think it could be something to explore. These conditions are very rare, but for example, if a patient has hypothalamic a amenorrhea where her brain is. Not communicating to her ovaries at all. I would say it would be fair to say that that might be, um, a contributor. Um, maybe the second thing is if the patient is menopausal and doesn't realize it mm-hmm. We know women in menopause can have, uh, low libido issues. Um, but I feel like we wouldn't necessarily need to check the hormones to know those things. We could usually pick it up from their history. Um, but the vast majority of women who come to see us will be probably having periods already. And number two, if we check their hormones and their normal, this is so important. They're still having the issue, right? Like you don't want to ever see somebody who says, well, I'm gonna check your hormones. They're normal, so there is no problem. Right? No, there's a problem regardless of what your hormones are. Yeah. And you need help with that, right? Right. Absolutely. If your hormones happen to be low, you know, okay, fine. Maybe that would take you back down on a different route, but I just wouldn't want people to be dismissed if they've got totally normal, normal hormone levels and, and are still having issues as well. Yeah. Such an important point. For sure. Because remember, if you feel like this is distressing to your lifestyle, then there's an issue. Right? Exactly. Even if your hormone levels are coming back normal. Yeah. On the blood work. I think the other kind of common thing that I do sometimes talk to my patients about mm-hmm. In situations like this is sometimes you might need to look at your medications that you're already on. Right. You said you're kind of a na That's true. Yeah. Natural holistic doctor. But we do know there are. Some medications that are big offenders that can cause sexual dysfunction. Yeah. And probably one of the number one prescribed medications. Mm-hmm. Out there for reproductive age, women are SSRIs, absolute antidepressants. Absolutely. Right. Yeah. Um, and you might have been prescribed an SSI because you're not feeling like yourself. Yeah. Right. Already. So these things can be highly associated, but we know that antidepressants, which is commonly in SSRI can decrease your desire, right. To lower your libido and. Can have some sexual side effects. Sometimes it could be as simple as maybe switching amongst them. Mm-hmm. Maybe there's another medication that's good for you. Yeah. Um, we've talked on our podcast before about mm-hmm. Some alternatives. Yeah. That now that they have for depressive Yeah. And other anxiety, um, diseases. Yeah. So that you can do maybe if you wanna come off of your SSRI. Mm-hmm. Um, so that's really neat too. There's, um. Let's see. It was the magnetic MR mri. Yeah. Therapy. They stimulated the brain. Mm-hmm. Every so often. Yep. So we had the um, psychiatrist come on and talk to us about that. Mm-hmm. So there are some different ways that I think you can manage your mm-hmm. Anxiety disorder or depression if you do wanna try and come off of your SSRIs. But that can be something that you also explore if maybe there's a medication that could be leading to this as well. Yeah. Um, such a good idea. Yeah. And I think one of them that's actually famous. For potentially helping too is Wellbutrin. Mm-hmm. Mm-hmm. Um, so you could always ask your prescribing doctor, Hey, I seem to be doing well on this one, but I'm having this side effect. Do you think this other one could, you know, work well for me? I'm not an expert in that at all. So of course you would talk to them, you know about what's appropriate for what you have going on. But I do think it's nice to consider those things as possible contributing factors as well. Um, the other things that I think are really important, really for all of us and our patients out there, mindfulness and stress reduction. I think that this can have a big impact. Yeah. On libido and sexual dysfunction. Mm-hmm. Um, it's something that I've tried to work on, I think at this point in my life, it's hard to do. Yes. Yes. It's, it's really hard to do, but I think. Sometimes those counselors that we mentioned too, they can give you some techniques to help with more mindfulness and other techniques to reduce stress. Yeah. Because all of this, I think the better you feel, even if you're going through fertility treatment. Mm-hmm. Or maybe you're done. Mm-hmm. And you delivered your baby. But these are some techniques that I think can be helpful. Whatever phase of life you're in. Yeah, absolutely. Well, you mentioned too, delivering your baby I, I think that's another challenge for women too, as they get in that postpartum period. A lot of women breastfeed, right? So first of all, you're leaking milk all the time that I'm sure that doesn't help. It's very romantic. Yes. And then your hormones are so low because when you're breastfeeding, most of the time you're not making hormones and then you're not getting sleep. Your baby's up every couple of hours and everything and it can so complete. This is a very common time for people to have low libido. And I would say another thing to maybe remember in those moments too, is this period is not gonna last forever. It is temporary. It should get better for most people once you, you know, be, start being able to have more time to yourself and being able to sleep and, and all of those things too. Um, and so I guess maybe the point of that is just 'cause you're feeling this way in this moment, it won't be like that forever, forever. Um, and then I guess the other thing, um, to maybe think about is do we have any pills? I said, I don't like when doctors just give you pills. Do we have any pills that we can just give our patients effective for them? Yeah. So, um, we'll preface this by saying there are some medications that are out there. Like I said, hypoactive sexual disorder is one of the more common, um. More common disorders that these can treat, but I think they can actually help you with different types of sexual dysfunction as well. But these are what they're FDA approved for. Um, unfortunately if you are currently trying to conceive or pregnant, you can't take these medications, so there'll be many of our list. Centers that maybe it's not applicable for, but yeah. Um, if you're out of that phase of your life and you're still struggling with this, there are some medications that are available. Um, so one of them has been around a little bit longer. Mm-hmm. The second one I wasn't as familiar with. Mm-hmm. But the medication that's been out there, and I've even had friends that have taken this firsts one before, but Phil Banin, I think is, um, how you say it Yeah. Has a brand name. Mm-hmm. Um, but this is a pill. Mm-hmm. Um, it's a daily oral medication. Mm-hmm. So it's a daily pill. So I think that sometimes that can be also. People don't love the idea of taking the medication daily. Yeah. For something you're probably not having sex daily if you are good for you, but we're probably not. Right. So you, you do have to take this one daily. Mm-hmm. Um, it's really for premenopausal women. Mm-hmm. Right. So just women who have not gone through menopause and are having lower libido basically. Mm-hmm. Um, it's a serotonin modulator, so it basically is in creep. Increasing a lot of those neurotransmitters that are in your brain, increasing your dopamine. Um, and it does have good data to show that it can increase your sexual desire and satisfying sexual events. Mm-hmm. Which I liked that. Yeah. But I will say my caveat to that, and admittedly I haven't looked at this data since I was in fellowship. Mm-hmm. Which has been a while now. Um, sometimes it's tricky when people say it increases, right? Mm-hmm. And then you have to go look, but like increases by how much. Sure. So at least at that time, it looked like it was one sexually satisfying event a month. Mm-hmm. Which to me didn't sound like that much for like a pill every day. I'm kind of like just one, like, you know, but I dunno. I guess that's very personal. Yeah. If somebody's like, I want to take a pill every day and possibly have these side effects. For one. I mean, yeah, maybe, maybe you want that, but like, I don't know. I, I'm like, I don't know if that's worth that, but Yeah. Yeah, yeah. But what did your friends think? Who tried it? They liked it. They said they didn't help them. But I think my phase of of life is really hard. I will say I'm in the phase of life where a of us have young babies. Yeah. You know, don't think we're. Great at it. So this is So we're not a commercial for this. Yeah, we're not basically, yeah. Yeah. Okay. Perfect. But then, okay, so I guess there's this new one. I don't really know as much about this new one. Can you tell me a little bit about this? Yeah. So I feel like I'm gonna butcher how you pronounce the real name of this. Okay? Okay. But the real name of this medication is bro. Okay. Bide. Okay. Okay. Um, and so this is a newer medication, so this is an injection on demand, right. So I just like, I don't know why, just the thought of like, all right babe, let's get to it. I'm gonna shoot, lemme take my shot. I imagine kind like, you know, like an EpiPen. You know, I haven't seen this. You know, like think about with our patients doing I Vf Uhhuh and the husband's like, I. It's Saturday night. Let's, let's get out your injection. Um, so yeah, I mean, I thought this one was interesting, so I think that this could be more appealing. I'm so curious. I hope someone listening has tried this and maybe could give us. Their personal experience, I do not prescribe this medication. Yeah. So I don't have any experience with patients being on it, but it is something that you OnDemand inject at the time of sexual activity before any sexual activity. Um, and its mechanism is a little bit different as well. It's a melanocortin receptor agonist, which I'm not familiar with that pathway. It just doesn't make as much sense to me. Mm-hmm. Um, but it is. Basically useful for women who prefer episodic rather than daily treatment. Mm-hmm. Right? Mm-hmm. So what you're saying, like, yeah, maybe if you do it four times a month, you might get four. Yeah. You know? Right. Um, there are some side effects with this one. They said nausea is common, which seems frustrating if you're trying to get to it and you're feeling a little nauseous. Um, and opposite actually of the other, the daily medications kind of known for causing lower blood pressure. Mm-hmm. This one can increase your blood pressure, which to me kind of makes sense. Yeah. You know, kind of rev you up. Yeah. But, um, I thought that this is probably a newer medication that it may gain some traction. Yeah. I'm curious to see what people say about it. Yeah. Yeah. Okay. Can I also just make a, um, make a comment about testosterone? Mm-hmm. You know, how I get all worked up about testosterone and so, um, you know, I did write a paper on this. It's called, um, does testosterone Pass the test for Low Libido and Premenopausal Women? Mm-hmm. Um, because there is some confusion there is. Some data showing in postmenopausal women that physiologic doses of testosterone may help your libido, but that hasn't been shown in premenopausal women. And those things get very confused. And one of the things that drives me crazy all the time is this common issue. Women with low libido, they go to somebody who doesn't know the data and they're always trying to push testosterone on them. You need a testosterone pellet. You need testosterone medication. And here's the issue is. Will testosterone give you higher libido? If you take male levels of it, yes, it'll, if we give you enough testosterone that your testosterone level is 300, you will have a high libido. Okay? But then you're gonna transition into a man, okay? You're gonna start growing facial hair, you're gonna get temporal, balding. Your voice is gonna deepen. Your clitoris will grow into a micro penis. Like we know these things happen. How do we know they happen? Well, for people who want to transition to a different gender, that's how they do it. They take high levels of testosterone. You guys should have all seen it by now. This is what happens. And so if, so, of course you don't wanna take testosterone levels that high, although unfortunately I am seeing people prescribe that. And, and here's what people say is they say, well, I'm taking levels that high. And look at me, I, I look great. I feel great. Well, yeah, because you've only been taking it three months, okay? It takes time. Once you're on it for about 18 months, that's when you start to see some of those things. And they're not reversible. Some of them will never go away once you've done it. And so this is why I get very concerned whenever I see these things now. Let's say you say, okay, well I'm gonna take testosterone, but just a little bit. Okay? If you just do physiologic doses, I mean, maybe I can get on board with it, but the woman who's done the most research on this, you should follow her on Instagram. Professor Susan, uh, Davis. Mm-hmm. Mm-hmm. Yes. Susan Davis. Um, so you should follow her. She's got great information about it. Ongoing studies are, are, are trying to figure out what the answer is, but it just doesn't look like this is the answer. If a little bit of testosterone is helping you, it might even be placebo effect, right? Mm-hmm. And placebo effect is powerful sometimes, right? Yeah. But maybe kind of knowing and understanding that like, oh, you kind of put this on and you think, oh no, it's great. It might be more so that your mind is thinking it, it's working, um, when it may not truly be, um, helping that much. So I think here's kind of the challenging part is we have to admit as doctors, we don't know all the answers yet. We don't know how to fix this yet. Yeah. Um, we can give our suggestions on how to best help, but people have kind of turned it into this issue of like, women don't get enough, you know, FDA approved treatments and everything. And it's like, okay, I agree that's true, but also let's not just approve something that doesn't work very well just to say you did it. Mm-hmm. Yeah. Um. And so, you know, I think really this involves complex conversations sometimes, um, between the doctor and the patient saying, look, you know, yes, you're suffering. Yes, this is common. These are the things we know may be helpful, but at the end of the day, we're still figuring these things out too, and we don't wanna lead you as straight to something that Yeah, absolutely. Absolutely. The testosterone conversation is complex. Yeah. Mm-hmm. Okay, perfect. Well, should we wrap it up in the week? Yeah. Okay. Hope this was helpful for you guys. Um, if you wouldn't mind, we would love if you would us a review on our podcast platform or YouTube or even on our peak, um, page, and we will. See you next on, I hope, um, chat. GPT is listening and they'll That's right. And they'll review us in taste. It was a little spicy chat. GPT is gonna change. Yeah, it's mine. It's gonna say we're a highly entertaining podcast for all people, so. Alright, thanks. Bye bye