Unlocking Women's Sexual Wellness: Hormonal and Non-Hormonal Solutions

In this insightful interview, Dr. Simon discusses women's sexual health during perimenopause and menopause, exploring hormonal and non-hormonal treatments, addressing common issues like low libido and dryness, and sharing practical tips for couples to enhance intimacy.

keywords

women's sexual health, menopause, libido, hormonal therapy, sexual dysfunction, intimacy tips, perimenopause, menopause treatment, sexual wellness, Dr. Simon

key topics

• Hormonal changes during menopause and perimenopause
• Treatment options for low libido and dryness
• Couples' communication and intimacy strategies
• Innovations in women's sexual health treatments
• Psychological and biological factors affecting sexual function

Work with Dr. Simon:

202-293-1000

www.IntimMedicine.com


Episode is sponsored by Boston Scientific and EDCure. For more information click here:
www.EDCure.com/BTS 


Connect with Between the Sheets:

IG: @betweenthesheetswithdrz

www.betweenthesheetswithdrz.com

Email: podcastbetweenthesheets@gmail.com


Work with Dr. Stephanie:

www.ReviveISH.com

Transcript

Stephanie Zwonitzer (00:01.484)
Welcome back to Between the Sheets. We are going to have a fun conversation today. I have Dr. Simon with me today and we met at a screening of the Pink Pill, which is about a medication called Addi, and that serves women's sexual health. So how much better to have a professional and an expert in women's sexual health on with me today. Dr. Simon is a DC-based physician who provides for women across the lifespan and sexual health for them and their partners.

He is also very heavily involved in research in this area, so it is a pleasure to have you. Thank you for coming, Dr. Simon.

James A. Simon, MD (00:38.735)
Thanks very much. really appreciate being here, Stephanie, and it's lovely to see you again. And I'm excited. Let's get into it.

Stephanie Zwonitzer (00:50.08)
All right, tell people about your practice first so they kind of know where you're coming from.

James A. Simon, MD (00:55.973)
So I'm a reproductive endocrinologist by training. So gynecology and reproductive endocrinology. And quite some time ago, I decided to stop doing infertility treatments, mostly because I found them to be boring. And I also found them to be quite frustrating as a

super specialist, I was seeing mostly people who had failed traditional fertility treatments through others. And so without good options to offer them, it was very, very frustrating for everyone. In addition, I was extremely interested in hormones and many of my patients, including some I couldn't help with their fertility were in that

perimenopausal and menopausal transition phase, and they needed hormonal support, balance, et cetera, as did their partners, and that led into sexual function and dysfunction as well.

Stephanie Zwonitzer (02:11.98)
Yeah.

It is amazing how many women are unsupported during that time and how many providers, you know, don't seek out the education and the knowledge to really help them. And it's such a big need. think if you would agree, I'm not sure, that the Women's Health Initiative was a huge downer for women. And we had a couple of generations go through without the support because everybody was terrified of estrogen. And now we know

James A. Simon, MD (02:16.603)
Thank you.

Stephanie Zwonitzer (02:42.798)
better, thank goodness!

James A. Simon, MD (02:44.771)
Yeah, so try and put yourself in my position. I was president of the Menopause Society the year after the Women's Health Initiative came out, and I was a big hormone lover and promoter from the beginning, and that didn't dissuade me when the WHO came out, but I got a tremendous amount of pushback. On the other hand,

Stephanie Zwonitzer (03:10.05)
Mm-hmm.

James A. Simon, MD (03:12.001)
It did give me a lot of perspective and have continued to do research and education in that area, which has allowed a tremendous amount of gratification in my practice, which by the way, my practice is located five blocks from the White House, which has its own challenges.

Stephanie Zwonitzer (03:27.766)
Yeah, yeah, it's amazing.

Stephanie Zwonitzer (03:37.202)
Sure, yeah. DC is busy. I taught at Howard University for a semester and that was all I could handle. I can't handle going back there. And it was a great school, it was a great opportunity, but man, I hate DC traffic.

James A. Simon, MD (03:52.059)
It's challenging. President Biden's church was less than a block from my office. And every time he decided to go to church, I had to close the office because you couldn't get there except on foot and most of my patients drive to see me.

Stephanie Zwonitzer (04:14.286)
Yeah, oh my goodness, that's crazy. Things you don't think about in other areas, right? Yeah, absolutely. So talk to me about sexual dysfunction, and really in this paramenopause menopause phase, because I think that's what most of our listeners are kind of going through. We have a few young ones out there, but for most of us, we're going through this right now, myself included. So what are you seeing when women come in? What are...

James A. Simon, MD (04:18.843)
You do not.

Stephanie Zwonitzer (04:41.76)
We know the hot flashes, know the brain fog, the night sweats, but sexually, what are they coming in with during this phase that is new for them?

James A. Simon, MD (04:51.523)
So most of the time the primary or the most commonly reported complaint is a decrease in sexual desire, especially spontaneous sexual thoughts, sexual fantasies, whatever used to get them going in the past, it's now infrequent or absent.

And you know, those women miss it. It's like a piece of their persona has left them for no particular reason. Now, there are always some reasons. They might be biologic reasons and hormonal reasons. They may be other diseases or the treatments for those diseases. Very common.

Stephanie Zwonitzer (05:44.302)
Yes.

James A. Simon, MD (05:49.217)
It may be their relationship. I also think that there's a variable that we, I won't put this on you, but we in the medical profession often discount. And that is the length of the relationship and the fact that many couples, regardless of who they are, where they are, they lose excitement.

sense of playfulness and desire for novelty as opposed to the quickest, easiest, most routine way that they used to have sex together. And I think humans, like a lot of mammals, they like new things. They like surprises.

You might love going to a particular restaurant as your favorite place, but if you went there and ate the same thing every night or twice a day, pretty soon you wouldn't be able to stand it. You'd want something new or different. And yet, we humans develop a sexual script

Stephanie Zwonitzer (07:06.509)
Right.

James A. Simon, MD (07:17.807)
with our longstanding partners. And it's hysterical to me because I have my patients write it down. She writes down the script over here, he writes down the script over there, independent of one another, and almost always they get it exactly the same. He does this, I do this, he does this, I do this, he does this, I do this, he has an orgasm, sometimes I do.

Stephanie Zwonitzer (07:17.934)
Mm-hmm.

Stephanie Zwonitzer (07:25.358)
You

Stephanie Zwonitzer (07:42.862)
Yep, sounds about right.

James A. Simon, MD (07:48.675)
And when a couple knows exactly what's going to happen next, just like eating in that formerly favorite restaurant all the time, it becomes boring. It becomes routine. Excitement fades and that doesn't contribute to, you know, desire, spontaneous desire for something new, for something different.

for something playful, for something exciting. And I think that's a big issue as all of us grow older together.

Stephanie Zwonitzer (08:29.334)
Yeah, I agree with you. I see that a lot. the shame that women feel surrounding their decreased desire is unfortunate as well. And I love that you brought up that it's multifactorial because it really is for women, you know, and a lot of us in this phase are

going through being coming an empty nester and maybe if you've been in that long-term relationship all of a sudden you have to spend more time together and talk to each other more because the kids aren't there. So I think there's so many factors in addition to what you said like with the menopause and things like that hormonally going on but our lifestyles change a lot during this time frame as well.

James A. Simon, MD (09:07.033)
So let me give you and your audience a tip exactly about that time when the kids are leaving home. So for most or for many couples, their young adult or late teenage children never go to sleep. And since most couples have sex when they're in bed or getting ready to go to sleep,

Stephanie Zwonitzer (09:30.327)
Yes.

James A. Simon, MD (09:37.359)
There are limited times that get constricted further with those young adults just down the hall who are up on their phones or talking to friends or doing whatever they're doing, but they're not sleeping.

Stephanie Zwonitzer (09:46.221)
Right.

Stephanie Zwonitzer (09:53.064)
No. And they know what the noises are at that age.

James A. Simon, MD (09:54.875)
So a couple of.

Yes, they do. And so there is an issue of sense of privacy that intrudes on mom and dad's sex.

Then they leave and as you said, it's a new paradigm. Couples have much more time, but they need to seize that opportunity to take the old script, which had been compressed into a very narrow time with their kids up all night or opposed to the night and flip it on its head and create something new.

And I like to think of that as a sexual surprise in the context of the script. So everybody likes reading a book, a mystery novel, where there's a twist or a turn or a surprise new character or something happens to throw you off the track to discovering who done it. The answer is

Stephanie Zwonitzer (11:08.663)
Yeah.

James A. Simon, MD (11:09.817)
This is an opportunity for couples together to plan a neurotic surprise. Your night is this week, my night is next week, whatever. Shouldn't be too big a surprise. You don't want your partner running out the front door. But, but, yes, it has to be consensual. But, but it's a, see it as an opportunity to reconnect.

Stephanie Zwonitzer (11:25.55)
Yes.

Right. Still needs to be consensual.

James A. Simon, MD (11:38.267)
in a novel way and maybe express to your partner, could be at the breakfast table, what would they think about if you did X or if you asked for Y or whatever?

Stephanie Zwonitzer (11:44.492)
Mm-hmm.

Stephanie Zwonitzer (11:53.398)
Yeah, yeah, I like that. I think that's great. And it really helps.

reignite those conversations too that they probably haven't had for a while if they ever did. And having those conversations can really help, especially as your body's changing and hey, maybe we've never used lube before, but now I need to. And it's not you not turning me on enough. It's not that I don't want it. It's just functionally, I need this now. And it makes it more comfortable and all those things. You know, for the men, maybe they need a little bit longer to get stimulated.

James A. Simon, MD (12:01.819)
Thank

Stephanie Zwonitzer (12:27.898)
Maybe they need something different now than they used to. And if you don't have those conversations, I know a lot of my patients, and see if this is the same for you, they take it personally. he's not getting that turned on by me anymore. He can't get an erection easily. She's not that turned on anymore. She's not getting as wet as she used to. There's so much more that goes into it than that.

James A. Simon, MD (12:50.039)
So I want to give your audience a clue that I learned from taking care of a bunch of animals. That's a different story, but we can talk about it.

Stephanie Zwonitzer (13:00.909)
Mm.

James A. Simon, MD (13:07.119)
So in animal behavior, looking straight at the other animal, particularly two males, is a very aggressive posture. If you have a dog and you're out walking the dog and you come up against another dog, two male dogs, and they're looking straight at each other, you will notice that the tails go straight up or very rigid.

Stephanie Zwonitzer (13:16.6)
Mm-hmm.

Stephanie Zwonitzer (13:20.91)
Okay.

James A. Simon, MD (13:36.803)
and they are about to fight. So what I learned is it's much less aggressive, less threatening, important word, even if you're a long standing connected partner for you to not look directly at your partner when you're having these intimate kind of conversation.

Stephanie Zwonitzer (14:03.95)
Hmm.

James A. Simon, MD (14:07.329)
When can that easily be integrated into a normal activity? And I use two as an example. One, go for a walk with your partner where you're both looking straight ahead. Hand in hand is great. There's connection there. There's warmth there. There's support. I'll hold you. I'll take care of you, vice versa.

Stephanie Zwonitzer (14:27.406)
you

James A. Simon, MD (14:34.991)
but you're not looking directly at each other when you're walking together. And so the conversation could or should be a little easier. The other time is sit together on the couch. Again, you can be sitting right next to each other. could be holding hands, but watching TV and turn the sound down or wait till there's a bunch of commercials and turn the sound off.

Stephanie Zwonitzer (14:44.449)
Okay.

Stephanie Zwonitzer (14:48.462)
Mm.

James A. Simon, MD (15:03.631)
and then you can start the conversation to be concluded after the show is over, but you're starting initiating in a non-threatening way, not looking at each other. And it seems to work. I'm sure there are many, many other better examples, but it seems to work.

Stephanie Zwonitzer (15:24.844)
Yeah, I love that idea because you're right. I'm like picturing it in my head while you're talking like yes, it is much less threatening to talk next to someone than to them when it's a delicate situation. Yeah, that's amazing. What kind of so we've kind of talked about like some couple tips here. What kind of tips do you have for the ladies who are coming in specifically for their low libido and you know, vaginal dryness, things like that?

James A. Simon, MD (15:37.285)
Yep.

James A. Simon, MD (15:41.381)
It's a

James A. Simon, MD (15:54.543)
So the first thing is we have to make sure there's no pain

That is a line in the sand. You do not have sex if there's pain because that reinforces pain, that reinforces pelvic changes, flinching and behaviors that want to avoid the pain. And we got to get the pain fixed first. Whatever the causes may not be obvious, but we got to figure that out. And I actually

Stephanie Zwonitzer (16:23.182)
Mm-hmm.

James A. Simon, MD (16:31.003)
prohibit couples from having penetrative vaginal sex until we figured out what her pain is, because it's counterproductive for them to continue to engage if she's still having. So once the pain is solved, then we can get to what are the real issues beyond the pain. You mentioned dryness.

Stephanie Zwonitzer (16:41.26)
Mm-hmm.

Stephanie Zwonitzer (16:49.996)
Yeah.

Stephanie Zwonitzer (16:59.064)
Mm-hmm. Mm-hmm.

James A. Simon, MD (17:00.623)
Well, that's pretty straightforward. First, we want to make sure that she is capable of producing her own lubrication. Sometimes that's not as obvious as it may seem. Sometimes it may be age, hormonal health, vascular health. You mentioned diabetes. As men and women age, they develop type 2 diabetes. Very, very common.

get into the issues of body image. What has changed about her body in midlife that she doesn't like or that she fears her partner doesn't like? And let's address those issues. There's a new twist in that department, by the way. You know, a lot of women have been successful

Stephanie Zwonitzer (17:36.974)
Yeah.

Stephanie Zwonitzer (17:45.186)
Mm-hmm.

James A. Simon, MD (17:57.761)
at losing a whole boatload of weight on these GLP-1 weight loss drugs like Ozempic. But their bodies are now completely different than the ones their partner fell in love with, number one. And number two, there are some very specific sexual changes, sagging breasts, sagging butts, sagging vulvas, et cetera.

Stephanie Zwonitzer (18:05.976)
Mm-hmm.

Stephanie Zwonitzer (18:21.357)
Mm-hmm.

Stephanie Zwonitzer (18:27.169)
Yep.

James A. Simon, MD (18:27.385)
that are a consequence of weight loss that may be altering her sexual self-image as well as her partners. So those are new issues in our current sexual environment that need to be addressed. A good lubricant in a perimenopausal woman or in a woman of any age, quite frankly, who needs more lubricant

Stephanie Zwonitzer (18:52.993)
Mm-hmm.

James A. Simon, MD (18:56.855)
And I usually am very careful about which one or ones I recommend. And I'll just be straight, your audience is into this, so they'll get it. If it's a heterosexual couple, I'll ask her, is he quick or is he slow? There's no middle ground here. is either he comes relatively quickly or he comes relatively slowly.

Stephanie Zwonitzer (19:08.513)
Yep.

Stephanie Zwonitzer (19:18.638)
Mm.

James A. Simon, MD (19:26.605)
And then I'll pick a lubricant that's either shorter acting or longer acting. Nothing worse on the planet than having your lubricant dry up and become not slippery, but sticky and gummy when it used to be slippery. That is not a good feel for anybody. And so knowing in advance, quick or slow, you can pick a lubricant.

Stephanie Zwonitzer (19:32.494)
Mm-hmm.

Stephanie Zwonitzer (19:46.007)
Yes.

No.

James A. Simon, MD (19:56.377)
that lasts a very long time or that is short acting because that's all you need.

Stephanie Zwonitzer (19:59.363)
Mm-hmm.

Stephanie Zwonitzer (20:03.948)
Yeah, no, I agree. And I always recommend, you know, look at the ingredients, make sure there's only a couple ingredients because if you get ones with all those extra fillers in it, you're doing more harm than good.

James A. Simon, MD (20:17.827)
Yeah, I've already self selected a group of them, but quicker slope gets them focused on what is happening, which may not be acceptable, by the way.

Stephanie Zwonitzer (20:29.74)
Mm-hmm, that's right.

James A. Simon, MD (20:31.535)
and work on that as a separate problem to her desire. Because obviously, as both men and women age, everything takes longer, everything.

Stephanie Zwonitzer (20:37.581)
Yeah.

Stephanie Zwonitzer (20:47.724)
Yep. Yep.

James A. Simon, MD (20:50.573)
He may still get his reward and she may not. Or she may need a lot more time and attention, which may change the paradigm, but certainly changes the amount of time they have to spend together. And that may require a change in that lubricant that they've been using for a long time to something that doesn't get sticky and gummy.

Stephanie Zwonitzer (20:54.668)
Mm-hmm.

Stephanie Zwonitzer (21:02.862)
Mm-hmm.

Stephanie Zwonitzer (21:08.44)
Yep.

James A. Simon, MD (21:19.503)
but lasts a long time. So we get into all of those issues. It doesn't have to take an arm and a leg and a really long time, but they are required because all of these little pieces of that jigsaw puzzle have to come together for everybody to really enjoy themselves.

Stephanie Zwonitzer (21:21.506)
Yeah.

Stephanie Zwonitzer (21:30.702)
Mm-hmm.

Stephanie Zwonitzer (21:42.646)
Yeah, I agree with you. And I think, you know, talking about everybody slowing down, it's on the men's side too. Their refractory period gets longer. It takes them more stimulation to get the erection to achieve the orgasm. you know, that quicker or slower might, you may have been on the quicker side for years and using one lube, like you said, and now it's taking so much more effort for you to get there as a man that

you need to protect your female partner and again a heterosexual relationship and help keep her comfortable by using the right lube. think you're absolutely correct.

James A. Simon, MD (22:18.755)
No. The other thing, and you mentioned getting an erection, I think that there's not been enough focus on aging men, but there are comparable analogies in women to maintaining their arousal or their erection. Getting it is one thing, making sure there's enough stimulation, which might be different in this older group of couples.

but also maintaining and not nearly enough discussion, not nearly enough focus within the urologic community about the non-surgical, non-medical use of constrictive penis rings as just an easy approach to helping older guys maintain

or obtain and maintain an erection with a willing part.

Stephanie Zwonitzer (23:24.91)
Absolutely. It's one of the things that I learned by going to sexual medicine conferences and talking with others like yourself and really figuring that out because when I came into urology, none of-

or the exercise and maintenance either. So I will talk to my guys about getting a vacuum erection device, a constriction ring, and using it two or three times a week, whether you're having sex or not, like physical therapy. Pull that blood into your penis, get a good erection, use it for 10, 20 minutes, whatever, to really strengthen and stretch that penis tissue so you can get better erections when you are being sexually active.

And then I agree, I'm a huge believer in the constriction rings, cock rings, they're also known as for people listening. They come in variety sizes, so you can find one that's not too tight, not too loose. They come with adaptations for your partner and all kinds of crazy stuff. But for the men to maintain their erection, it's really important. Get a good solid erection, roll that ring on, and you'll maintain better, maybe not 100%, but definitely better than without the ring.

James A. Simon, MD (24:35.483)
I think in terms of building trust, understanding and a willing partner, go shopping for that ring together.

Stephanie Zwonitzer (24:44.888)
Mm-hmm.

Yeah, absolutely. And there's great online places as well. AdamandEve.com, they've always got sales, they're a great store.

Even Amazon carries this stuff now and sends in their Amazon boxes so you don't have to worry about it showing up and you're all your neighbors knowing what you're doing. So yeah, I think it's great. There's so many opportunities to either go to stores, but the stores aren't always as frequently available as online anymore. And some people just feel more comfortable shopping online at home where they don't have to be out in public and seen at a sex toy store.

James A. Simon, MD (25:20.005)
Yeah, absolutely. And the other thing is, if you have access to a VPN, a virtual private network using your computer or your phone, you can go shopping reasonably anonymously if that's a concern of yours, which I would argue in DC is more of a concern than we give credit.

Stephanie Zwonitzer (25:33.667)
Mm-hmm.

James A. Simon, MD (25:49.84)
There's a lot of animus in our world of politics these days, and you want to maintain as much privacy as possible.

Stephanie Zwonitzer (25:59.948)
Yeah, absolutely. I think that's great. You know, it's, it's sad that we still have to protect ourselves sex wise, because I want it to be more of a open conversation and more talked about and more acceptable, I guess. But at the same time, you don't want the general public knowing what you're doing in the privacy of your own home with your consensual partner either. So there's kind of a flip switch there.

James A. Simon, MD (26:27.547)
Yeah, it's bit balancing, but yes, you're absolutely right. I too would love it to be just more of a natural process without shame. That's a biggie, as you already mentioned, but I think in your lifetime and certainly in mine, that ain't going to get fixed.

Stephanie Zwonitzer (26:30.37)
Yeah.

Stephanie Zwonitzer (26:49.61)
Yeah, yeah, I agree. I agree. So what other kinds of things are you helping these couples or individuals with that are coming into your office?

James A. Simon, MD (26:59.931)
So we already started out with the premise that the most common problem that women bring to me in this phase of life is low or lower or altered desire. you know, we've mentioned addressing the situation with the aging kids, with the older partner getting rid of pain in the brain, both male and female.

Stephanie Zwonitzer (27:11.832)
Mm-hmm.

James A. Simon, MD (27:30.431)
our sexual desire is frequently triggered by hormones. Certainly in women who are menstruating, mid-cycle peaks in hormones and for a smaller group of women fall in hormones right before the start of a period are triggers for her sexual desire. And when a woman is not ovulating,

or is or irregularly opulating or menopausal and not opulating, those triggers may be completely lost. And without them, she and her spontaneous sexual interest may likewise be lost. Fortunately, we have what I call second messengers. These are medications that can

that are non hormonal that can be used downstream to those hormonal triggers or with hormonal treatments to increase those spontaneous sexual thoughts, fantasies and sexual desire while also reducing any pain. And we need to talk about those in the specific context of that woman. The other

Stephanie Zwonitzer (28:55.479)
Yeah.

James A. Simon, MD (28:58.785)
issue, and I think it's the most difficult for me to actually fix or address, has to do with prolonged arousal time and difficulty achieving orgasm when it wasn't a problem before. It's just become a bridge too far, so to speak, and many women

are not happy with that. Some may be happy just to be engaged with their partner in that intimacy, in the pleasure of his pleasure or the pleasure they have together. But many women really miss their orgasm or it's become so hard to achieve that it feels clinical, technical, more like work than like

Stephanie Zwonitzer (29:41.57)
Mm-hmm.

Stephanie Zwonitzer (29:57.868)
Yeah, yeah, and the orgasm isn't always the end-all be-all, right? We can have great experiences without it, but if you never have one and you used to have them, that's really disappointing.

James A. Simon, MD (29:59.704)
Thank

James A. Simon, MD (30:12.217)
Yes, you've lost something. And I totally agree. Orgasm shouldn't be the primary or the only goal. Goal-oriented sex can be very frustrating for both women and men. But if you've lost something or you feel as if you've lost something, then it's my job to try and help you get it back.

Stephanie Zwonitzer (30:14.412)
Yeah, yeah, absolutely.

Stephanie Zwonitzer (30:29.272)
Mm-hmm.

James A. Simon, MD (30:41.955)
And that's not always easy. Sometimes it's biological, sometimes it's social. Sometimes I've even found cases where it's psychological. Boils down to, I'm not going to let you make me calm.

Stephanie Zwonitzer (30:44.023)
Yeah.

Stephanie Zwonitzer (31:00.84)
Mm, yeah.

James A. Simon, MD (31:10.039)
It's a barrier that's been set up. I'm gonna let you, I'm gonna let us have sex, but I'm not gonna like it.

Stephanie Zwonitzer (31:19.491)
Mmm. Yeah. That's a tough one.

James A. Simon, MD (31:21.775)
That was a one, a lot of stuff going on there. So gotta unpack it little by little, figure out what the story is, and then make the best intervention that we can. But even if there's not a lot of baggage or psychological issues, orgasmic dysfunction can be very hard to address.

Stephanie Zwonitzer (31:25.742)
You

Yeah.

Stephanie Zwonitzer (31:35.586)
Yeah.

James A. Simon, MD (31:50.728)
We're working on it.

Stephanie Zwonitzer (31:52.362)
Yeah. Tell me about the medications that you can use for the ladies with the lower libido.

James A. Simon, MD (31:59.451)
So for lower libido, one of the primary approaches is hormonal. Make sure that that woman has plenty of estrogen and or testosterone. These naturally occurring bioidentical hormones cause both desire and arousal.

by affecting blood vessels. So they affect nerves in the brain that are like those triggers that she had when she was menstruating. And they affect the blood vessels in the vulva, in the clitoris and vagina that help with lubrication and arousal. Beyond the hormones, we have two FDA approved products for women that

do increase desire and downstream effects on arousal and orgasm. So we have phlebanthrin or ADDI, A-D-D-Y-I, and ADDI is a daily pill that a woman takes every single day, whether she's having sex or not, and it increases sexual desire.

And it's approved for both women who are premenopausal and those that are postmenopausal. So those that are in what I call the limbo of perimenopause, they're included either way. The other agent or the other drug is Vilece. And Vilece is remelanotide, which is a injectable.

It's an auto injector, just like we have for those weight loss drugs. And it's used as desired or sometimes called on demand. The way we think of Viagra being used in men, they want to get an erection. They take their Viagra pill or their sildenafil. In this case, in women, they take their little injection of Vilece and they become

Stephanie Zwonitzer (34:10.136)
Mm-hmm.

James A. Simon, MD (34:24.203)
interested, aroused, etc. And it's not one or the other is better or worse, but they tend to be used in ways that the couple has sex. So just as an example,

Stephanie Zwonitzer (34:39.928)
Okay.

James A. Simon, MD (34:46.051)
Let's imagine that a given couple, Mr. and Mrs. Smith, have sex where he always is the initiator and she has to be interested enough or receptive enough to engage. Well, if he's the initiator, she doesn't know when he's going to initiate or whatever, then having a daily pill on board

Stephanie Zwonitzer (34:57.741)
Mm-hmm.

Stephanie Zwonitzer (35:07.309)
Okay.

James A. Simon, MD (35:15.957)
is really well adapted to their way they have sex. Let's imagine in a different circumstance that she has been the primary initiator or shares that responsibility with him and she wants to be ready to go when she's initiating and she might just say, okay, by least he's the perfect thing for me.

Stephanie Zwonitzer (35:21.474)
Mm-hmm.

Stephanie Zwonitzer (35:35.48)
Mm-hmm.

James A. Simon, MD (35:45.869)
I want to have sex next Thursday because I know we haven't had sex in a week or whatever. I'm going to give myself a shot and initiate. And that seems to work extremely well in that circumstance. Although I've seen both work extremely well in a variety of circumstances and they can be used together if absolutely needed.

Stephanie Zwonitzer (35:52.056)
Mm-hmm.

Yeah.

Stephanie Zwonitzer (36:08.302)
Hmm.

Stephanie Zwonitzer (36:12.778)
Okay. And it's interesting, when Addy came out, they kind of dubbed it the female Viagra, which it has similar characteristics with the blood flow and the increase in arousal, but it's completely different in that Viagra doesn't work on your brain at all.

James A. Simon, MD (36:30.566)
little brain

Stephanie Zwonitzer (36:32.654)
It's a little brain.

I like it, I like it. Yeah, so I found that really interesting, but I love knowing that there are options for women who, even once we get your hormones balanced or you didn't have hormone issues to begin with, there are options that we can continue to help you with. Because I think sex is such a fundamental part to our overall health and wellness, it's fundamental to our relationship, and it can be a huge...

issue in a relationship if one or the other or both partners are having sexual dysfunction.

James A. Simon, MD (37:10.437)
Totally agree. Also say that while you and I are having a conversation about the principle uses of these drugs or the principle situations of these drugs, there are much younger women who can sometimes benefit from them. And there are much older women for whom a drug may not be FDA approved, but if it's safe, they may also benefit.

Stephanie Zwonitzer (37:30.158)
Okay.

James A. Simon, MD (37:40.027)
from them. And as you're well aware from your experience with men, many of the drugs that we've used for men historically can also be used for women in special circumstances. For example, not for desire, because as you correctly point out, Viagra, Levitra, Cialis, Stendra,

Stephanie Zwonitzer (37:40.407)
Mm-hmm.

James A. Simon, MD (38:08.803)
These are drugs for blood flow to the penis, but women have analogous tissue to the penis. And the answer is if they're not becoming aroused or if they have difficulty achieving orgasm, not desire, these drugs can be additive to desire drugs to help them with arousal and or orgasm. So

Stephanie Zwonitzer (38:37.431)
Okay.

James A. Simon, MD (38:38.373)
There's, you know, we're different. We've got different junk. But the answer is, but the answer is we have a lot of similarities.

Stephanie Zwonitzer (38:42.124)
Yeah. Yep.

Stephanie Zwonitzer (38:49.068)
Yeah. Have you seen anything about the this topical cream Viagra that's coming out for women?

James A. Simon, MD (38:55.769)
Yeah, and I've had a hand in developing actually all of these products. So the topical cream Viagra, if you will, from Dare topical sildenafil was tested primarily for women with arousal issues. They could also have desire issues, but primarily for arousal defined in women as

Stephanie Zwonitzer (39:02.059)
Okay.

James A. Simon, MD (39:25.189)
clitoral tingling and vaginal lubrication. And it's applied just like Viagra is taken in men. It's applied as a cream to the clitoris and the anterior part of the vagina about, you know, 30 to 60 minutes before anticipated sexual contact. And it works. It's documented to increase blood flow and

arousal. So she can both be ready and to the degree that feeling wet and tingly tells you, Hmm, I'm interested in sex. The answer is she can have a secondary effect on her desire. And there's one other thing I want to bring up, bring to light about this. is almost certain.

Perhaps it's evolutionary that there's a gap between the time to orgasm for men and women. And to the degree that women take longer under most circumstances, use of this topical cream or the medications I mentioned, particularly Vilece, can

raise desire before there's any connection, before they're even in the same room together and give her a little head start and by virtue of that reduce her time to orgasm and make them more at least in the same ballpark as with him.

Stephanie Zwonitzer (40:59.374)
Mm.

Stephanie Zwonitzer (41:03.82)
Okay.

Stephanie Zwonitzer (41:15.36)
Okay, that's really cool. Is the topical sildenafil, is that going to be prescription or is that over the counter?

James A. Simon, MD (41:24.291)
It's going to be prescription. It's I'm not entirely sure whether it's available right this minute, which is the end of February in Maryland, where you live. It is not currently available in D.C., but it is available widely in the U.S.

Stephanie Zwonitzer (41:26.381)
Okay.

Stephanie Zwonitzer (41:42.615)
Yeah.

James A. Simon, MD (41:50.467)
and I would guess in the next month will be available pretty much everywhere by prescription.

Stephanie Zwonitzer (41:56.802)
That's amazing. That's amazing. I love having all these options. you know, as, as we're talking through here today, I'm just hoping that listeners are seeing there is hope. There are things that we can do. There's a variety, not just one or two things. There's a variety of things that we can do to get you back to having better sex, to wanting better sex and all of these things and getting that connection back with your partner. I, this is just such an amazing conversation today. Thank you so much for being here.

James A. Simon, MD (42:27.291)
Really my pleasure. you know, it's an important part of the work that I've been doing for a long time. And it's very gratifying to see both young women and young men coming into the field to carry the ball when it was.

really behind the scenes, out of sight, out of mind, or frowned upon as it related to hormones following the Women's Health Initiative for us to be able to really help men, women, and couples as they go forward. And so I tip my hat to you and others who are in the next generation of experts to help all of those patients in need.

Stephanie Zwonitzer (43:22.53)
Well, thank you and we have great people to learn from, unless it's like yourself. Remind people how they can get in touch with you and come and see you if they're in the DC area.

James A. Simon, MD (43:33.471)
So my practice is called Intim Medicine Specialists, intimmedicine.com. And we have a very extensive website. You can search by my name, James Simon, or by Intim Medicine. And I have two female practitioners with me, physicians assistants.

And they've been with me for 35 and 30 years respectively. So we have a lot of shared experience and knowledge. And we see patients both virtually and in person. As I mentioned, five blocks from the White House. I also have licenses to practice in Colorado.

in Michigan, Ohio, Tennessee, and Virginia, so I could prescribe in those states. But if you just wanted an educational online visit, I do them all the time with patients, couples, et cetera, all over the world, quite frankly. But I don't want to work past midnight local time. That's my only prescription.

Stephanie Zwonitzer (45:01.034)
I love that. I am so grateful Dr. Simon for having you on here for your expertise in this field and just being able to know you in real life. This is very exciting. Not a lot of my guests do I know in real life as well. So thank you so much for being here. Everybody have a great week. Don't forget to check out reviveish.com for all your hormone and sexual health needs in Maryland. And we will see you next time. As always, go have some fun between the sheets.