#259 - Women's sexual health: Why it matters, what can go wrong, and how to fix it | Sharon Parish, M.D.

The Peter Attia Drive

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Sharon Parish is a Professor of Medicine in Clinical Medicine and Clinical Psychiatry at Weill Cornell Medical College and a prominent sexual medicine specialist who has been practicing for 30 years. In this episode, Sharon tackles the topic of women's sexual health, including the conditions associated with decreased sexual function and desire and available treatment options. She explores the influence of sexual health on overall well-being while also examining the potential effects of childbirth, birth control, metabolic health, and more on sexual function and desire. Through case studies, Sharon teases apart the differences between desire and arousal, explains the various factors that affect them, and walks through hypothetical treatment plans for the case study patients. In addition, she delves into the subject of menopause, addressing its impact on sexual health as well as the misguided fears around hormone replacement therapy. Stay tuned for next week's launch of our complementary podcast on men's sexual health.

We discuss:

• Sharon's interest in sexual medicine and the current state of the field [3:00];
• How hormones change in women over time and how that impacts sexual function [8:15];
• Changes after childbirth and its impact on sexual function [11:00];
• The role of metabolic health and systemic vascular health in sexual health [20:15];
• Conditions associated with decreased sexual function and the importance of sexual health for overall wellbeing [26:15];
• Sexual dysfunction case study #1: A 41-year-old mother of two, the sexual response cycle, and the difference between arousal and desire [38:45];
• Medications that may reduce sexual desire [49:45];
• The effect of birth control pills on sexual desire [56:30];
• The importance of testosterone in women for sexual function and desire, and why the FDA hasn't approved exogenous testosterone as a therapeutic [1:01:15];
• Challenges faced by physicians who are open to prescribing off-label testosterone for women, and Sharon's approach in managing this aspect with her patients [1:14:30];
• A hypothetical treatment plan for the patient in case study #1 [1:26:45];
• The role of DHEA (a precursor to testosterone) in female sexual health [1:32:15];
• Case study #2: A 30-year-old woman with anorgasmia (inability to orgasm) [1:38:30];
• Resources for helping women and their partners to enhance the pleasure experienced during sex, overcome anxiety, and increase desire [1:51:30];
• Two drugs for premenopausal women with low desire [1:59:30];
• Why treatments are potentially underutilized for both desire and genitourinary syndrome of menopause [2:13:15];
• Case study #3: A menopausal woman with symptoms [2:19:00];
• Addressing the misguided fears around hormone replacement therapy and cancer [2:24:15];
• Symptoms and treatment of genitourinary syndrome of menopause [2:32:45];
• Age 65 and beyond, and resources for finding a provider [2:37:30]; and
• More.

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