Episode Transcript
Dr. Laurie Landeen: I’m going to give you the number. I’m going to throw it out there. 42% of women at some time in their life have some issues with sexual functioning, whether it’s decreased libido, whether it’s inability to orgasm, whether it’s painful intercourse, you know, so you are not alone. That’s my message to women. You are not alone. You should not be ashamed. And please, if you come see us, we’re going to validate your concerns and, and let you realize that you know what? We just want you to have a life that is as full as you want it to be.
Courtney Collen (Host):
Hello and welcome to “Her Kind of Healthy,” a podcast series brought to you by Sanford Health. I’m your host, Courtney Collen with Sanford Health News. We want to start new conversations about age-old topics from fertility and pregnancy to postpartum managing stress, healthy living, and so much more. “Her Kind of Healthy” is here to bring you honest conversations about self-care, happiness, and your overall well-being with our Sanford Health experts.
In this episode, we are having a sex talk specifically about why you might not be enjoying your sex life. Well, if you’re someone who just doesn’t like sex or intimacy, I’m here to say that’s OK. But we’re going to take a deep dive into some of the reasons why you might not be enjoying it and how to overcome that.
If there is any physician at Sanford Health whose mission it is to ensure you have a healthy sex life, it’s OB/GYN Laurie Landeen, MD. Joining her for this conversation is Molly Kuehl, DNP, APRN, CNP. Both of them specialize in sexual health at Sanford Women’s, and we are so grateful to have you both for this conversation. Welcome.
Dr. Laurie Landeen:
Thank you.
Courtney Collen (Host):
Now, Dr. Landeen, I know you’re so passionate about this topic. Both of you are, really, and you’ve said before intimacy and sex are part of our natural well-being. And as women, we go through so many stages of life in our marriage, partnerships through parenting beyond. Is it normal to experience sort of an ebb and flow of intimacy and desire?
Dr. Laurie Landeen:
Absolutely. And you use the exact words I was going to use, ebb and flow. I mean, there’s no doubt that, you know, sexual well-being has a lot of things that help it and hinder it. You know, we have what we call the things that enhance and give us our acceleration. And we also have the things that put on the brakes. And actually that’s a great way, it’s out of a book that we actually recommend patients read.
And so I think that what women need to realize is, number one, our testosterone levels are one-tenth that of a man, even if we have normal testosterone levels. So, of course our drives are different. We can’t expect to be the same.
Number two, what causes us to have sexual desire? Certainly hormones. There is no doubt it is natural for a woman to feel more amorous with her partner during ovulation because her estrogen levels peak. It is very natural for a woman to have no sex drive after having a baby because her estrogen levels plummet. Stress plays a major role. Medications can play a major role.
And then on the other side of life, you know, having a cancer diagnosis, you know, just for instance, a breast cancer diagnosis, we remove your breasts. We take away your, you know, what I would call your self-esteem about your own sexual well-being. And then on top of that, we take away your estrogen. And, you know, it’s a surgical menopause. You know, when we stop your estrogen levels, it’s not like the, you know, you’re rolling down a hill, going through menopause. You’re jumping off of a cliff. So that can also do that.
And then just natural menopause. Again, you’re going to have changes that cause painful intercourse. A lot of the reasons why women say they have decreased libido is because they’re not enjoying sex and they’re not enjoying sex because they have some medical reason why it hurts to have sex.
Courtney Collen (Host):
Why are we having painful intercourse? Let’s talk through that, Molly.
Molly Kuehl:
There are a lot of reasons that women may have painful intercourse. Some of them are self-limiting, many are not. And anytime a woman is having painful intercourse, it’s really, it’s not normal, and they should seek medical care for that. And evaluation.
Some of the reasons, as Dr. Landeen already mentioned, could be hormonal. And that can happen again after having a baby. For instance, with low estrogen levels, there can be pain at the opening of the vagina and within the vagina after certain medical treatments like radiation to the pelvis. Even with colon cancer, some women receive kind of radiation to that area that may, you know, leak into the vagina, so to speak. And that can affect those tissues causing stiffening of the vaginal membranes, scarring of the vaginal tissue that causes loss of elasticity.
There can be, you know, lacerations with birthing that can cause scarring and pain. Some women who are, you know, elite athletes in high school, who are elite athletes in college, women who are marathon runners, things like that, they can have injuries in their pelvis, their lower extremities that alter their gait. And even those types of things can cause high tone in the pelvic floor. And women don’t realize it, but that is the, the base of our entire body. It holds all of our organs. And any alteration in that musculature can actually cause painful sex.
And things as simple as contact irritants can cause almost an allergic dermatitis type reaction at the opening of the vagina, recurrent yeast infections, recurrent bladder infections, something as simple as constipation can cause painful intercourse. So there is a whole, you know, gamut of reasons and they range from very simple to very, very complex.
And that’s our job as specialized clinicians, is to do a detailed evaluation, a detailed history, and to kind of tease those things out. You know, when did this first start occurring? Does it happen all the time? Is it a limited thing? Is it just with this partner or did its precede this partner, et cetera?
"You are not alone. You should not be ashamed." Dr. Laurie Landeen, Sanford Women's
Courtney Collen (Host):
Dr. Landeen, do you see a lot of patients come in and may be embarrassed to express?
Dr. Laurie Landeen:
Absolutely. So I’m just, just before I came here, I had a sexual health consult. I usually save that as my last appointment in the morning. And then I have a special clinic that we will do just exclusively with sexual health patients, because number one, we want to give you time. You know, in general, you do a pap smear yearly exam, you know, 15 minutes, boom.
But with the patients that have these issues, half of it is just making them feel comfortable with us to even talk about these issues because we have shamed people. You know, society has made it a taboo.
I’m going to throw it out there: 42% of women at some time in their life have some issues with sexual functioning, whether it’s decreased libido, whether it’s inability to orgasm, whether it’s painful intercourse, you know, so you are not alone.
That’s my message to women: You are not alone. You should not be ashamed. And please, if you come see us, we’re going to validate your concerns and, and let you realize that you know what? We just want you to have a life that is as full as you want it to be.
Studies have shown that women who have a very fulfilling intimate life, they live longer, you know? Women who have painful intercourse may also have some urinary symptoms. This weekend I read an article and it was stated, “genital urinary syndrome of menopause is killing women.” I thought, what a great article. I was actually going to show it to Molly here, because people don’t realize that if you have vaginal irritation and you’re having recurrent urinary tract infections because the estrogen levels are low, it can also, people will maybe have painful intercourse. But you can also have some urinary symptoms that can lead to what’s called sepsis.
And that’s like a majority of women who are menopausal. It can lead to death. I mean, so there’s a lot of things that, you know, we dismiss because we don’t want to talk about it because we’re embarrassed.
Courtney Collen (Host):
And Molly, we know that having a healthy sexual relationship in our marriage or in our partnership is important. And, and having intimacy is important. If something is painful and maybe we’re seeking care or we’re going to seek care, hopefully after listening to this, it would encourage someone to seek care as to not continue having painful intercourse. But Molly, how do you keep your partner satisfied in the meantime? How can we be intimate when sex is painful?
Molly Kuehl:
So there are a lot of ways to be intimate without having penetrative intercourse. And I think number one, we want to encourage women to be open with their partner and to not continue to have penetrative intercourse if it is painful for them.
One of the worst things that women can do is to just grin and bear it, so to speak, because that’s just going to reinforce that cycle in their mind, the sexual response cycle, that pain, painful sex equals bad, you know, and their libido is going to continue to decline. They may actually build up some resentment against their partner. And if their partner doesn’t know that this is causing them pain, number one, how are they to understand this? But number two, if they do not openly and honestly communicate with them what they’re experiencing, they really have no fair chance at helping their partner solve this problem.
There are many other ways to satisfy a physically intimate relationship, and we can kind of help you come up with some of that. But you can, you know, use oral stimulation. We actually prescribe vibrators there, you know, digital stimulation, penetration, things like that. But ultimately there’s many ways.
Intimacy is about physical and emotional intimacy and being emotionally vulnerable with your partner. And one of those things is to openly and honestly communicate about when you are feeling pain. And we want to encourage women that it’s not embarrassing to be vulnerable with your partner. And this will only further expand, you know, the depths of your relationship.
We also encourage you to bring them to your appointments because a lot of the appointments are education-based, and the partners really seem to get a lot out of that by understanding that what we’re able to provide informationally at the appointments.
Courtney Collen (Host):
Where do we begin to seek care when it comes to painful intercourse or otherwise?
Dr. Laurie Landeen:
Well, one of the first things is, you know, certainly any of your primary physicians can refer you to our clinic, to our intimacy clinic that we have.
The other thing is we do telemedicine. You know, we can have the first visit. I don’t have to physically examine a patient at the first visit, and sometimes I don’t do that because I feel like I need to build that relationship with them because they’re vulnerable with us as well because of what they’ve gone through.
The other thing is, there is always an emotional and psychological component that we always want to make sure is OK. And, you know, some patients have had a history of sexual abuse, a history of rape. And although they love their current partner, they’re having a hard time disassociating lovemaking with the one they love, with a past experience where it was non-consensual and painful and caused trauma.
So you know, again, you don’t have to physically come in if you cannot and you’re far away, we would prefer it because I always feel like one-on-one close up. I like to see my patients. And, you know, we all know in this day and age of Zoom and everything, it’s taken away a little bit of the relationship piece, you know?
Courtney Collen (Host):
Let’s talk about sex after pregnancy. What can we expect during postpartum and how can we resume intimacy after baby?
Dr. Laurie Landeen:
There’s two main things that occur when you’re postpartum, your estrogen levels plummet and you have significant sleep deprivation. And this is even worse with breastfeeding moms and bottle-feeding moms. OK? But it can happen with both.
But two-thirds of relationships postpartum take a dive. Two out of three relationships. I don’t care how good they are, they take a dive during that first 12 months because you are forgetting to help each other with your own love language.
You know, so you are resentful that he even wants sex. He’s resentful because you’re watching the baby. And he hasn’t become the number one player on the team anymore. You know, and it’s not that he doesn’t love the baby, but the bottom line is, first of all, acknowledging it. That’s the biggest thing, is acknowledging that piece. And number two, doing what you can.
I say go on a date night. If you hopefully have, you know, grandparents are willing to watch the kid, maybe even overnight, you know, go to a hotel room where there is no interruption. You don’t hear a baby crying, you know? Get out the good old lubricant. And we’re a fan of natural products. Bring your olive oil, your coconut oil that you have at home. They are not harmful. They are natural.
Anytime that you, you know, use anything that’s over the counter, look at the label, it usually has a whole bunch of ingredients. And you don’t need that. If you look at olive oil, look at the label, it says olive oil. Right.
So again, there’s a lot of things you can do to maintain an adequate and maybe even enhanced intimate life, even in those situations where, you know, you just don’t feel it, feel it as much, and it’s understandable.
Molly Kuehl:
And I’ll say too, Courtney, you know, I am a little over two years out. My daughter still doesn’t sleep. She’s up multiple times a night. I do this for a living. And, you know, our sex life is not back to where it was pre-kids. And we work hard at it, you know, we really try. Mama’s touched out, at the end of the day. Mama’s tired. Baby only wants Mom in the middle of the night. She doesn’t want Dad. And again, the best thing you can do is just be open and honest.
And, you know, he still comes to me, you know, horny as ever asking for it, you know, five times a week. And he might only get it two times a week, and that’s how it is. But he understands that I am tired. I’m touched out. I still deeply love him. And, you know, it’s just not at the top of my priority list right now to be physically intimate when the kids need so much attention.
There’s great books out there. There’s great relationship resources out there that can help with a woman’s or a partner’s ability to communicate these types of things to their significant other.
Dr. Laurie Landeen:
I’m also going to say that even if you don’t have the desire, most women, once they get into the actual intimate time, they actually enjoy it and they get aroused. Yeah. So I basically tell women whether you have the urge or not in your mind, make an appointment.
Because studies show that if you can have intercourse twice a week with your partner, it’s also going to make the relationship better. You know, most women are going to still enjoy it while they’re in the moment.
Molly Kuehl:
That is true. Mama usually enjoys it once she’s in it.
Dr. Laurie Landeen:
(Laugh) Right. And so, you know, so again, realizing that this is the biggest thing, you know, you get a lot of conflict resolution when you become intimate. And that’s the biggest thing is, if there’s conflict in relationship, intimacy can really help it. And it may not be the end-all. You have to have, communication is the key, but intimacy is such an important part of relationships.
Courtney Collen (Host):
How often should we be intimate with our partners?
Dr. Laurie Landeen:
Studies have shown that having intercourse two to three times a week is what keeps us healthier. And we live longer. And I’m not telling you that you have to. I’m not talking penis in vagina either. You know, there’s other ways to be intimate.
We have what we call the five love languages. I encourage all women and men to read that, because for a lot of women, it’s not the physical touch. For men, it’s more physical touch than for women. For a lot of women, it’s affirmation, you know? I mean, there’s other things that you know, but if it sets you off, that’s going to make you want to have intercourse more. And if it’s physical touch, well, we as women, we need to understand if our significant other, that’s what’s important to them, then we need to answer to their love language also.
Courtney Collen (Host):
Thank you so much. And just to wrap things up here, both of you, how would you encourage women listening, no matter what stage of life they’re in at this point, that it doesn’t have to be painful. It doesn’t have to be not enjoyable for one person, that it can get better and there is help. What would you say to those listening?
Molly Kuehl:
I would say that, in this day and age, there are so many resources available. And they’re good research evidence-based, scientifically sound resources that we can help you with, we can direct you to.
If you feel hopeless, please do not. Please reach out and allow us to help you. If we can’t solve it for you, if we can’t answer your questions, we have a vast network of great clinicians that we can refer you to. But the amount of women that we have been able to help, the amount of partnerships that we’ve been able to help in just the couple years we’ve dedicated to this is amazing. And it’s been really rewarding work that Dr. Landeen and I have been able to do together.
Dr. Laurie Landeen:
This is a multidisciplinary thing that we do here. We have physical therapists involved. We have you know, our mental health therapists and triage specialists involved. We have couples therapists involved. We have, you know, primary care physicians because lots of times it’s not just a girl thing or a boy thing, it’s a we thing, you know? And so, you know, it may be, people don’t realize this, but a little bit of erectile dysfunction in a dry vagina that sets the stage. It’s like a synergism. So it might be that we need to help, you know, the male partner as well.
And although Molly and I don’t take care of the male partner, we have great resources to get them to be taken care of. Come see us. We want you to have the best fullest life that you can have. And there really is not a taboo. And, you know, we are open to hearing what you have to say and not feeling ashamed, not feeling judged.
Molly Kuehl:
We have fun together. We take it seriously, but we have fun and we try to make things as comfortable as possible. We always ask for consent before we do an exam. You know, we’ll never do anything that you are not personally comfortable with. We encourage you to bring your partner with. And we would love to meet you.
Courtney Collen (Host):
This is a topic that I just feel like isn’t discussed enough, and we are so grateful for your time and all that you do for Sanford patients. Your expertise. Dr. Landeen, Molly Kuehl, thank you so much for your time today.
Molly Kuehl:
Thanks, Courtney.
Courtney Collen (Host):
To learn more about Sanford Women’s or to make an appointment and find solutions to improve your sexual health, visit sanfordhealth.org. This was another episode of “Her Kind of Healthy,” a podcast series by Sanford Health. For Sanford Health News, I’m Courtney Collen.
Thanks for being here.
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Posted In Gynecology, Menopause Care, Sioux Falls, Women's
