Today is World Sexual Health Day!
We’re kicking off a new Q&A series with sexual health expert Dr. Leah Millheiser
September is Sexual Health Month, and today is World Sexual Health Day! We thought it’d be a great time to kick off a new Q&A series with Dr. Leah Millheiser who is Hims & Hers SVP of Medical Affairs and also an Ob/Gyn and sexual health expert. Dr. Leah is a WEALTH of information and today she’s telling us a bit more about her background, what sexual health is and why it’s important to talk about and recognize. We’ll be sharing more Q&As with Dr. Leah as time goes on, so if there’s a topic you want us to cover please don’t hesitate to reach out to us on social media! Our Instagram accounts are @hims and @hers.
Q&A with Dr. Leah Millheiser
Q: What is sexual health?
A: The World Health Organization (WHO) defines sexual health as “a state of physical, emotional, mental and social well-being in relation to sexuality. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled”. Sexual health isn’t just about STD checks, cancer screenings, contraception, and pregnancy, which is what many people believe it to be. It also comprises sexual function, sexual pleasure, and sexual education. Unfortunately, there still exists a taboo around this topic and many people fear judgment if they bring it up with their healthcare provider (HCP) in the clinic setting. It is every person’s right to have access to sexual healthcare. If an HCP doesn’t ask a person about their sexual health, specifically sexual function, during a routine exam, they should feel empowered to bring it up on their own. If the HCP doesn’t treat sexual function issues, then they should request a referral to someone in their community who does. The International Society for the Study of Women’s Sexual Health (ISSWSH) is a great resource as well. Their website (ISSWSH.org) offers a list of medical providers across the US who specialize in sexual medicine.
Q: Can you share a bit more about your background and how it pertains to sexual health?
A: As an Ob/Gyn, I have devoted my entire career to the study of female sexual medicine. Following my residency, I received an NIH research grant to study sexual dysfunction in women, with a specific focus on Hypoactive Sexual Desire Disorder. This laid the foundation for the creation of the Female Sexual Medicine Program in the department of Obstetrics and Gynecology at Stanford University Medical Center 12 years ago.
Q: What are some current or trending topics related to sexual health you can share as examples?
A: Finding a highly effective treatment for chronically low libido in women (the most common sexual dysfunction) has always been a challenge. Currently, there are 2 FDA-approved treatments available for premenopausal women, and they are only about 40–50% effective due to the complex and multifactorial nature of sexual dysfunction in women. There isn’t a “one size fits all” treatment. It’s not like the treatment of erectile dysfunction in men, which is a blood flow issue often easily treatable with a pill (keeping in mind that these ED meds won’t work unless the desire to have sex is present!). We still don’t have an FDA-approved treatment for postmenopausal low libido, which is the population that is most affected. Other areas of research and clinical interest include the sexual function concerns of cancer survivors, the impact of commonly-used contraceptives on sexual function, as well as the concern around adolescents using media/social media to learn about and engage in sexual activity and the risks that this poses.
Q: What topics of sexual health do you believe deserve more attention and why?
A: I believe that, historically, the sexual health concerns of postmenopausal women have been pushed “under the rug” by the medical establishment as well as the media. Low sex drive is the most common sexual concern in women and has its biggest impact on those over the age of 50, yet the only FDA-approved drugs for treating this condition are available only for premenopausal women. Menopause does not mean the end of sexuality and femininity for women, yet they are often made to feel that way. It’s a cruel reality that evolutionary biology played on us. At some point in our remote history, women developed the ability to go into menopause. We are animals like any other, and if we are no longer procreating, why need a sex drive, right? Well, we are animals with high-level intellect who often choose to be monogamous with an age-matched partner of the opposite sex. Here’s the thing though, men may have issues related to erectile dysfunction as they age (which they can often take a pill for), but will for the most part maintain their sex drive. This presents the issue of sexual desire mismatch in the couple and may be one of the reasons divorce rates increase during and after menopause. A 2018 study in the Journal of Menopausal Medicine found that menopause-related symptoms such as vaginal dryness and decreased sexual desire led to sexual disharmony within marriages. Another study conducted by AARP found that over 60 percent of divorces are initiated by women in their 40s, 50s, and 60s, the menopausal years.
Q: How do you think the COVID-19 pandemic is going to affect different areas of sexual health?
A: There is no doubt that this pandemic has had a negative impact on the sexual health of many individuals, with women seemingly taking the brunt of it. Women exhibit greater “sexual plasticity” (sometimes referred to as “erotic plasticity”) than men and this theory is certainly being put to the test right now. Sexual plasticity is defined as the degree to which the sex drive is shaped by social, cultural, and situational factors. For many women, shelter-in-place presented a whole new set of challenges. The disruption of daily routine, mental fatigue brought on by work and financial stressors, homeschooling children, and fears about health have had many women collectively sighing “not tonight, I have a headache”. This is not an unexpected response given the increase in anxiety, stress, irritability, insomnia caused by the pandemic’s impact on mental health.
Q: If you could have the attention of the world, what one thing about sexual health would you want them to know?
A: You are certainly not alone. In the United States, sexual function concerns affect 44% of women across the lifespan. That’s almost half of the women in this country! Once the root cause of the problem is identified, the appropriate treatment can be recommended. These may include the following: treatment of an underlying medical cause (e.g., depression, hypothyroidism), FDA-approved medications for sexual dysfunction, “off-label” treatments, over-the-counter solutions (personal lubricants, sexual devices — vibrators, dildos, vaginal moisturizers), and behavior interventions (e.g., sex therapy, cognitive behavioral therapy, couples’ therapy). Women should not have to suffer in silence any longer.
Q: Why is bringing awareness to sexual health important?
A: For many women, sexual health is as important as other aspects of their health. Research tells us that when a woman’s sexual function is not what she would like it to be, it can have a negative impact on many different aspects of her life. Think of it like an octopus with tentacles that extend into multiple aspects of a woman’s life: her self-esteem, relationship with her partner, body image, even how she interacts with her family members or her peers at work.
Overall though, sexual healthcare is not a luxury. It is a right for people of all ages.
