The Doctor's Channel - Sexual Medicine

Commission on the Status of Women

2010-03-12T15:02:36+00:00

Dr. David Best attends the 54th Commission on the Status of Women, held at the United Nations in New York. The featured speaker of the day is world renowned sex expert Dr. Ruth Westheimer. Dr. Ruth spoke on "The Importance of Literacy in Sex for Women and Men," to a large audience from around the world. The event was hosted by the Panamanian Ambassador to the United Nations, Mary Morgan-Moss.

For more information about the Commission on the Status of Women, check out their website at
Commission on the Status of Women.

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Tart Boutique - Vancouver, BC

2010-02-26T19:50:56+00:00

Tart is a deliciously sexy boutique filled with beautiful things. Born from the idea that life is sexy, Tart’s fantasy atmosphere - a European Bohemian Venetian Jewish Courtesan’s salon – is the perfect place for women and men to share and explore all that is sexy, sensual and beautiful. Join Dr. David Best for a private tour of the boutique with owner/founder Edie Orenstein.

For more information about Tart Boutique, check out their blog at
Tart Boutique.

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New guidelines call for first cervical cancer screen at 21; less frequent Pap tests

2009-11-23T12:48:36+00:00

NEW YORK (Reuters Health) - Cervical cancer screening should begin when a woman turns 21, according to newly revised evidence-based guidelines issued November 20 by the American College of Obstetricians and Gynecologists (ACOG).

ACOG previously recommended that cervical screening begin 3 years after first sexual intercourse or by age 21, whichever occurred first.

"The recommendation to start screening at age 21 years regardless of the age of onset of sexual intercourse is based in part on the very low incidence of cancer in younger women," the guidelines state. "It is also based on the potential for adverse effects associated with follow-up of young women with abnormal cytology screening results."

The updated guidelines also call for women between the ages of 21 and 29 to be screened every 2 years, instead of annually, using the standard Pap test or liquid-based cytology.

Women aged 30 and older who have had three consecutive negative cervical cytology test results and who have no history of cervical intraepithelial neoplasia (CIN) 2 or 3, or cancer, are not HIV infected or immunocompromised, and were not exposed to diethylstilbestrol (DES) in utero may extend the interval between cervical cytology examinations to every 3 years.

Cytology and human papillomavirus (HPV) DNA testing is an appropriate screening strategy for women older than age 30, the guidelines state. Low risk women aged 30 and older who receive negative test results on both cervical cytology screening and HPV DNA testing should wait at least 3 years before being rescreened.

“The tradition of doing a Pap test every year has not been supported by recent scientific evidence," Dr. Alan G. Waxman of the University of New Mexico in Albuquerque, said in an ACOG-issued statement.

"A review of the evidence to date shows that screening at less frequent intervals prevents cervical cancer just as well, has decreased costs, and avoids unnecessary interventions that could be harmful," added Dr. Waxman, who headed development of the updated guidelines, which appear in the December issue of Obstetrics & Gynecology.

In women who have had a total hysterectomy for benign indications and have no prior history of high-grade CIN, routine cytology testing should be discontinued, the guidelines state.

Because cervical cancer develops slowly and risk factors decrease with age, it is reasonable to stop cervical cancer screening at age 65 or 70 among women who have three or more negative cytology results in a row and no abnormal test results in the past 10 years, the guidelines state.

Women who have been vaccinated against HPV should follow the same screening guidelines as unvaccinated women.

Reference :
Obstet Gynecol 2009.

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Vibrator study for sexual dysfunction in women

2009-11-16T17:45:42+00:00

Marsha Guess, MD, Assistant Professor of Obstetrics, Gynecology and Reproductive Medicine at Yale University, discusses altered sexual function in women and a Yale study that is looking at arousal dysfunction in women and the role of vibrators to provide sensate stimulation.

Veronelli A, Mauri C, Zecchini B, Peca MG, Turri O, Valitutti MT, dall'Asta C, Pontiroli AE. Sexual dysfunction is frequent in premenopausal women with diabetes, obesity, and hypothyroidism, and correlates with markers of increased cardiovascular risk. A preliminary report. J Sex Med. 2009 Jun;6(6):1561-8. Epub 2009 Apr 23.

Alonso-Alvarez C, Pérez-Rodríguez L, Garcia JT, Viñuela J. Testosterone-mediated trade-offs in the old age: a new approach to the immunocompetence handicap and carotenoid-based sexual signalling. Proc Biol Sci. 2009 Jun 7;276(1664):2093-101. Epub 2009 Mar 11.

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Lying supine for 15 min improves pregnancy rate after intrauterine insemination

2009-11-03T12:03:51+00:00

NEW YORK (Reuters Health) – Women who lie on their backs for 15 minutes after intrauterine insemination have a better chance of becoming pregnant than women who move around immediately afterward, according to a report in the October 30th Online First issue of BMJ.

A trial in 2000 suggested that remaining supine for 10 minutes after intrauterine insemination could increase pregnancy rates, but that study was small and unbalanced, lead author Inge M. Custers and colleagues note.

To verify the benefits of supine immobilization, Custers, from the Academic Medical Centre, Amsterdam, The Netherlands, and co-researchers compared pregnancy rates in 199 women who were randomized to 15 minutes of supine immobilization and 192 who were assigned to an immediate mobilization group. Intrauterine insemination was being performed for unexplained, cervical factor, or male subfertility.

The immobilization group had an ongoing pregnancy rate per couple of 27%, significantly higher than the18% rate seen in the control group (RR 1.5). The corresponding live birth rates were 27% and 17% (RR 1.6).

The ongoing pregnancy rates in the immobilization group for the first, second, and third treatment cycles were 10%, 10%, and 7%, respectively, compared with corresponding rates of 7%, 5%, and 5% in the control group.

In an accompanying editorial, Dr. William L. Ledger, from the University of Sheffield, UK, notes that while a 15-minute immobilization period may improve pregnancy rates, it may present logistical issues for a busy assisted reproduction center. “The results,” he adds, “suggest that units should carry out their own evaluation of immobilization versus immediate mobilization after intrauterine insemination, to test the hypothesis in the ‘real world.’”

Reference:
BMJ 2009.

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Long-term risks of sildenafil use unclear

2009-10-08T14:56:42+01:00

NEW YORK (Reuters Health) – Sildenafil (Viagra) is associated with a number of side effects, but data on long-term harms are still lacking, a systematic review and meta-analysis has shown.

As reported in the October issue of Urology, Dr. Alexander Tsertsvadze, from Ottawa Health Research Institute, Ontario, Canada, and colleagues analyzed data from 49 randomized placebo-controlled trials of sildenafil identified through a search of MEDLINE, EMBASE, PsycINFO, SCOPUS, and Cochrane CENTRAL.

Men treated with the popular erectile dysfunction drug were 56% more likely than those given placebo to experience any adverse event, the report indicates. Specific side effects linked to the drug were headache (RR = 2.57), flushing (RR = 4.99), dyspepsia (RR = 3.00), and visual disturbances (RR = 3.51).

The results also show that the risk of these adverse events increased as the dose of sildenafil rose.

Rates of serious adverse effects and withdrawals from adverse effects were similar in sildenafil-treated men and those given placebo.

In most of the studies, however, follow-up did not exceed 12 weeks, the authors note.

“More efforts should be directed toward achieving an optimal balance between the degree of effectiveness and safety of sildenafil use in men with erectile dysfunction,” the authors conclude. “For example, consideration of flexible dosing regimen of sildenafil to minimize the occurrence of adverse events may be an option.”

Reference:
Urology 2009;74:831-836.

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New Sterilization Technique

2009-09-29T15:48:41+01:00

Ted Anderson, MD, PhD, FACOG, FACS, Director of Gynecology/Gynecologic Surgery, Vanderbilt University Medical Center, discusses the new Adiana Hysteroscopic Sterilization System.

The permanent sterilization technique does not involve incisions or general anesthesia and can be performed in the office.

Dr Anderson has disclosed the following:
Consulting Fees: hologic
Contracted Research: hologic

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Altered genital sensation in women with pelvic organ prolapse

2009-08-25T15:39:30+01:00

Marsha Guess, MD, Assistant Professor of Obstetrics, Gynecology and Reproductive Services, Yale University, discusses altered genital sensation in women with pelvic organ prolapse, in particular altered blood flow and arousal problems.

Summary
1. Arousal dysfunction is caused by the parasympathetic nervous system and orgasmic dysfunction is caused by the sympathetic nervous system.
2. It is known that women with pelvic organ dysfunction have blood flow and arousal problems which will lead to the identification of new treatment options in the future.

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References and Resources
Kammerer-Doak D. Assessment of sexual function in women with pelvic floor dysfunction. Int Urogynecol J Pelvic Floor Dysfunct. 2009 May;20 Suppl 1:S45-50.

Espuña Pons M. Sexual health in women with pelvic floor disorders: measuring the sexual activity and function with questionnaires--a summary. Int Urogynecol J Pelvic Floor Dysfunct. 2009 May;20 Suppl 1:S65-71. PMID: 19440785 [PubMed - in process]

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Syncope and thrombotic events seen with quadrivalent HPV vaccine

2009-08-19T18:25:00+01:00

NEW YORK (Reuters Health) – In general, the quadrivalent human papillomavirus vaccine (qHPV, Gardasil, Merck and Co.) licensed by the US Food and Drug Administration in June 2006 is no more likely than other commonly used vaccines to cause side effects, new research shows.

However, the vaccine was linked to higher rates of syncope and venous thromboembolic events relative to prelicensure data and rates with other vaccines.

“The significance of these findings,” the authors conclude, “much be tempered with the limitations (possible underreporting) of a passive reporting system.”

Using data from the Vaccine Adverse Event Reporting System, Dr. Barbara A. Slade, from the Centers for Disease Control and Prevention, Atlanta, and colleagues assessed the safety of qHPV following licensure and distribution.

A total of 12,424 reports of adverse events were logged, which corresponds to a rate of 53.9 reports per 100,000 doses distributed, according to a report in the Journal of the American Medical Association for August 19.

Of the reports, 772 (6.2%) documented a serious event, including death in 32 reports. The numbers of adverse event reports per 100,000 qHPV doses distributed were “8.2 for syncope, 7.5 for local site reactions, 6.8 for dizziness, 5.0 for nausea, 4.1 for headache, 3.1 for hypersensitivity reactions, 2.6 for urticaria, 0.2 for venous thromboembolic events, autoimmune disorders, and Guillain-Barre syndrome, 0.1 for anaphylaxis and death, 0.04 for transverse myelitis and pancreatitis, and 0.009 for motor neuron disease.”

As noted, the syncope and venous thromboembolic rates were higher than expected.

In an accompanying commentary, Dr. Sheila M. Rothman and Dr. David J. Rothman, from Columbia College of Physicians and Surgeons, New York, discuss the marketing of qHPV and the negative impact it may have had on adolescent health.

“As marketing of this HPV vaccine demonstrates, pharmaceutical company campaigns can undercut the most cost-effective and appropriate use of new agents to the detriment of adolescent health. By making this vaccine’s target disease cervical cancer, the sexual transmission of HPV was minimized, the threat of cervical cancer to all adolescents maximized, and the subpopulations most at risk practically ignored.”

Reference:
JAMA 2009;302:750-757,781-786.

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Dr. Ruth’s Top Ten Secrets for Great Sex

2009-08-18T18:56:42+01:00

Dr. Ruth Westheimer discusses her new book, Dr. Ruth's Top Ten Secrets for Great Sex: How to Enjoy it, Share it, and Love it Each and Every Time. While Dr. Ruth objects to the title – she wouldn’t keep secrets about sex from you! – she promises that the book is a fun read and that it will help you to let go of your worries and enjoy a great sex life.

For more information, please visit
Dr. Ruth's Top Ten Secrets for Great Sex.

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