"[It’s about] understanding that as urologists, we are board certified to take care of all genders, and we do have data and evidence to support us in taking better care of our female patients," says Rachel Rubin, MD.
In this video, Rachel Rubin, MD, a urologist in practice in North Bethesda, Maryland, discusses 24th Annual Fall Scientific Meeting of Sexual Medicine Society of North America sessions “Fundamentals Course in Women's Sexual Health” and "Couples Approach to Testosterone Therapy."
This is very exciting. SMSNA sponsored a women's sexual health course that was cosponsored by the International Society for the Study of Women's Sexual Health. It's very exciting because a lot of times, this meeting is very focused on men's sexual health, and there's not only excitement, but there was a lot of interest in registration in the women's sexual health course that we did. It was a really wonderful half-day course that really looked at all of the different ways that we both diagnose and treat women's sexual health conditions.
I think as urologists, we look at the guidelines for treating testosterone deficiency in men, and men really need to have signs and symptoms of testosterone deficiency, as well as lower numbers; we tend to look at lower than 300 as our cut-off. [Those are] our guidelines from the American Urological Association. Those symptoms are very broad; they can be fatigue, they can be erectile dysfunction, low libido. They can even be “man, I'm not getting as much work done as I used to get done.” And so we have a very broad definition of male testosterone deficiency. What I'm going to be presenting is how we need to do a better job of looking at the whole couple. I always say, “The couple that testosterones together stays together,” and looking at the data that we have for women's sexual health, when it comes to testosterone issues, and we really have quite a number of areas where we have data. The biggest one of course, is in low libido, so in postmenopausal women, for hypoactive sexual desire disorder, we have quite a bit of data. In fact, we have global consensus that testosterone therapy works to improve libido and decrease distress around having low libido. It's just that we have no FDA-approved product for women. There is an approved product by the Australian government that has been used for a very long time, and a lot of the research has come out of Australia, and we have a lot of work to do when it comes to giving our female patients safe and effective testosterone therapies. We have to use male testosterone products, and we use it at about 1/10 a dose as we would in our male patients. We also have data that the bladder, the vagina, the vulva, and the urethra are also very testosterone dependent. And so we have data in both genitourinary syndrome of menopause, as well as something called hormonally mediated vestibulodynia, which is like people who have pain with intercourse, people have recurrent urinary tract infections. A lot of these people getting diagnosed with things like interstitial cystitis actually have a hormonal deficiency that may be from lactation, from birth control pills, from menopause, all sorts of things that can decrease testosterone in people's bodies. And we have data to show that using androgen-based therapies in the form of either vaginal DHEA or sometimes we will have to compound low-dose estrogen testosterone products for these patients that you see a lot of improvement in these bladder conditions and these vulvovaginal conditions as well. So I'll be presenting really getting the sexual medicine community to think about the couple when you're dealing with testosterone issues because if you get a man's libido up and his erection are perfect, but his partner has low libido and pain with intercourse, if it’s a heterosexual couple, you're really hurting the relationship there. [It’s about] understanding that as urologists, we are board certified to take care of all genders, and we do have data and evidence to support us in taking better care of our female patients.
This transcription was edited for clarity.