181: When Sex Hurts – Dr. Irwin Goldstein

Summary: Dr. Irwin Goldstein, the founder of field of sexual medicine, joins me in the conversation about female sexual pain. He drives the talk with tons of fascinating information about sexual pain, including what are the different categories, common causes, and treatment options. <br><br>The prevalence of female sexual pain <br>Within the last month, 1/3rd of women reported experiencing sexual pain or some form of discomfort during sex, while only 2% to 7% of men reported sexual dysfunction or secondary pain. He urges women to ensure they find the correct medical professional and find answers to their questions as he has found many women go untreated due to misdiagnosis. <br><br>Dr. Goldstein best categorizes various kinds of sexual pain by the area it originates. The pain in the vulva is diagnosed as vulvodynia. However the vestibule is often overlooked as the source of pain, and more than 90% of the time is misdiagnosed as vulvodynia. <br><br>Hormonally Mediated Vestibulodynia <br>Dr. Goldstein warns against birth control pills as they have harmful side effects that can eventually affect your sex life. He urges women to consider other birth control methods like Long-acting reversible contraceptives (LARC) – IUDs, Nexplanon and Implanon contraceptive implants, and progesterone. He further informs that The American College of Obstetricians and Gynecologists and The American Academy of Pediatrics no longer consider birth control pills as the leading method of contraception. <br><br>Causes in Older Women and Treatment Options <br>For older women over 40, the hormonal challenges of menopause are a leading cause of pain. He mentions that women go through two stages of menopause, where the first one causes low testosterone levels and the latter causes low estrogen levels. He shares available treatment options for this. <br><br>Other Common Causes and Treatment Options <br>Among other causes, Dr. Goldstein talks about Neuroproliferative vestibulodynia, a condition where women suffer from life-long pain. Monistat is the number one medicine women use that causes neuroproliferative vestibulodynia. The only treatment option available is surgically removing the vestibule, which has an 80% cure rate and is completely non-disfiguring. <br><br>Tune in for valuable advice that can make a huge difference in your life. <br><br>Background <br><br>Dr. Goldstein has been involved with sexual dysfunction research since the late 1970s. He has authored more than 350 publications as well as multiple book chapters and edited 6 textbooks in the field. His interests include penile microvascular bypass surgery, surgery for dyspareunia, sexual health management post-cancer treatment, genital dysesthesia/persistent genital arousal disorder, physiologic investigation of sexual function in men and women, and diagnosis and treatment of sexual dysfunction in men and women. <br><br>Dr. Goldstein is Director of Sexual Medicine at Alvarado Hospital, Clinical Professor of Surgery at the University of California, San Diego, and practices medicine at San Diego Sexual Medicine. He is also Editor-in-Chief of Sexual Medicine Reviews and past Editor of The Journal of Sexual Medicine. He is a Past President of the International Society for the Study of Women’s Sexual Health and of the Sexual Medicine Society of North America. He holds a degree in engineering from Brown University and received his medical degree from McGill University. <br><br>The World Association for Sexual Health awarded the Gold Medal to Dr. Goldstein in 2009 in recognition of his lifelong contributions to the field, 2012 he received the International Society for the Study of Women’s Sexual Health Award for Distinguished Service in Women’s Sexual Health, in 2013 he received the Lifetime Achievement Award from the Sexual Medicine Society of North America, and in 2014 he received the ISSM Lifetime Achievement Award from the International Society for...