Common Myths Surrounding Female Sexual Dysfunction [Interview][Transcript]

dr_leah_millheiser_sexual_healthGuest: Dr. Leah Millheiser
Presenter: Neal Howard
Guest Bio: Dr. Leah Millheiser is a Clinical Assistant Professor in the Department of Obstetrics and Gynecology and Director of the Female Sexual Medicine Program at Stanford University Medical Center. She is also a Fellow in the American College of Obstetricians and Gynecologists; as well as, the International Society for the Study of Women’s Sexual Health. In addition, Dr. Millheiser is the Chief Scientific Officer of Nuelle, a sexual wellness and intimate care company focused on delivering groundbreaking solutions made specifically for women.

Segment overview: Dr. Leah Millheiser, MD, OB/GYN, talks about common myths related to female sex drive and desire, and offers guidance and resources for women to take control of their sexual health.

Health Professional Radio – Myths Surrounding Female Sexual Dysfunction

Neal Howard: Hello and welcome to the program, I’m your host Neal Howard here on Health Professional Radio. Our guest in studio is returning to speak with us Dr. Leah Millheiser, Clinical Assistant Professor in the Department of Obstetrics and Gynecology and Director of the Female Sexual Medicine Program at Stanford University Medical Center. She’s here with us today to talk about some common myths that are related to female sex drive and desire and maybe offer some guidance and resources from women to take control of their sexual health. Welcome to Health Professional Radio Dr. Millheiser.

Dr. Leah Millheiser: Thank you for having me.

N: You know last time when you were with us, we talked about some of the well the 4 Forms of Female Sexual Dysfunction. Let’s talk now about some of the common myths that you seem to encounter in your travels when you’re speaking and teaching and what not. What are some of the things that just drive you nuts and you wish that more of us had an understanding of when it comes to FSD or Female Sexual Dysfunction?

M: You know, I think that’s a great question. I think two of the more common myths that I hear has to do, one with sexual desire in women and the second has to do with achieving orgasm in women. So I would say the first myth is that if a woman is not always in the mood for sex, there must be something wrong with her and that is probably the one thing that drives me crazy. I’ve had women come to my clinic and actually say, ‘I really didn’t feel like I needed to come see you today but my partner and it’s typically a male partner, wanted me to come in because he thinks there’s something wrong with me and when I ask them what it is, the answer is always, ‘My desire is not always there. I’m not always in the mood for sex, his desire is much stronger than mine so there must be a problem.’ If you asked the majority of women, ‘Are you bothered by your low sex drive?’ and we know that it’s very common for women as they age, as they take certain medication, if they have certain medical conditions to experience low sex drive. They’ll say ‘No’ because I know that it’s a result of this issue and I know that if I get into a sexual act with my partner, even if I’m not in the mood, that I’ll develop desire along with the way and I will ultimately enjoy the experience. That is pretty typical for women throughout their lifespan. Medications like birth control pills, medical conditions like hyperthyroidism or depression, breastfeeding, going thru menopause, all of those experiences can affect the woman’s sexual desire. I think men often times tend to look at desire from their own construct, “So how do I think about desire and it if that’s the way it works from me then that’s the way it should work from my female partner.” And unfortunately that isn’t the case, so what is the norm for women especially if they’ve been in a relationship for a long time and is the best way if she is experiencing these life-stressor or changes, is that she will have waxing waning desire, it won’t always be spontaneous. But usually so be able to develop that responsive desire during a sexual act and many people say “Well why do women engage in sexual activity if they’re not in the mood?’ Well there’s many reasons and instances. One is, a woman wants to feel close to her partner. She wants to feel good, she knows she will feel good, she wants to make her partner feel good. So there are instances and reasons that women engage in sexual activity even if their desire is low. But I think it’s really giving women and their partners that information, that spontaneous sex drive is not always there for women, like it is in men.

N: When it comes to starting the conversation about FSD with your healthcare provider, you say that this information or lack of education in health care providers adds to the understanding gap among patients. Do you find that female practitioners sometimes have just as big a disconnect when it comes to FSD as their male counterparts?

M: You know, that’s a really great question. I’m not going to say that I think it’s gender specific, I think it’s been a problem in medical education. Unfortunately it wasn’t made a priority over the last 15 years, but in the last few it have, we’re seeing more and more medical schools spending more hours into what such female sexual dysfunction is. So I think we’re seeing improvement across in both genders when it comes to health care providers and how they are approaching at sexual function with their patients and how they’re addressing it and I think there’s been an improvement. Also the treatments have changed over the years, we have more solutions available now and I think that really opens up a door for a clinician to say, ‘I feel more comfortable addressing sexual function because there’s something I cannot tell to my patients.’

N: With drugs such as Cialis and Viagra available for men, women seem to be of much more complicated when it comes to, you can’t just pop a pill and everything is okay in that area with men. Are there any drugs that are available or are we talking about therapy in women, how do you address the situation?

N: So we always want to be able to provide solutions and you bring up a great point. With Viagra and Cialis of the world, it really is you take a pill, you either have an erection or you don’t ,it’s very clear objective evidence. With women, there’s so many factors that contribute to her low sex drive. It could be an imbalance in brain chemistry, it could be relationship issues, it could be medications or disorders or medical conditions that she has. You really have to tailor the approach to treatment based on what the factors are. So there’s no one size fits all. Often times women who have long standing sexual dysfunction will need counseling, emotional counseling, to either deal with issues that they themselves have been encountering as a result of their sexual dysfunction, specifically emotional concern and also they may need a treatment to address the physical issues. So we tend to not treat one thing in isolation. You’ll find that women who have a Desire Disorder may eventually develop an Orgasmic Disorder or an Arousal Disorder. So I always say, “Go after what does first concern was that that woman has and often times the other issues will go away but we tend to treat from a multidisciplinary approach.” Often times that can be, seeing a clinician for medication, seeing a sex therapist or a relationship therapist, seeing a …physical therapist. So there are so many great solutions available to women today to treat their sexual dysfunction.

N: When it comes to menopausal women and pre-menopausal women, does menopause always mean that you will develop FSD? And if you’re pre-menopausal and you have FSD, does it always mean that you’re going into menopause before your time?

M: No. So there’s no link between sexual dysfunction and pre-menopausal women being were dated to early menopause. When we talk about going to menopause, that really is a, this is a change in the hormonal environment for women. And what we see is the decline in … estradiol levels or estrogen levels and testosterone levels. We know that estrogen and testosterone are both important for overall vaginal health. So without estrogen, we see dry vaginas that can lead to sexual pain. This is quite common, it’s the part of something called ‘Genitourinary Syndrome of Menopause’. So we see this quite commonly in post-menopausal women. In terms of testosterone, when testosterone starts to diminish, even before menopause women will experience a change in their level of sex drive and it becomes so much more pronounced after menopause. Not all women are bothered by it, women will say, ‘Yeah, I have vaginal dryness, but I’m not sexually active. It does not really bother me’. Some women will say, ‘Sure, I have vaginal dryness, but I use a lubricant and it’s fine’. But for other women, it’s devastating. It has devastating effects on their relationship, on their own personal self-esteem and body image and needs to be addressed. So many women who are post-menopausal will notice a sexual function concern if they are sexually active, but I think what’s important is it’s not just about menopausal and beyond. We see these issues starting in women as young as in their late 20’s so we really shouldn’t ignore younger women, millennials, and women who are generation X who have sexual concerns.

N: Alright. You’ve been listening to Health Professional Radio, I’m your host Neal Howard with Dr. Leah Millheiser, talking about FSD or Female Sexual Dysfunction and some of the common myths that are out there about Female Sexual Dysfunction and she’s been with us dispelling some of those myths and setting us on a path of understanding. It’s been great having you here with us today Doctor.

M: Thank you so much for having me.

N: Transcripts and audio of this program are available at and also and you can subscribe to this podcast on iTunes.

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