S10 EP1_SEXUAL HEALTH_Low Sex Drive: Audio automatically transcribed by Sonix

S10 EP1_SEXUAL HEALTH_Low Sex Drive: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Kristyn Hodgdon:
Hi, I'm Kristyn Hodgdon, an IVF mom, proud women's health advocate, and co-founder of Rescripted. Welcome to From First Period to Last Period, a science-backed health and wellness podcast dedicated to shining a light on all of the women's health topics that have long been considered taboo. From UTIs to endometriosis, we're amplifying women's needs and voices because we know there's so much more to the female experience than what happens at the doctor's office. With From First Period to Last Period, we're doing the legwork on your whole body so you can be the expert in you. Now, let's dive in.

Kristyn Hodgdon:
Hi everyone, and welcome back to From First Period to Last Period. I'm your host, Kristyn, and I'm so excited to be here today with Dr. Priya Maseelall. Hi, Dr. Maseelall.

Dr. Priya Maseelall:
Hello, Kristyn.

Kristyn Hodgdon:
How are you?

Dr. Priya Maseelall:
I'm doing well today. It's sunny in Ohio, so what can we ask for the spring?

Kristyn Hodgdon:
It's beautiful in New York today, too. I'm definitely going to be going for a walk after this, but I'm so excited to talk about sexual health with you today. We were talking offline about how when people are trying to conceive, you assume that they're having sex all the time, and that's not always the case. So we're going to be talking a little bit about low sex drive intimacy issues when trying to conceive underlying health issues that might be to blame, etc., etc.. For those of you who don't know Dr. Priya Maseelall, she is a double board-certified reproductive endocrinologist and infertility specialist at RGI Fertility in Ohio, a part of the Pinnacle Fertility Network. Okay, awesome. Let's dive in, I think. Can you actually expand upon what I just said a little bit, like how sexual health issues or sexual intimacy issues are more common than we might think?

Dr. Priya Maseelall:
Yeah, I think for everybody baseline, I think everybody assumes that people are having sex all the time. But life gets in the way; stress gets in the way. And particularly for people who have been trying to get pregnant and have not had success, sex can become a chore. And so I think that is one of the main issues that makes going forward hard or arduous, mentally, physically, all those things. And so many people I've come to come to me, and you assume that at baseline they're having sex, and when you talk to them, they're like, no, we're not because my husband has this issue, and we can have sex for fun. But when it comes to making a baby, it's, he can't get an erection, or it hurts so much because I'm having sex day after day during my fertile window, and it's just too much I can go on. And so I think those things in themselves, we have to find workarounds, solutions and get to the bottom of perhaps saying it's okay not to have sex every day. And when do you need to have sex? And why is this happening to him? And perhaps we can help him. So, there are so many things that we can dive deep into to explore and help people.

Kristyn Hodgdon:
Yes. And to reiterate, if this is happening to you and your partner, you're not alone. Actually, the inspiration for this episode is that one of our top-performing articles of all time is "Help! My Husband Can't Perform During Ovulation," so it's incredibly common for them to get stage fright. We're going to dive into exactly why timed intercourse is so important during ovulation and how much you should actually be having sex during your fertile window. So let's talk a little bit about that. Like how much should you actually be having sex, and how many fertile days are there really?

Dr. Priya Maseelall:
And so we usually like to say, if someone knows that if they're not doing things like ovulation predictor kits to pinpoint their fertile window exactly, then if someone has a 28-day cycle, you presume ovulation is happening around day 14. So we're just saying that the middle of the cycle, somewhere around day 12, 13, or 14, would be the ultimate time to have sex. And we only say once a day, right? One because you don't want to dry up the well, so to speak. And two, you want it for three consecutive days. The myth of every other day, you actually may miss your fertile window. People who are doing ovulation predictor kits have their surges or their smiley faces or whatever, and if they have it today, we usually say sex today, tomorrow, and the next day. And so it's really three days. And again, that can be hard for some people three days in a row. Usually, I would say the day of the day after, or the most important time, the day of the surge, exactly the day after. And if we're doing inseminations with that or artificial inseminations in the office, we typically do our artificial insemination 36 hours after a trigger if they have a trigger surge or 24 hours after a normal LH surge. That's the timing. Otherwise, I say in the month, really, sex is for fun. If you're having sex a week before ovulation or a week after, it's really the purpose of not procreation, right? It's just for fun. And hopefully, you're having some fun, too, with the sex for recreation.

Kristyn Hodgdon:
Yeah, no, for sure. I think there can be a lot of emotions, though, tied to intimacy when you're struggling to conceive because, like, you associate sex with other people who can get pregnant. And I always say we're taught in sex ed that if you have sex, you will get pregnant.

Dr. Priya Maseelall:
The whole mantra your whole life is, oh my gosh, if sperm touches me, I'm going to get pregnant. And so again, changing your mind to all those things we were taught aren't exactly true, and then realizing how difficult it really is to become pregnant. Actually, for a 25-year-old, every month, there is about a 25% chance for months, so educate people, and then beyond that, look at how it changes your life. So, for instance, if it's like an ovulation problem and, let's say, it's a male factor problem, there's feelings of guilt, oh, it's my fault, and then that can compact the inability to perform, if you will. And again, there are so many workarounds. There are so many ways to look at it and ways to have fun with the situation. I think the first thing is to let one know we talked about this a little bit. Know you're not alone because everybody's lying. If they say that this is super easy, even the sex part when you're trying to get pregnant, because it is a different way to think about sex. And so I think that people have just to be real and honest about it. And then, platforms like this talking about it is really important, and so that's what we're doing.

Kristyn Hodgdon:
Absolutely. So, what are some of the reasons couples struggle with low sex drive or intimacy issues when trying to conceive?

Dr. Priya Maseelall:
Okay, so let's take the female. One, I think the female, sometimes it can be like a physical thing. There's a condition called vaginismus where you have an involuntary spasms of the vagina and things like that. Now, certainly, it's a medical condition, but sex becomes hard sometimes. Just having intimacy and foreplay can help with that situation. A lot of these people do things like physical therapy, so maybe they're able to have sex, but to do it continually and do it at the right time is difficult for them. So specifically, if you have vaginismus, we're recommending things like pelvic floor physical therapy. I literally tell my patients to go to the sex store, buy things like feathers, and try to zhuzh up their sex life because having fun with it doesn't have to be done in five minutes, right? Like sex, if you can, this might be an opportunity to do different things sexually. You might have a story to tell, or it might open your eyes to other things in this hard time of trying to get pregnant. Oftentimes, women take a little bit more to get to that climax. And then men typically and sometimes vaginal lubrication or having sex too quickly, your body's oh my gosh, it hurt last time because it happened too fast. I don't know if I want to do it as much now, but you have the other side of your shoulder saying, oh, we need to do this. We need to do this because we need to get pregnant now. So I think it can be stressful because you want to feel, sex should feel good. It should be a good thing. But sometimes, because you make it like a business transaction, it's not as good. And I think dealing with that and finding your way to maybe talking to your partner, I think is essential, like being open and saying, hey, this is how I'm feeling, maybe we should take a minute. Maybe we should try that thing we bought at the sex store or watch something that stimulates us, or what works for one person and one couple may not work for the second couple, but be open to a conversation and trying things, I think, is super important. For a guy, sometimes, guys may have things like low testosterone, which may affect their libido and their ability to ejaculate and have an erection. As we age, you know what guys don't get, let's say, as hard as they may once, and it might be hard for them. So, things like Viagra may be helpful in these situations where it's hard for people to perform every day after day.

Kristyn Hodgdon:
So, that affects fertility at all, viagra?

Dr. Priya Maseelall:
No, it does not, but testosterone does. So, guys typically take testosterone because they have low testosterone and may need that for their libido. The irony is that it does affect the sperm. So they come off of it, and they may have difficulty with sex now or ejaculation or erection. And so there are different medicines that we can use that can increase testosterone. So your male reproductive urologist or sometimes your reproductive endocrinologist can help suggest and prescribe these medicines. So things like HCG or things like an FSH can help, or an LH can help. So someone can get off testosterone, but use these different drugs to increase testosterone more naturally in the body to help with ejaculation erection.

Kristyn Hodgdon:
Okay. And is that a part of an initial male fertility evaluation?

Dr. Priya Maseelall:
The semen analysis always is. And if someone would say, hey, I've been on testosterone, or Hey, I have trouble with ejaculation erection. Usually, we look at their semen analysis first, and then, based on our semen analysis, I usually do more hormonal blood work. Or again, if they said, hey, I'm getting off testosterone, we see if we can rebound it or give them other hormones to increase production and then therefore increase libido faster. And if someone said, hey, I have trouble baseline with ejaculation erection, and my testosterone spiked, then we say, okay, perhaps try something like Viagra and see if that will help.

Kristyn Hodgdon:
Interesting. I hadn't heard that before, and I don't know why. I assumed maybe it would impact fertility, but it's so good to know that it doesn't. And so, are there any male fertility supplements that you typically recommend, or is it more just medication?

Dr. Priya Maseelall:
I think as far as libido is concerned, if there's a low semen analysis, we use things like CoQ10 or Fertile Aide, I think, what are they, a magic pill that totally changes things ..., but we're into adjuncts. We're into doing everything that we can to improve the environment. And for males, I would say mostly it's just that CoQ10.

Kristyn Hodgdon:
And then, going back to vaginismus for a second, like, how do you bypass that? I know you talked about taking your time, taking your time with intimacy, and stuff like that.

Dr. Priya Maseelall:
So, if you can't take you, I have had patients in the past who literally cannot. They have beautiful, healthy marriages, but for them, sex isn't part of that. And usually, I have them come in. I usually have one practitioner, let's say it's myself, and I work with them enough to be able to do insemination. So I can think of 2 or 3 in particular, recent patients that can't have intercourse. But if I tell them, if I can get speculum and I can do an IUI, they so want to be parents, and they want to do it as naturally as possible. I'm able to collect sperm with caution and time, be able to do artificial insemination, and then they've had success, and they've come back over the years. And then, of course, we address, hey, their vaginismus, and how can we help you? As I mentioned before, pelvic floor physical therapy and working with a partner both partners to help. However, there are ways around it because if people want a baby like they want it now, they don't necessarily want to wait, and because they've already been waiting and we there's workarounds.

Kristyn Hodgdon:
Yeah, okay, I love that. And sometimes, the patients don't necessarily always have fertility issues. It's just like this, okay.

Dr. Priya Maseelall:
Lots of my patients may say I always ask the male partner if there's a male partner. Have you ever had problems when your wife's? Let's, perhaps, having an egg retrieval, and she's having surgery that day, it's a lot of stress. Do you think you're going to have problems performing? And they say, maybe, I don't know. We always have the option to freeze sperm prior in a low, like a less low-stress environment. And they have many days or a month to try to keep that specimen. So, for people who have had problems with that, I always offer that prior to treatment so that they feel better. So because it can cause issues, let's say it's your fertile window, and for some reason, we can't get sperm that day. We don't want to cause more trouble in a marriage. We want to say, hey, we can save some, and if we need it, that would be great. If we don't need it, great, and just have backups.

Kristyn Hodgdon:
Yeah, absolutely. We also did a post one time on spontaneous desire versus responsive desire. Meaning, I think some people think that they have to be like ready to go at all times, but really it's like a two-way street, and sometimes it's doing like more foreplay, as you said, or like responding to your partner or it's a process, and it's not always, wait, I'm ovulating. We should be ready to go doing this.

Dr. Priya Maseelall:
Exactly. I think people have to take a minute, take a step back, and then think about it. And there are certain things, too. I don't know if you asked me this, but in a woman's body, when we talk about ovulation, certain things like foreplay physiologically are also essential because natural mucus comes, which helps the sperm in transport and things like that.

Kristyn Hodgdon:
I was going to ask that actually about, in theory, women are supposed to, I guess, when your body's ovulating, you're supposed to be a little bit more.

Dr. Priya Maseelall:
Yeah, and that's lots of people with natural planning, family planning. They the stretchiness or the like, clearness of their cervical mucus. And that, I always joke, I feel like the cervical mucus is like a highway for the sperm to get up into the cervix and go. And so if you have things like lack of foreplay or you're just using a bunch of lubricants, it can actually be detrimental to the sperm as opposed to, like you said, meeting your partner where they are, increasing that foreplay, increasing the cervical mucus, and try to make it a pleasurable experience. And again, we've all had a lot of us have had infertility issues, and I know that it can be very hard, but you have to take things slow in a way. And we tell you this: doctors are telling you, on the one hand, take it slow, but on the other hand, hey, there's this fertile window, and it's X amount long, and to try to do it, but there is more time than people perceive. And again, just communicating with people and both people being, as you said, responsive to the other person, we know more than that, and it's okay that the world is not going to end if you don't have sex today. You just have to, maybe it'll happen tomorrow, maybe it'll happen a couple of hours from now.

Kristyn Hodgdon:
Clearing up some of the misinformation or myths is so important because I actually told a friend recently that she just started trying to conceive. I told her that sperm can live in the female reproductive tract for up to five days, and her mind was literally blown.

Dr. Priya Maseelall:
Yeah, that's true. Even though we say three days, it's not impossible for the sperm to hang out there on the fourth or fifth day. Yeah, it does.

Kristyn Hodgdon:
Because like her husband travels a lot, and she was worried about all the logistics, and yeah, I was like, okay, you'll be okay.

Kristyn Hodgdon:
Yeah. Oh, something I thought was interesting on my own journey was that when I actually got to IUI and IVF, it almost took some of the pressure off.

Dr. Priya Maseelall:
Yeah.

Dr. Priya Maseelall:
Isn't it funny? A lot of people say that because you're manning the ship, and sometimes, once you get to IUI and IVF, I always tell people again to have sex for fun. I'll tell you when I need the sperm or when you have to have sex. Go back to the old way. Let me help you on this side. And so it's ... in a way that people aren't like peeing on sticks anymore and trying to figure this out and taking temperatures and monitoring in their app like that gets really old and stressful when we're doing IUI and IVF. I'm just going to tell you, okay, this is when I need it, and ironically, it's sometimes easier for people.

Kristyn Hodgdon:
Yeah, I had a bunch of failed embryo transfers, and then I decided to take a year off because it was getting really stressful, and I started tracking naturally. But I have PCOS, which was.

Dr. Priya Maseelall:
Hard to track.

Kristyn Hodgdon:
Almost impossible, and I was putting so much pressure on myself to go to acupuncture and do all these holistic things. But then it was like I couldn't time it for the life of me still, and it put so much pressure on me like I was beating myself up and then trying to, like, then tying sex to that again. It just did not feel good. And that's when I hit my breaking point and said, okay, I'm just going to do one last IVF cycle, and the weight off my shoulders at that point was enormous. Like, I just felt, okay, I'm handing it over. I'm handing it all over.

Dr. Priya Maseelall:
Exactly. There are so many things that people go through. I wanted to go back to a question you asked me about why sometimes it can be painful and like underlying things. You talked about your PCOS, but even when we're giving sometimes medicines to people, they may feel bloated because they're getting more than one egg at a time. They may feel like they may have other things. We talked about vaginismus, but things like endometriosis, where they may have pelvic factors and things are stuck in certain positions for sex, can be painful—so exploring different positions, exploring, and going perhaps to do an IUI instead of having sex. I think all are things that we want to talk about. And having sex gingerly, right? Sometimes, it is also something that we talk about a lot around here.

Kristyn Hodgdon:
What's your recommendation for lube? What do people need to know about if they want to use that?

Dr. Priya Maseelall:
When I asked my andrologist, they surprisingly told me most lube is toxic, so natural lube is the best. And because people for a long time, a lot of my patients are like, oh, we're buying this one brand of lube, and it's pro sperm. And I was like, according to my andrologist, they say the best lube is none, and second, would be honestly saliva. They said the third would be this one brand of lubrication, but it's not. It doesn't enhance your fertility. No lubrication enhances your fertility. So I think that's ...

Kristyn Hodgdon:
Of course, yeah. Yeah, it's so important to reiterate the importance of doing your research when it comes to TTC products, lube supplements, etc., always run it by your doctor because you never know what you're getting.

Dr. Priya Maseelall:
Exactly.

Kristyn Hodgdon:
On or anything like that.

Dr. Priya Maseelall:
Another thing that I always tell people that I feel like is a myth. People always talk about the break that you took, right? I think sometimes breaks can be essential because we get in this rat race of, oh, you have to do this month after month. So I tell people it's okay to take breaks, and it's also okay to plant life. I think a lot of us are like, oh, I'm not going to go on that vacation, or I'm not going to do this because I'm going through infertility treatment, and I don't, I'm anti-that. I think you should plan your life. You should do these things because all of that leads to more stress, which can lead to decreased libido that can lead to less success. And so yeah, I think it's really important that you take time for yourself, that you make things that plan, that vacation plan, that go to that wedding, do all those things. Otherwise, it gets hard.

Kristyn Hodgdon:
Yeah, I've done it both ways. Like the first time around, I did not take a break. I refused because I was just so dead set on becoming a mom. This time, I had two other kids to think about. It was the way it was more stressful, just like logistics, and I wanted to be the best version of myself for them. And it depends on what you're currently going through, but I think, I wish I had taken a break back then because I was not emotionally in the best place, and sometimes, you need a little regrouping, even if it's just one month off.

Dr. Priya Maseelall:
Exactly. A lot of people ask me about, do you need an orgasm to get pregnant? I would say, like, the two things that I would say about orgasms are that, no, it's not essential to, I suppose in a man it's essential because it's the same as ejaculation, but in a woman, I wouldn't say that it's, that it helps you. In theory, there could be some muscle spasms that may help with taking the sperm up into the uterus, and so, if anything, perhaps that can be beneficial. But I think it's not necessary. And we always want your sexual experience to be pleasurable. And I think that sometimes what gets caught up in here is sexual pleasure versus the act of sex. And so I really think always, like you said, going back and trying to think of it every these experiences is a pleasure. And you're trying to connect with your partner. That's why you're trying to have a child because you want to have a baby with you. And I really think that's another myth that because people beat themselves up, oh my God, that sex didn't go well. And so I'm probably not gonna get pregnant this cycle.

Kristyn Hodgdon:
But that's a great one. The other one that we just wrote about on our site was, do you have to pee after sex to get pregnant, to flush everything, or can you pee after sex?

Dr. Priya Maseelall:
Can you pee after sex?

Kristyn Hodgdon:
Will you flush the sperm out?

Dr. Priya Maseelall:
Yeah. And no, you won't flush the sperm out. You don't have to stand upside down. You don't have to do a headstand, all that stuff. But you can definitely pee, that kind of stuff. You can even take a shower afterward if you want, and you can still get pregnant.

Kristyn Hodgdon:
That's awesome. So I was like to ask, towards the end of the episode, what would you rescript about the way individuals and couples think about sex as it relates to getting pregnant?

Dr. Priya Maseelall:
I guess I would rescript that you should focus on sex still being fun. You should focus on the fact that you're there as a partner. And I would say that I guess the other part of this is sex is not necessary to have a baby. So, if you want to have a baby and you can't have sex, or sex in the traditional way that we are speaking about, you can still have a baby. You could still be a mom; you can still be a parent.

Kristyn Hodgdon:
And that's so freeing to just say out loud.

Dr. Priya Maseelall:
Yeah, it's true. So be honest with your doctor. Tell them what you want. Tell them what difficulties you're having because it's very likely that they have some solutions for you. And if you don't feel like you can ask that doctor, ask a different doctor. There are always ways for us to help because this is what we do for a living.

Kristyn Hodgdon:
Yeah, for sure. At what point would you suggest going from your OB or PCP to the fertility specialist, like when dealing with this kind of issue?

Dr. Priya Maseelall:
And I think if you have an issue like vaginismus and you aren't having sex, you probably should go to your fertility doctor right away. Traditionally, the definition of infertility is 12 months of unprotected intercourse, or if and without success, if you're under 35 or 6 months above 35. But if you're having pain with your period, the sex or intimacy is a problem, if you're having problems with ejaculation or erection, if you have been prescribed things like testosterone, these in my head, go straight to the fertility doctor kind of things, and check yourself out, see where you are.

Kristyn Hodgdon:
Yeah. Do any fertility clinics still absolutely require that you've been trying for a year?

Dr. Priya Maseelall:
I think any, yes. But I think most, no.

Kristyn Hodgdon:
Okay. I feel like that needs to be put out there into the universe because some people still think that they have to try for a year.

Dr. Priya Maseelall:
And then there are people that have concerns. You may be a single lady and have concerns because you have. There's another condition called vulvodynia that's just even as soon as you touch any part of the vulva, it's like excruciating pain. And they may even want to get married or talk about how to have sex, and maybe how does it affect my fertility in the future? There are people that talk about, I'm sure, you've done podcasts and stuff about, just where am I in my fertility? I know I want to have a kid someday, but where am I? And so many of those patients that have come just been educated about the process and, in general, all these myths. We were joking that you were told your whole life that you can get pregnant so easily, right? All our health classes and even when I was in college and after, you're like, oh my gosh, you just have to be so careful because we're going to get pregnant if someone looks at us the wrong way. And in reality, it's not like that, and so just teaching people.

Kristyn Hodgdon:
Absolutely, that's what we're here for. Thank you so much, Dr. Maseelall. This was amazing and informative. I did not realize how much fertility specialists deal with sexual health issues, so thank you for ...

Dr. Priya Maseelall:
A pleasure being on. I love it, and hopefully, people get the help and know that they're not alone.

Kristyn Hodgdon:
Absolutely. Thank you, again.

Kristyn Hodgdon:
If this podcast means something to you, be sure to hit follow or subscribe. This helps you because you'll never miss an episode, and it helps us because you'll never miss an episode. For science-backed women's health content that meets you exactly where you are, head to Rescripted.com or follow us on social @HelloRescripted.

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