When it comes to female health, women often turn to their gynecologist for guidance and if that gynecologist is also a woman, the question may get more personal. "What do you recommend?" may turn into "what do you do?" While "sisterly" advice is invaluable when it comes to matters of the body, gynecologists may be reluctant to share their personal choices or preferences mainly because it doesn’t always match up with their patient's medical and personal needs. But there are other reasons too.
Up-to-date physicians know about new approaches to gynecological care long before the public because they read medical journals, attend medical conferences, and converse with their colleagues. But being privy to new methods doesn't guarantee it will be voluntarily shared with patients. Not because doctors are unwilling, but because new methods often need time to gain public acceptance, credibility or approval by the Food and Drug Administration (FDA).
And patients tend to want to go the conventional route, what they have heard about from friends and family, before trying things still on the fringe. Medical providers in general have so little face-to-face time with patients as it is; explaining the benefits and risks of a new drug, device or procedure takes time.
Here are some innovative approaches women gynecologists are secretly embracing that consumers might not yet be tuned in to.
Secret #1 – Vaginal Ring For Birth Control
The hormones estrogen and progestin are a very effective form of reversible birth control. Most women are familiar with hormonal birth control pills taken by mouth. The Pill is the leading form of contraception in the US taken by more than 11 million women. The pill dissolves in the stomach and the hormones travel in the bloodstream to prevent ovulation, and to change in the integrity of the uterine lining and mucous that makes it difficult for pregnancy to take hold. When taken correctly it is 92–99% effective – less than 1 out of 100 women will get pregnant each year.
But hormones can also be delivered in other ways via a patch or ring.
When a yet unpublished survey asked a group of women gynecologists which reversible hormonal contraceptive they would use, the vaginal contraceptive ring (NuvaRing) was high on the list. This flexible ring looks like a diaphragm without the rubber dome barrier. It is inserted the same way, in the vagina, wedged against the pubic bone circling around the cervix. The ring contains the same combination of estrogen and progestin found in combined oral contraceptives, but it is absorbed into the bloodstream through the wall of the vagina. It stays inside the vagina for 3 weeks and removed for 1 to allow for menstruation. Sexual partners rarely feel the ring.
Pluses: Unlike the oral form, you only have to remember to change the ring once a month, rather than take a pill every day. Missed pills are the main reason the oral pill fails to protect against pregnancy.
Minuses: Insertion requires a certain amount of dexterity. The risks are the same as other hormonal forms of birth control – mood changes, nausea, weight gain, breast tenderness, high blood pressure, menstrual changes, blood clots, heart attack and stroke. Additionally, some women experience discharge, swelling and irritation around the ring. Like other forms of hormonal birth control, the ring may not be advisable in people who smoke, are taking certain medications or have certain medical conditions (check with your doctor).
Secret #2 – Testosterone for Low Libido
There are many reasons why a woman lacks sexual desire or has problems getting aroused or achieving orgasm. It is a great source of distress among women who want to have intimate relationships. It affects 27% of premenopausal women and more than half of women in natural menopause. Lack of interest in sex can be attached to many natural or situational psychological, social or physical changes. Unfortunately there are few ways to measure sexual function and even fewer treatments available to help women who want to gain back lost or absent sexual vitality.
One possible cause of low libido or hypoactive sexual desire disorder is an imbalance of testosterone. Testosterone is a hormone most often associated with men. But the ovaries and adrenal glands in women make testosterone too, just in much smaller amounts. And not unlike most hormones, testosterone levels fluctuate throughout the lifespan in response to feedback from other hormones in the body or hormonal medications. (For example, the progestin in combined oral contraceptive pills can lower testosterone.)
Lower sex hormones are universal during natural and surgical menopause, but the effects on the body vary; some women experience few symptoms while others suffer immensely.
Testosterone replacement therapy in women has been controversial and the Food and Drug Administration (FDA) has yet to sign off on its use in women for this purpose.
It's confusing because blood levels of testosterone don't necessarily parallel the level of sexual desire and there are active and non-active forms of the hormone. So deficiency is not easy to measure.
Gynecologists are not apt to mention testosterone therapy for low sexual desire because it hasn't passed muster with the FDA. Although there is lots of evidence to support testosterone use in women for sexual dysfunction, long-term studies are still needed for the FDA to give the stamp of approval. (The FDA is concerned about the effects of sex hormones on breast cancer and heart disease risk similar to that found with hormone replacement therapy that contains estrogen.)
Still, gynecologists can offer the testosterone that has a legitimate indication in men, but in a smaller woman-sized dose.
Pluses: One recent study examined the use of a testosterone patch in postmenopausal women not taking any other form of hormone therapy and found that it increased the number of satisfying sexual episodes (increases in sexual desire, arousal, orgasm, and pleasure). It is well tolerated with few side effects.
Minuses: It's not FDA approved so it can only be given "off label." Side effects include increased hair growth, acne, male-pattern baldness, enlarged clitoris, deepening of the voice and lower good (HDL) cholesterol. Periodic liver function tests might be required.
Secret #3 – Vaccine to Prevent a HPV Infection
The human papilloma virus (HPV) is a sexually transmitted infection transferred from an infected person via oral, vaginal or anal sex or any skin-to-skin contact. It is a group of viruses that can cause a wide range of conditions such as genital warts and cancer of the cervix, vagina, anus, penis and throat. Infections are usually acquired during adolescence and young adulthood and the infection can persist indefinitely. Over time, the infected cells can undergo a transformation; sometimes changes can develop into cancer.
Today there are vaccines that can prevent infections from 4 types of HPV, the 2 types that cause about 75% of cervical cancer cases, and 2 types that cause 90% of genital warts cases.
The vaccines are approved for girls and boys under the age of 26. The reason for the 26 year cut off is that the vaccine is most beneficial to people who haven't yet been exposed to the virus. Most women over 26 have had sexual relations and most likely have HPV exposure.
However, many women who are older, who have had few or no sexual encounters and suddenly find themselves sexually active, could become exposed to the virus if they aren't protected. Although the vaccine is not approved for women over 26, gynecologists are giving the vaccine to this newly active group.
Pluses: Can prevent many deadly cancers caused by HPV with a series of vaccines.
Minuses: Does not protect against current HPV infections or cancer underway.
Secret #4 – Estrogen Cream for Vaginal Lubrication
During menopause and treatment for certain types of breast cancer, the load of estrogen in the body is greatly reduced. And that shrinks the vaginal cells that produce mucous, causing atrophic vaginitis, an uncomfortable and sometimes extremely painful drying condition.
Because there are health risks associated with supplemental estrogen given to treat symptoms of menopause, many people are skittish about using estrogen in any form at all. Higher doses of estrogen replacement therapy given in a pill or patch can increase risk for breast cancer and heart disease. But many gynecologists think that short-term, very low-dose creams applied directly to the vagina may be fine for all, even in women who have had breast cancer.
Pluses: Applying vaginal cream inside the vagina can reduce vaginal dryness well enough to keep women lubricated for sexual activity.
Minuses: The cream is only used intermittently, a dab a few times a week and not for more than 3 months at a time. It is not used as a lubricant. Using estrogen alone without progestin has been associated with cancer of the uterus, strokes and blood clots.