Why does the Dept. of OB/GYN at the University of Utah offer a premarital exam for women?

Get ready for your wedding night with the University of Utah’s Department of OB/GYN! Say what??? Let me set the scene. There was a Reddit post two weeks ago from a woman whose fiancée insisted she have some kind of premarital exam checking her hymen to be performed by her father-in-law and witnessed by other […]

New study says ultra low dose vaginal estrogen ineffective for pain with sex

A new study has been published looking at the lowest prescription strength of vaginal estrogen (10 mcg estradiol) available in the United States to treat the vaginal discomfort associated with menopause or Genital Syndrome of Menopause (GSM). GSM affects approximately 50% of women and causes many symptoms including (but not limited to) pain with sex, […]

Vaginal Valium: another study shows it’s ineffective for pelvic pain

There are providers who recommend vaginal diazepam (Valium) for pelvic pain due to pelvic floor spasm. I have never understood why they do this as based on our understanding of how diazepam works it cannot be an effective therapy. I have written previously about vaginal diazepam (Valium) here, reviewing that diazepam works on GABA receptors which are […]

“Vaginal Kung Fu” could injure your vagina

Allure in their bid to out Goop Gwyneth Paltrow in our post-jade egg society asks if “Vaginal Kung Fu” is the secret to better sex?   By vagina Allure and I mean pelvic floor muscles (the muscles that wrap around the vagina). I am an expert in these muscles. I treat pelvic floor muscle conditions every single […]

Women should get a routine check in with their GYN, not a routine pelvic exam

I have been a gynecologist for over 20 years. Including residency I have been performing pelvic exams for over 26 years. I have done thousands of routine well-woman pelvic exams and thousands of exams for women with symptoms. While my personal n of 1 is certainly not research I have not once picked up a […]

Freezing your genitals at a spa will give you frostbite not better sex

The good people of Twitter alerted me today to the concept of recreational genital cryotherapy. Cryotherapy, for those who may not know, is freezing tissue for medical benefit. The spa, because that’s EXACTLY the place you would want someone to freeze your vulva or scrotum or wherever is at the The Ainscow Hotel in Manchester, […]

Hysterectomy for chronic pelvic pain? Ask these 7 questions first

Chronic pelvic pain (CPP, pain in the pelvis that is present for more than 2 weeks a month and has been there for more than 6 months) affects 15% of women and accounts for upwards of $2 billion a year in direct medical costs. To say it is a significant health burden is a gross […]

Vaginal Valium is ineffective for pelvic floor muscle spasm

A common cause (possibly the most common cause) of both pelvic pain and pain with sex is spasm of the pelvic floor (the levator ani and obturator internus muscles). Some physicians have promoted vaginal Valium as a treatment. There is a retrospective study of 26 patients (which has all the inherent problems of small retrospective […]

Jimmy Choo wants to steal your orgasm and other sex fallacies from Time magazine

I was just about to go to bed when I saw Time magazine’s list of 12 Shocking Sex Facts and so I thought, well, maybe Time know’s something I don’t. However, what followed was perhaps the worst piece of what-the-fuck-drivel that made every sex lists that I’ve ever read in Cosmo and O Magazine seem […]

Causes of painful sex (dyspareunia) simplified in one image

Up to 50% of women experience pain with sex (dyspareunia) at some point in their lives. There are a variety of causes, many of which are not considered by providers and/or patients. I’m lecturing on this subject today and came up with a slide that I think encompasses the main pain generators for dyspareunia, but […]