Let’s talk about sex. Sexual wellness is an essential part of overall health, yet it’s not often discussed — even behind the closed doors of a doctor’s office. “People have a hard time bringing up sexual dysfunction issues with their doctor, and doctors can sometimes be dismissive of it,” says Dr. Vinita Tandon, Lifeforce’s Medical Director and a board certified endocrinologist. “Yet it’s such a prevalent problem in midlife and beyond.”
According to one study, up to 43% of women and 31% of men experience sexual dysfunction, and the prevalence increases significantly in men over 45 and in menopausal women. A large study called SWAN (Study of Women’s Health Across the Nation) also found that 24% of post-menopausal women never felt sexual desire and 41% infrequently felt desire. Even those stats may be falsely low, according to Dr. Tandon, who says sexual issues are often underreported.
At Lifeforce, we weren’t satisfied with the status quo. And so, Dr. Tandon and her team of clinicians set out to create a safe, effective, and holistic solution to optimize men’s and women’s sexual function. Lifeforce Physician Russell Van Maele, DO, says, “We want to make sexual health and optimization a foundation of wellness and give people a platform to feel comfortable talking about it.”
Types and Causes of Sexual Dysfunction
By definition, sexual dysfunction “prevents a person or couple from experiencing satisfaction from sexual activity,” says Dr. Tandon. Just as there are many different ways to experience healthy, satisfying sex, there are also a wide variety of possible sexual issues.
According to Dr. Tandon, there are typically four categories of sexual dysfunction:
Desire disorders: Lack of desire or interest
Arousal disorders: Inability to become physically aroused or excited
Orgasm disorders: Delay or absence of orgasm
Pain disorders: Pain during intercourse
In men, the most common issues are lack of interest, inability to achieve or maintain an erection, and premature or delayed ejaculation, according to Dr. Tandon. For women, the chief complaints are a lack of desire, inability to achieve orgasm, and pain with intercourse.
These problems can be caused or exacerbated by physical issues. “Hormones are a huge component,” says Dr. Van Maele. For men, testosterone and DHEA levels drop with age, which can lead to lower arousal, desire, and sometimes difficulty achieving and maintaining an erection, according to Dr. Van Maele. For women, levels of both estrogen and testosterone lower in perimenopause and menopause, which may impact arousal and ability to orgasm. Estrogen loss may also lead to vaginal dryness and pain.
Chronic health conditions, especially high blood pressure and diabetes in men, can also affect sexual wellness. “These conditions limit blood flow to all areas of the body, and particularly to our sexual organs,” says Dr. Van Maele. According to Dr. Tandon, up to 50% of men with diabetes can experience sexual dysfunction.
In addition to the physiological causes, there are also “psychological things like stress, anxiety, depression, relationship issues, and past trauma that play into sexual health,” notes Dr. Tandon. In those cases, Dr. Tandon suggests consulting with a mental health professional. “There are some things we can’t address at Lifeforce, but we are going to work on the physical and hormonal aspects as best we can.”
Sexual Optimization with Lifeforce
How do we do that? By taking a “multifunctional approach to sexual optimization,” says Dr. Van Maele. The first step is doing the Lifeforce Diagnostic, an at-home blood test that measures 40+ biomarkers to give you a complete picture of your health, including organ health, metabolic condition, critical nutrients, hormone balance, and yes, sexual wellness. Then, you’ll have a one-on-one consultation with a Lifeforce physician to talk through your results and goals. “It’s best to have a very honest conversation with your doctor,” Dr. Van Maele says. “We have an open forum to do that and tools in our toolbox to help you.”
Those tools can include nutraceuticals, lifestyle recommendations, and hormone optimization therapies, which can provide the baseline for sexual health, says Dr. Tandon. (With the Lifeforce Membership, we offer prescriptions such as testosterone and micronized progesterone.) And for those who still experience sexual dysfunction, there’s now more help at hand.
Our clinical team combed the research and carefully selected three gold-standard, FDA-approved products to optimize your sexual function.
To Optimize Erectile Function for Men: Tadalafil
What it does: Tadalafil is a phosphodiesterase 5 inhibitor that is FDA-approved to treat erectile dysfunction in men. “This is a very common condition as men get older,” notes Dr. Tandon. Tadalafil increases relaxation of smooth muscle and improves blood flow to the penis, according to Dr. Tandon. “You can take it every day for more spontaneity or use it as needed when you want to be intimate.” It takes 30 to 60 minutes to work.
Who it’s for: Men ages 18 to 88 who can feel arousal but cannot achieve or maintain an erection to complete intercourse.
Who it’s not for: People with active heart disease or on a nitrate medication because it can cause blood pressure to plummet, according to Dr. Tandon. This excludes many people who have had cardiac events. If you have chest pain with intercourse, this treatment is also not a fit.
To Optimize Desire: PT-141
What it does: “PT-141 is a very unique peptide that improves libido in both men and women,” says Dr. Tandon. The exact mechanism for how it works is still unclear, but we know that it binds to melanocortin receptors in the brain, which increases desire. This is key because sex often starts in the brain, says Dr. Tandon. These self-administered injections can be used once or twice a week, and the effects can last up to 24 hours.
Who it’s for: Premenopausal women who don’t have hormone issues, but experience little or no desire. This is known as generalized hypoactive sexual desire disorder. PT-141 is the first and only FDA-approved as-needed treatment for premenopausal women with HSDD. PT-141 can also be used off-label for men who have issues getting aroused but cannot take or haven’t gotten optimal results from phosphodiesterase 5 inhibitors or optimizing testosterone levels.
Who it’s not for: People who have active heart disease, uncontrolled high blood pressure, or anyone nursing or trying to conceive. “About one-third of people temporarily feel nauseous when they start PT-141,” says Dr. Tandon. “If that doesn't go away, you may not be a good candidate.”
To Optimize Pleasure: Vaginal Estradiol
What it does: “Women lose estrogen in menopause, so their vaginal mucosa dries up,” explains Dr. Tandon. “It can become very dry and sensitive, so any type of penetration will hurt.” Vaginal Estradiol is applied topically to help re-epithelialize and lubricate the vaginal wall. Apply it daily for two weeks and then just three times a week, advises Dr. Tandon. “Within three to four weeks, you’ll start to get some relief.”
Who it’s for: Perimenopausal and post-menopausal women who have vaginal dryness, irritation, and pain with intercourse.
Who it’s not for: If you experience any spotting, stop using the cream and consult with your doctor.
Learn more about these products here, and consult with a Lifeforce doctor to find out what’s right for you. Remember, don’t be shy to talk sex with us. Says Dr. Van Maele, “Just know that this is a private conversation and this is something that Lifeforce doctors are comfortable talking about because it’s a part of humankind to have great sex.”
Ready to get optimized? Take your first step with the Lifeforce Diagnostic.
This article was medically reviewed by:
Vinita Tandon, MD, ABIM Board Certified in Endocrinology and Metabolism
Russell Van Maele, DO, ABIM Board Certified in Internal Medicine