Q & A with Dr. Berman

Frequently Asked Questions

I lose control of my bladder during orgasm. I talked to a urologist many years ago and he told me to empty my bladder--no joke. What is wrong?

Assuming no incontinence (loss of control) during sneezing, coughing or straining at stool, or even during sex in advance of orgasm, the release of urine during orgasm is possibly due to sudden relaxation of the sphincter of the bladder. If the problem is truly isolated to this setting, emptying the bladder prior to sex is sound practice, before resorting to more complex examination of urinary and bladder function and residual bladder volumes.

I haven't seen/heard any mention of the connection between breastfeeding and the different types of dysfunction. I have two young children and am nursing both until they self-wean. I read somewhere that nursing releases chemicals that inhibit the mother's desire and I know that having infants constantly on your breasts changes nipple sensitivity, but I haven't heard the Berman's mention any of this. I'd love to hear what they have to say about this! I'm curious, too, if it's safe for a nursing mother to follow any kind of hormone therapy. We'd like to have another baby, but my lack of sexual motivation is being a REAL problem!

That is such a great question and you are right, there are some connections between breastfeeding and sexual response. First of all, because of the hormonal shifts, many women experience problems with vaginal dryness and lack of genital sensation. Furthermore, when you breast feed your body releases a chemical called Oxytocin which is the “feel good” chemical (this serves an evolutionary purpose because it makes you want to keep doing it!). However, there has been some evidence to propose that Oxytocin suppresses testosterone.

However, even if your levels are low, it is certainly not advised to be on any kind of hormonal replacement while breastfeeding or pregnant. As for the non-medical side, if you have two young children and are breastfeeding, it is likely you are exhausted, don’t have much time for yourself, and don’t have much energy to put into your relationship. Besides just having sore nipples, your body is not completely your own, much less available to your partner. It is really important to take this into account when evaluating your situation and its causes. Give yourself and your body time to recover. Best of luck and keep us posted.

I am a 25-year-old female and I hope you can enlighten me. I often experience pain after orgasm. It feels as though my uterus and anus tighten (I've never had anal intercourse). It doesn't happen every time, but more often than not. It's extremely uncomfortable, and it takes roughly 10 minutes or so for the pain to subside. Other than that, everything is fine. This is normal for me, as it's happened ever since I became sexually active.

Spasm of the muscles of the pelvic floor sometimes occurs during or after intercourse, especially if orgasm may not have occurred. Since the pelvic floor muscles enwrap both the vagina and rectum, discomfort in both areas may be possible. Remedies must be individualized. If failure to climax is related, this should be addressed. Hormonal levels, especially testosterone may also be of value. As a nonspecific remedy, application of heat to the lower abdomen may be helpful.

Married, young, without child -still no libido My sex drive used to be just fine, although I have never been one to have overwhelming interest or self-stimulate. I noticed a rapid decrease in my sex drive about 7 years ago - I am now 27. There was no reason that I can trace this to. I have been with the same man for 10 years and we are very happily married, except for this one area. When I decided to tell my Dr. about this, he told me that this was normal. I have since switched doctors and we have been experimenting with different birth control pills. I am now a hormonal mess. Nothing is working and my doctor is not receptive to any hormonal (testosterone) therapies. I feel this part of me has been permanently shut down. I have tried herbs, videos, you name it. Any advice?

Unfortunately without evaluating you in person it is difficult to determine what the causes of your complaints are. It seems like you are referring to something called Hypoactive Desire Disorder. The change in your desire could be related to so many things; stress, anxiety, depression, lack of time and space for yourself, changes in attitude about yourself or your relationship, sexual response problems, etc. But there also may be some medical explanations for your complaints and I would strongly suggest getting your hormonal levels tested.

I would give your body a few months off all hormones to readjust and get back to a baseline, then get your testosterone levels checked in order to determine if androgen deficiency is part of the explanation for your complaints. If this doctor won’t help, try insisting, and if it still doesn’t work, I would think about finding another doctor! Best of luck and keep us posted.

Gyns are no help either!!! I have been married for 13 years, LOVE my hubby so very much, and lost my libido after our second daughter. I also have Epstein-Barr virus, which makes me tired all the time. I went to a female Gyn thinking she would help...HA. She wouldn't give me any testosterone and told me to take some vitamin E and make an appt with a psychotherapist. I walked out, because I thought she'd help me. I moved, went to another female, she was a little better, ran some tests, came up with nothing, once again she wouldn't give me any medication either and told me to see a psychotherapist.... So, if you ask me, that is a gyn's way of saying , "I wash my hands of you." My question is how can we FIND a doctor who is WILLING to give us these creams, devices, etc? Someone who is willing to let us try out this stuff to see if it works? I would much rather have a little extra hair on my lip because of the testosterone than to lose my husband to a lack of my libido!

Your frustration is clear and shared with many women. While there may be some part of your lack of libido that is caused by psychosexual issues like exhaustion, depression, anxiety, etc., you should certainly be evaluated for what we call Post- partum Androgen Deficiency Syndrome which seems to be typically experienced in women after their second child.

All your doctor has to do is order a simple blood test looking at your total and free testosterone levels. Unfortunately, because so many of the treatments for sexual function complaints are new, they, and the disorders they treat are not fully understood by many doctors. We are trying to change that, but it is not easy and will take time. In the mean time, the best advice we can give is not to take no for an answer and not to give up. Bring your doctor literature to educate him/her. Let him/her know that there are FDA approved interventions that may be appropriate for you depending on your circumstances and specific complaints.

Also understand that it is only a matter of time before there are a range of FDA approved treatments for FSD as well as a great many doctors who take the problem seriously. Hang in there! Best of luck and keep us posted.

Help. I am a 51-year-old female. I want to get married again; I'm dating a great guy. There's nothing he won't do for me. I have been having a problem also of not being able to have an orgasm. I go through the motions of enjoying having sex. I have all the thoughts of a romantic night and that's as far as it goes. We went on a cruise and I stayed in the casino until I knew he was asleep. I fake most of the sexual feelings when we have sex. In my mind I want to make love, but when it's time I just don't have the desire. How can I find a doctor to help me? I don't want to lose him because of this. But no one wants to marry any one with out a sex drive.

It sounds like you are referring to both low desire and low sexual response. These are two areas of complaints that are separate but often interrelated. Both are complex and have a range of emotional, relationship, and medical causes. I would certainly look into all of these. At the very least it would be important to get a psychosexual evaluation to rule out the potential emotional causal factors. Also, you would want to have a blood test to make sure your total and free testosterone levels are where they should be. Also, you may want to have further testing in order to evaluate the blood flow in your genital area as well as the genital sensation in order to determine the potential medical causes of your difficulty achieving orgasm.

Unfortunately there are only a few centers that do the range of testing that we do at the Female Sexual Medicine Center. However, any doctor should be able to measure your hormonal levels. If your doctor is resistant, bring him/her information on the topic (see our book “For Women Only” or newshe.com for resources on low testosterone and low desire and response).

If that doesn’t work, keep trying until you find a doctor who is willing to work with you on this! Best of luck and keep us posted.

I haven't seen/heard any mention of the connection between breastfeeding and the different types of dysfunction. I have two young children and am nursing both until they self-wean. I read somewhere that nursing releases chemicals that inhibit the mother's desire and I know that having infants constantly on your breasts changes nipple sensitivity, but I haven't heard the Berman's mention any of this. I'd love to hear what they have to say about this! I'm curious, too, if it's safe for a nursing mother to follow any kind of hormone therapy. We'd like to have another baby, but my lack of sexual motivation is being a REAL problem!

That is such a great question and you are right, there are some connections between breast feeding and sexual response. First of all, because of the hormonal shifts, many women experience problems with vaginal dryness and lack of genital sensation. Furthermore, when you breast feed your body releases a chemical called Oxytocin which is the “feel good” chemical (this serves a evolutionary purpose because it makes you want to keep doing it!). However, there has been some evidence to propose that Oxytocin represses testosterone.

However, even if your levels are low, it is certainly not advised to be on any kind of hormonal replacement while breast feeding or pregnant. As for the non-medical side, if you have two young children and are breast feeding, it is likely you are exhausted, don’t have much time for yourself, and don’t have much energy to put into your relationship. Besides just having sore nipples, your body is not completely your own, much less available to your partner. It is really important to take this into account when evaluating your situation and its causes. Give yourself and your body time to recover. Best of luck and keep us posted.

Schedule an appointment with Dr Berman

  • This field is for validation purposes and should be left unchanged.