Dr Marie Tudor has attended many sexuality, sex therapy, family therapy and hypnosis trainings over the last 25 years. She teaches the topic ‘Sexuality and Disease’ to medical students at the University of Adelaide. In early 2016 Dr Tudor passed a post graduate Sexual Medicine exam in Madrid for urologists, gynaecologists and general medical practitioners from all around the world specialising in sexual medicine. Dr Tudor is now a Fellow of the European Committee of Sexual Medicine.
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Testosterone is a hormone found in both men and women, although men have much higher levels of testosterone than women. Testosterone plays an important role in the feeling of sexual interest and desire – i.e. libido in both men and women.
During puberty in a male, testosterone influences the development of the mature male sex characteristics including: the growth of the genitals (penis and testicles), deepening of the voice due to growth of the larynx and vocal cords, growth of facial, body and pubic hair, development of male pattern hair line (including varying degrees of baldness), the growth of muscles and broadening of the shoulders, an increase in aggressive characteristics, an increase in sexual interest and an increase/thickness of secretions in the skin glands (the reason for acne being more common in men).
Some of the following facts may surprise you:
More sexual activity (by oneself or with a partner) can result in a slight increase in a man’s testosterone levels.
Testosterone levels in healthy men remain at about the same level with increasing age.
Another way to say this:
‘Ageing has only a minuscule effect on testosterone levels in men’.
A recent study (1) calculated the average decline in serum testosterone is 0.5% per year – lower than has been previously claimed (0.8-2% per year).
A marked reduction in healthy mens’ testosterone levels occurs only after the age of 80 years.
A reduction of testosterone levels in men is associated with co-morbidities (co-existing health problems) such as:
- Cardiovascular disease
- Heavy alcohol intake
- Severe disruption to sleep patterns
- Some drugs – e.g.1) opioids and 2) certain statins (cholesterol lowering drugs) particularly atorvastatin
- Loss of a spouse/social defeat/recent fatherhood
- Stopping smoking – please don’t think this is a good reason to keep smoking. Apart from causing damage to many parts of the body and increasing the risks of many cancers, smoking also has long term and DIRECT negative effects on erections.
Further research is required to understand the role that ‘co-morbidities’ play in the levels of testosterone in men as they age.
If you need any help to improve your sex life, particularly if you are concerned about your libido (levels of sexual interest) then do feel free to consult with me, Dr Marie Tudor. I can assess your situation from a medical, psychological and relationship perspective and then offer strategies and solutions suited to your needs.
Please be aware that there are rules regarding the prescription of testosterone for men who have low testosterone levels. In Australia, endocrinologists and sexual health physicians are able to prescribe PBS subsidised testosterone to men. The rules regarding this PBS prescribing are specific and need to be adhered to. I am a doctor with a fellowship in sexual medicine but this qualification does not come under the PBS umbrella of doctors who have permission to prescribe testosterone to men.
If you are specifically concerned about your testosterone level, the first line of call is your general medical practitioner (GP). If your testosterone level is low (shown on two occasions), then the decision to prescribe PBS subsidised testosterone needs to be made via a referral to an endocrinologist or ‘sexual health physician.
Age-specific population centiles for androgen status in men
D J Handelsman, B B Yeap1,2, L Flicker1,3, S Martin4, G A Wittert4 and Lam P Ly
European Journal of Endocrinology (2015) 173, 809-817.
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The desire for sex (libido) is complex and influenced by psychological, biological, relationship and cultural factors.
To have the motivation to be sexual, a person needs:
- Drive – the biological component of sex drive (libido) dependent on well functioning ‘neuroendocrine’ (the connection of hormonal and nerve pathways) and anatomical systems.
- Motivation – the psychological component of sex drive – including mood (affected by stress and psychological issues), the state of the interpersonal relationship with the partner and the general social context.
- Wish – the cultural component – The cultural beliefs, values, rules and ideals about sexual expression that influence the individual.
(Levine, S.B., 2003)
The DRIVE and MOTIVATION components of sexual desire can be adversely affected by:
- Any significant psychological issue (e.g. depression)
- Conditions affecting the hormonal pathways that support libido (e.g. conditions that lead to low testosterone levels, an under active thyroid or high levels of prolactin)
- Many chronic illnesses
- Many medications and recreational drugs
- Lifestyle factors and the common stresses of everyday life, such as large workloads, long working hours, family needs/pressures, technology intrusions (mobile phones, computers, social media, TV) can all influence sexual desire.
The relationship of a couple will inevitably evolve over time.
Interests, beliefs and expectations regarding intimacy and sex can change for each in the relationship. As time goes by there is a challenge for a couple to keep the interest in sex alive. Some couples slip into a ‘rut’ of sexual styles or behaviours that can soon become predictable and boring. Even finding time together can be an issue when life becomes busy, when childrens’ needs take priority or when couples forget to invest time in their relationship in favour of individual or family pursuits.
Is a lack or mismatch of sexual desire affecting your relationship?
Sex therapy can be a way to address some of these issues. Please feel welcome to meet with me so that I can assess your particular case and work with you and your partner to find solutions to support you both and the needs of your relationship.
For more on desire concerns see here.
Levine, SB The Nature of Sexual Desire: A clinician’s perspective’
Archives of Sexual Behaviour – 2003; 32: 279-85.
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Most men experience short lived or unexpected problems attaining or maintaining an erection at various times in their adult years. It is important NOT to panic or fear the worst with any erection problem.
As a sexologist, I have met many men in my consulting rooms who have been extremely worried, believing that their erectile functioning is ‘at the beginning of the end’. My recommendation is that a man seek help very promptly for any erection concerns so that negative or pessimistic thoughts do not take hold in his mind.
It is known that there are various risk factors for developing ‘erectile dysfunction’ – that is, problems with erections. Even when a man has several risk factors, he is advised to have his particular problem and medical status assessed by an experienced doctor who has a positive and optimistic approach.
The presence of risk factors in themselves do not necessarily condemn a man to ongoing or permanent erection problems. Therefore, following a medical assessment, the aim is to work toward achieving the best possible improvement of erections for the enjoyment of the man’s sexual experiences with his partner. Men who have no current partner and who need sexual confidence can benefit from seeking help for their erectile problems .
This is a wonderful example: Over 20 years ago, a 58 year old insulin-dependent diabetic man consulted me about ‘failing’ erections. This form of diabetes is known to be a very significant risk factor for problems with erections in the long term. Several doctors told him that what he was experiencing (very poor erections and an inability to have intercourse) was a permanent effect of his diabetes and that this was ‘as good as it could get’. This was well before Viagra came on the market. I worked with this man and his partner, suggesting sexual/behavioural techniques for them to practice together. The couple were delighted to experience a significant improvement of erections sufficient for intercourse and more enjoyable sexual experiences. Through various exercises over some weeks, the man was able to relax and focus enough in ways that supported the best erectile functioning his body was capable of.
The main medical risk factors for erectile dysfunction/problems are those that affect the cardiovascular system: diabetes, high blood pressure, coronary artery disease and high cholesterol. A number of other medical conditions and medications can affect erectile functioning – this is a topic in itself!
Significant lifestyle risk factors include smoking, obesity, high alcohol intake, a sedentary lifestyle, stress and certain recreational drugs.
Men who have the ‘metabolic syndrome’: (increased blood pressure, high blood sugar levels, an excess of body fat around the waist and high cholesterol levels) have a greater risk of a number of medical conditions, particularly heart disease. Metabolic syndrome increases a man’s risk for developing erectile dysfunction.
Viewed another way, men who have erection problems need to be assessed by a doctor for their general cardiovascular (heart and blood vessel) health. As erection difficulties may suggest damage to the arteries (blood vessels) supplying the areas that support erections, other areas in the body (including blood vessels supplying the heart) may also be damaged.
There are many statistics about the percentages of men who experience ‘erectile dysfunction’ at various ages. In general, the older a man is, the more risk he has for developing erection problems. However, for the individual man, statistics may not be helpful – and may even cause him to be disheartened and to give up hope.
I strongly encourage any man who is experiencing problems with erections to seek a medical opinion in order to look after his health and to take positive action.
Please feel free to book in with me, Dr Marie Tudor at ‘Adelaide Sex Therapy’ if you would like me to assess your particular symptoms. I am always keen to liaise with GP’s to ensure the best possible health outcomes for people.
Click here to learn more about erectile dysfunction and how I, as a sexologist can help.
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The latest news about a new drug recently approved in the USA to help women and their sexual desire.
Since the availability of Viagra for men more than 10 years ago, many women have been hoping for a treatment for their sexual needs. On August 18th 2015 the FDA (the U.S. Food and Drug Administration) approved ‘Addyi’ (flibanserin) to treat ‘acquired, generalised hypoactive sexual desire disorder’ (HSDD) in premenopausal women.
The quest for the approval of flibanserin took about five years, 2 rejected FDA applications, a change of drug company ownership and the inception of an online action group called ‘Even the Score’ (‘Women’s Sexual Health Equity’). The process became heavily politicised, with ‘Even the Score’ declaring that, from a feminist perspective, it is unfair that men have several dozen medications to help their sexual problems and women have none.
Dr Leonore Tiefer, associate professor of psychiatry at New York University has been a vocal critic of the medicalisation of women’s sexual concerns for years. I remember her speaking about this very topic at the World Association of Sexology Congress in Montreal in 2005. Dr Tiefer asserts that ‘womens’ sexual issues shouldn’t be treated with a daily dose of medication that changes the chemistry of the brain, but should be prevented through sexual education and relationships that are equal’. I believe that Dr Tiefer’s view is important. Drugs need to be approved on the basis of safety and need and not due to the pressure of public relations activities driven by the very drug companies who are seeking to profit from drug sales.
Flibanserin was developed as an antidepressant but never used for this purpose. It’s action is within the brain upon the neurotransmitters and needs to be taken daily. It can take up to several months before an improvement of sexual desire is noticed – and the improvement has been described as ‘less than one extra satisfying sexual experience per month’. Flibanserin is therefore NOT a ‘Pink Viagra’. Viagra is a drug that is taken only when a man wants to improve the quality of his erection. A man needs to have a significant desire for sex for Viagra to be able to boost his ‘hydraulics’!
Why was there such a long drawn out process to have this drug approved?
Flibanserin has significant side effects: dizziness, sleepiness, nausea and fatigue. More concerning is the potential for a woman to faint and lose consciousness due to a sudden drop in blood pressure. This can happen when flibanserin is taken with alcohol or with medications that use the same processing pathways in the liver. There is also no data available about possible long term side effects. The FDA has instructed Sprout Pharmaceuticals Inc. to conduct more comprehensive tests on flibanserin (Addyi) as a condition of it’s approval for use in the USA.
Women who have a concern about loss of libido, no desire for sex or a lower sexual desire than their partner need not despair that this medication is not available in Australia. Even if it were available, having done my research, I would be prescribing it in a very limited way. Sexual desire (or ‘libido’) is dependent on many factors. The person needs to address any significant medical conditions, mental health issues and relationship concerns.
At least a quarter of the people who consult me have sexual desire issues. I am well placed with my knowledge and experience to help you and your partner find solutions to these and any other sexual or relationship concerns. Please feel welcome to phone for an appointment with me. It is my pleasure to help couples experience joy and fulfilment in their intimate relationships.
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How often are we reminded about the ‘dangers’ of sex? It can start at school when messages about sexually transmitted infections (STI’s) and unplanned pregnancies are emphasised rather than the pleasures that can be experienced during sex. People are often fearful of returning to their usual sex lives after heart attacks or strokes. Many people with very serious or life threatening illnesses have told me their questions about sexual problems were swept aside as their medical needs were seen as more pressing by their specialists.
At the 22nd Congress of the World Association for Sexual Health in Singapore (July 2015) a whole symposium was dedicated to: ‘The Health Benefits of Sexual Expression’.
Dr Woet L. Gianotten of De Trappenberg, Centre for Physical Rehabilitation, Huizen, the Netherlands spoke of our need as health professionals to view the health benefits of sexuality rather than just dealing with the associated diseases and problems.
Dr Gianotten and his team analysed all available journal articles that examined the potential long-term benefits of sexual expression.
These are some of the aspects of sexuality or sexual experience that were found to be beneficial for physical health:
- increased longevity for men who have more frequent intercourse and for women with a greater past enjoyment of sexual intercourse.
- a decrease in cardiovascular ‘events’; an Israeli study found that women with ‘poor sex lives’ were more prone to have heart attacks
- a (5%) decrease in prostate cancer for men who had a history of more frequent ejaculations
- a decrease in vaginal atrophy (‘thinning and drying) for post menopausal women who continue to have intercourse
- a slowing down of cognitive decline
- contact with semen was found to be ‘mood enhancing’
- a study in Japan found that intimate kissing reduced the incidence of allergic skin conditions
- he release of the neurotransmitter ‘Oxytocin’ (during massage, touch, breast stimulation and sex) can increase one’s pain threshold, reduce anxiety levels as well as giving a feeling of closeness and trust with one’s partner.
- the endorphins (opiate related ‘happy hormones’ released during genital stimulation can also increase pain thresholds, hence reducing the experience of pain
- Orgasm has been found to relieve 50% of migraines (I’m already in pain, why not have sex – it may help!!)
- More frequent sex may help menstrual cycles for a particular woman
- more sex in pregnancy can result in a reduced incidence of premature AND delayed deliveries AND a better quality of the post partum relationship of the couple
Dr Gianotten’s conclusion was that ‘sexuality is more healthy than dangerous’!
We need to view sex and sexuality with these positive messages in mind. If you are concerned about your health and your sexual experience and are unsure about the best way to seek help, please feel free to contact me via Email, leave a message for me to return a call to you or by booking in for an appointment.
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Dr Marie Tudor has attended many sexuality, sex therapy, family therapy and hypnosis trainings over the last 25 years. She …