Sexual Wellness & Intimacy
Sexual health is an important part of overall wellness. Changes in desire, arousal, sexual response, comfort, and erectile function can occur at different stages of life and may be influenced by hormones, medications, stress, sleep, menopause, aging, circulation, medical conditions, and other factors.
Our approach to sexual wellness begins with a private medical consultation to better understand your concerns, medical history, current medications, and treatment goals.
Depending on your individual needs, treatment may include prescription medications, hormone evaluation or management, compounded therapies when medically appropriate, and other personalized treatment options.
All sexual-wellness medications require an appropriate medical evaluation and prescription.
Women’s Sexual Wellness
Changes in sexual desire, arousal, sensitivity, lubrication, comfort, or satisfaction are common and can occur for many different reasons.
Women may experience changes associated with:
Perimenopause and menopause
Hormonal changes
Certain medications
Stress or poor sleep
Medical conditions
Changes in relationships or lifestyle
Vaginal or genitourinary symptoms
Decreased sexual desire or arousal
Because sexual-health concerns are often multifactorial, treatment should be individualized rather than based on a single symptom.
Our provider can evaluate potential contributing factors and discuss treatment options that may include hormone management, prescription medications, or selected compounded therapies when medically appropriate.
Bremelanotide / PT-141
Bremelanotide, sometimes referred to as PT-141, works through pathways in the central nervous system involved in sexual desire rather than functioning primarily by increasing genital blood flow.
The FDA-approved bremelanotide product, Vyleesi®, is approved for certain premenopausal women with acquired, generalized hypoactive sexual desire disorder (HSDD) when low sexual desire causes significant distress and is not primarily due to another medical or psychiatric condition, medication, or relationship problem. It is not FDA-approved for postmenopausal women, men, or general enhancement of sexual performance.
Bremelanotide may not be appropriate for everyone. Medical screening is particularly important for patients with cardiovascular disease or uncontrolled high blood pressure.
Potential side effects can include nausea, flushing, headache, and injection-site reactions.
Compounded PT-141
Some patients may receive PT-141 through a compounding pharmacy when determined medically appropriate by their provider.
Oxytocin
Oxytocin is a naturally occurring hormone involved in several normal physiological processes, including reproductive function and social behavior.
In sexual-wellness medicine, some clinicians may consider compounded oxytocin as part of an individualized treatment plan for selected patients.
Use of oxytocin specifically for sexual desire, arousal, or orgasm is considered off-label, and response varies between patients.
Oxytocin is not a guaranteed treatment for decreased libido or sexual dysfunction and should only be considered after appropriate medical evaluation.
Apomorphine
Apomorphine is a medication that acts on dopamine receptors within the central nervous system.
Certain sexual-health practices may prescribe compounded apomorphine off-label for carefully selected patients with sexual-response or arousal concerns. FDA-approved apomorphine products are approved for certain symptoms of Parkinson’s disease—not for female sexual dysfunction.
Because apomorphine can cause nausea, dizziness, low blood pressure, fainting, and other side effects, appropriate medical screening is important.
Important Medication Interaction
Apomorphine must not be used together with ondansetron (Zofran®) or certain other 5-HT3 anti-nausea medications.
The combination is contraindicated because profound low blood pressure and loss of consciousness have been reported.
Patients should always provide a complete medication list before starting treatment.
Hormones & Sexual Wellness
Hormonal changes can sometimes contribute to changes in sexual desire, vaginal comfort, energy, mood, and overall sexual wellbeing.
When appropriate, evaluation may include discussion of:
Estrogen
Progesterone
Testosterone
Menopausal or perimenopausal symptoms
Vaginal and genitourinary symptoms
Other potential medical or medication-related causes
Hormone replacement therapy is not required for every patient experiencing sexual-health concerns. When clinically indicated, it may be incorporated into a broader individualized treatment plan.
Men’s Sexual Wellness
Erectile dysfunction and changes in sexual performance can occur for many reasons and should not automatically be considered a normal part of aging.
Potential contributing factors can include:
Cardiovascular disease
High blood pressure
Diabetes
Hormonal changes
Low testosterone
Certain medications
Stress or anxiety
Sleep disorders
Neurologic conditions
Smoking or alcohol use
Changes in circulation
Our approach begins with a medical evaluation to help identify potential contributing factors and determine which treatment options may be appropriate.
Erectile Dysfunction Treatment
Prescription medications can be highly useful for appropriate patients experiencing erectile dysfunction.
Treatment options may include medications such as sildenafil and tadalafil, depending on the patient's medical history, current medications, treatment goals, and desired duration of effect.
Sildenafil
Sildenafil, commonly known by the brand name Viagra®, is an FDA-approved medication used to treat erectile dysfunction.
It belongs to a class of medications known as PDE5 inhibitors, which support the normal blood-flow response required to achieve and maintain an erection when sexual stimulation occurs.
Sildenafil does not automatically produce an erection and is not considered an aphrodisiac.
Your provider will determine whether sildenafil is appropriate based on your health history and medications.
Tadalafil
Tadalafil, commonly known by the brand name Cialis®, is another FDA-approved PDE5 inhibitor used to treat erectile dysfunction.
Depending on the individual patient, tadalafil may be prescribed for use as needed or as a once-daily medication.
Tadalafil has a longer duration of action than sildenafil, which may make it preferable for certain patients depending on lifestyle and treatment goals.
Important ED Medication Safety
Sildenafil, tadalafil, and other PDE5 inhibitors are not appropriate for everyone.
These medications must not be combined with nitrate medications, because the combination can cause a potentially dangerous decrease in blood pressure.
Patients should provide a complete medication list and discuss cardiovascular history, blood pressure, previous cardiac events, and other medical conditions before beginning treatment.
A Personalized Approach to Sexual Health
Sexual wellness is rarely about a single hormone or medication.
Our goal is to understand the factors contributing to your concerns and develop an individualized treatment plan based on your health, symptoms, and personal goals.
Depending on your evaluation, treatment options may include:
Bremelanotide / PT-141
Compounded oxytocin when medically appropriate
Compounded or off-label apomorphine when medically appropriate
Sildenafil
Tadalafil
Hormone evaluation
Hormone replacement therapy when indicated
Review of medications or medical conditions that may be affecting sexual health
Not every treatment is appropriate for every patient.
Private, Personalized Care
Sexual-health concerns are common, but they can be difficult to discuss.
Our goal is to provide a private, professional environment where women and men can openly discuss changes in sexual health and learn about available medical treatment options.
Schedule a confidential consultation to discuss your concerns and determine which treatment options may be appropriate for you.
Important Medical Disclosure
Sexual-wellness treatment requires individualized medical evaluation and, when applicable, a prescription.
Some medications used in sexual-wellness medicine may be prescribed off-label, meaning they are being prescribed for a use that is different from their FDA-approved indication. Some medications may also be prepared by a compounding pharmacy.
Compounded medications are not FDA-approved and are not reviewed by FDA before marketing for safety, effectiveness, or quality.
No medication or treatment can guarantee improvement in sexual desire, arousal, orgasm, erectile function, or sexual performance. Results vary between individuals.
Treatment recommendations will depend on medical history, medications, cardiovascular health, blood pressure, pregnancy status when applicable, potential medication interactions, and other individual risk factors.
The information provided on this website is for general educational purposes and is not a substitute for individualized medical advice, diagnosis, or treatment.