Sexual Medicine in south bend, in

Gender Affirming Care

Gender Affirming Hormone Care is the process of using hormones to make a person’s physical attributes more closely align with their gender identity. These interventions support and affirm an individual’s gender identity when it is not the same as the sex they were assigned at birth. For transmasculine patients the goal is to use estrogen and androgen blockers to aide in developing female secondary sex characteristics and suppress male characteristics. Adding progesterone can help aid in the development of breast tissue. Utilizing a biopsychosocial approach to this therapy also helps to work with the changes in emotional and social functioning during the transition process. During masculinization hormone affirming therapy the goal is to develop male secondary sex characteristics and suppress female characteristics. Using testosterone and suppressing the menstrual cycle Candescent Health and Wellness is able to help our clients smoothie transition to a more masculine physique in order to more closely match their gender identity. Similarly to feminizing hormone therapy, a biopsychosocial approach is utilized to promote mental and emotional wellness during the transition process. For our clients who identify as genderqueer, non-binary or gender fluid hormone therapy is utilized on an individualized basis to optimize the gender identity felt by each client.

Pelvic Pain Disorders

Pelvic pain is defined as pain between your hips and your belly button, this pain can have a variety of causes, it can either be a symptom of another disease or its own condition. Pelvic pain caused by another problem often resolves when that other condition is treated. Regardless of cause, treating pelvic pain can improve quality of life. An appointment for pelvic pain related concerns will include asking the patient to describe the pain, when it started, if it is localized to a specific spot or changes location, whether it is constant or comes and goes, how it feels during vaginal penetration, and whether or not it is cramping, dull, throbbing or stabbing pain. If you’re experiencing pain during defecation, urination or standing there may be a number of causes and seeking medical help is recommended.

Decreased Sexual Desire/Hypoactive Sexual Desire Disorder (HSDD)

Decreased sexual desire, could be caused by Hypoactive Sexual Desire Disorder. This occurs when an individual has a decreased sexual desire and it bothers them. HSDD can be an abrupt or gradual decrease in sexual desire. If an individual has a decreased sexual desire (also known as low libido), but it is not bothersome to them, they likely do not have a diagnosis of HSDD. A sex medicine provider is able to offer a full workup for possible causes and interventions related to HSDD.

Desire Discrepancy

When a partnership of any sort experiences a difference in levels of sexual desire (libido) between partners a diagnosis of desire discrepancy may be present. Desire discrepancy can be attributed to different libido levels, interpersonal conflict, lack of time or energy to engage in intimacy. Regardless of cause for desire discrepancy, evaluation by a sex counselor can help identify cause and treatment options. Of note, responsive desire and spontaneous desire two different types of desire, and often identifying the type of desire you are experiencing or lacking is the first step in identifying treatment methods.

Compulsive Sexual Behaviors

Compuslive sexual behaviors may be classified as sexual addiction, hyperactive sexual behavior or hyperactive sexuality. This excessive preoccupation with sexuality, fantasties, sexual behaviors or sexual activity take up a significant amount of an individual’s time and is often beyond the control of the person experiencing compulsive sexual behaviors. After the sexual beahvior, there is usually a release of tension- but also remorse, and these behaviors cannot be controlled. These behaviors likely have significant consequences for the individuals involved and there may be trouble in maintaining relationships as a result. Seeing a sex counselor can assist in identifying cause and treatment for compulsive sexual behaviors.

Female Orgasmic Disorders

If female orgasm is delayed, infrequent, less-intense or absent after adequate sexual stimulation, a patient may be experiencing female orgasmic disorder. Women who experience female orgasmic disorder repeatedly experience less intense orgasms, though it is worth noting that among all women orgasmic intensity and frequency varies from sexual encounter to encounter. There are multiple factors which can lead to anorgasmia, including relationship concerns, cultural upbringing, medical conditions and medications. Candescent Health and Wellness can work with a client and her partner or partners to address these concerns and work to enhance orgasm through medication, sexual enhancement devices, counseling and education regarding sexual stimulation.

Genital Arousal Disorder

Genital Arousal Disorder is a condition which is bothersome to a client, in which they have difficulty becoming or staying aroused (turned on) with genital stimulation. The specific cause of genital arousal disorder may be a medical condition such as depression, anxiety, cardiac disease, cancer or diabetes. This condition may also be caused by a history of trauma, present or past relationship troubles, or stress. Menopause, pregnancy or lactation can also cause genital arousal disorder for some individuals. Treatment includes sexuality counseling and education, resolving or working with the cause of the condition in order to achieve a level of arousal which is satisfying to the client.

Persistent Genital Arousal Disorder (PGAD)

While rare, persistent genital arousal disorder (PGAD) is very concerning to the individual experiencing this, as well as disruptive to their daily life. This condition almost exclusively affects women, and arousal occurs so suddenly- sometimes to the point of orgasm, that women have no control and it is disruptive to their daily life. The anatomic and physiologic arousal can last for hours, or in severe cases days to weeks. When a patient presents with complaints of PGAD a thorough history and physical exam is completed in order to best identify the root cause of the start of symptoms, some patients will require extensive imaging studies such as CT scans and MRIs to determine the cause of this condition.

Gender Inclusive Contraception

Candescent Health and Wellness is committed to understanding that not everyone utilizes contraception to prevent birth. Some individuals are hoping to cope with painful menstrual cycles, some are hoping to elicit a smaller volume of blood loss, others are hoping to cause a cessation of menses entirely. If you are in need of contraceptive care, Candescent Health and Wellness offers comprehensive contraceptive options and is able to provide referrals for permanent sterilization for those who desire.

Dyspareunia/Painful intercourse

Painful intercourse, either at insertion or with thursting is referred to as dyspareunia. While there can be a variety of causes for dyspareunia it is essential for clients to receive a comprehensive evaluation. There are several interventions available for painful penetration, and the mode of treatment will often depend on the cause of the pain. Candescent Health and Wellness is committed to promoting pleasure in sexual exchanges and will work with partnerships of all types in order to achieve this goal.

Genitourinary Syndrome of Menopause

Genitourinary Syndrome of Menopause (GSM) is a very underdiagnosed symptoms of perimenopause and menopause. Unfortunately this is due to a combination of lack of provider expertise, lack of provider history taking, and patients feeling uncomfortable discussing these concerns with their healthcare providers. GSM was formerly called vulvovaginal atrophy, atrophic vaginitis or urogenital atrophy. It is a chronic condition, without a cure, which affects the vagina, vulva and lower urinary tract. GSM affects up to 50% of peri and post menopausal women. A common complaint people encounter with GSM is vaginal dryness coupled with painful intercourse. These symptoms are more intense for people who are sexually active. Additional symptoms include vaginal itching and burning, increased yellow or brown vaginal discharge, pelvic pressure, decreased physiologic vaginal lubrication, bleeding during or after sex, decreased libido, pain with orgasm, painful urination, increased urinary urgency, urinary incontinence, increased risk for or frequency of urinary tract infections. The cause of GSM is reduced estrogen levels associated with menopause which causes the skin at the vaginal and vulvar tissue to thin and weaken. There is also a reduction of smooth muscle and vaginal blood flow. Those at increased risk for GSM include individuals in perimenopause through post menopause, those with a history of surgical menopause (hysterectomy and removal of ovaries), individuals who smoke or drink alcohol, those with a history of or are actively being treated for cancer. Hormone testing and supplementation, vaginal and/or oral estrogen, vaginal moisturizers and wearing cotton underwear during the day and no underwear at night have been shown to improve symptoms of GSM. The painful and uncomfortable symptoms of GSM have been shown to exacerbate a person’s menopausal transiton and those who struggle report higher incidents of depression and anxiety associated with menopause.