A substantial, new dimension has been added to the urologic care available in the Shreveport-Bossier area over the past few years. Regional Urology now has three women urologists. While each of them engages in the full spectrum of urologic surgery, including care of kidney stones, cancer and male health, they have a unique insight into female urologic issues.

For this month’s Forum, we would like to tap their knowledge.

FORUM: Dr. Baker, there was a great deal of interest in “female Viagra,” but we have not heard much about that anymore. What is going on there?

Dr. Ashley Baker:

Flibanserin, commonly known as Addyi and colloquially known as “Viagra for women,” was approved by the FDA for hypoactive sexual desire disorder in women. While there are several medications that improve sexual function in men, flibanserin is the first drug approved by the FDA for women for similar indications. It is thought to work by increasing chemicals in the brain that regulate a woman’s desire to be sexually intimate, which is a very different mechanism than that of medications for men. It is FDA approved for pre-menopausal women, as that is the population studied. Potential side effects include nausea, low blood pressure and fainting. Additionally, women who take the drug are forbidden from consuming alcohol (black box warning) or taking birth control pills. Women’s sexuality is very complex, and it is often affected by a combination of brain chemistries, hormonal status, relationship issues, medications and their side effects, and overall physical and mental health. Because of the restrictions of this drug, as well as the side effects, we have not seen the overall popularity of the medication that manufacturers imagined. The good news is that they have paved the way for research and development of new and more tolerable medications to help women with disorders of sexual function or desire.

FORUM: Dr. Chiles, update us on female hormone therapy.

Dr. Leah Chiles: Post-menopausal changes occur when a woman’s estrogen levels decrease with normal aging, surgical removal of the ovaries, or ovarian failure secondary to treatments for certain cancers. This change in estrogen can result in a variety of different symptoms including mood and sleep changes, decreased metabolism, osteoporosis, vaginal dryness, discomfort with intercourse, urinary frequency, urgency, burning with urination or leakage of urine. All of these symptoms can be managed with systemic hormone replacement therapy; however, systemic replacement has the highest risk of adverse events. The risks versus benefits of systemic therapy should be discussed with your provider prior to initiation or continuation of such therapy.

Vaginal atrophy (thinning of the vaginal tissue) can very much affect a woman’s quality of life. Thankfully, the associated symptoms can be treated with vaginal estrogen creams that have limited systemic absorption, thereby greatly reducing the risk of cardiovascular disease and thrombotic events. Typically, the vaginal cream is applied two to three nights per week and over time will restore the vaginal epithelium. While these creams are efficacious in treating vaginal atrophy, they can be costly and require continued treatment to see the desired effects. Vaginal estrogen replacement is also relatively contraindicated in women with gynecologic cancers.

Fortunately, new technology is available to help some women without resorting to hormones.

FORUM: Dr. Spann tell us about nonhormonal treatments to improve sexual function or help vaginal health.

Dr. Alison Spann: As many as 50 percent of post menopausal women suffer from changes in their vaginal health that can really affect their quality of life. Studies show that only 25 percent of women seek help from their doctor. I’m sure there are many reasons for that, but what I would want women to know is that there are things that can be done about it! Previously, hormones have been the mainstay of treatment. Now, there’s a new option. MonaLisa Touch is a vaginal laser treatment which delivers gentle laser energy to the vaginal wall tissue, stimulating a healing response and restoring vaginal health by generating new collagen, elastin and vascularization. This can significantly reduce vaginal dryness. In turn, it eases painful intercourse, vaginal itching and painful urination. Many people even experience relief from recurrent urinary tract infections, urinary frequency and urgency. This is a hormone- and surgery-free inoffice procedure that requires no anesthesia and, essentially, no down time. Studies have shown overwhelmingly positive and immediate results which last up to one year. Single maintenance treatments can be given annually as needed. This procedure is well suited for patients who cannot, or prefer not to, receive estrogen therapy (including breast cancer patients). I’m proud Regional Urology is offering this novel therapy for a problem that is all too common.

FORUM: Thank you, doctors.

Drs. Baker, Chiles and Spann are accepting new patients at Regional Urology. All three offer the MonaLisa Touch Laser treatment along with more traditional therapies. They provide care for both women and men.