Full Transcript Show Introduction and Guest Welcome 0:00 Welcome to The Coalition. 0:02 This is a talk show dedicated to discussing health, wellness, and inspiration. 0:07 I'm your host, Dr. 0:08 Shani Belgrade. 0:09 Hello, everybody. 0:12 Thank you for joining The Coalition. 0:14 I'm your host, Dr. 0:15 Shani Belgrade. 0:16 I am a bariatric emergency basic surgeon. 0:20 You can get connected with me and learn about what I do at I'm excited to welcome to the show today Dr. 0:29 Peehan Gandhi. 0:31 Dr. 0:31 Peehan Gandhi is an accomplished neurobiologist and founder of religion, women's wellness, and cosmetic pathology based in Alpharetta, 0:40 Georgia. 0:40 She joins the show today to let us know what we should know about women's sexual health. 0:46 The topic of today's show is myths surrounding armogeo. 0:50 Dr. 0:51 P. 0:51 Hingandi, thank you so much for joining the show. 0:55 Thank you so much for inviting me. 0:57 I'm so excited. 0:58 You have such a great show. 0:59 Thank you. 1:00 I appreciate it. 1:01 So, Dr. 1:02 P. 1:02 Hingandi, as you know, the show is all about health, wellness, and inspiration. 1:07 And so I'm grateful that you are here to share your perspective as a urology oncologist on sexual health. 1:13 So please get started by telling us a little bit about who you are and what you do. 1:19 Yes, I'm a gynecologist board certified, and I have a special interest in helping women through the menopause transition, 1:28 but I also see women for general gynecology because your gynecology is. 1:35 quite expansive. 1:36 It affects women of younger age, of midlife age. 1:41 So I am very passionate about just helping them understand their pelvic health as it relates to hormone changes and physical changes and emotional changes
Dr. Gandhi's Practice and Women's Health Focus 1:52 because we hold a lot of energy in our pelvis. 1:55 I feel that way. 1:56 I really appreciate you having this topic on your show. 1:59 I think it's really important to be able to freely talk about it. 2:03 Absolutely. 2:04 That's what the show is all about, fostering collaboration and dialogue surrounding health, wellness, and inspiration. 2:10 So Dr. 2:11 P and Dondi, before we get into it, can you please tell us a little bit about your practice? 2:16 Yes. 2:16 My practice is located in Alpharetta, Georgia. 2:19 We're full scope general gynecology, urogynecology practice, focused on treating not only pelvic health issues, but hormonal issues and metabolic disease. 2:31 So I have patients that come in because I'm also board certified in obesity medicine. 2:36 So I have patients that come in with metabolic conditions like polycystic ovarian syndrome. 2:41 And as it relates to sexual health, a lot of patients that have fertility issues, they come to me. 2:48 And we have to kind of tackle that, especially patients that, younger patients that may be going through IVF. 2:54 And then I also see a lot of sexual pain disorder patients, patients that may have had issues with endometriosis as I still do general gynecology. 3:06 And then I see the menopause transition patients who are having, you know, unwanted changes in their body. 3:14 And I assist them through that phase of their life too. 3:18 All right. 3:18 Well, I am looking forward to getting into these myths. 3:21 So you're going to kind of explain what's true and false surrounding some of these ideas. 3:26 The myth number one is low libido. 3:29 If someone has low libido, that just must mean that there's something wrong with their relationship, true or false. 3:36 Yeah, definitely false. 3:38 This is such a good one because I think people don't realize how prevalent libido issues, low sexual desire is. 3:46 40% of women through their lifetime will have issues surrounding low sexual desire, low sexual arousal, and that spans from the younger years, 3:59 the childbearing years, and the menopause transition because of changes that occur in our body, we have biological changes, 4:08 we have psychological changes, and then social changes that occur too. 4:12 And all of those things come into play when we talk about libido issues. 4:18 So no, it doesn't mean that there's necessarily something wrong with your relationship, But I think the problem is people don't communicate in their relationships 4:30 about this issue. 4:31 And so that is why at the base level, this is false. 4:36 But when I counsel my patients, communication is the most important thing because it really breaks my heart when everything is great. 4:45 You know, they have a loving relationship, but then they're not able to talk about this. 4:50 Communication. 4:52 Myth number two, if you do not have spontaneous desire, you are broken.
Myth 1: Low Libido and Relationship Problems 4:59 So is that a myth that you have heard? 5:02 Oh, yes. 5:03 I have a lot of patients that come in that say exactly this. 5:08 Dr. 5:08 Gandhi, I really don't feel like having sex anymore. 5:11 And then I'll follow up and I'll say, are you able to be aroused by erotic media or self stimulation or even when your partner is, 5:22 you know, during foreplay? 5:24 Oh, yeah. 5:24 Oh, yeah, that's fine. 5:25 But I never really initiated. 5:28 So because women feel like they don't initiate intercourse or intimacy, they feel almost as if that is reactive or responsive arousal is not normal. 5:44 And it totally is. 5:46 I feel like patients need to know that. 5:48 That is something next to communication. 5:52 realizing that responsive arousal is normal. 5:57 It doesn't always have to be spontaneous. 5:59 And you shouldn't seek treatment so that you only have spontaneous arousal and desire. 6:06 I think a lot of women feel pressured to have spontaneous arousal and desire. 6:10 So they come to me for medications or procedures, and I have to remind them and tease that out from responsive arousal or desire and helping them with 6:21 that portion and normalizing that for them versus there being an issue that requires treatment. 6:31 Okay. 6:34 Myth number three. 6:36 This one I found to be interesting. 6:38 If you don't have sex regularly, you will lose your libido forever. 6:45 Da, da, da. 6:47 True or false? 6:47 Obviously false. 6:48 Obviously false. 6:49 This is such a good one because people say this all the time. 6:54 If you don't use it, you will lose it. 6:56 That is just not true because there's a sexual peak in our later years. 7:02 And I know people don't believe that, but studies have shown that artesostrone waxes and wanes. 7:07 And it can decrease starting at the age of 25, 30. But then there's a surge. 7:14 in women in their 60s and 70s. 7:16 And I think that there's a protective effect of testosterone on our bones, our muscular health. 7:22 But interestingly, it also secondarily affects our libido and our sexual health.
Myth 2: Spontaneous Desire vs Responsive Arousal 7:27 So it's not true. 7:28 However, I will say most women don't realize that a lot of our libido issues also come from our general health. 7:37 If generally we're not healthy, we're not treating maybe depression, we're not treating our hypertension, we have uncontrolled diabetes, 7:46 all of those things affect blood flow to the area. 7:49 And by self-stimulation or having sex frequently does improve lubrication and blood flow to the area. 7:58 And that helps keep tissue revitalized. 8:02 But there are other ways that you can improve your general health. 8:06 So I think it's really, really important to make sure you're generally healthy. 8:10 You're putting good nutrients in your body. 8:13 and you're trying to be at a normal weight, you're making sure that you're not indulging in processed foods. 8:20 All of those things affect our general health, it increases inflammation and decreases blood flow to our general organs. 8:30 Yes, so that's a topic that's come up many times on the show is really reducing the limiting processed foods. 8:38 I think it would have a negative impact on our health or sexual health. 8:42 It's our general health. 8:45 But when you talk about libido, this is something I kind of wanted to hone in on a little bit, is how do women know if something's normal or at all? 8:58 Like, what defines it being a problem? 9:00 Is it a problem when a patient comes to you and says that it's a problem? 9:04 And if so, what is the work? 9:07 I think that there's different types of female sexual desire disorder. 9:12 So firstly, it is very important to take a history because low libido or low sexual desire is a problem when the woman says it's a problem. 9:25 If for her, Having a normal interval of intimacy is once or twice a month, that's normal for her. 9:35 I think a lot of times women feel pressurized because of the commercialization of sexuality in media and I think they feel a lot of pressure. 9:47 And that is one thing that anytime a woman comes in, I take a sexual health questionnaire because I think it's important part of their pelvic health. 9:56 A lot of times when patients come to me for urinary incontinence or vaginal laxity or pelvic prolapse, they will concurrently have issues about sexual health. 10:07 And so the workup includes an extensive history and making sure that we do a physical exam because of those three factors,
Myth 3: Sex Frequency and Losing Libido 10:18 the biological, the psychological, and the social factors. 10:22 And if I have somebody that really has an unexplained change in their libido, and I suspect that there could be relationship issues or social factors, 10:33 it's really important for them to have a sex therapist I refer everybody to a sect or the American Association of sexuality educate educators counselors 10:46 and therapists. 10:47 There's actually a website that patients can go to and I will give that to them where they can find a therapist near them. 10:53 And it's so, so important to have that in your repertoire because we can treat patients with their hormonal issues, their anatomic issues, 11:01 and their psychological factors. 11:02 But if you don't have a sex therapist in your toolbox to help you navigate through this whole transition, or even I have patients that have had history 11:13 of sexual trauma, and it's very, very important to have a therapist. 11:18 So, as part of the workup, yes, we take an extensive history and the physical exam is important, but it's also important to have another team member that 11:30 can go in a little bit from a different angle, talking about the social factors that may be affecting the patient's libido. 11:40 So what are some of the treatments? 11:43 I know you mentioned the therapist. 11:46 You also give hormones, but what are some of the things that you offer to women that are dealing with this issue? 11:53 Well, there are two FDA approved medications right now for premenopausal women. 12:00 It's been tested in postmenopausal women, but it's not FDA approved for postmenopausal women. 12:04 We don't have an FDA approved medication for postmenopausal women. 12:08 But there are both. 12:09 So one is phlebancerin. 12:12 So that is ADDI, the pink pill. 12:15 And that is taken every day. 12:17 It's an oral medication. 12:19 And both ADDI and the second one that I'm going to mention, which is brimelanotide. 12:27 And that works on melanocortin receptors in the brain. 12:30 They both work on neurotransmitters that are excitatory. 12:34 So things that are like oxytocin and dopamine. 12:39 And, you know, unlike the ADDI, the Bremelanotide or Vilece is an injection that you give about 45 minutes before intercourse. 12:50 Its effects last for about 24 hours, but it helps increase the nitrous oxide infiltration to the general area and also works on neurotransmitters in the 13:04 brain that help kind of put you in the mood, if you will, again, a responsive arousal mechanism. 13:12 And the addy, one of the side effects of it are sometimes blood pressure issues. 13:18 So you do wanna take it at night. 13:21 The injection, the main side effect is nausea. 13:25 So when I have a patient who's premenopausal and they may be on birth control pills or maybe they are on medications like SSRIs, 13:35 that can affect libido because serotonin and GABA, they are like anti libido helpers. 13:43 So we want to increase dopamine. 13:45 We want to increase oxytocin. 13:47 And so those medications are targeted for that. 13:50 But for postmenopausal women, a lot of time we're limited to hormonal treatment with testosterone, which does help sexual vitality desire issues. 14:03 But if we have somebody that has an arousal issue, then what we're trying to do is improve blood flow, improve class three and four collagen in the area. 14:13 And we can do that with some regenerative therapies that are not FDA approved, but we use it off label.
How Low Libido Is Evaluated and When It Becomes a Problem 14:21 And that is PRP. 14:25 So platelet rich plasma platelet rich plasma is blood that's collected from the patient and we spin it in a very high spin centrifuge and we concentrate 14:39 the platelets. 14:40 And the platelets are a very rich healing component because they are like the first people to go to a wound and they help with the healing process. 14:52 So when you concentrate the platelets about four to five times the normal amount in your serum and you place it strategically in areas that you can improve 15:02 blood flow, and neovascularization, it helps with arousal and sensation because it takes women on average 20 to 25 minutes to get aroused and very rarely 15:17 is that time spent. 15:19 in the bedroom to make sure the woman comfortably feels aroused. 15:24 So a lot of times women are left with feeling slightly uncomfortable. 15:28 Maybe they don't have the vaginal moisture. 15:30 Maybe their cervix and their uterus hasn't lifted away and their vagina hasn't elongated because they haven't spent enough time In the arousal phase due 15:40 to menopause or hysterectomy, or even birth trauma from last rations during their obstetric delivery. 15:50 So we're using things like PRP that we use in other areas. 15:56 They use an orthopedics, they use it in neurology and dermatology to help with regenerative science and tissue, you know, 16:05 to help tissue regenerate. 16:06 We do the same thing in the genital area. 16:09 You can also do that with radio frequency energy and ablative techniques using CO2 lasers. 16:16 Now, I feel like a lot of these things have to be Managed by someone who very much understands if there's an anatomic problem versus a hormonal problem 16:31 versus a psychological problem. 16:32 So there's not a 1 size fits all. 16:35 I think it's just so important to me when I have a patient. 16:38 That I kind of talk to the whole person because when you get into the story a little bit deeper if you have a 55 year old woman who says that my husband's 16:48 complaining I never feel like I'm in the mood, but I'd really rather just you know drink my wine watch my favorite show and. 16:55 You know, call it a night. 16:56 I'm happy with that, but my husband's not happy and it's affecting our marriage. 17:00 So then that's the conversation that starts. 17:04 You know, okay, if this is bothering you, what do we do next? 17:09 And it's not a everything. 17:12 We throw the kitchen sink at it. 17:14 It's layered. 17:15 You know, it's a stepwise treatment plan that I most of the time do with my patients because a lot of these, unfortunately, 17:25 a lot of these treatments are not FDA approved.
Treatment Options for Female Sexual Dysfunction 17:27 There's not very many studies in women on sexual health. 17:31 And the menopause, I'll say revival, you know, right now has really highlighted the lack of studies in women, particularly women of color. 17:44 I don't know how many women I see, women of color, that go through menopause the worst. 17:52 They have the most severe symptoms and they are the least likely to seek care. 17:57 Asian women, interestingly, have fewer symptoms and they almost never seek care, but they deal more with sexual health issues. 18:08 than Caucasian and African-American women. 18:10 So there's cultural issues that come into it too, which I find very fascinating. 18:15 And as an Indian woman, there's a lot about sexuality culturally in my own, I would say population, but a lot of the patients that I see, 18:26 they come in for sexual pain issues and really it's a hormonal concern. 18:31 And so I'm very passionate about it because nobody really talks about it. 18:36 And when you go to your doctor and you might be, seeing them for 10 minutes at an annual visit, you can't really get into it. 18:43 When a patient comes in with low libido, they've seen a lot of doctors. 18:47 Most of them have told them just to shut it down. 18:49 It's no big deal. 18:50 Everybody goes through this. 18:52 You're done with childbearing. 18:53 But it does bother women because some women want to have that sexual vitality into their later years. 19:00 And also, there's a lot of gaslighting of younger women. 19:04 Because more and more younger women are struggling with metabolic disease, like polycystic ovarian syndrome, which is linked to low desire and low libido. 19:17 So, you know, I could talk about it forever, but yes, I'm very passionate about increasing awareness for this issue. 19:25 Yeah, well, thank you so much because the coalition is really meant to give people information, particularly information that they may not otherwise be 19:38 privy to and it kind of can be a start. 19:42 because maybe if you've never even heard that certain things are out there, you wouldn't even look into it or seek that kind of consultation. 19:49 So thank you so much for sharing your expertise. 19:52 I have two follow-up questions. 19:54 When you were talking about the treatment with the platelets, the PRP, is that being done as an injection? 20:02 Yes. 20:03 And how often is that given? 20:07 about 8 to 12 months. 20:09 So once we sequester the platelets, and typically about 30 cc's are drawn, and we apply a numbing medication so that the patient doesn't feel anything. 20:25 And while we are spinning the sample down and preparing the sample, it's about 45 minutes while they have this on, about 30 to 45 minutes. 20:35 I keep it on quite long because I really don't want my patients to have any pain. 20:39 And the injection is into the glands of the clitoris and then also into the anterior vaginal wall. 20:47 Because the research on the use of PRP for mild stress urinary incontinence and the benefits, there's a lot of good studies on that. 20:55 But for arousal issues, There is not very many great studies. 21:02 There was a pilot study that was initiated in 2014, still hasn't finished. 21:06 It hasn't finished recruiting patients. 21:09 But I think some of the issues are also getting a high quality sample because a lot of times I will have patients make sure that a few weeks before they've 21:20 really eaten well, they're in good shape because the quality of the sample is based on the health of the individual. 21:27 So if you have an individual who's a smoker, who has poorly controlled diabetes, while I want to do the PRP injection for them, 21:36 I really want them to improve their health so the sample is better. 21:41 And the sample is injected into those two areas and lasts eight to 12 months. 21:46 It takes three weeks for the recruitment of collagen three and four. 21:50 And they start feeling things waking up down there. 21:53 That is what like almost all of my patients will say. 21:57 And it's not as if it helps with desire.
PRP Therapy, Costs, and Home Devices 22:00 It helps with arousal issues. 22:02 So it's really important to make sure that the treatment is matching what the issue is. 22:08 Because if a patient comes in with low desire, and a lot of times it's marketed for that, but that's not truly the best use of it unless you are using 22:19 it as an adjunct to other treatments because a lot of times purely low desire is not the factor. 22:26 You know, it's usually multifactorial why women have female sexual dysfunction. 22:31 So is that covered by assurance? 22:35 No, it's not covered by insurance. 22:37 It is expensive. 22:38 You know, it's about a thousand dollars. 22:41 And for women that it's indicated for, it can be life changing. 22:47 It also is really good for patients who don't want, who have mild urinary incontinence. 22:52 that are not candidates for a sling and they don't want polyacrylamide. 22:58 It also is a very good option for women that have had breast cancer and maybe they can't have hormone therapy, although vaginal estrogen now has widely 23:11 been used because of the low systemic absorption. 23:14 So it's expensive. 23:15 A lot of these treatments are very expensive. 23:17 So you wanna make sure in order To, you know, give the patients the best outcome that you're choosing the right patients, 23:25 you know, for sure. 23:27 But now there is a, there's a number of home devices that use red light therapy. 23:34 Inter vaginally, one of them is called V fit. 23:38 And it's a medical device, so your HSA or FSA may pay for it. 23:43 And it does similar things to what PRP does. 23:48 It improves blood flow. 23:49 It recruits collagen. 23:51 It recruits healing to that area with continued use. 23:54 So there's going to be some home devices too that patients can use that aren't as expensive as doing some in-office treatments. 24:02 But for those patients who have failed traditional treatments, I think these are good options too. 24:10 Fascinating. 24:12 Another question I have is you mentioned hysterectomy. 24:15 Yes. 24:16 What, explain to me, what is the connection between hysterectomy and sexual health? 24:22 Well, it depends on what type of hysterectomy is done. 24:26 A total hysterectomy removes the cervix and the uterus. 24:30 And sometimes those patients also have removal of their ovaries. 24:36 Young patients that have removal of their ovaries along with the hysterectomy do suffer issues with low libido and female sexual dysfunction because of 24:47 the lack of proper hormonal release. 24:50 And so I do think it's really important to know what type of hysterectomy patients have had.
Hysterectomy and Sexual Health 24:57 Before, when we were, it's very popular to do supracervical hysterectomies and we were leaving the cervix, there was some benefit sexually to that. 25:08 There are nerve endings there, there's blood flow there. 25:11 And so now that we don't use more slaters as often in removing the uterus and the cervix, sometimes that can shorten the vagina depending on what type 25:21 of hysterectomy and the approach. 25:24 that it's done with and also it affects lubrication for some women. 25:29 And so initiating hormone therapy for some patients that it's indicated for will help prevent some of these things down the road. 25:38 But I do think that that's important. 25:42 Wow, Dr. 25:43 P. 25:43 Hindani, you have really dropped many jabs. 25:47 Thank you so much. 25:49 It was a fascinating conversation that I know will help a lot of people. 25:55 For people that have enjoyed this conversation and want to learn more, what is the best way for people to reach out to you? 26:02 They can reach us at Renugen, R-E-N-U-G-Y-N dot com. 26:06 I also have an Instagram page. 26:08 It's Dr. 26:09 P. 26:09 Henggandi. 26:11 And my office number is 470-458-9705. 26:13 Wonderful. 26:19 Well, thank you so much, Dr. 26:21 P. 26:22 Henggandi. 26:23 You got to come back to the Coalition another time. 26:25 I'm sure there's a lot more things for you to do. 26:26 Great. 26:26 So I would love it.
Closing Remarks and Contact Information 26:27 Thank you so much. 26:28 I really appreciate it. 26:30 Thank you. 26:33 Wow, everybody. 26:34 Thank you so much for tuning in to another impactful episode of The Coalition. 26:40 Very special thank you to Dr. 26:42 P. 26:43 Henggandi. 26:43 She is an accomplished Eurogynecologist with a passion for women's health. 26:48 So very special thank you to her for sharing her expertise and making this a very impactful episode. 26:55 You can get connected with Dr. 26:57 P. 26:57 and Valerie on social media. 27:00 You can stay connected with me. 27:02 I'm Dr. 27:02 Shani Belgrade at Banner Bariatric Surgery. 27:05 You can stay connected with me at www.DrShaniBelgrade.com. 27:10 Make sure that you share this episode with family and friends to raise awareness on myths surrounding your mojo. 27:18 I'll see y'all next time.
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