Questions? I have answers.

What is the difference between a sexuality counselor and a sex therapist?

A sex therapist is a mental health professional who specializes in helping clients with sexual concerns. They provide intensive therapy through the modality they see fit. Furthermore, they are excellent at working through trauma, couples issues, betrayal, and beyond.  Typically treatment is long term, some people develop a relationship with their therapist over many years, but certainly progress can be seen in a few sessions. 

A sexuality counselor is a healthcare provider (PA, NP, PT, MD, DO) who specializes in sexuality. We are trained to take a thorough history, do a focused physical exam if needed, and provide specific suggestions and treatment plan.  A lot of what we do is education about anatomy and physiology, as well as incorporating our expert understanding of how chronic medical conditions and/or medications can effect sexual functioning.  We often prescribe non-prescription treatments as well as prescription medications when needed.  Typically treatment spans a few sessions, more complex cases may require longer. 

The other big thing about ALL these professionals (therapists, PA, NP, PT, MD, DO) is that we must look at sexual dysfunction from a multidisciplinary lens meaning part of your treatment plan may be a referral to someone else - for example I refer to therapists and PTs on an almost daily basis! Together we work concurrently to make you feel well.

Are you trauma informed?

I have spent a lot of time learning and un-learning my own biases and cultural awareness, and that process will continue lifelong for me.  I understand that trauma plays a role in your physical and mental health. I understand that some folks have experienced trauma from all sorts of avenues - medial trauma, relational trauma, sexual trauma, and the list goes on.  Some ways I make an effort to be trauma informed and trauma conscious: I do not weigh my patients, pelvic exams are optional and you will have the opportunity to provide verbal consent for these to occur, using language that is gender and orientation inclusive, giving you time and space to ask questions, and you may bring a partner with you.  If you have specific needs or requests, please feel free to discuss with me prior to your visit.

Do you prescribe medication?

Yes, I do.  With experience in family medicine, and additional training in sexual medicine (University of Michigan and ISSWSH), psychopharmacology training in women's mental health (Mass General Hospital and Postpartum Support International), and training in menopause medicine (North American Menopause Society), I take pride in following guideline based therapies with accurate diagnosis.  

I recognize that there are therapies for which we do not have FDA approval for or evidence based guidelines backed by randomized control trials.  Testosterone therapy in women is one of them.  For these instances, I use expert guidelines as well as ongoing peer discussion so that I am certain what we are doing is safe and effective.  

Do you see clients in person?

I do! My address is on the contact me page. 

I am also seeing patients virtually.

What is the difference between perimenopause and menopause?

Perimenopause is the time period surrounding the menopause transition.  It can begin as early as 10 years before actual menopause.  Menopause is defined as one year since your last menses or period.  The average age of menopause is 52 in the United States, therefore perimenopause starts in women's 40s for most individuals.  You do not need a lab test to define where you are at in the spectrum of menopause transition.  

Do you prescribe bioidentical hormones therapy?

Yes.  But let me clarify what bioidentical means so we are on the same page.  Bioidentical hormones mean that they have the exact same chemical and molecular structure as hormones that are produced in the human body.  There are FDA products that meet this criteria (Estrace & Prometrium, for example).  Custom-compounded preparations are marketed as bioidentical as well.  Compound prescriptions are great when appropriate, but because they are not regulated no one can be certain the precise dose in them.  Meaning, you could be under-dosed or over-dosed on the particular ingredient.  The terminology "bioidentical" was coined early on to be applied to compounded hormone therapies to imply that they were natural and therefore safer.  However, that is not an accurate definition of what they are! 

I use FDA-approved bioidentical hormones, as well as compounded hormones in appropriate clinical scenarios.  I do not do pellet therapy. 

Are depression/anxiety medications safe in pregnancy and/or breastfeeding?

In general, yes they are safe.  There are certain ones we have more data for, compared to others, which we tend to lean towards unless she is already using an SSRI and was in remission from major depressive disorder or anxiety prior to conception.  I like to tell women that there is no risk free decision - we know that exposure to stress (or high levels of cortisol) can pose a risk to baby, as can any medication taken during pregnancy.  My goal is to help you feel comfortable with whatever decision we work together to come up with.

Do you see folks who are part of the BDSM/kink community?

Yes! I do.  Part of my sexuality counseling training was experience with BDSM/kink folks. 

Someone told me to just drink wine to get me "in the mood".  Do you think this is a good idea?

This is one of the most common "recommendations" I hear from the health care community when it comes to advice for low desire/sexual problems.  If it were that simple, I wouldn't have spent one whole year learning how to treat this! This is not a helpful suggestion, and neither is prescribing benzodiazepines (Xanax, Valium, Ativan, Klonopin) prior to sexual activity, or opioids (Norco, Vicodin, oxycodone, Percocet, hydrocodone) which is why I do not prescribe these medications to help you "relax" before intercourse.

Alcohol, opioids, and benzodiazepines (or any substances for that manner) put the brakes on sexual desire.  Instead, we will get to the root as to WHY you are having a problem and address that.

How many visits will I need with you?

That is up to you! In general, I suspect that it will take 3-4 visits to come up with a treatment plan (done in the first visit) and then implementing these items with feedback.  I like for you to set the pace, but I will likely make a suggestion how soon you should follow up after your first visit.  

Can my partner come to my visit?

I like to interview you first and dedicate the initial consultation to you, and then we can come up with a plan how we want to incorporate your partner(s) in subsequent visits.

Do you work with cancer patients who are having sexual dysfunction?

Yes, I do.  Part of my career was working in gynecologic oncology, and I am very aware of the side effects of hysterectomies, pelvic radiation, and chemotherapy.  I am certain we can work together to come up with a feasible treatment plan.