Expert Commentary: Marjorie Green & Eman Elkadry

Part of our weekly Share MayFlowers (SMF) plan is to showcase physicians, midwives and other providers involved in women’s health and ask them to talk with us: sharing their frustrations, their experiences, and their hopes for the future with regard to each weekly topic. We are deeply grateful to these providers - partners with us in caring for the most intimate needs of women - for giving us the time and the gift of their insights to the SMF campaign.

This week we are happy to share a summary of conversations with a gynecologist and urogynecologist, Marjorie Green, MD and Eman Elkadry, MD, respectively, both of Mount Auburn Hospital in Cambridge, MA, regarding their thoughts and experiences in clinical practice pertaining to female sexual health.

Dr. Green has a practice specializing in gynecology, menopause, and sexual dysfunction and reports that she very commonly sees women with complaints of pelvic pain, dyspareunia (painful sex), decreased libido, and shortened, tight and painful muscles in the pelvic floor. She reports that most of her patients exhibit a combination of these and other symptoms that “create a vicious cycle” affecting mental, overall physical, and sexual health.

Dr. Elkadry shares that she sees much of the same issues in patients presenting to her urogynecology practice, even if they present with primary complaints of pelvic floor dysfunction (constituted primarily by symptoms of urinary and/or fecal incontinence, urinary urgency and frequency, and pelvic organ prolapse). In fact, recent research indicates that the prevalence of sexual symptoms of decreased arousal, infrequent orgasm, and dyspareunia are significantly associated with pelvic floor symptoms. Dr. Elkadry reports that urogynecology as a discipline can be very effective at addressing the physical components contributing to female sexual complaints, such as those pelvic floor issues cited previously. In the case of inflammation, vulvar skin disorders, hormonal issues, and co-morbid mental health or psychiatric issues, she advocates for a multidisciplinary approach to yield the best results for the patient. She also reports that many of her colleagues in urogynecology are familiar with screening and some treatment interventions for sexual dysfunction for women with combination pelvic floor and physical complaints.

In Dr. Green’s practice, women of all ages come to her and they are self-referred or referred by other providers. Regardless of age or background, she indicates that they frequently feel at a loss to explain their symptoms, wondering “ can I get this problem better and make the pain go away?” A few of her most highly recommended interventions are the use of topical estrogen (particularly for young women who are on birth control), pelvic floor physical therapy, and mental/behavioral health services and support, adding that only in rare circumstances does she recommend surgery.

Both Drs Elkadry and Green tell us that they want to see more “open discussion about these issues that present to our offices on a day-to-day basis”, believing that such openness will be beneficial for patients and providers, alike. As testament to the necessity of open dialogue and accurate information, Dr. Green adds that when she was in consult with a 24 year-old female for dyspareunia, the “mother was present during the visit, raised her hand and asked ‘You mean it’s not supposed to hurt?’“ Her feeling is that young women are learning about sexual practice primarily though online sources and via their friends - information that can be easily misconstrued - and that the correct information should be made public and for women of ALL ages.

As far as what the future holds, Dr. Green suggests the following for the direction of female pelvic health:

  • “Make birth control a right - for women to choose to have it or not.”
  • Provide more access and information to the public to help women with issues regarding sexual health and pelvic floor dysfunction. We want to create an environment that discourages “sweeping it under the rug” and instead allow women to engage in open and free dialect with healthcare providers and get away from “being afraid to talk about it.”
  • More research needs to be conducted specifically with the young female athlete population. She says, “most young female athletes are trained to keep their pelvic floor muscles tight (in their sports), which can then lead to urinary urgency, frequency, pelvic pain, dyspareunia, etc. Essentially, we need to learn more about sport-specific pelvic floor muscle tightness and the effects of that in different populations (comparing across sports and comparing to non-athletes).”

Marjorie Green, MD, MPH is a gynecologist specializing in menopause, sexual medicine, and general gynecology. She is the Director of the Mt. Auburn Hospital Menopause and Sexual Medicine Center in Cambridge, MA.

Eman Elkadry, MD is a fellowship-trained urogynecologist, specializing in Female Pelvic Medicine and Reconstructive Surgery, including minimally-invasive surgery for incontinence and pelvic organ prolapse. She is the Fellowship Director at Boston Urogynecology Associates, Mount Auburn Hospital in Cambridge, MA.