Sexual Dysfunction

What you may have been labeling as “lack of sexual interest” or “painful sex” is a form of sexual dysfunction, a common and frequently treatable issue. The term “sexual dysfunction” refers to a recurring or persistent problem that interferes with a person’s ability to have sex or enjoy a sexual experience.  Sexual dysfunction can occur at any point in a woman’s life.  The process of sexual enjoyment is complex, especially in women.  There are multiple points at which the “dysfunction” can occur, and many times there is more than one factor at play.

Common problems which can occur include:

  • Low desire or the lack of sexual interest
  • Lack of arousal or difficulty maintaining the arousal
  • Inability to achieve orgasm
  • Pain instigated by intercourse or chronic pain preventing intercourse

Low desire, lack of arousal and inability to achieve an orgasm can be due to:

  • Medications, such as anti-depressants, high blood pressure medication, alcohol, and illicit drugs.
  • Mental state as it relates to the relationship with your partner, cultural or religious issues as it pertains to the act of sex, and issues with body image.
  • Stress and anxiety—This can be situational as well as chronic
  • Hormonal changes, such as menopause or changes in contraception.
  • Medical problems, especially those that affect the nerves and blood vessels (i.e., diabetes, peripheral vascular disease).
  • History of sexual abuse and post-traumatic stress disorder, or a negative sexual experience.


Menopause is the point in life where the body no longer produces estrogen.  Natural menopause is defined as no menses for one year.  You may be at the point where menses may be present but irregular, which is referred to as peri-menopause.  Sexual function can change both with peri-menopause and menopause, as well as with surgical menopause (when the ovaries are removed surgically).  This is due to the lack of estrogen in the vagina which makes the vagina drier, less elastic or flexible, and decreases the blood flow to the area causing the vaginal skin to become thinner.


Vaginal pain can be caused by other reasons beyond hormonal changes, especially in women who are premenopausal.  Pain disorders can cause sexual dysfunction cycles which can be a challenge to break. One can experience pain with intercourse, vaginal dryness, constant vaginal/pelvic/lower abdominal pain, and vaginal irritation which may be mistaken for vaginal infections or urinary tract infections. However, the negative experience associated with a painful sexual experience can trigger an ongoing sexual dysfunction cycle.

Steps to Addressing Pain with Intercourse

The first step is to identify what is prompting the pain (there may be more than one contributing reason), then to focus therapies (more than one therapy simultaneously is often necessary):

  • An anatomic issue with the vagina—Sometimes if a woman is dealing with a scar tissue band or pelvic organ prolapse/vaginal bulge this may change the anatomy (the shape) of the vagina.  This change in structure may result in painful intercourse. Addressing these anatomical changes may require pelvic floor physical therapy or surgery to correct the issue.
  • Pelvic floor dysfunction—If you have experienced pain with intercourse or even without intercourse, the cause may be abnormally tight pelvic muscles. This inability to relax pelvic floor muscles may cause abnormal feedback to pelvic organs causing pain, bladder dysfunction or anorectal dysfunction.  Pelvic floor physical therapy is the most commonly prescribed treatment, but other therapies may be necessary in conjunction with physical therapy to achieve better sexual function and alleviate pain.
  • Vulvovaginal skin changes— The thinning of the walls of the vagina caused by decreased estrogen levels is a change in the vagina that occurs with menopause, and sometimes during the peri-menopausal period.  There are hormonal and non-hormonal therapies which can be initiated for treatment.  Other times, hormonal changes may not be the issue. Lichen sclerosus is an autoimmune skin condition of the vulva (outside of the vagina) which can cause irritation and pain.  The treatment for lichen sclerosus is different and will need a biopsy first to confirm the diagnosis.
  • Interstitial cystitis (IC) or Bladder Pain Syndrome—This is a condition of the bladder which can cause bladder pain, urinary urgency and frequency, and painful intercourse.  IC often makes one think she has urinary tract infections but will have negative urine cultures.  There are many ways to try to alleviate IC which include diet changes, pelvic floor physical therapy, stress management, or medications.
  • Stress and anxiety, history of sexual abuse—Finding outlets or methods to manage stress and anxiety are paramount to break the pain cycle. Psychotherapy is very important with pain and anxiety disorders, as well as, with a history of sexual abuse to obtain better overall function and strengthen relationships thus helping sexual function.
  • Other medical issues may cause pelvic pain and pain with intercourse such as endometriosis and irritable bowel syndrome.  Other specialists may need to be involved in helping manage these issues.

Multidisciplinary approaches with pelvic floor physical therapists, psychiatrists/counselors, gynecologist or urogynecologist, and other specialists such as urologists and gastroenterologists are often required for managing pain disorders or painful disorders.

Talking to your primary care physician or gynecologist openly about your sexual dysfunction, and how it is impacting your life and relationships is a necessary first step.  Your physician may be able to help you or may refer you to a specialist.  Therapy will take time, especially since there is no “magic cure” for sexual dysfunction. However, with positive steps in the right direction, sexual function can be improved.

Call 404-778-3401 to make an appointment or visit emoryhealthcare.org/gyn to learn more.

About Sana Ansari, MD

Sana Ansari, MD is a Urogynecologist and Pelvic Reconstructive Surgeon with Emory Women’s Center, and Assistant Professor at Emory University School of Medicine. Her specialties include Female Pelvic Medicine & Reconstructive Surgery, Urogynecology, and Obstetrics and Gynecology. She is currently accepting patients at Emory Johns Creek Hospital and Emory Saint Joseph’s Hospital.

Top 10 Things Care Coordinators Do For You

Care coordinators are there to help you navigate the sometimes confusing world of health care so you can get and stay healthy, or manage chronic disease. Whether you are juggling multiple doctors’ appointments or returning to daily life after a hospital admission, staying on top of your health can seem like a full-time job. That’s where care coordinators come in. Care coordinators are registered nurses, social workers, health educators and case managers who help you manage your chronic health condition and stay in touch with you after a hospital stay or doctor’s appointment to ensure you have the resources you need to get and stay healthy.

Emory Healthcare provides care coordination services through the Emory Coordinated Care Center and Emory Healthcare Network Care Coordination.

Keep reading to learn the top 10 things care coordinators can do for you.

1. Help you set and meet healthy lifestyle goals. Care coordinators can work with you to set achievable health goals and prevent chronic disease, such as diabetes and heart disease.

“We use motivational interviewing skills, health education and lifestyle modification discussions to help patients to improve our patients’ knowledge and get them more engaged in their healthcare,” says Misty Landor, RN, MSN, CNS, ANP-C, manager of Emory Healthcare Network Care Coordination.

2. Keep you accountable to your goals. Your care coordinator may reach out to you on a weekly, monthly or quarterly basis depending on your health needs.

“We have a multidisciplinary team of that helps patients get the care they need in the time they have,” explains Landor. This team includes:

  • A registered nurse who serves as care coordinator or case manager to oversee chronic disease management
  • Licensed social workers who support patients with psychosocial needs, like transportation, caregiver support or mental health care
  • Health educators who work with people to develop healthy lifestyle goals
  • Care coordination associates who help patients schedule appointments, get prescriptions filled and complete referral forms

3. Connect you with a primary care provider. Care coordinators can help you find a primary care physician so you can see him or her when you have a health need, rather than visit the emergency department.

4. Help you manage chronic disease. “We bring patients with chronic diseases into our disease management program, which is run by a nurse practitioner,” says Varnette Robinson, RN, BSN, lead case manager at Emory Coordinator Care Center. “The disease management program covers diabetes, hypertension, chronic obstructive pulmonary disease (COPD), heart failure and chronic kidney disease (CKD). We also assist patients if they need wound care.”

5. Get your prescriptions filled. Care coordinators can help you get your prescriptions filled and will follow up to ensure you are taking your medications correctly.

“Many times, patients come back to the hospital because they were unable to get their prescriptions filled, perhaps because they didn’t have a caregiver or transportation,” says Robinson.

6. Schedule doctor’s appointments. A care coordinator can help you schedule doctor’s appointments at a time convenient for you.

7. Provide access to mental health care. Care coordinators are trained to identify patients with depression and anxiety, and connect them to mental health resources.

8. Find caregiver or home health services. “We follow patients after they go home and make sure they are connected to appropriate community resources as needed,” says Robinson. “We make sure they have good social support, transportation, food and medication. We go the extra mile to figure out what the patient needs.”

For example, if a patient is discharged from the hospital and does not have anyone to care for her once she is home, the care coordinator will connect her to a community resource that can provide in-home care until she is well again.

9. Prevent hospital readmission. “If the patient is in pain or having recurring issues, we can bring them in to the Emory Coordinated Care Center so they aren’t going to the emergency department. This prevents unnecessary hospital readmission. If we identify any issues during our calls, we bring them to the Center.”

10. Be a source of support. “We are there to support patients 100 percent,” says Robinson. “Getting them what they need when they need it is going to improve their quality of life. We are part of a support system to facilitate them living well.”

To learn more about care coordination at Emory, click here.

Emory Metabolic Camp Helps Young Women Manage Metabolic Disorders

This summer marked the 21st annual Metabolic Camp hosted by Emory University. This camp helps girls and young women with inherited metabolic disorders, including phenylketonuria (PKU) and maple syrup urine disease (MSUD), learn how to better manage and live with their disorders. Metabolic Camp provides the girls with educational opportunities for handling the lifetime responsibility of managing their diets and health along with traditional camping activities.

These disorders are caused by the body’s inability to process proteins normally. In individuals with these rare genetic disorders even one gram of protein can cause irreversible brain damage or death. However through Georgia’s newborn screening program, metabolic disorders can often be detected early on.

“Metabolic Camp has had a tremendous impact not only on the quality of life of girls over the years but also on the outcome of the next generation of their children,” says Rani Singh, PhD, RD, camp director and director of Emory’s Genetics Metabolic Nutrition Program. “Most of these girls can’t attend other camps because of their special dietary needs, and this allows them to interact with others with their conditions and feel less isolated, while learning things that can save their lives and the lives of their future children.”

People with these disorders must learn as children to stick to a special diet of fruits and vegetables along with their specialized medical formula, and they are able to live normal lives if they adhere to this routine. It is important for females to follow specialized diets before and throughout pregnancy in order to avoid maternal PKU (MPKU) and prevent mental disabilities in their children. Emory University Metabolic Camp helps these girls and young women understand the importance of these diets and learn how to fit it into their everyday life.

The Emory University Metabolic Camp allows young women to be around others that can understand what they are going through and show them that they are not alone. The camp helps them learn skills and gain knowledge that will help them throughout a lifetime of managing and living with their disorder.

Metabolic Camp is a collaboration between the Atlanta Clinical and Translational Science Institute(ACTSI) and the Department of Human Genetics at Emory University Medicine.

For more information about Emory University Metabolic Camp visit the Emory News Center.

Emory and Ebola – FAQ’s

Emory Healthcare New BrandEmory Healthcare has been given the privilege of treating multiple patients infected with Ebola virus.  Emory University Hospital physicians, nurses and staff are highly trained in the specific and unique protocols and procedures necessary to treat and care for these type of patients. We are honored to have the privilege of caring for these patients who contracted Ebola while serving our global community. It is our moral obligation to always use our expertise, training, knowledge and gifts to provide such extraordinary care for others.

We have prepared the following FAQs to provide more information on the topic of Ebola and Emory’s care for patients infected with this deadly virus. You can also watch this Video Q&A from Emory Healthcare Physicians on Ebola.

About Ebola

About Emory University Hospital

Related Resources:


Cochlear Implants Could be a Game Changer for Those Affected by Hearing Loss

Cochlear ImplantAccording to the American Speech-Language-Hearing Association, hearing loss affects millions of children and adults worldwide. Hearing loss can stem from conductive problems or problems with the external ear canal, ear drum, middle ear space or middle ear bones. Conductive hearing loss often can be treated with surgery to address the structure that is affected; however, this is not an option for nerve hearing loss. Nerve or sensorineural hearing loss is caused by intrauterine infections, congenital malformations of the inner ear, trauma, medication induced, sudden deafness or a progressive hearing loss from genetic predisposition. While many patients benefit from standard hearing aid technology, there are some who do not. Fortunately, a result of decades-long research, in 1985 the FDA approved cochlear implant use in humans to address sensorineural hearing loss. Cochlear implants have now helped more than 300,000 people worldwide.

What are cochlear implants?
Cochlear implants are implantable hearing devices that allow people who are deaf to hear.

How do they work?
Cochlear implantation provides electrical stimulation directly to the cochlea, the auditory portion of the inner ear. This is accomplished by inserting an electrode into the cochlea. It requires surgery under general anesthesia. Most patients go home the same day of the procedure. A cochlear implant is comprised of an internal processor that is attached to an electrode array and lies under the scalp skin. It is not at all visible!

There are external components that have a receiver, microphone and transmitter. The external components relay sound to the internal processor through connection with a magnet, which is under the scalp skin. The external components can be removed at any time, much like standard hearing aids. Once implanted, the expectation is that the implants are permanent; however, the internal components can still be removed surgically if it becomes necessary.

Cochlear implants have revolutionized the quality of life in children and adults. Children who are born deaf can now be implanted as infants and go on to live near normal lives. Adults with profound hearing loss also have benefitted from cochlear implants.

Who is eligible?
The indications for cochlear implants have evolved over the last three decades and are still changing. While, both children and adults can be implanted, the specific criteria is complex. If you are living with hearing loss that is not helped by hearing aids, your otolaryngologist will be able to help you determine your eligibility.

Two Ebola Patients Discharged from Emory University Hospital

In an effort to keep our community informed on the status of the Ebola patients being treated at Emory University Hospital, today we confirm that as of this afternoon, both Ebola patients have been discharged from our Infectious Disease Unit at the hospital.

Nancy Writebol was discharged from the Emory University Hospital on Tuesday, Aug. 19, 2014, and Kent Brantly, MD, was discharged today, Thursday, Aug. 21, 2014.

“After a rigorous and successful course of treatment and testing, the Emory Healthcare team has determined that both patients have recovered from the Ebola virus and can return to their families and community without concern for spreading this infection to others,” says Bruce Ribner, MD, medical director of the Emory University Hospital Communicable Disease Containment Unit.

Criteria for the discharge of both patients were based on standard infectious disease protocols and blood and urine diagnostic tests. Our team has maintained its extensive safety procedures throughout this treatment process and is confident that the discharge of these patients poses no public health threat.

“The Emory Healthcare team is extremely pleased with Dr. Brantly’s and Mrs. Writebol’s recovery, and was inspired by their spirit and strength, as well as by the steadfast support of their families,” says Ribner.

The mission of Emory University Hospital is to heal and to advance knowledge. The team of health care professionals who cared for these Ebola patients has trained for years to treat and contain the most dangerous infectious diseases in the world. The experience, understanding and learning that Emory’s medical professionals have gained during this process will be applied, not only to Ebola, but to other emergent diseases that the world may confront in the future.

Related Resources:

Get Your Cardiovascular Screening from One of Our Convenient Mobile Locations in September

Emory Healthcare Mobile ScreeningsEmory Healthcare, along with mobile health screening partner, HealthFair, continues to offer cardiovascular screenings around the metro Atlanta area in the month of September. This collaboration provides metro Atlanta communities greater access to important screening services and to the Emory Healthcare Network of physicians and providers. Below is listing of screening dates and locations coming to your neighborhood.

Cardiovascular screenings offered by HealthFair meet the established screening guidelines by the American College of Cardiology. Each patient, along with the medical staff, can tailor their screening packages to their specific needs. Details about the screenings can be found at emoryhealthcare.org/screening.

September 2014 Cardiovascular Screening Schedule

  • September 2, Walmart, 1735 S Highway 27, Carrollton
  • September 3, The Fresh Market, 100 N Peachtree Parkway, Peachtree City
  • September 4, Walgreens, 6671 Covington Highway, Lithonia
  • September 4, Kroger, 3000 Old Alabama Road, Alpharetta
  • September 5, Kroger, 1715 Howell Mill Road, Atlanta
  • September 6, Rite Aid, 1550 Kennesaw Due West Road NW, Kennesaw
  • September 8, Walgreens, 2365 Buford Drive, Lawrenceville
  • September 9, Walgreens, 4395 Kimball Bridge Road, Alpharetta
  • September 10, CVS, 3285 New MacLand Road, Powder Springs
  • September 11, Publix, 2451 Cumberland Parkway SE, Atlanta
  • September 12, Kroger, 12050 Georgia 92, Woodstock
  • September 13, Rite Aid, 3055 Washington Road, Atlanta
  • September 15, Just Fitness 4U Marietta, 3101 Roswell Road, Marietta
  • September 16, Dunwoody Pines, 4355 Georgetown Square, Dunwoody
  • September 17, Kroger, 7125 Georgia 85, Riverdale
  • September 18, Walgreens, 10 East May Street, Winder
  • September 19, CVS, 4377 Atlanta Highway, Loganville
  • September 20, Rite Aid, 2113 S Cobb Drive, Smyrna
  • September 22, Walgreens, 4075 Cherokee Street NW, Kennesaw
  • September 23, Delmar Gardens of Gwinnett, 3100 Club Drive, Lawrenceville
  • September 25, Olive Springs Baptist Church, 1528 Austell Road SE, Marietta
  • September 26, CVS, 6330 Roswell Road, Roswell
  • September 27, Kroger, 3030 Headland Drive SW, Atlanta
  • September 29, Kroger, 1690 Powder Springs Road SE, Marietta
  • September 30, Walmart Supercenter, 600 Carrollton Villa Rica Highway, Villa Rica

For more information on screening options and/or to schedule your screening appointment, visit www.emoryhealthcare.org/screening.

May is National Stroke Awareness Month!

Every 40 seconds, someone in the United States has a stroke, according to the National Stroke Association.

In recognition of May as National Stroke Awareness Month, Emory Healthcare encourages you to learn the signs, symptoms and risk factors for stroke. Mark your calendar for the following events:

Stroke Awareness

Go Red for Women Event at Emory University Hospital Midtown

  • Where:

Emory University Hospital Midtown
Medical Office Tower Lobby
550 Peachtree Street, NE
Atlanta, Georgia

  • When: Friday, May 9 ; 7:30 a.m. – 1 p.m.
  • What: Come out and enjoy this fun, educational event, where you can meet the Emory Women’s Heart Center physicians and staff, learn how to prevent heart disease and find out if you are at risk for heart disease. The event will also feature nutrition consultations, body mass index (BMI) and blood pressure screenings for attendees.

Also, join us at 12 p.m. in the Glenn Auditorium for a short educational talk on how to prevent heart disease by Emory Women’s Heart Center cardiologist Alexis Cutchins, MD.
Nurses who attend the talk will be offered 0.5 Contact Hours. Refreshments will be served.

Stroke Awareness Fair at Emory University Hospital

  • Where:

Emory University Hospital
1364 Clifton Road, NE
Atlanta, Georgia 30322
E Wing Auditorium and Classroom Lobby, 2nd Floor

  • When: Wednesday, May 21, 2014 ; 10 a.m. to 2 p.m.
  • What: Come out to learn signs and symptoms of stroke, understand how to manage blood pressure, exercise properly and maintain a healthy diet. You can talk to experts about stroke prevention and response for suspected stroke. Also, plan to participate in two community stroke lectures, beginning at 10:30 a.m. and 11:30 a.m.
  • Who: Emory employees, patients, families and you!

Stroke Awareness Fair at Emory University Hospital Midtown

  • Where:

Emory University Hospital Midtown
Medical Office Tower Lobby
550 Peachtree Street, NE
Atlanta, Georgia

  • When: Thursday, May 15, 2014; 11 a.m. to 3 p.m.
  • What: Join us to learn the signs and symptoms of stroke, ask a neurologist about stroke care, speak to a pharmacist, get your BMI checked and learn about stroke rehabilitation programs.
  • Who: Emory employees, patients, families and you!

Stroke Awareness at Emory Johns Creek Hospital

  • Where:

Emory Johns Creek Hospital
6325 Hospital Parkway
Johns Creek, GA

Related Resources:

Less Invasive Treatment Now Available For Barrett’s Esophagus

Often dismissed as a little acid reflux or heartburn, gastroesophageal reflux disease (GERD) affects 44 percent of adults in the United States. For some of those, their GERD can be resolved by antacids, changes in diet and a healthier lifestyle. But, for others GERD can lead to Barrett’s Esophagus, a condition which significantly raises the patient’s risk of esophageal cancer. Suddenly, GERD doesn’t seem so harmless.

While only a small percentage of patients with GERD will develop Barrett’s, but when a patient is diagnosed with it, doctors keep a close watch out for the emergence of cancer. Traditionally, Barrett’s has been treated by removing tumors of the esophagus with combinations of surgery, chemotherapy, radiation, and photo dynamic therapy (PDT ). But now there is an alternative approach that is less invasive and has fewer side effects. With radiofrequency ablation (RFA), doctors guide a balloon-type device to the affected site and trigger a radio frequency signal to slough off the malignant or precancerous cells.

“RF Ablation is so well tolerated now that we can safely offer it to a great many patients with Barrett’s Esophagus,” said the Director of Endoscopy at Emory Healthcare, Field Willingham, MD, MPH.

Major surgery is still not uncommon among late stage esophageal cancer patients. But when the cancer is caught early it can now often be successfully removed using radiofrequency ablation.

Both Field F Willingham, MD, MPH, and Kevin Woods, MD, MPH offer RFA for patients with Barrett’s Esophagus at Emory Healthcare.

Watch the video below:

Breast Augmentation, What are Your Options? Have Your Questions Answered.

breast augmentationChoosing breast augmentation surgery is a big decision, and we know it’s important for you to understand your surgical options, the implants, and what you can expect after the surgery. Join Emory Aesthetic Center’s plastic surgeon, Felmont Eaves, MD, on Tuesday, July 9, 2013 as he helps walk you through the journey. Dr. Eaves will answer all of your questions to ensure you are confidently ready to take the next step. He will be available to answer questions such as:

  • Is breast augmentation right for me?
  • What is the breast augmentation procedure?
  • Are there other options available to me?
  • What can I expect after surgery?
  • What types of breast implants are available and which one(s) are best?
  • What kind of an outcome can I expect?