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Dr. Steinberg

Estrogen in Men – Not Just a Female Hormone

Traditionally, estrogen is thought to be an exclusively female hormone. However, if you take a closer look at what estrogen does, you’ll learn that this “female” hormone plays a vital role in men’s (sexual) health as well.

There are three major endogenous estrogens in females that have estrogenic hormonal activity: estrone, estriol, and estradiol. However, the estradiaol, the predominant form of estrogen, is critical to both men and women. Estradiol plays a key role in sexual function as it is essential for modulating libido, erectile function, and spermatogenesis (the production or development of mature sperm, without which, one might not be able to fertilize the female counterpart).

Estrogen receptors, as well as aromatase (the enzyme that converts testosterone to estrogen) are abundant in the brain, penis, and testes. All three of these organs are essential to “normal” sexual function. When aroused, estradiol synthesis is increased in the brain as well as in the penis and testes.

Our hormones co-mingle in a variety of ways, for example, estradiol regulates testosterone in the mature penis. Although our hormones work together to balance our bodies, low testosterone or elevated estrogen can increase incidences of erectile dysfunction.

As with women, men can have a fluctuation in estrogen production. When a man’s body produces too little or too much estradiol, there are a range of symptoms that may occur:

  • Sexual dysfunction (low libido, decreased morning erections, decreased erectile function)
  • Enlarged breasts
  • Lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH)
  • Increased abdominal fat (mostly associated with low estrogen)
  • Feeling tired
  • Loss of muscle mass

Estradiol boosts serotonin levels naturally. When this hormone is out of balance, serotonin levels drop (this is true for women too – which is why estrogen is most commonly known as the hormone connected to mood and behaviour). Typically, when one’s serotonin drops, the body will naturally counteract it by kicking out norepinephrine and epinephrine (thanks adrenals!), to balance the body. In cases where a person suffers from chronic stress or has weak adrenals, the whole balancing act gets out of whack. That’s when symptoms kick in:

Hormone therapy is an effective solution in cases where the body isn’t producing a natural amount of any given hormone. Other ways to help your body balance and regulate hormone levels include: reducing stress, eating well, and exercising routinely. You can take your health into your own hands by understanding the basic ways your body functions.

If you are ever uncertain about what does what or how something works (or if something isn’t working the way you think it should), call us up! We encourage you to get in touch if you are ever concerned about anything related to your overall health, especially when related to your sexual wellness. You’d be surprised to learn that you aren’t alone if you call your doctor and #HaveTheBallsToTalkAboutIt

 

Dr. Steinberg

Estrogen and the Cycle – Part 2

Traitement PRP pour femmes Montréal - o shot

All month long, a woman’s body produces estrogen. If you have a “normal” menstrual cycle, then you will see fluctuations in the amount of estrogen produced, with a high during ovulation, and a low when you have your period. But, there are many other factors that play a role in a woman’s increased or decreased production of estrogen.

Estrogen is mainly produced in the ovaries (small amounts are also produced in the adrenal glands and fat tissue). Estrogen then moves through your blood and acts everywhere in your body helping with growth, maintenance, and repair of reproductive tissue, as well as influencing other body tissues and bone mass (think osteoporosis).

As a woman’s body naturally has highs and lows of estrogen levels, you might notice anything from mood or behavioural changes, oil secretions (acne), to fluctuations in sex drive. Although it is natural to see peaks and dips in estrogen throughout the cycle, let’s look at what it might feel like if your estrogen levels dip lower than your monthly usual.

Fluctuations in Estrogen: A Dip

Why would your estrogen levels fall? This question is often asked, and although there is no one certain reason, here are a few possibilities:

  • Hypogonadism
  • Hypopituitarism
  • Pregnancy failure (due to estriol)
  • Perimenopause and menopause (due to estradiol)
  • Polycystic ovarian syndrome (PCOS)
  • Anorexia nervosa (eating disorder)
  • Extreme exercise or excessive training
  • Temporal and temporary cause: immediately after childbirth and during breastfeeding

Some of the symptoms of low estrogen levels include:

  • painful sex due to a lack of vaginal lubrication
  • an increase in urinary tract infections (UTIs) due to a thinning of the urethra
  • irregular or absent periods
  • mood swings
  • hot flashes
  • breast tenderness
  • headaches or accentuation of pre-existing migraines
  • depression

Taken in stride, any one of these symptoms might be something you feel every now and again, but if these symptoms persist, then perhaps you suffer from low estrogen levels. A simple blood or urine test from your doctor could clarify the situation, and treatment can begin.

Fluctuations in Estrogen: A Rise

Puberty brings on a normal rise in estrogen levels. That’s because estrogen is a “chemical messenger” that helps your body develop from girl to woman. Playing a role in breast development, a more mature curved figure, and hair growth. In terms of adolescent surges in estrogen, the hormone is doing its job. But if you are already a woman (hormonally speaking), then excess estrogen (called estrogen dominance) might contribute to weight gain (or women who are extremely overweight), fibroids (non-cancerous tumors) in the ovaries, loss of sex drive, depression, and fatigue.

Estrogen and Sex

So let’s get down to the business of Sexual Wellness: Reduced estrogen levels can cause shrinkage of the vaginal mucosa. This shrinkage results in the narrowing of the vaginal opening, which is a condition called vaginal atrophy. Commonly, if the opening is narrowed, a woman might experience pain during sexual intercourse. Estrogen plays an integral role in maintaining a healthy sex life, and when it comes to staying lubricated, there are topical creams that can help. However, there are a number of other ways to treat vaginal dryness. The standard treatment today consists of applying vaginal creams or suppositories containing Estrogen. This can be very effective but the regular application of the medication can be messy and cumbersome. 

Here are two other treatments you might want to look into if you’re experiencing an underproduction of natural lubrication:

  1. Vaginal Laser Therapy (diVa) involves a renewal treatment with diVa Laser. It’s an effective solution to vaginal dryness or laxity. The laser painlessly stimulates the thickening of the mucosal layer, restoring a more youthful tone. diVa works both internally and externally to tighten skin, and restore function and appearance.
  2. The O-Shot PRP injection stimulates vaginal and clitoral tissue rejuvenation for a better overall sexual and urinary wellness. Although still a new therapy under evaluation, the early results of PRP therapy are encouraging with minimal side effects. And for many women, the results are almost immediate.

By restoring vaginal health we often see a return in libido, orgasm more easily achieved and vaginal lubrication increased, putting an end to painful intercourse.

Estrogen affects your physical, mental, and emotional health. Impacting everything from your stress levels to sex drive. It’s important that if you feel any symptoms related to a rise or fall in estrogen that you seek medical assistance; professional help may help alleviate any underlying causes. There is no reason you should feel out of sorts, we can help.

 

Dr. Steinberg

Estrogen: A 3-Part Series

Estrogen is a natural hormone produced by the body, and although it is most commonly associated with women, estrogen occurs in men as well. There are a few vital contributions that estrogen has to the healthy development of our bodies, especially when it comes to puberty and reproduction. But, there are times when our bodies may produce too much or too little estrogen; when that happens, shifts occur and a number of symptoms may arise. In this 3-part series, we will go through what estrogen is, the various under- and over-production effects of estrogen in women, and lastly, we’ll take a peek into how estrogen plays a role in a man’s overall health. In this article, you’ll get a simple overview of what estrogen’s role is in our bodies.

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The first thing you need to know about estrogen is that it is produced naturally in the body with fluctuating highs and lows throughout a woman’s cycle. The highest is in the middle of the menstrual cycle and the lowest during your period. As we stop ovulating, estrogen levels drop, this explains the connection between low levels of estrogen and menopause.

Known as the sex hormone, estrogen contributes to a variety of functions:

  • turns a girl into a “woman” through puberty – growth of breasts and pubic hair, and start of menstrual cycles
  • important to childbearing
  • keeps cholesterol in control
  • protects bone health (for example, osteoporosis)
  • affects your brain (mood), heart (decreased estrogen can bring on increased inflammation), skin (dry), and other tissue (vaginal walls)

Estrogen is just one of the hormones that plays a role in the normal sexual and reproductive development in women. Women with low levels of estrogen who are experiencing difficulty getting pregnant, might be put on hormone therapy which will introduce extra estrogen to the body to help simulate the hormone cycle. For women who are trying to ward off pregnancy, birth control acts as a bio-identical hormone supplement to maintain levels of estrogen (and progesterone); without a surge in estrogen, your ovaries will not release an egg.

The effects of increased or decreased estrogen levels in the body extend beyond whether our reproductive organs can successfully do their jobs or not. As our sex hormones are not solely made to reproduce, one of estrogen’s other functions is to keep the walls of the vagina lubricated with clear fluid and the lining healthy, thick, and elastic. By maintaining healthy levels of lubrication, the vagina welcomes penetration (i.e. sexual intercourse) without distress or pain. Should the levels of estrogen dip, this can impact the amount of moisture available, making sexual intercourse less enjoyable due to dryness.

Vaginal dryness is a treatable symptom of reduced estrogen levels. Also known as vaginal atrophy or GSM (Genitourinary Symptoms of Menopause), this condition can lead to distressing urinary symptoms. Vaginal estrogen cream has been the only therapy available up to recently. But now, through Vaginal laser Therapy (diVa) or the O-Shot PRP Therapy, we can restore function and appearance of the vagina both internally and externally. Your sexual desire will often return and vaginal lubrication will increase, helping you maintain healthy vaginal function and allowing sexual intercourse to be more pleasurable.

Estrogen plays a vital role in a woman’s development. As we saw, estrogen helps with the reproductive aspect of being a woman (puberty, menstrual cycles, childbearing), but it also helps with a woman’s overall health from affecting mood and behaviour to producing natural lubrication in the vagina.

There is so much to learn about estrogen, in our next blog, we’ll talk more in depth about what happens when your body produces too little or too much estrogen. We’ll take a look vaginal dryness as well as all of the treatments available.

It’s important to know your body and understand what is going on beneath the surface. It may seem like you don’t have control over the what your body naturally does on its own, but you do – and by paying close attention to your behaviour and general health, you can play an active role in tending to your happiness and overall well-being.

 

Dr. Steinberg

Elna Sexual Wellness Was Created for You

The Elna Sexual Wellness clinic was created with one vision in mind: to provide a safe space for people to restore and enhance their sexual health. What does that mean?

Sexual wellness includes a wide spectrum of topics ranging from physiological health to psychological wellness. At times an issue might take on a physiological manifestation when in fact the cause lies in an unhealthy thought process. Or, sometimes the opposite is true: the mind is stressed or anxious and so your body responds by malfunctioning. Most often, when it comes to matters of sexual health, the root of any issue is a healthy dose of both body and mind. By taking a holistic approach to our patient’s overall well-being, we are able to best assess what the core of the issue is and from there provide a better and more precise targeted treatment program.

Sexual wellness is open communication. Sexual wellness is maintaining healthy function over your body parts. Sexual wellness is understanding yourself, your limits, what feels good and right, and what feels comfortable. Sexual wellness is a vital aspect of your life.

First and foremost, establishing open and honest communication with your partner is fundamental in establishing a sexual relationship that works on a highly functional level. Before you can explore a frank dialogue with your partner about intimate matters, it is important that you take the first step in taking the conversation inward through self-exploration and self-reflection. By building a strong sense of what a healthy sex life looks like to you, you will better be able to articulate that to your partner.

Sexual wellness is open communication

Counselling is instrumental in getting the ball rolling. Whether you have an issue on your mind or if you’re curious about what is “right,” “normal,” or “common” when it comes to sex, a sex therapist can help unpack any ideas or misconceptions you might currently be holding that are hindering you from a healthy sex life. The notion that there is an established set of rules as to what is considered “normal,” for example is something that a counsellor can help you think about; sexuality is a highly cultured and socialized topic, and so by having an impartial expert with whom to discuss matters, is a healthy place to start. By exploring notions that keep you bound in thoughts and feelings that might not belong to you, you can free yourself of conventions and rules that aren’t yours. All of this is done with the utmost discretion and confidentiality.

Sexual wellness is maintaining healthy function over your body parts

Our mission is to restore and/or enhance your sexual wellness. We have a multidisciplinary approach to treating men and women on their sexual health; with every issue that is brought forth, there is opportunity to build a multi-layered treatment plan that integrates all parts of the being both body and mind. Urology plays a strong role in sexual wellness in treating anything from erectile dysfunction and painful intercourse to low sex desire (or low libido) and incontinence. With cutting-edge treatments and technologies, we treat with oral or topical medications, non-invasive procedures, counselling, and more. It’s all about finding the right fit for you and making sure you feel the most at ease with whichever program we decide to proceed with.

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Sexual wellness is understanding yourself

Elna Sexual Wellness holds no judgment. Our patient-doctor confidentiality is set in place so that you feel comfortable diving deep into your thoughts so we can best understand where you are coming from. Our discretion and confidentiality is our promise. The safer you feel, the more chance we have of restoring your sexual wellness.

A healthy intimate relationship is something we strive to achieve when working with individuals seeking to improve or restore full function of their physical body and mind when it comes to sexual matters. There are far too many people living with anything from discomfort to embarrassment, but it shouldn’t have to be that way. That’s why we created the Elna Sexual Wellness clinic—to offer a holistic approach to treating your sexual wellness, because #sexmatters.

-The Elna Sexual Wellness team

Premature Ejaculation: You Can Have Control

You’re in bed with your partner and you’re getting intimate. Sexual intercourse begins and before you can control it, you’ve finished. You lay there, beside your partner and begin spiralling down the rabbit hole with negative thoughts about what is wrong with you. You’re embarrassed and your anxiety about your performance takes over. Sound familiar?

Many men suffer from what is known as Premature Ejaculation. But, just to be clear, premature ejaculation is not defined by the speed in which you finish, but rather whether you finished when you desired to. Being in control of your ejaculation is a more precise definition of what we, in the medical field, call Premature Ejaculation (PE).

Although many men have been known to finish too quickly, there are a large set of factors that distinguish a one-time occurrence from frequent PE. If you ejaculate sooner than you’d like to during sexual intercourse, and this is happening more often than that one time you got too drunk or went a long time without ejaculating, then it’s probably time to see a doctor to figure out what’s going on.

When it comes to premature ejaculation, there is always the possibility that psychological factors (poor body image, depression, relationship issues, and so on), are working in tandem with the physiological causes (abnormal hormone levels, abnormal levels of neurotransmitters, inflammation and infection of the prostate or urethra, and so on). By understanding the full spectrum of the disease, you will be able to begin treating the issue so that sexual intimacy can be improved.

By sitting down with men or couples (depending on the situation), we try to learn where the problem is stemming from. There can be a host of variables that are playing a role in your sexual experiences, by knowing all of the symptoms and how the disease is affecting you (and your relationship), we can better prescribe a course of action that will help you gain control of your ejaculatory function.

We will often recommend sex therapy for patients suffering from premature ejaculation. Counselling is vital for so many reasons, but the main one is whether your premature ejaculation is caused from psychological issues or not, once a man starts to experience PE, anxiety settles in fairly quickly thereafter. Anticipating frustration or shame, or feeling embarrassed about ejaculating prematurely is common and can exacerbate the issue. Talking through the stress of performance can dissipate the anxiety that goes along with it.

In the realm of medication, we typically prescribe anti-depressants (like Paxil, for example) which can help delay ejaculation. We could also explore numbing ointments (such as EMLA cream) in the realm of topical medication. EMLA is rubbed onto the head of the penis approximately 30 minutes prior to sexual activity. There are also a variety of behavioural changes or techniques you could try to help delay ejaculation. These can all be discussed with a counsellor or doctor.

Sexual experiences should not bring on stress, and anticipating ejaculating before desired is no fun for anyone. You can improve your overall sexual wellness by seeking help. It’s that easy. You just need to #HaveTheBallsToTalkAboutIt.

Dr. Steinberg

The Orgasm Gap

Elna Sexual Wellness - Erectile Dysfunction

You may have heard of things like the pay gap or age gap, but what you might not have heard of is a little thing called the Orgasm Gap.

Let’s rewind a few decades, way back to the 1960s when the sexual revolution was at its core. The idea of sex being a taboo topic was being challenged in hopes of celebrating the act as a part of normal life. Talking about sex and liberating it from it from the repressive state it was in for so long was quite the feat for the 60s. So much changed for women because of the fight they put up. Take contraception for example, that’s a notion that is so common in this day and age, it’s crazy to think that at one point it was against the law. But, despite the road that was paved by our foremothers, one major inequality remains to this day: equal pleasure.

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Today, sexual education is part of school curriculums as early as Kindergarten. Children are taught about their reproductive organs and the mechanics of sex. But, what about the pleasure aspect of it all? By not describing potential sensations, encouraging self-exploration, and being given the tools to speak to your partner about intimate issues, then sex is not an act people engage in for fun, rather it becomes something more results-oriented. See where we’re going with this? Here’s the thing, as long as pleasure is left out of the conversation, then sex is being misrepresented as being an act exclusive to reproduction. You know what that means?

Think about it. Go through the motions in your head. If sex is for reproduction, then who is the one who orgasms? That’s right. The man. Well, there you have it. The Orgasm Gap.

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The Orgasm Gap refers to men having more orgasms than women in heterosexual encounters (yes, heterosexual, because funny enough, in lesbian sexual encounters, the gap is not quite so big). Culturally, the importance of women “finishing” or feeling pleasure is considered less important than a man reaching the finish line. But why?

A lot of factors play key roles in why a woman’s pleasure is less sought after than a man’s:

  • Sex for reproduction
  • Feeling self-conscious
  • Lack of communication between partners
  • Insufficient clitoral stimulation
  • Not feeling entitled to feeling pleasure

When referring to sexual intercourse, we immediately connect the idea to penetrative sex. However, most women do not reach climax through penetration. Mislabeling clitoral stimulation as “foreplay” is part of the problem, because as long as we think of a woman’s orgasm as the pre-act, the less likely the woman will ever reach an orgasm. Very few women are able to reach orgasm through penetration, unlike what is represented in the media. Most women can achieve orgasm through masturbation, but again, this can make a woman feel uncomfortable during the act… to reach down and take care of herself evokes a take-charge kind of woman. But it shouldn’t.

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In the wake of #MeToo, women of 2019 are picking up where our 60s sisters left off. The Orgasm Gap is just one more challenge to take on. A reflection of today’s woman, roaring, empowered, justice-seeking, the Orgasm Gap is going to be squeezed tight.

Equal pay? Working on it.

#BelieveWomen? We do.

Eternal search for the missing orgasm… On our way!

Lori