Dr. Amy Brenner talks about orgasms in celebration of Orgasm Day. Topics include…
1. Medications that may interfere
2. Surgical causes of problems with orgasm
3. Why gynecologists may avoid talking about sex.
4. The best treatments for depression that won’t interfere with orgasm
5. Does hysterectomy interfere with orgasm.
6. Medical causes of problems with orgasm.
Dr. Amy Brenner, MD, FACOG Talks About Orgasm
Charles Runels: So I'm honored to be talking with Dr. Amy Brenner, who's an amazing gynecologist whom I met about a year ago, coming up on a year. She lectures around the world. She is stationed … Or her office is based near Cincinnati. Tell us about your practice and then let's … You know, this whole interview we're celebrating Orgasm Day. But before we get to that, just tell us more about you and your practice.
Dr. Amy Brenner: Sure. I've been a practicing gynecologist for 15 years and about five years ago, I decided to focus on gynecology. I still practice traditional gynecology and do surgery and have a large hormone practice with bioidentical hormones and medi-spa and currently cool flow team and we use functional medicine and started offering PRP procedures such as the O-shot and P-shot and the empire procedure, about a year ago.
Charles Runels: Beautiful. And you have physicians working there with you right? I just want people to understand that you're a hard core gynecologist. You have a new surgeon gynecologist working with you, you have a family practitioner physician who helps you with some of the hormone part of your practice, plus you have… Tell me more about what goes on in your office. I want people to understand how busy you are.
Dr. Amy Brenner: Sure. Well, busy place. There's about 45 people that come to work every day. I have a gynecologist who also did additional training in GYN surgery and then a fellowship in minimally invasive gynecology. I have a family practice physician who also does aesthetics and focuses on integrated medicine and bioidentical hormones. Then four nurse practitioners that do the routine GYN care and pap smears and FPD management and just typical gynecology and their main focus is also on hormones as well. Then we have three aestheticians and two wellness counselors.
Charles Runels: That's just amazing. Now that people understand that this is not… you're not just someone who read about orgasms yesterday, and you have literally thousands of women who come through your office and you have… I mean most people if they had 45 cars in their parking lot that would be a busy day, that's just your staff. So I have a lot of respect for your ideas and your experience in gynecology and I know you came and I shared some ideas about the O-shot and that's worked well for you. But before we talk about that, just talk with me about orgasms in general. Maybe, let's start with why you think they might be important or maybe they're not important. Just what do you hear women say about orgasms?
Dr. Amy Brenner: Sure. I mean being a gynecologist for 15 years, I'll be honest, up until about five years ago, when people would talk to me about their problems with libido or just any sexual problems, my only answer was you should go on a date with your husband. That's all I had in my toolbox. I know traditional gynecologists still feel like that and maybe think that [Addie 00:03:38] is their only alternative. About five years ago when I started with hormones, women came out of the woodwork which is why I feel like we've been so successful in such a short period of time, in Cincinnati, of doing something that really not a lot of people were doing. I've heard it over and over that people say that their sex life now is better at 40 from the tools that we've been able to give them from before.
Issues with libido and sexuality is something that me personally seeing patients here at least 10 times a day. So multiply that by seven providers and that's a lot of women who are talking about issues with sexuality on a daily basis.
Charles Runels: Talk more about, because as you know I did research in that area as well, and it always surprised me how many women would come to me and say, "Well, the doctor told me all hormones are normal." And they would've come from a very expert, well respected gynecologist, but who just thought a little bit differently about how to measure acute hormones. I don't think I was smarter than somebody, but as you know there's different schools of thought. Tell me, does that happen in your office with new patients and what's the difference between thinking the way you do now and the way you thought say six, or seven, eight years ago?
Dr. Amy Brenner: So first of all, that conversation happens every day, which is again, why I think we have a lot of patients because we don't feel like that. We hear all the time, "My doctor said that I'm fine and there's nothing to do."
Charles Runels: Yes.
Dr. Amy Brenner: That's what I used to tell people too. I think it's because in OB/GYN there's a lot of education going on by drug reps rather than doctors seeking out their own answers. Up until five years ago I didn't think there was a problem with birth control pills of SSRIs or sleeping pills, let alone what it does to your sex life.
Charles Runels: So talk to me… back to the sex part and the orgasm part, before we get into the details of the way you think about the hormones, the different medicines, because you just mentioned SSRIs, which to interpret for some of our people, so you're referring to some of the anti-depressants. Before we get into the details, tell me more about some of the things that you hear women tell you about how orgasm problems, however you want to define that, interfere with their life. Either difficulty having one or can't have one.
Dr. Amy Brenner: Well, I think just women's sex life and their libido and their relationship with their significant other is a huge part of their relationship. I hear from patients who's life goes better when their sex life is better. They get along better with their significant other, just life is better when people are having good sex.
Charles Runels: Isn't that interesting. I have people tell me that they're not as… they sleep better, they think better, their work goes better. Do you hear those things? Can you elaborate on that or am I making that up?
Dr. Amy Brenner: I think that the patients that are coming in, it's more of the negatives of things aren't as good because I'm not having good sex. Or I don't want to have sex or sex is painful. It can create controversy in a marriage. It can create disappointment and frustration. I'm hearing more of the these are the negative things than that type of thing, of what's missing and please help me because it's not good.
Charles Runels: And then after they get well, what do these women tell you that's different about their life?
Dr. Amy Brenner: They may tell me I'm the best doctor ever.
Charles Runels: Because what's happening in their life. I know they love you.
Dr. Amy Brenner: Because we helped them and we're willing to look outside of the box when their other doctor may have said that's just part of getting old and that's just how it is.
Charles Runels: So when you say you helped them, specifically, what do they say is better about their life because their sex is better? I think you sort of said it already with relationships, but can you expand on that? Can you think of a story of someone, something someone told you about what happened with their life?
Dr. Amy Brenner: Well, I think I told you about this one patient that always comes to mind of… as a couple, I treated both the husband and the wife. Her exact words were, "You're the only person that's helped me. I haven't had good sex and we've basically had a sex-less marriage just until you helped me because I was having pain with sex and it became this vicious circle of I had pain and I didn't want to have sex and it didn't feel good so I never did it. And it created emotional distance with my husband." With some things we did with hormones and the O-shot for her and the P-shot for him, basically they rekindled things and things were better than ever.
Charles Runels: So when you say rekindled, tell me more what that looks like in their house. What did it look like?
Dr. Amy Brenner: Well I guess for them it's not really rekindled, it was just started to begin with, because she basically said they had a sex-less marriage because of issues with pain.
Charles Runels: So now they're having intimacy and they're happier together.
Dr. Amy Brenner: Going to Cancun with just the two of them.
Charles Runels: Oh fun.
Dr. Amy Brenner: You know the story.
Charles Runels: That sounds happy. That's rewarding isn't it? Tell me about, if a woman were to say to you, or if a woman were to say to another woman, because I see this on the blogs a lot, shouldn't worry about that because you're just trying to please your husband. What would you say to that? You're just trying to please a man. It shouldn't bother you that you can't have an orgasm. You should just be happy. And, let's face it, there becomes this thing– one of my favorite stories is the Velveteen Rabbit. So, you reach this place where you're 100 years old or you're 80 years old or something, although people have sex at that age, but you can reach a place where a love relationship goes without sex. On the other hand, the five-year giving up, was you see it on the blogs and you hear women tell other women, even some therapists telling women that you shouldn't worry about it because you're just trying to please a man. If you're happy without sex, just be happy. Does that resonate or am I just making that up? You ever see those comments on the blogs?
Dr. Brenner: I guess– I don't know. In my practice, I'm not really seeing that–
Dr. Runels: I know it's not the way you think but I see it in some of the sex therapist comments.
Dr. Brenner: Yeah, I would say that, that's not what I'm seeing from my patients. My patients want to have good sex. So I'm not really seeing–
Dr. Runels: For their own self.
Speaker 2: — that.
Dr. Runels: That's what I'm looking for.
Speaker 2: And if they were saying that, I would say that there's a lot of health benefits to having an orgasm a day. I think I heard somewhere that you should have an orgasm a day to keep the doctor away rather than an apple a day. So–
Dr. Runels: Yeah, I do think it helps mental health. Well, I know there is this idea in my feeling from what I've been able to observe in people have been together a long time, often times, the man wants the woman to be well just because he loves her and she doesn't feel whole. Not to please him, but she wants her body to function. And so I know that's the way you think but I see some judgment going sometimes against women who are trying to make things better.
So anyway, so let's talk about if you were talking to a woman who wanted orgasms to be better or just can't have an orgasm and you were looking at her medications for things that might be throwing her off, what medicines would you be very suspicious could be causing the problem? And, again, I don't want anybody stopping their medicine just for watching this video, but yet they maybe haven't asked for a physician about changing something and this could prompt them to ask their doctor when they go. So what medicines would you worry about interfering with sex?
Speaker 2: The two most common things are anti-depressants. I find it really hard for women to have a good sexual experience for either from libido or orgasms when people are taking anti-depressants. And so I think there's a lot of other options that can help with mood other than anti-depressants. So in our practice, [inaudible 00:12:53] can start talking about what we're going to do to treat people. I like to get people to talk about other alternatives to anti-depressants. And then the other are synthetic hormones like birth control pills or synthetic progestins.
Dr. Runels: Yes. So birth control pills are going to drop testosterone levels, right? Which are going to, even in a young woman. It's not a [inaudible 00:13:17]. It's just a thing that will happen. It's going to drop because that's how it works, right? So there's this feedback loop to drop [inaudible 00:13:25] testosterone falls, and so that is the thing that will happen and has an effect on women and we know it's a thing that's going to happen. So that's going to affect the libido. Tell me, so if you had an anti-depressant, which anti-depressant would you think would be least likely to interfere? So if someone's takin an anti-depressant–
Speaker 2: If someone has to take an anti-depressant, we like to switch them over to Wellbutrin.
Dr. Runels: Yes. Yeah, I never asked you that question before so I was seeing if you could [inaudible 00:13:56] it. Absolutely. It's the one that is least likely to interfere [inaudible 00:14:01]. Of course testosterone can act as an [inaudible 00:14:04] as a– it helps depression when you correct low levels. So you know, I just wanted to–
Speaker 2: The next couple of other ones, like if somebody's taking chronic pain pills I think that can suppress testosterone and or things like tamoxifen if somebody has had breast cancer, or– those are some other things that can negatively affect.
Dr. Runels: Yeah. So the narcotics populates the [inaudible 00:14:33]so there is less stimulation to make testosterone as well. So let's say that they have their medicines with them. You've gotten them the best you can get them. Tell me some other things that you would do to improve orgasms as a physician. I don't want to discount, we both realize that relationships, sex therapy, family therapy can be extremely huge. And is much underused, but still thinking as a physician with procedures and medicines at your disposal, what other ideas would you have to make things better? So you have testosterone, what else?
Speaker 2: So first I just want to look at other things in their medical history, like other physical or anatomical things that could interfere with orgasm or stimulation or things like that. So anything that causes atrophy or loss of estrogen in the vagina and vulva can make sex painful and painful is certainly not enjoyable. So any kind of hormone deficiency that can cause atrophy or any kind of scarring in the vagina either from prior procedures, hysterectomy, child birth, or even other medical problems that can cause scarring in the vulva, lichen sclerosus or other more rare skin diseases that can interfere with the anatomy and–
Dr. Runels: So you, along those lines, you've treated some of these painful conditions with the O Shot is that correct or no?
Speaker 2: That is correct. Or no?
Dr. Runels: So tell us some stories, tell us what you've seen. How do you think it might be healthy? Explain it as a scientist, what you've seen and what you think has happened when you've done this?
Speaker 2: So I'll just tell you about our most recent lichen sclerosus patient, who had decades of itching, and vulvar pain, and she periodically used a topical steroid, and I think periodically is she didn't find it was really helpful so she wasn't really compliant with it because she really didn't notice that it made a big difference for her.
Dr. Runels: Let me stop you for just a second right there. I just want people to stop and think about that for a second. A decade of itching, and burning, and an uncomfortable genitalia. Just stop and think about how miserable, I mean I would be angry. I can tell you as a child I used to always get chiggers because I live in the south where it's like being in the swamp. We played in the forest and my little genitals would just be swollen and scratchy and it was just the most miserable, miserable thing, and so the last thing that someone like that would want to do is have sexual relations and it's horrible isn't it? So tell me, so you're thinking of a particular person who had this [inaudible 00:17:59]for a decade. I'm sorry, so I just wanted people think about that.
Speaker 2: Yeah. Most women can relate to having a yeast infection, that's miserable and you usually have that for a day before you get cured.
Dr. Runels: Yeah.
Speaker 2: So this was feeling like that every day, so she wasn't looking to make her sex life better, she just wanted– that wasn't even part of the discussion. She just wanted not to be itchy and in pain every day, so, but when I talked to her about sex, no, I don't even think like that. So recently I treated her with the O Shot and PRP to the vulva and within a month she's not itchy anymore.
Dr. Runels: Oh wow, that's so beautiful, and you know we just. I think I've told you already, but last week we had our research paper that was accepted by the Journal for the American Academy of Dermatology, so that will be out this year. Probably within a month or so, so I'm excited about that. About lichen sclerosus, so hopefully more people will know how to do what you're doing, and we've talked about you and you're at such an expert level and so busy, you haven't had time, but I'm hoping you can give a speech to [inaudible 00:19:20]. I see you as being an excellent teacher. So tell me more about, have you treated anyone who had scarring from childbirth or from surgical procedures with the O Shot or not?
Speaker 2: You know, just that couple I was telling you is, she just had a long history of just painful sex that we didn't really have a good anatomical reason why. She didn't have atrophy, she didn't have a cirrhosis, she never had a hysterectomy, but she had pain and it did get better for her.
Dr. Runels: What did that do for her? Is she married?
Dr. Amy Brenner: Yeah, that's the lady I told you about that's now going on to Mexico.
Dr. Runels: Oh, that's going to Cancun. Isn't that wonderful?
Dr. Brenner: Yeah.
Dr. Runels: I've had several of our doctors tell me, because we've both with life and death sort of situations. Not sort of. Truly. You're a surgeon. [inaudible 00:20:21] Delivering a child can be life and death, but bad things happen and [inaudible 00:20:26] for 12 years, but I have found that patching up these relationships and giving people their sexuality back is as rewarding or more so than anything I've ever done in medicine. Are you feeling that, or am I making that up for [inaudible 00:20:40]? I mean, do you find that very rewarding?
Amy Brenner: No, [inaudible 00:20:45] when you bring couples back together sexually.
Dr. Runels: It's wonderful, isn't it?
Amy Brenner: It just makes their relationship better, it makes their [inaudible 00:20:55] better, and when it's broken it's just not the same.
Dr. Runels: Yeah. All right, so another thing I want to talk with you as a scientist. So there is still a debate about whether female ejaculation is a thing or not. Actually, when I went to medical school, I was there at UAB in Birmingham and we'd had a two month class on sex, and guess what the first day was shown to us? A movie of a woman ejaculate, and our teacher who was a Ph.D. teaching our class said, "I do not want anyone leaving this medical school thinking that female ejaculation is not a reality."
I didn't really think that much about it, but since we've been doing the O-Shot, I've had more women tell me they're experiencing it, written about it, thought more deeply about it actually before the O-Shot [inaudible 00:21:51]. Tell me what you think. First of all, is it a thing? Second of all, is it a thing, what do you think is causing it, and do you think the shot makes it more likely to happen? I mean, talk to me. I mean, I know that's sort of a … Maybe you don't want to talk about it, but because it's getting …
Okay, let me stop right here. Let's change the subject for just a second. Do you know any gynecologists that do not want to talk about sex?
Amy Brenner: That do not want to talk about sex? Most gynecologists [crosstalk 00:22:24] [inaudible 00:22:26].
Dr. Runels: Yeah, it's most of them. Yeah, I was setting you up for that.
Amy Brenner: Because they don't know what to do about it, so …
Dr. Runels: Most of them don't want to talk about it, do they?
Amy Brenner: No.
Dr. Runels: And so I want to brag on you for now for just a second, because I can tell that question is getting close to your edge, but I want to brag on you about this for a second because you are comfortable and being very brave, because I know that the majority of gynecologists are, first, they're afraid to talk about sex because they're not comfortable with their own sexuality. Number two, they don't understand how to treat sexual problems. Even though they might be amazing gynecologists, it wasn't part of their curriculum and new ideas have come along, and so they're not sure what to say. They're not comfortable saying it. So I just want to double brag on the fact that you're being very brave, not only just embracing these ideas. You're helping to think about them.
I've never asked you to think openly in public about this phenomenon, so if you want to decline the question, you can. But if you want to tackle it as a scientist, tell me what you think about it. And talk not as if you're talking to me. Talk as if you're talking to a woman who's wondering, "Is this a thing? Is it worth thinking about? Would the shot help me, and if so, tell me more about how to think about it."
Amy Brenner: Well, I don't think doctors are taught about sex, let alone female ejaculation, so I think that's an advanced topic.
Dr. Runels: And they're not getting the basics down.
Amy Brenner: Yeah. That's for the experts to talk about.
Dr. Runels: Well, maybe we should just skip it. We'll skip it. Let's see, what else can we talk about? You tell me. What else have you seen in the area of sexuality that on a daily basis you find frustrating, that you wish more women knew about? So you mentioned the hormone piece of it. Anything else along those lines? Maybe with relationships or medicine, any piece of it?
Amy Brenner: I think I've talked to you about this before. I think using the O-Shot and PRP for incontinence and dryness is just a chip shot. It's so easy, because there's not a lot of other factors that go into that. Either you notice that your dryness improves or it doesn't, and so using PRP and the O-Shot to treat those medical problems that, again, is something … That conversation I have multiple times a day about treatment options for incontinence and treating for vaginal dryness, and it's so easy to treat those.
But I think it is a little bit more tricky to talk about sex and what goes into a good sex life and good orgasm, because although the O-Shot helps with the physical part with blood flow and nerves, there's just so many other components to that.
Dr. Runels: Yeah. I'm glad you brought that up, because we don't get everybody well, do we? What do you think is the most difficult problem to treat? I have an idea, but what do you think is really difficult to treat?
Amy Brenner: Well, just last week I saw somebody for a follow-up for the O-Shot and the first words out of her mouth were, "I don't think it works." And I'm like, "Okay, well, tell me more about that, because I know we're also wanting to help incontinence." And she's like, "Oh, yeah, that's better. I don't need the oxybutynin anymore. I don't even leak at all." And she's like, "And the dryness is better, but I've never been able to have a orgasm with my husband and I still can't."
Dr. Runels: Yeah.
Dr. Brenner: That part is out of my control.
Dr. Runels: Yes. What's the lab rate on that [inaudible 00:26:29]? Because that is one of the things. Although it happens, the women who have difficulty having orgasm with their lover's penis inside of them … We don't have control over the lover, do we? What he knows or she knows about her lover's anatomy, how they're sensitive to it, and so we can't control that piece, can we?
Dr. Brenner: No.
Dr. Runels: But it does happen. But that's hard. I think the other one is the woman who's never had an orgasm in her life. I think it's more difficult to figure out how to help that one. There is this system. I like to keep reminding people there's an orgasm system. It involves everything you just said. The relationship, the lover, the lover's anatomy and understanding of her body, hormones. Tell me some more of the surgical things that you would think about from the surgeon that might cause problems when you have your surgeon hat on with sex.
Dr. Brenner: Yeah, I mean, certainly when somebody has a surgical menopause, that instantly takes their hormones to zero, so-
Dr. Runels: So if they have their ovaries taken out.
Dr. Brenner: Yeah, or even just a shortened vagina that can lead to pain with sex. Radiation for cancer, that can interfere with things, or even just childbirth and vaginal lacerations. I've seen women with scar tissue that … Sometimes I examine them and I don't even know how they're having sex, let alone it's enjoyable, so I don't even know how they're doing it.
Dr. Runels: Okay.
Amy Brenner: Trauma. I mean, it's rare, but …
Dr. Runels: What about ovarian cysts or fibroids? Do those interfere very much, because I'm not a surgeon, so I have [inaudible 00:28:28].
Dr. Brenner: [inaudible 00:28:31] pain.
Dr. Runels: Yeah, I've seen pain. I'm a big believer in surgery, actually. I think it's a natural treatment. I always tell women, "Well, after you pass about 35, I can probably do your hormones better than your ovaries can. And if you get them out, we don't have to keep worrying about ovarian cancer, and that one goes off the radar. And if you have a hysterectomy, we can quit thinking about cervical cancer." Although some women argue that the cervix has something to do with orgasm. What are your thoughts on that? 'Cause I'm still making up my mind on that.
Dr. Brenner: Yeah. I think that when you read about physiologically what happens to it when women get aroused and what happens with orgasm, certainly that's described, but that hasn't been my experience of women saying that everything changed when you take their cervix out. I do like to take women's cervix out when I do a hysterectomy because if you leave it in place, then 20 to 30 percent of the time, they still have bleeding. That's another physical [inaudible 00:29:37] that can interfere with sex, too. Somebody's bleeding all the time, they don't … It's embarrassing. It's messy and …
Dr. Runels: It's like they're still having their period.
Dr. Brenner: Yeah.
Dr. Runels: If you're gonna have a hysterectomy, why still put up with a menstrual period? I'm with you.
Dr. Brenner: Right. I mean, most people don't want to have a gynecological exam when they're bleeding, let alone be intimate with somebody when they're bleeding, so if somebody's bleeding for seven days out of the month, then you're like, "Okay, well, I'm not doing it that week, and this week I might have PMS," so you're down to … Bleeding issues can also interfere, just 'cause … embarrassing, and people don't like that.
Dr. Runels: Well, I see your sweet baby walking by, so I'm gonna let you go, but before I do I wanted to thank you. I consider you one of the top GYNs on the planet, and I consider myself blessed to know you and work with you and share ideas with you. Anything else you want to say about the celebration of Orgasm Day, or just anything else about what we're doing before you take off?
Dr. Brenner: Yeah. Everybody should have an orgasm on Orgasm Day.
Dr. Runels: That sounds fun. Okay, Doctor Brenner. You have a wonderful day. Bye-bye.
Dr. Brenner: Bye.