Hormones and Reproductive Health

Hormones and Reproductive Health

Written by Michelle Violi, Pharm.D. – Women’s International Pharmacy

 

Couple expecting babyWhat would we do without the human reproductive system? True, we might have fewer hormonal ups and downs, but it wouldn’t be long before humans would no longer populate the earth. Let’s take a closer look at how this very important system works in both women and men.

The Female Reproductive System

A woman’s reproductive system is delicate and complex. In order for conception to occur, it is important for a woman’s hormones to be balanced and her organs and tissues healthy. Hormones such as estrogen and progesterone play leading roles; however, there are many other hormones that are important players in the intricate process that is the female reproductive system.

Immediately following menstruation, estrogen levels begin to rise, causing the lining of the uterus to thicken. At ovulation an egg is expelled from the ovary into the fallopian tube where it travels to the uterus. After ovulation occurs, progesterone is produced from the corpus luteum, which forms in the ovary from which the egg was released.

Progesterone causes the uterine lining to become secretory and ready for the egg to implant should fertilization occur. If fertilization occurs, the fertilized egg implants in the uterine lining. The corpus luteum continues to produce progesterone until the placenta takes over its production in the second trimester of pregnancy. If fertilization does not occur, the corpus luteum breaks down, estrogen and progesterone levels fall, menstruation occurs, and the cycle begins anew.

The Male Reproductive System

A man’s reproductive system is no less complex. The primary hormones involved in the functioning of the male reproductive system are follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone.

FSH and LH are produced by the pituitary gland located at the base of the brain. FSH is necessary for sperm production (spermatogenesis), and LH stimulates the production of testosterone, which is necessary to continue the process of spermatogenesis. Testosterone also is important in the development of male characteristics, including muscle mass and strength, fat distribution, bone mass, and sex drive.

Hormonal Effects on Fertility

Infertility issues are very complicated and have many possible causes, including hormone imbalances or deficiencies. The following are just a few ways hormones play a role in fertility.

Hypothyroidism, or low thyroid function, can affect fertility due to menstrual cycles without ovulation, insufficient progesterone levels following ovulation, increased prolactin levels, and sex hormone imbalances. In a study involving 394 infertile women, 23.9% had hypothyroidism. After treatment for hypothyroidism, 76.6% of infertile women conceived within 6 weeks to 1 year.

Luteal phase deficiency (LPD) is a condition of insufficient progesterone exposure to maintain a normal secretory endometrium and allow for normal embryo implantation and growth. Progesterone is used in patients who experience recurrent miscarriages due to LPD. In addition, studies have shown progesterone can reduce the rate of preterm birth in certain individuals.

Conclusion

The human reproductive system is delicate, complex, and affects the overall health of women and men. Hormones serve an important role in maintaining harmony and promoting fertility in this intricate system. Because of this, achieving hormonal balance is a crucial component to supporting reproductive and overall health.

  • Lessey BA, Young SL. Yen & Jaffe’s Reproductive Endocrinology. 7th ed. Amsterdam, The Netherlands: Elsevier; 2014. https://www-clinicalkey-com.ezproxy.library.wisc.edu/#!/content/book/3-s2.0-B978145572758200010X?scrollTo=%23hl0000927 Accessed July 3, 2017
  • https://my.clevelandclinic.org/health/articles/the-male-reproductive-system Accessed July 3, 2017
  • Liedman R, Hansson SR, Howe D, et al. Reproductive hormones in plasma over the menstrual cycle in primary dysmenorrhea compared with healthy subjects. Gynecol Endocrinol. 2008;24:508-513. Accessed April 11, 2017.
  • Hassan SS, Romero R, Vidyadhari D, et al. Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: a multicenter, randomized, double-blind, placebo-controlled trial. Ultrasound Obstet Gynecol. 2011;38:18-31.
  • Barda G, Ben-Haroush A, Barkat J, et al. Effect of vaginal progesterone, administered to prevent preterm birth, on impedance to blood flow in fetal and uterine circulation. Ultrasound Obstet Gynecol. 2010;36:743-748.
  • Mesen TB, Young SL. Progesterone and the luteal phase. Obstet Gynecol Clin North Am. 2015;42(1):135-151.
  • Verma I, Sood R, Juneja S, et al. Prevalence of hypothyroidism in infertile women and evaluation of response of treatment for hypothyroidism on infertility. Int J Appl Basic Med Res. 2012 Jan-Jun; 2(1):17-19.
Hormones and Reproductive Health 2017-12-05T12:33:07+00:00

Ovulation is Crucial

Ovulation is Crucial to Women’s Health

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

ovulation is crucial to women's healthMany of us, including medical practitioners, think that if we are having monthly, regular periods, then our reproductive system is healthy. Dr. Jerilynn Prior believes we haven’t studied ovulation closely enough. She details her position in a series of newsletters from the Centre for Menstrual Cycle and Ovulation Research (CEMCOR). Dr. Prior estimates that, among regularly menstruating women whose cycles have been normal for 10-30 years after menarche (one’s first period), one third do not ovulate. She suggests that ovulation is “a missing link in preventing osteoporosis, heart disease and breast cancer.”

Let’s Start at the Beginning

Let’s refresh our memories with a little physiology review. Ovulation is the release of an egg from an ovary. Once the egg leaves the ovary, the corpus luteum (a temporary endocrine gland) forms in the ovary and begins to produce progesterone. The egg travels down the fallopian tube to the uterus where it can be fertilized by sperm. If fertilization does not occur, the egg is swept from the uterus along with the thickened lining of the uterus during a woman’s monthly period, also known as menstruation.

The release of the egg at mid-cycle and the formation of the corpus luteum are necessary for the abundant production and release of progesterone, which is the hallmark of the second half of the menstrual cycle known as the luteal phase.

As a young girl reaches menarche, estrogen influences her body. Breasts start to develop and body fat is redistributed, rounding the body’s contours gradually into a “womanly” shape. However, ovulation doesn’t start immediately and therefore, neither does the release of progesterone. It could be as long as a year before ovulation actually starts, and only after ten years does ovulation occur 95% of the time. One indicator that ovulation has begun, Dr. Prior explains, is the size of the areola around the nipple. When ovulation starts the areola becomes larger and darker.

Ovulation may be disturbed by stress, emotional upset, inadequate nutrition, and over-exercising without adequate food intake. Dr. Prior writes that there are two types of ovarian disturbances. One is an anovulatory cycle when no egg is released by the ovary. The other is luteal phase defect when an egg is released but there is insufficient progesterone produced by the corpus luteum in the ovary, leading to a shortened luteal phase. Both ovarian disturbances result in an inadequate production of progesterone.

Testing for Ovulation

No test actually “sees” the egg being released from the ovary, so medical practitioners have developed tests that use indirect methods to detect when ovulation has occurred.

  • One test requires a daily ultrasound of the ovaries to track the formation of the pre-ovulation cyst on the ovary and the eruption that occurs when an egg is released.
  • Another test involves taking a biopsy of uterine tissue, which can show cell proliferation caused by estrogen exposure and cells that have matured under the presence of progesterone.
  • Blood tests can verify that progesterone levels are rising to expected levels during the luteal phase.
  • Ovulation predictor kits, available online and at drug stores, test for a release of LH (luteinizing hormone) from the pituitary gland (a precursor to ovulation), but do not establish that ovulation has actually taken place.

In Dr. Prior’s studies, she documented the effectiveness of monitoring molimina to predict ovulation. Molimina is the set of symptoms that appear before the menstrual period that indicate ovulation has occurred. These symptoms include:

  • The onset of pain high up in the underarm region
  • Fluid retention
  • Mood sensitivity
  • Appetite increase

These symptoms may be mild and not reach the severity of PMS symptoms. Dr. Prior notes that nipple pain and general pain in the breast indicate high estrogen levels, but not necessarily ovulation. If a woman has no awareness of an oncoming period, ovulation has probably not taken place.

Another way to track ovulation is to monitor body temperatures first thing in the morning. The progesterone produced following ovulation acts on the hypothalamus and increases body temperature. Temperatures will be above average for 10-16 days if ovulation has occurred. To monitor body temperatures, use a digital thermometer to record readings every day. Add up all the temperatures for the month and divide by the number of days to get the average temperature, and then count how many days have been above average.

Ovulation and Our Health

Few researchers have tracked the effects of ovulation and its related hormones on the body over the course of a lifetime, but Dr. Prior shares findings from a number of studies addressing specific aspects of women’s health, as well as her conclusions from this information.

  • A recent study demonstrated that the greatest increases in bone density for young women don’t occur until about one year after menarche, when ovulation starts and progesterone is produced from the ovaries. Progesterone has been seen to be active at the bone building sites, the osteoblasts. On the other hand, menstrual cycles without ovulation, especially during the perimenopause years, may account for increased bone loss.
  • For many years, researchers have observed that both estrogen and progesterone can contribute to breast cell growth and proliferation. However, initial observations were usually only made over a day or two. After a few days in cell cultures, estrogen continues to stimulate cell growth, but progesterone contributes to breast cell maturation and differentiation. These mature cells are less prone to become cancerous in the presence of progesterone.
  • A common myth about heart disease is that it is the same disease in women as in men. For example, cholesterol levels in women do not appear to correlate with heart disease as they do in men, and taking a daily aspirin for preventing a heart attack may work for men but not for women. It was thought that estrogen prevented heart disease because HDL levels were increased with adequate estrogen levels, but repeated studies demonstrate that this is a myth.
  • Progesterone may affect heart health in a number of ways. It may decrease blood pressure, and it doesn’t appear to be associated with clot formation. While restriction of blood flow in the arteries can increase heart attack risk, progesterone may reduce this risk by increasing blood flow as well as or better than estrogen. Progesterone also appears to help prevent insulin resistance and obesity, two important cardiovascular risk factors. Cycles without ovulation and progesterone production, therefore, could be considered a risk for heart disease.

What can we do to support ovulation and progesterone production? Reducing stress and a healthy, balanced diet are good first steps. In order to detect if ovulation is occurring, monitor pre-ovulatory days for symptoms, chart morning temperatures, or use ovulation predictor kits. If ovulation isn’t occurring, progesterone levels may become depleted. In this case, progesterone may be supplemented to achieve optimal levels. Dr. Prior recommends 300 mg of progesterone used in a cyclic fashion (use for two weeks, stop for two weeks) to restore progesterone lost from lack of ovulation.

As it turns out, we can’t assume everything is well just because we are having a monthly period. Much is going on behind the scenes. However, as stated above, we can pay attention to what our body is trying to tell us. By listening to our body, we can keep our body strong and healthy for years to come.

Ovulation is Crucial 2017-12-12T15:35:51+00:00

Book Review – The Pill Problem by Ross Pelton, RPh, CCN

Book Review – The Pill Problem: How to Protect Your Health from the Side Effects of Oral Contraceptives by Ross Pelton, RPh, CCN

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

In 1981, Barbara Seaman published Women and the Crisis in Sex Hormones and warned us emphatically about the dangers of using synthetic hormones, particularly in the form of birth control pills. Before oral contraceptives were approved, there were only studies involving small numbers of women and, although the FDA is supposed to give its stamp of approval for safety and efficacy, it was clear from the beginning that oral contraceptives are not safe. Women have died as a result of using oral contraceptives and yet, at the time, it was argued that women also die from pregnancy and delivery.

Fast forward to the present and we find that not only are oral contraceptives still being offered to young women (in fact, over 100 million women, thus making it a very lucrative business), but now women struggling with hormone imbalances at menopause are also being offered oral contraceptives as a solution!

It is unfortunate that in the few short minutes that are usually allotted for a visit with a medical practitioner, not much information can be shared about the breadth of health issues associated with oral contraceptives. And, it is even more unfortunate that some practitioners may not be fully aware of or realize the whole gamut of potential issues.

Pharmacist Ross Pelton is known for his extensive writing about the nutrient depletion that occurs when using various pharmaceuticals. His most recent book, The Pill Problem, is completely dedicated to the health problems associated with “The Pill.” He describes in great detail the myriad of health issues induced by the nutrient depletion associated with taking oral contraceptives. And, similar to other pharmaceuticals, because the depletion takes place over time, the problems that emerge are not always linked to the medication.

Pelton identifies the following health problems, and their associated depletions, as attributable to oral contraceptive use:

  • Energy depletion: Oral contraceptives deplete the B vitamins and co-Enzyme Q 10, all of which are involved in cellular energy production.
  • Blood clots: The depletion of magnesium, which could be made worse by also taking calcium supplements, can lead to life-threatening blood clot formation. This occurs not only with oral contraceptives but with other estrogens as well.
  • Birth defects: Folic acid (one of the B vitamins) is the nutrient needed to prevent neural tube defects.
  • Atherosclerosis: B vitamin depletion can also create abnormalities in homocysteine levels, which have been associated with the buildup of plaque in the arteries.
  • High blood pressure: Low magnesium and co-enzyme Q 10 can both contribute to elevated blood pressure.
  • Heart attacks: The heart is a muscle and, like all muscles, will go into spasm when magnesium is inadequate.
  • Cancer: Both selenium and folic acid have cancer protective properties.
  • Osteoporosis: Both calcium and magnesium are needed to create healthy bones. Without enough magnesium, calcium is not absorbed.
  • Immune System deficiencies: Both vitamin C and selenium are needed for white blood cell production. Zinc is also depleted and is needed to protect against all sorts of pathogens.
  • Depression: Deficiencies in B6, folic acid, B12, and tyrosine contribute to the significant amount of depression typically associated with oral contraceptives. Tyrosine is needed to make thyroid hormones, as well as the neurotransmitter hormones norepinephrine and dopamine.
  • Sleep disorders: The deficiency in B6 compromises the ability to make both serotonin and melatonin.
  • Candida overgrowth: The imbalances in hormone induced by oral contraceptives leads to a high risk of candida related issues. Candida overgrowth can impair the digestive tract, cause chronic sinus problems, and recurrent vaginal infections and discomfort.
  • Migraine headaches: The cyclic changes in oral contraceptives may be a trigger for migraine headaches. Additionally, depletions in magnesium, co-enzyme Q 10, and vitamin B2 may contribute to migraine headaches.
  • Fluid retention and weight gain: These effects can vary with individuals and the type of oral contraceptive used. High estrogen causes increases in kidney renin and angiotensin, which in turn increases water and salt retention. Weight gain from oral contraceptives can be as much as five pounds per year.
  • Sexual disturbances: Oral contraceptives can cause diminished interest, dry vaginal tissues and loss of orgasm. In addition, because sex hormone binding globulin (SHBG) increases, it interferes with testosterone and DHEA activity, potentially leading to painful intercourse.

Pelton explains that, because these effects do not occur shortly after swallowing just one or two pills, and because many practitioners do not know or take the time to describe the negative effects of oral contraceptives, many women may not make the connection that their health issues are directly tied to using “The Pill.”

The detailed information available in Ross Pelton’s book will help women and their practitioners understand the potential dangers and unintended health effects of taking oral contraceptives. Armed with this knowledge, women can work with their practitioners to either supplement for the losses they know will occur with oral contraceptive use, or they can choose alternative methods of birth control or menopausal symptom relief.

Book Review – The Pill Problem by Ross Pelton, RPh, CCN 2018-04-05T13:25:22+00:00

Dyspareunia (Painful Intercourse)

Dyspareunia: Painful Intercourse

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

The word dyspareunia is a general medical term referring to painful sex. Terms such as vulvodynia, vestibulodynia, and vaginitis refer to types of dyspareunia, and also indicate the origin of the pain.

Most of us usually don’t pay much attention “down there” until something goes awry. The issues can be a complex blend of emotional, psychological, and physical origin, thereby encompassing more than one medical specialty. Sometimes proper diagnosis and treatment of a physical condition can help emotional and psychological issues fade away, and vice versa.

Painful sex was the focus of the November 2012 meeting of The International Society for the Study of Women’s Health. Many of the case studies presented were about women who had consulted with many different practitioners, all of whom were unable to piece together the relevant information for proper diagnosis and treatment.

A critical aspect of proper diagnosis is the patient being familiar with and using proper terminology. Here’s a brief review for the purpose of this discussion: The vulva consists of the clitoris, urethra (for emptying the bladder), the opening to the vagina and the bit of tissue that surrounds the opening to the vagina, which is called the vestibule. The labia (lips) majora and minora fold around the opening to the vagina. The perineum is the tissue that extends from the opening of the vagina to the anus, which is the opening to the rectum. (For more information, please see the diagram in our newsletter on vaginal health titled Starting a Conversation About Vaginal Health)

One fairly common source of pain is the perineum tissue, which may sometimes tear and/or be cut and later stitched during childbirth. However, the part that tends to be the most troublesome and the source of the most pain is the vestibule.

Located on the inner side of the labia minora is Hart’s Line, which marks a transition between vaginal tissue and vestibular tissue. The vestibule is not made up of the same type of tissue as the rest of the vaginal area; it is the same tissue as that found in the urethra. Of particular interest is that this vestibular tissue requires adequate amounts of estrogen and testosterone to be healthy. Also of interest is that this tissue supplies the majority of the secretions that lubricate the area for sex.

Whether or not the vestibule is the source of pain can be detected by a simple cotton swab test. This involves touching the tip of a moistened cotton swab to the vestibular tissue and noting whether this touching elicits or increases the pain. Touching different parts of the vestibule can elicit different responses.

Causes for pain arising from the vestibule can include an excess number of nerve endings present since birth, nerve damage from childbirth, episiotomy (cutting the perineum), or accidents. Treatments vary from topical anesthetics to antidepressants, depending on the cause.

Pain can also stem from muscle spasms in the pelvic floor, which in turn causes problems with nervous system tissue. Treatments for muscle spasm include drugs such as Valium or muscle relaxants, physical therapy, or even hypnosis.

Dr. Irvin Goldstein maintains that the use of birth control pills is the greatest cause of vestibular pain. The interference of the synthetic hormones in birth control pills results in a deficiency of estrogen and testosterone in the vestibular tissue. Treatment consists of using preparations containing both of these hormones to restore the tissue to health. However, the type of cream or ointment used is key to avoiding or minimizing additional trauma to the painful area. Anti-inflammatory hormones, which are sometimes prescribed, provide little benefit. It is also important to stop any medications that may be interfering with the proper uptake of hormones to this tissue.

Dr. Deborah Coady has several suggestions to promote the health of the genital area. She advises against using soaps in the genital area because they are too drying, and avoiding creams containing benzocaine, alcohol, parabens, perfumes and propylene glycol. She also suggests wearing cotton underwear, changing it two or three times per day, and sleeping without underwear. She cautions against using minipads and recommends using hypoallergenic sanitary napkins.

To hydrate the area and reduce irritation due to friction, Dr. Coady suggests applying non-irritating products such as Aquaphor® healing ointment, vitamin E in grapeseed oil, or edible oils such as olive oil, safflower oil or coconut oil.

This discussion covers just a few important points to help begin the conversation about this sensitive topic. If you or someone you know is dealing with painful sex, please see the references below for more detailed information.

Dyspareunia (Painful Intercourse) 2018-04-09T12:19:28+00:00

How Important is Sex to Health?

How Important is Sex to Health?

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

These days, “sex” seems to be everywhere – in the news, in movies and on TV, in ads, on the internet – but that may not be the reality for a lot of people. What do we mean by “having sex?” Dr. Diana Hoppe defines sexual activity as caressing, hugging, foreplay, masturbation, or intercourse. And, according to Dr. Othniel Seiden, “A healthy person can expect to have an active sexuality throughout his/her life.”

Just how important is sex? Dr. Steven Lamm contends that “We are all sexual beings and sex is an essential part of who we are.” There is an important connection between sexual activity and good health. Men, in particular, define themselves by the quality and hardness of their erections. Physical strength, self-confidence, and mental acuity are the essence of being a man. The quality of their erections mirrors the quality of their health. In The Hardness Factor: How to Achieve Your Best Health and Sexual Fitness at Any Age, Dr. Lamm proposes that the key to increasing a man’s awareness of his own health is to motivate him with the potential for better sex.

The “X”

Sexual performance is not just a concern of older men; young men can experience difficulties with sex as well. Approximately 34% of men between the ages of 40 and 70 experience some degree of sexual dysfunction. Lifestyle choices such as smoking or poor diet play a significant role in sexual health. Diseases such as hypertension, diabetes, obesity, sleep apnea, high cholesterol, and heart disease are also contributing factors. Many common medications (such as anti-depressants, statins, and drugs to treat high blood pressure, heart disease, and obesity) have side effects that hinder sexual function in men.

Dr. Dudley Seth Danoff claims that there is a veritable epidemic of penis weakness occurring today, including both real and imagined deficiencies in sexual function. One very significant problem is the increased stress in our society. Men (and women) who work long and stressful hours are often physically and mentally drained at the end of their day. Topping that off with fighting traffic to come home to financial worries and/or family conflicts creates an immediate stress response that is both psychological and physical. The accumulated stress and anxiety triggers an outpouring of epinephrine from the adrenal glands, causing blood to move away from the genitals and into the larger muscles in the arms and legs. No wonder many people struggle with getting “in the mood” for sex.

The “O”

Central to any discussion about sex is “the big O” (slang for orgasm). Orgasm refers to the release and intense pleasure felt at the climax of sexual excitement. Orgasms are good for you! Not only are they a great stress reliever, but orgasms increase blood flow and reduce blood pressure. The risk of heart attack and stroke plummets in people who have orgasms on a regular basis.

Orgasm also increases the production of some hormones, with beneficial results. For example, increases in dopamine (a brain neurotransmitter) create a feeling of well-being and pleasure. The adrenal hormone DHEA can increase as much as five times its normal level during orgasm, which boosts the immune system and leads to improved bone and tissue growth. Having orgasms at least once or twice a week also promotes formation of the antibody IgA, which contributes to a strong immune system.

However, the hormone most associated with orgasm is oxytocin, a primitive hormone produced by the hypothalamus and secreted by the pituitary gland. Both men and women produce large amounts of oxytocin during pleasurable sex, peaking at orgasm. During orgasm, oxytocin stimulates the muscle contractions associated with climax, stimulating the release of the female’s eggs and aiding in the transport of the male’s sperm.

Unlike other hormones, oxytocin even stimulates the production of more oxytocin. As it floods the body during and after intercourse, oxytocin relaxes the blood vessels making us feel calm and a bit drowsy. It reduces pain and helps heal wounds, both physical and psychological. Oxytocin functions as a bonding hormone, creating a closeness between consensual sex partners; it is also present in large amounts in women at childbirth and during breast feeding, fostering the close relationship between mother and child.

Dr. Gordon Gallup, Jr., an evolutionary psychologist at SUNY, proposes that orgasms are a biological imperative. He theorizes that the orgasm evolved as a pleasurable response for higher mammals to encourage a higher frequency of sex. In mammals, the rate of conception as the result of a sexual encounter is only 1%. Having sex associated with pleasure makes future encounters more likely.

A woman’s rate of orgasm is dependent upon the desirability of her partner. It seems that good genes and physical appearance contribute to that desirability. However, a study done in China showed that women have more orgasms if their partners are wealthy. It may be that wealth has become a modern day indicator of biological fitness. Wealth implies more intelligence and competitiveness, qualities that may be seen as more important than physical qualities in today’s society.

Women who have unprotected intercourse seem to benefit from various hormones found in semen. Studies have shown that they experience an elevated mood and decreased stress, lasting for days afterwards.

Sex is Healthy!

Dr. Hoppe claims that sex is good for us for many reasons, not the least of which is that it burns calories. Sex can be a great workout! Sex also contributes to longevity—it actually slows down the aging process. Health reasons for promoting frequent sex with orgasm include:

  • Relieves stress
  • Eases depression
  • Improves digestion and sleep
  • Helps to relieve pain by releasing oxytocin
  • Boosts the immune system with increased DHEA and IgA
  • Improves memory and learning by increasing blood flow to the hypothalamus
  • Improves the sense of smell by releasing prolactin, a pituitary hormone
  • Increases blood flow to the vagina to keep the tissue less likely to dry out and atrophy
  • Seems to improve bladder control.

Endorphins (our bodies’ own opiates) also increase during orgasm, so it just makes us feel good all over. Plain and simple, sex is a natural high. If that’s the case, then why do some people lose their interest in sex?

The Power of the Brain

While the excitement seems to build in the genitals, the brain is the largest sex organ. And it is the brain that controls libido, the drive that fuels the desire to have sex.

Women tend to have a fluctuating libido, depending on their age, their partner desirability (mentioned above) and a host of other factors (see box at right). Men have stronger sex drives than women and are almost always in the mood. This is not surprising because the male area of the brain devoted to sex drive is approximately 2½ times larger than the female counterpart.

Stages in a Woman’s Life and the Effect of Libido
Follicular Phase:Desire fuels up
Ovulation:Desire is on full “go”
Luteal Phase:Desire is diminished
Pregnancy:Desire fluctuates
Perimenopause:Desire fluctuates but tends to be in “maybe”
Menopause:Desire fluctuates between “red hot” and “no thanks”

The Magic of NO

Nitric oxide (NO) is a small but powerful molecule produced by the epithelium, which is the lining (only one cell thick) of all the blood vessels, large and small, in the body. When NO is released, the blood vessels relax. And when the blood vessels in the penis relax enough to fill with blood, the penis hardens producing an erection. Drugs like Viagra and Cialis work by making more NO available.

It is now thought that the inability to maintain an erection, or erectile dysfunction (ED), is an early warning sign for cardiovascular disease. All of the risk factors for cardiovascular disease—including high blood pressure, high cholesterol, high triglycerides, diabetes, cigarette smoking, physical inactivity, high homocysteine levels, and aging—cause damage to the endothelial layer and consequently impair the normal production of NO. It seems like men get all the attention surrounding this, but NO production and increased circulation to the clitoris are absolutely necessary for orgasm to occur in women, too.

Diet also plays an important role in the production of NO in the body. There has to be enough nitrates and nitrites available to provide the nitrogen needed to form the nitric oxide molecule. Foods rich in nitrates include dark chocolate, (skip the milk chocolate, since milk can potentially worsen inflammation in the endothelium), black tea, walnuts (the best of all the nuts), brown rice, spinach and leafy green vegetables, pomegranate juice, orange juice, popcorn (high in l-arginine, the amino acid that increases NO), and beetroot juice.

The Mysteries of Sex

Even after so many years of existence and practice, the how and why of human sexuality still contains many mysteries. The production (or supplementation) of testosterone—long thought to be the hormone of desire—is just one of many factors. There are many biochemical intricacies, which are compounded by issues like self-esteem, a person’s general mental and physical health, and the various subtleties of attraction. We encourage you to explore the wealth of information in the references below to enhance and enjoy your sexual health.

How Important is Sex to Health? 2018-04-09T13:28:02+00:00