Sexual Healing by Dr. Margarita Kressin

A penis is not just a penis.

One of the things that was covered quite comprehensively at the Sexual Medicine Society of North America meeting I recently went to was the topic of how erectile dysfunction (ED or when a man can’t get an erection) can be a marker for cardiac disease. Let me explain:

There is a huge association between ED and coronary heart disease (CHD). We know that CHD is a marker for ED and consequently, ED is a predictor for future CHD especially in younger (40s) patients. One study that took into account the age of the patient when he develops ED showed that if you are young (40s) and have ED, you have double the risk of having CHD versus if you are older (70s) when you develop ED.

We know that there are common risk factors between ED and heart disease such as:

• Age >40
• High blood pressure
• High cholesterol
• Diabetes
• Depression
• Obesity
• Sedentary lifestyle (couch potato)
• Smoking

So, the message is if you have any of the above, you have a greater chance of developing ED. And if you have ED, you need to make some lifestyle changes or at least get checked to prevent heart disease. On the plus side, if you are healthy, and prevent the development of the above conditions, your risk of developing ED and CHD is lowered. So yes, it’s a bit simplified, but the penis is a measure of cardiac health.

I came from a meeting this past weekend in Chicago of the Sexual Medicine Society of North America (SMSNA). It was a very good meeting, and I learned a lot of new things that I can incorporate in my practice.

What was interesting, and one of the speakers did make an observation of it, was that Female Sexual Medicine was not well-represented. Case in point, the meeting started on Thursday at 1:00 pm and went until Sunday at 12:30 pm. Essentially four days of sessions — mostly on male sexual medicine. The lecture on female sexual dysfunction (FSD) went from 9:00 to 9:30 one day as a debate. The debate was whether FSD was relevant to the ED (erectile dysfunction) specialist? There is nothing wrong with this question. The problem is that even the FSD session is linked to a male question. Even the topic of Circumcision for the Prevention of HIV was given a whole hour.

There were also six poster sessions, and one was at least delegated to FSD. Don’t get me wrong, I love treating my guys as much as my women. And they do have issues themselves (some of which will be covered in the next few blogs. Don’t worry I haven’t forgotten about Harriet and George.) that should not be ignored. But it just shows that women, female sexual health specifically, has a loooong way to go.

One may say, "But you have ISSWSH, the International Society for the Study of Sexual Health." And thank goodness for that. My point was that this is the SMSNA, not the Male SMSNA. Or maybe the meeting should be changed to that name.

Again, I was glad I went and learned a lot. I just couldn’t help noticing the disparity in the representation of female sexual health. And, unfortunately, I don’t foresee it changing anytime soon.

I recently caused an uproar in my clinic. I was seeing a young woman, I will call Irene, who was having urinary issues and part of her complaints was external vulvar burning. We go through the usual evaluation: history, physical, meds, habits.

I then asked if she douches, which women should NEVER do. The vagina is a self-cleaning oven. One does not need to flush stuff in it to get it clean.

No, but I do use soap to wash down there?

Oh, no, no, no.

The vagina’s pH is acidic (about 4) and most soap is basic (anything above 7). At best they are neutral (7).

You must have a base, or caustic solution to make soap. The two most common caustic solutions in use for soap making today are sodium hydroxide (lye) [NaOH] and potassium hydroxide [KOH], both bases.

Here are some sample pH values:

Soap	pH
Camay	9.5
Dial	9.5
Dove	7.0
Irish Spring	9.5
Ivory	9.5
Lever 2000	9.0
Palmolive	10.0
Zest	10.0

Irene, as well as the nurse and nursing student following me in my clinic, were surprised with this fact. They were all using soap in that area; as do the majority of our nurses and patients, I am coming to find out. In essence, they are going against the natural way the vagina keeps itself healthy by counteracting the vagina’s pH and neutralizing it.

I normally do not endorse any products, but since I told you what NOT to use, I should at least give alternatives. Plus, when I showed this article to some of my co-workers, they all wanted to know what was safe to use.

Summer’s Eve for sensitive skin and Sweet Spot Brand (Small Stones, a Froedtert & the Medical College of Wisconsin health resource center, carries this one). We actually tested these products with pH paper in the clinic and the pH’s came out to 4, which match the vagina.

So ladies, please, please, please do not use soap to clean the vaginal area. Tell your mother, sister and friends not to use soap. Water is good enough. If you must, for whatever reason (habit, fear of odor, just want to), use soap, there are pH-balanced (to the vagina, not just pH-balanced, as in, neutral) products out there.

Also, if there is truly a smell that is quite offensive, I would consult your doctor as this may be a medical issue.

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The following is feedback received for this blog:

The article about soap was really surprizing! I will forward it to my girl friends. Thank you. -   Kathleen T. I never heard of this before. I wonder if this would help some VV patients. I'm going to add you to my site. Thanks! -- Lauren Kunis www.vulvodyniasupport.com   Re: 'I fell I have to inform you'. Who ever knew?! Dr. Kressin's information re: the PH of soap is fasinating and clearly makes sense. Gardeners know that the soil PH needs to meet specific flower requirements to provide vibrant, gourgeous, long lasting flowers. Ladies, we are so much like flowers. Dr. Kressin's PH insite, I'm sure, will help my husabnd and me. thank you Dr. Kressin! - E. Lauren