Sexual Health Consultation — A Conversation Your Gynecologist Should Be Having With You
Sexual health is part of overall health — and one of the areas most consistently underaddressed in routine gynecologic care. Many women experience changes in libido, pain with intercourse, vaginal dryness, difficulty with arousal, or loss of satisfaction at some point in their lives — and most never bring it up with their physician because they assume it is a normal part of aging, or because they expect the conversation to be dismissed.
At Lapeer Women’s Health, Dr. Andrei addresses sexual health concerns directly and without judgment. The sexual health consultation is a dedicated appointment to evaluate the physical, hormonal, and where relevant, relational contributors to sexual dysfunction — and to present treatment options that are evidence-based, realistic, and tailored to your situation.
Sexual health concerns are not cosmetic. They are clinical. Low libido driven by testosterone deficiency, painful intercourse caused by vulvodynia or vaginal atrophy, and difficulty with arousal from estrogen insufficiency are all conditions with identifiable causes and effective treatments. The consultation is where that process starts.
Sexual Health Concerns Dr. Andrei Evaluates and Treats
These are the sexual health conditions most commonly addressed at the consultation visit at Lapeer Women’s Health.
Low libido (hypoactive sexual desire)
Reduced interest in sexual activity is the most commonly reported sexual health concern in women. Contributors include testosterone insufficiency, estrogen decline, depression, relationship factors, medication side effects (particularly SSRIs and hormonal contraceptives), and chronic illness. Dr. Andrei evaluates the hormonal contributors specifically and discusses testosterone therapy in appropriate candidates.
Painful intercourse (dyspareunia)
Pain with intercourse has multiple potential causes — vaginal atrophy from estrogen deficiency, vulvodynia, vestibulodynia, pelvic floor hypertonia, endometriosis, fibroids, or ovarian cysts causing deep dyspareunia. Dr. Andrei distinguishes between entry pain, deep pain, and pain occurring after intercourse to guide the evaluation and treatment approach.
Genitourinary syndrome of menopause (GSM)
Vaginal dryness, atrophy, burning, recurrent UTIs, and urinary urgency caused by estrogen decline — affecting the majority of postmenopausal women. Local vaginal estrogen, ospemifene (Osphena), and DHEA (Intrarosa) are all effective options. Dr. Andrei discusses each, including safety for patients with a history of hormone-sensitive conditions.
Difficulty with arousal or orgasm
Arousal and orgasm difficulties can be driven by hormonal insufficiency, pelvic floor dysfunction, medication side effects, neurologic factors, or psychological contributors. Dr. Andrei evaluates the identifiable physical and hormonal factors and provides appropriate treatment or referral to a pelvic floor physical therapist or sex therapist when indicated.
Vulvodynia and vestibulodynia
Chronic vulvar pain or burning without an identifiable skin condition — including provoked vestibulodynia causing pain specifically at the vaginal opening with touch or penetration — is evaluated by clinical examination. Treatment options include topical agents, pelvic floor physical therapy, low-dose tricyclic antidepressants, and referral to vulvar disease specialists.
Sexual health after cancer treatment
Chemotherapy, radiation, and aromatase inhibitor therapy cause significant sexual side effects — severe vaginal atrophy, loss of libido, dyspareunia, and body image changes. Dr. Andrei provides sexual health management for cancer survivors, including local vaginal therapy options appropriate for patients with hormone-sensitive cancers when approved by the treating oncologist.
What Sexual Health Treatment Looks Like at LWH
Sexual health treatment at Lapeer Women’s Health is evidence-based, individualized, and frank. Dr. Andrei does not offer a single-solution approach — treatment is matched to the specific diagnosis identified at the consultation.
- Local vaginal estrogen — cream, tablet, insert, or ring; highly effective for GSM with minimal systemic absorption; safe for most women including many with breast cancer history
- Ospemifene (Osphena) — oral SERM for dyspareunia from GSM; non-estrogen; improves vaginal tissue without vaginal application
- DHEA vaginal insert (Intrarosa) — converts locally to estrogen and testosterone in vaginal tissue; effective for GSM and dyspareunia
- Testosterone therapy — compounded topical gel or cream for low libido in appropriate candidates; monitored by lab values
- Pelvic floor physical therapy referral — for hypertonic pelvic floor contributing to dyspareunia or vestibulodynia
- Systemic hormone therapy — when GSM and libido concerns coexist with vasomotor symptoms requiring systemic treatment
“Sexual health concerns are among the most common things women don’t bring up — because they expect to be told it’s normal, or because they’re embarrassed, or because they’ve already been dismissed once. This is a clinical conversation I actively invite. There are almost always things we can do.”
- Consultation includes a focused history, pelvic examination, and hormonal lab review when indicated
- Q-tip test for vestibulodynia performed when entry pain is the primary complaint
- Hormone levels — estradiol, testosterone, SHBG — drawn when hormonal contribution is suspected
- Pelvic floor physical therapy referral coordinated locally in Lapeer County and Oakland County
- Sex therapy referral available when psychological or relational factors are the primary driver
- Ongoing management visits for patients on testosterone or local estrogen therapy
Questions About the Sexual Health Consultation
Sexual Health Concerns
Deserve a Real Answer.
Low libido, painful intercourse, vaginal dryness, or changes in sexual function — these are clinical concerns with identifiable causes and effective treatment options. The consultation is where that process starts.
The information on this page is intended for educational purposes only and does not constitute medical advice. Individual symptoms, diagnoses, and treatment options vary significantly. Reading this content does not establish a physician-patient relationship with Dr. Ramona D. Andrei or Lapeer Women’s Health. If you are experiencing a medical emergency, call 911 or go to the nearest emergency room immediately. Please consult a qualified healthcare provider for advice specific to your situation. Content reviewed by Dr. Ramona D. Andrei, MD PhD FACOG.
Gynecologic care for women of every age
Lapeer Women’s Health — Rochester Hills
2710 S Rochester Rd, Suite 2
Rochester Hills, MI 48307
Serving patients in Lapeer, Rochester Hills, and surrounding communities throughout Southeast Michigan.