The Insider:
Hi Dr. Horowitz. Thanks for speaking with The Insider today.
Dr. Renee Horowitz:
My pleasure.
The Insider:
Before we get started, I’d like to find out a little about your background and your practice. Which city do you practice in?
Dr. Renee Horowitz:
I practice in two locations near Detroit: Farmington Hills and Royal Oak. One location is for my general gynecology practice and the other is a multidisciplinary clinic for woman with chronic pelvic pain and/or sexual and urologic issues.
The Insider:
How would you briefly describe the patient population that you see? Young? Old?
Dr. Renee Horowitz:
I really see all ages. A lot of menopausal women, but when you are dealing with sexual issues, they occur in young women, older women and in-between.
The Insider:
How would you describe your area of specialization?
Dr. Renee Horowitz:
I specialize in sexual dysfunction, whether it is due to pain, arousal or orgasmic disorders or low libido. Because much of pain involves vulvar disease, I see a lot of women with issues involving their vulva. Studies have revealed that the highest incidence of sexual dysfunction is in the 45-65 year range; consequently, I do a significant amount of menopausal medicine.
The Insider:
And you’re an OB/GYN by training?
Dr. Renee Horowitz:
I am but no longer doing the birthing.
The Insider:
How did you happen to end up with the specialty of sexual dysfunction?
Dr. Renee Horowitz:
Even as a resident I was interested in it. I would frequently have women come in, and as I was finished with an exam and about to leave they would say, “one more question, please. I love my partner but have no desire to have sex.” Unfortunately, at that time, there was minimal research or answers for these women. In the early 2000s, I went to a conference in Amsterdam that was put on by The International Society for the Study of Women’s Sexual Health that really got me excited about the field.
The Insider:
You’ve said before that low libido is the most common sexual complaint that you hear from your patients. I think that would surprise many people.
Dr. Renee Horowitz:
It is a complicated issue that I see frequently. Our libido is controlled by our biology, our interpersonal relationships, our psychology and our culture. There are many, many factors that make up our desire Who wants to have sex if their relationship is conflicted, if they are depressed or anxious, if they have significant health issues or are on medications that have a direct effect on the neurotransmitters that control their desire?
The Insider:
I’m guessing that many women find it difficult to ask you for help about this.
Dr. Renee Horowitz:
That is true, but as a health care provider, it is my responsibility to ask and give my patient permission in a safe environment to talk about it without judgement . Unfortunately, most primary care providers do not screen for sexual issues. They are embarrassed, don’t want to open a Pandora’s box and don’t have the knowledge to help because it is not taught in medical school.
The Insider:
I would imagine that it takes some detective work to figure out why a particular woman is having low libido issues.
Dr. Renee Horowitz:
It does. So many issues may influence it. Is there enough privacy in their home? Having a child burst in the room while you are engaged in sex is a mood killer! Our body image may play a part as well as our stress level.
I think what is important is for women to realize that most of the time they are not broken. There is nothing wrong with them. Some of this boils down to the sexual response cycle. Briefly, most men have desire and then become aroused. For women–and this does not necessarily apply to all times in their live and with all partners–they become aroused and then they have desire.
Certainly pain affects desire, as does the inability to become aroused and/or have an orgasm. Next to low desire, pain is a huge part of my practice. If someone has pain and low desire, I treat the pain, and in a large percentage of the time, desire improves. Who wants to have sex if it’s painful? Sex should never be painful and if it is, a woman should seek help.
The Insider:
Do you ever talk to their partners, or would that be too much like “marriage counseling”?
Dr. Renee Horowitz:
I initially talk with the women. I think they are less inhibited talking about their problems without their partner there. But if they want, I will always set up another appointment with their partner.
The Insider:
At times, do you ever get the sense that it’s situational, a relationship between two people who don’t belong together?
Dr. Renee Horowitz:
Absolutely. Those are cases where the couple might benefit from marital therapy.
The Insider:
What should a woman who is experiencing this do about it? Should she start by talking with her partner or go and get professional help?
Dr. Renee Horowitz:
Communication is essential and I always encourage patients to discuss how they feel with their partners in an honest and truthful fashion. Discussing sex can be very difficult, even for long term partners. Sometimes it might be something as simple as timing–some like sex in the morning, some at night. If it can’t be resolved, then seek out a provider who is interested in treating sexual issues.
The Insider:
What is your advice for women about finding the right expert? Would a medical expert be the best first stop?
Dr. Renee Horowitz:
I would start with your gynecologist, and if they are not equipped, then I would ask for a referral. I would look for someone who is a member of the International Society for the Study of Women’s Sexual Health (ISSWSH.org).
I think an important message is that there is treatment. whether it is medication, marital therapy, sexual therapy, or pain management. There are providers out there who can help.
The Insider:
Are there books that offer useful advice?
Dr. Renee Horowitz:
I personally like Mating in Captivity.
The Insider:
Does the same thing sometimes occur in men?
Dr. Renee Horowitz:
It does. Not as often but some men have low desire. Maybe it’s due to their health, medicine or just an inherent low sexual desire.
The Insider:
Many thanks, Dr. Horowitz! This has been very illuminating.
Dr. Renee Horowitz:
You are very welcome.