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Readers recently submitted questions about female sexuality to Dr. Susan Kellogg , a professor of obstetrics and gynecology at the Drexel University College of Medicine in Philadelphia; a professor of human sexuality at Widener University in Chester, Pa. Kellogg is also the co-founder of the Pelvic and Sexual Health Institute of Philadelphia, where she is the director of vulvar and sexual medicine, and a member of the editorial board of The Journal of Sexual Medicine. Some questions have been edited. Because of the large number of submissions, we will print a second round of responses next Wednesday, but not every question may be addressed. This feature is closed to further questions.

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SEE VIDEO BY TOPIC: Scientists trial female sex hormone for Covid-19 patients

By the way, doctor: Is vaginal estrogen safe?

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To determine if sexual intercourse reduces absorption of vaginal progesterone gel in women and to determine if progesterone is absorbed by the male during intercourse. Study Design. Serum progesterone for both male and female partners were measured 10 hours after intercourse. One week later, subjects were crossed over to receive the opposite formulation. In the third week, women used progesterone gel at night and abstained from intercourse.

Men absorbed significant progesterone during intercourse with a female partner using vaginal progesterone gel compared to placebo. Conclusion s. Vaginal progesterone gel is reduced in women after intercourse which may decrease drug efficacy during luteal phase support. Because men absorb low levels of progesterone during intercourse, exposure could cause adverse effects such as decreased libido.

Vaginal progesterone cream may be used by women for several clinical indications, and if intercourse alters the absorption and distribution of vaginal progesterone, clinical outcomes may be compromised. Progesterone supplementation is commonly used for luteal phase support in assisted reproductive technology ART as it has been shown to increase ongoing pregnancy rates [ 1 ].

ART outcomes have been shown to be equivalent when using vaginal progesterone gel and intramuscular progesterone, but vaginal progesterone tends to be better tolerated by women [ 2 , 3 ]. Additionally, vaginal progesterone has been shown to reduce the rate of spontaneous premature delivery before 34 weeks in women with a short cervix [ 4 ]. Male absorption of progesterone could have adverse effects.

Progesterone therapy was introduced in the s as a potential treatment of men who were convicted as sexual offenders and paraphilias. Medroxyprogesterone use in men was reported to temporarily decrease serum testosterone and gonadotropin levels resulting in decreased libido, frequency of erection, and spermatogenesis [ 5 — 7 ].

Increased amounts of progesterone in men whose partners are using vaginal progesterone gel could have similar consequences. The effects of intercourse on the absorption of vaginal progesterone for the female user and her sexual partner have not been studied.

However, a previous study performed by our group found that intercourse lowered the absorption of vaginal estrogen cream in women, and men absorbed a small but statistically significant amount of estradiol during intercourse [ 8 ].

This was a prospective, randomized, placebo-controlled, blinded, crossover study of 20 reproductive-aged women and their male sexual partners, ages 18— Sample size was based on a previous study performed by our group assessing vaginal estrogen absorption; the sample size was doubled from the previous study to achieve adequate power. Mircette was used to minimize variability in progesterone levels during the study; a prior unpublished internal study demonstrated that the progestin desogestrel had no cross reactivity with the serum progesterone assay used.

The study medication and placebo were assembled by the pharmacy, blinded to the investigators and women, and given to couples in computer-generated random order.

The progesterone or placebo was administered at night, 1 hour before intercourse, and serum progesterone was measured for the subject and her partner 10 hours after intercourse. One week later, the subjects were crossed over to receive the opposite formulation, but the same protocol was used. In the third week, women used progesterone gel at night and abstained from intercourse, and blood was drawn 11 hours later. The time of insertion of the cream and the time of intercourse when applicable were recorded to the nearest half hour on a data sheet and returned to the study nurse via preaddressed and stamped envelopes Figure 1.

Inclusion criteria included sexually active heterosexual women and their partners 18—40 years old, willing to take Mircette birth control pills for at least one cycle, willing to have intercourse and blood draws at defined times, and willing to sign informed consent. Exclusion criteria included contraindications for oral contraceptives, known sensitivity to vaginal progesterone gel, use of condoms during intercourse, or male erectile or ejaculatory dysfunction.

Recruitment of study participants occurred between November and September The trial ended when all 20 couples completed the entire three-week protocol of the study. Descriptive statistics including mean, medians, standard deviations, and interquartile ranges were calculated. Shapiro-Wilk tests were used to test for normality. Several variables were not normally distributed; therefore, nonparametric tests were used.

The Friedman two-way analysis of variance by ranks was used to determine if the distributions of the serum progesterone levels are different for the three treatment groups. Wilcoxon matched-pairs signed rank tests were used to compare the serum progesterone levels for the different treatment groups.

The Wilcoxon rank sum test compared serum progesterone levels between women who received vaginal progesterone gel in the first time period and women who received vaginal progesterone gel in the second time period.

Similarly, we also compared women who received the placebo gel in the first time period with women who received the placebo gel in the second time period. The order of treatments was not found to affect serum progesterone measurements for the two groups. SAS Enterprise Guide, version 5. A two-tailed value of less than 0.

When vaginal progesterone gel was used, intercourse markedly reduced serum progesterone levels 2. As expected, serum progesterone levels were significantly higher with vaginal progesterone administration compared to the vaginal placebo median 6. Serum progesterone with placebo and intercourse was significantly less than vaginal progesterone gel and intercourse median 0.

Serum progesterone levels were significantly higher in men whose female partners used vaginal progesterone gel compared with men whose female partners used placebo 0.

The final sample size was 19 couples; 1 couple moved out of town prior to completing the study. Demographic information is provided in Table 1. Each analysis included all 19 couples because it was a crossover study. No harms or unintended effects occurred during the trial. This study demonstrates that intercourse lowers serum progesterone significantly in women using vaginal progesterone gel. Progesterone levels were not different between 1st and 2nd cycles in the crossover design in either group.

Based on these results, it is possible that intercourse during luteal phase support could decrease drug efficacy in women using vaginal progesterone. It is well known that progesterone supports embryo implantation and helps to maintain early pregnancies [ 2 , 9 ]. Progesterone supplementation during luteal phase after ART has been shown to increase ongoing pregnancy rates [ 1 ].

Vaginal progesterone has also been shown to be effective in reducing rates of spontaneous preterm deliveries in women with asymptomatic short cervix [ 4 ]. Therefore, a decrease in drug absorption with intercourse could lead to reduced pregnancy rates and increased risks of miscarriage in women with otherwise successful fertility treatment, as well as increased rates of preterm delivery in women with a short cervix.

The exact mechanism which causes decreased absorption of vaginal progesterone during intercourse is unclear, and it is outside the scope of this study. Possible explanations may include absorption by the male partner, dilution effect from vaginal secretions or seminal fluid, or a rapid spike followed by rapid decline in progesterone levels due to increased blood flow to the vagina during intercourse.

Further studies regarding the pharmacokinetic changes over time after intercourse in both the male and female partners would be necessary to further elucidate the answer. Regardless, the observation that intercourse significantly lowers progesterone levels when vaginal progesterone cream is used is of concern, since intercourse may lower the efficacy of the drug.

Men absorb low but significant levels of progesterone after intercourse with a female partner using vaginal progesterone. Male exposure to progesterone during the typical 8—12 weeks used during early pregnancy could cause adverse effects such as decreased libido.

When progesterone medroxyprogesterone was used for treatment of male sex offenders starting in the s, men were noted to have reduced sexual thoughts and fantasies, frequency and pleasure of masturbation, and frequency of early morning erections on awakening [ 6 ]. Although vaginal progesterone gel is not similar to medroxyprogesterone, the effects of vaginal progesterone gel have not been directly studied in men and therefore are not known.

These results are consistent with results of a previous study performed by our group which showed that intercourse lowered the absorption of vaginal estrogen cream in women, and men absorbed a small but statistically significant amount of estradiol during intercourse [ 8 ]. Strengths of this study include being both blinded and a crossover study. Furthermore, our sample size was chosen based on power calculation and was sufficient to identify changes in progesterone levels.

Limitations include use of serum progesterone as a measure of vaginal progesterone absorption, no examination of delayed intercourse, and not knowing the clinical significance of decreased serum progesterone in women who use vaginal progesterone.

We chose to use serum progesterone levels to measure the absorption of vaginal progesterone gel in women and their male sexual partners. Because of their wide range and fluctuations, serum progesterone levels have not been proven to have clinical utility in determining luteal phase deficiency [ 11 , 12 ]. Another measure of progesterone absorption is histologic assessment of the endometrium, but endometrial histology has also proven to be invalid measure of luteal phase deficiency [ 11 , 12 ].

There are alternative measurements of absorption such as measuring endometrial progesterone levels in endometrial biopsy samples or assessing binding of endometrial progesterone receptors [ 13 , 14 ]. Serum progesterone measurements were chosen for this study because they are less painful and less expensive for the research volunteers than endometrial biopsy procedure. The aim of this study was to determine progesterone absorption as it is altered by intercourse, which is adequately measured by serum progesterone.

Further, variability in progesterone level was minimized using Mircette oral contraceptive, which does not cross react with the serum progesterone assay.

This study did not look at the effect of delayed intercourse on absorption of vaginal progesterone. In many women, vaginal progesterone is administered in the morning, and intercourse may take place later in the evening. We chose to use Crinone in this study as it is FDA-approved for luteal support [ 9 ]. Other forms of vaginal progesterone have been described in the literature [ 15 ]. Further research would be required to determine if our results apply to the use of other formulations.

The absolute treatment levels for pregnancy maintenance are not known, nor is it known what level of progesterone may impair male libido. While the absolute lowest serum progesterone level to achieve a viable pregnancy is unknown, one case report described first trimester progesterone levels of 1.

The difference in ratios should not be surprising, since serum levels are relatively low when vaginal progesterone is used. First, there is no vascular portal circulation from the vagina to the uterus. Vaginal progesterone must be absorbed by the capillaries in the vagina and then transported via veins, heart, and arteries before it is circulated to the uterus and the endometrium.

It is clear from our data that serum progesterone levels are relatively low, compared to typical mid-luteal levels. If endometrial progesterone exposure is low with vaginal progesterone, it could be predicted that more spotting would occur with the use of vaginal progesterone and less with the use of intramuscular progesterone, and more spotting or light bleeding with vaginal progesterone use is exactly what has been shown to occur when used for IVF [ 2 ].

While clinical studies have shown that vaginal progesterone is adequate to achieve ART pregnancies and live births and can achieve outcomes comparable to intramuscular progesterone [ 2 ], it is concerning that intercourse could further lower the endometrial exposure to progesterone when it is used vaginally and possibly lower live birth rates.

Although we do not yet know the clinical significance of decreased vaginal progesterone as a result of intercourse, important conclusions regarding progesterone absorption for both women and men may be drawn from this novel randomized controlled study.

The significantly decreased absorption of progesterone in women with intercourse may lead to adverse pregnancy outcomes for those undergoing ART and women with short cervix using vaginal progesterone to prevent preterm labor. Increased absorption in men after intercourse with women using vaginal progesterone gel, while not directly known, may have adverse effects on libido.

These observations are especially troubling since there are only two progesterone formulations approved by the FDA, and both require vaginal administration. However, further studies are needed to elucidate the effect of decreased vaginal progesterone on ART outcomes and on premature delivery rates in women with short cervix as well as on male response to increased progesterone. None of the authors Kathryn S.

Merriam, Kristina A. Leake, Mollie Elliot, Michelle L. Matthews, Rebecca S. Usadi, and Bradley S. Hurst have a conflict of interests to disclose.

Vaginal Estrogen Cream Not Good for Guys

Jump to content. Brand: Divigel 0. Estradiol may increase your risk of developing a condition that may lead to uterine cancer. Report any unusual vaginal bleeding right away. Estradiol topical is absorbed through the skin and can cause side effects in a child who comes into contact with the skin where you have applied the medicine.

To determine if sexual intercourse reduces absorption of vaginal progesterone gel in women and to determine if progesterone is absorbed by the male during intercourse. Study Design. Serum progesterone for both male and female partners were measured 10 hours after intercourse.

Transdermal estrogen, which is absorbed directly through the skin, offers one option for relief of menopausal symptoms. The gels Divigel, Elestrin, Estrogel and emulsion lotion Estrasorb are applied to the arms or legs as directed. The spray Evamist is applied to the inside of the forearm between the elbow and the wrist. There are also estrogen creams prepared and dispensed from compounding pharmacies but these are not approved by the FDA.

Ask Ila: Are vaginal estrogens safe?

Estrogens are hormones produced by the body. Among other things, estrogens help develop and maintain female organs. When your body is in short supply of this hormone, replacing it can ease the uncomfortable changes that occur in the vagina, vulva female genitals , and urethra part of the urinary system. Conditions that are treated with vaginal estrogens include a genital skin condition vulvar atrophy , inflammation of the vagina atrophic vaginitis , and inflammation of the urethra atrophic urethritis. Estrogens work partly by increasing a normal clear discharge from the vagina and making the vulva and urethra healthy. Using or applying an estrogen relieves or lessens:. When used vaginally or on the skin, most estrogens are absorbed into the bloodstream and cause some, but not all, of the same effects as when they are taken by mouth. Estrogens used vaginally at very low doses for treating local problems of the genitals and urinary system will not protect against osteoporosis or stop the hot flushes caused by menopause. Tell your doctor if you have ever had any unusual or allergic reaction to medicines in this group or any other medicines.

Sexual Absorption of Vaginal Progesterone

Veterinarians around the country are reporting a strange phenomenon: spayed dogs and cats, even some puppies and kittens, are suddenly becoming hormonal. In female pets, the symptoms resemble heat: swollen genitals, bloody discharge and behavioral problems. Male animals are showing up with swollen breast tissue and hair loss. Standard treatments and even repeated operations have had no effect.

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People's Pharmacy answers reader queries about estrogen creams; sunscreen; amitriptyline and heat; and medicine dosages for the elderly. A: According to the North American Menopause Society, Estrace or other vaginal creams Premarin should not be used right before sex because the partner may absorb the estrogen hormone through his skin Journal of Reproductive Medicine, January Over time, estrogen could have a feminizing effect. Q: How can I tell if I have applied an adequate amount of sunscreen to protect my kids?

Understand

My doctor prescribed a low-dose vaginal estrogen cream, applied twice a week, for atrophic vaginitis. I've heard this dose is so low that it carries no health risk. Do you agree?

Ask-Ila Ask Ila. Ila Shebar is a nurse practitioner at Pioneer Valley Urology. I often prescribe local vaginal estrogen replacement for my patients to address their issues that occur with urogenital atrophy. Vaginal estrogens have a low risk profile and are safe for most women to use. Local estrogen also works by rebuilding the lining of the vagina and the urethra and helping to maintain muscle tone of the vagina and the urethra, with only a very small amount being absorbed systemically, or into the blood stream. The major cause of urogenital atrophy in menopausal women is estrogen loss or deficiency that occurs after women stop menstruating and the ovaries stop producing estrogen.

Answers About Female Sexuality, Part 1

Vaginal estrogen cream cream inserted into the vagina that releases estrogen continuously. A low dose of estrogen released into the vaginal area has a localized effect only a small amount of estrogen is absorbed into the bloodstream. This rebuilds the lining of the vagina and urethra by promoting collagen production. A typical schedule for low-dose prescription estrogen cream is 3 weeks of daily use followed by twice-weekly use thereafter. For dryness and irritation of the external vaginal area labia only, you can rub a small amount of estrogen cream onto the affected area. Many women find that twice a week is often enough. Since women are now generally discouraged from using long-term hormone therapy HT because of health risks, low-dose vaginal estrogen is recommended for treating vaginal and urethral genitourinary dryness and weakening after menopause.

May 4, - Avoid using estrogen cream during sexual intercourse. A male sex partner regularly exposed to estrogen cream can develop enlarged breasts. See Drug Reference for a full list of side effects.‎How It Works · ‎Why It Is Used.

Drug information provided by: IBM Micromedex. It is very important that your doctor check your progress at regular visits to make sure this medicine does not cause unwanted effects. Plan on going to see your doctor every year, but some doctors require visits more often. It is not yet known whether the use of vaginal estrogens increases the risk of breast cancer in women. It is very important that you check your breasts on a regular basis for any unusual lumps or discharge.

Study record managers: refer to the Data Element Definitions if submitting registration or results information. Each applicator delivers 1. The reported time to maximum progesterone concentration is 6.

According to the North American Menopause Society, Estrace or other vaginal creams Premarin should not be used right before sex because the partner may absorb the estrogen hormone through his skin Journal of Reproductive Medicine , Jan. Over time estrogen could have a feminizing effect on a man. Most people do not realize that creams, lotions and other topical skin products can be absorbed through the skin and may produce unexpected complications.

Drug information provided by: IBM Micromedex. Estrogens are hormones produced by the body.

- Еще не было случая, чтобы в моих данных появлялись ошибки. Поэтому я хочу узнать мнение специалиста. - Что ж, - сказал Джабба, - мне неприятно первым тебя разочаровать, но твои данные неверны.

- Ты так думаешь.

Он толкнул дверь. Комната оказалась пуста. Пуст был и вращающийся стул Мидж. Звуки шли сверху. Он поднял глаза на видеомониторы, и у него закружилась голова. Одна и та же картинка смотрела на него со всех двенадцати мониторов наподобие какого-то извращенного балета.

Она оказалась в тоннеле, очень узком, с низким потолком. Перед ней, исчезая где-то в темноте, убегали вдаль две желтые линии. Подземная шоссейная дорога… Сьюзан медленно шла по этому туннелю, то и дело хватаясь за стены, чтобы сохранить равновесие. Позади закрылась дверь лифта, и она осталась одна в пугающей темноте.

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