Miscellaneous medical sex topics

Exercise + breast discharge = ?

Q: I'm a 29-year-old healthy woman who began jogging five months ago. Since I began jogging, I've noticed that my libido has diminished and occasionally my breasts have a slight milky discharge. Does this make any sense to you? I thought exercise was supposed to increase libido, if anything. My doctor is stumped. I'd be very grateful if you can help me. Thanks, Melissa.

A: It sounds as if you're suffering from a condition called benign galactorrhea. I will explain this so that it is easy to understand, so don't be fazed by the big medical words. Galactorrhea just refers to a condition in which breasts make and discharge milk at a time not associated with either childbirth or the nursing of an infant. Benign, of course, simply means that it isn't dangerous. However, it is a good idea for anyone with this problem to see a doctor for testing because certain medical conditions can predispose people to galactorrhea, and these conditions should be excluded before one assumes the condition is benign.

Your galactorrhea is probably induced by the nipple stimulation that results from the to and fro motion of your breasts rubbing against your bra. As I mentioned in The Science of Sex, nipple stimulation in both women and men increases the production of prolactin, a hormone that stimulates lactation (milk production). One of the side effects of prolactin is its ability to impair libido even if its concentration is not high enough to induce lactation. Therefore, even people without lactation may be suffering from the libido-suppressing effects of prolactin. Obviously, for some people nipple stimulation increases libido instead of decreasing it. The reason for this is because breast stimulation also increases the release of oxytocin, a hormone that improves sex in many ways. I'll discuss oxytocin in more detail at the end of this topic.

It is interesting to look at the connection between nipple stimulation and libido suppression from a teleological perspective. In other words, did Mother Nature or God have some logical reason for suppressing libido after childbirth? Of course! Pregnancy can be very hard on women, and that was probably more true eons ago before the advent of modern medicine and an assured food supply. If a woman with marginal deficiencies of some nutrients became pregnant, the fetus would further sap her. After pregnancy came lactation (no formula in the Stone Age, obviously), which really drains energy and nutrients from women. After that, another pregnancy following shortly thereafter could have been fatal, for the mother, her fetus, and her infant. Since there weren't any doctors around in those days to warn women of this serious risk, Mother Nature stepped in and shut down libido. In case an amorous caveman was able to seduce a woman who was still breastfeeding, the chance of conception was rather low because the hormonal changes associated with breastfeeding reduce the risk of pregnancy.

There are numerous causes of hyperprolactinemia (increased blood prolactin) besides jogging and breastfeeding, including eating, stress, strenuous exercise of any sort, alcohol consumption, exposure to xenoestrogens (man-made chemicals that mimic natural estrogens), certain drugs (oral contraceptives, estrogen, Aldomet^®, opiates, tricyclic antidepressants, phenothiazines, Reglan^®, Compazine^®, Phenergan^®, Tagamet^®, Prozac^®, and Haldol^®), hypoglycemia, primary hypothyroidism, and sexual intercourse (in women). Apparently bizarre causes of hyperprolactinemia are certain chest wall lesions, including neoplasms of the chest wall, herpes zoster (shingles), and surgical scars or trauma affecting the chest wall. Since prolactin serves to switch off sexual excitement after orgasm, anyone who wishes to maximize their potential for multiple orgasms should keep these factors in mind.

Prolactin output is normally held in check by dopamine, a neurotransmitter that often declines with aging. Hence, prolactin secretion tends to increase with age. Lindsey Berkson, an expert on endocrine-disrupting chemicals, stated in her book Hormone Deception that certain chemicals may either mimic or indirectly affect prolactin. Incidentally, prolactin can contribute to obesity since it can stimulate appetite and promote fat storage.

OK, what can you do about this problem?

Bromocriptine (Parlodel^®): Bromocriptine is a drug that can reduce prolactin secretion. Bromocriptine can improve libido, especially in people with high prolactin levels, and it may increase sexual pleasure, too. One of the unique properties of bromocriptine is its ability to increase sexual desire while postponing ejaculation. Interestingly, since bromocriptine can reduce prolactin secretion, it can therefore promote fat loss. However, that should be viewed as an ancillary benefit and not a primary indication for use of bromocriptine.

Ginseng: Ginseng's reputed aphrodisiac effect has a scientific basis because ginseng can depress blood prolactin levels. This effect is more pronounced with repeated use.

Vitamin B₆: High doses of vitamin B₆ can improve libido by reducing prolactin secretion in both sexes. B₆ can also improve the quality and intensity of sexual pleasure in some people who have poor genital sensation. Vitamin B₆ is excreted within 8 hours after absorption, and thus should be supplied at least every 8 hours. An average dose for these conditions would be 50 mg three times daily. Taking too much B₆ can result in too vivid dream recall. Doses over 200 mg daily can result in neurological disorders if taken for several months.

Those are some of the specific therapies for combating the libido-suppressing effects of prolactin. There are many other general ways of heightening libido, as I discuss in The Science of Sex.

More on oxytocin

Oxytocin is a hormone that promotes contractions of the uterus during childbirth, but it is produced at other times as well. Its secretion increases during sex and breast stimulation, and it is triggered by certain emotional stimuli. It has been termed the "cuddle chemical" because it promotes snuggling, pair-bonding, and the desire to please others. This may explain why women are more likely to want to cuddle after sex. Thus, there is some truth in the phrase "making love." Oxytocin stimulates erection, enhances vaginal and uterine contractions during intercourse, and increases sexual sensation before and during orgasm.

Oxytocin was available by prescription as a nasal spray (Syntocinon^®), intended to assist initial postpartum milk ejection from a woman's breasts after childbirth, but at the time of this writing it is not available; perhaps a generic version will be offered in the future. Oxytocin has been used cosmetically, too. Apparently unaware of the fact that application of a vacuum could achieve the same effect, some Las Vegas showgirls used to sniff Syntocinon to make their nipples more prominent.

Estrogen enhances sensitivity to oxytocin, and thus women with more estrogen are more likely to experience the positive effects of oxytocin—and perhaps its negative effects, too. According to Theresa Crenshaw, MD, author of The Alchemy of Love and Lust, oxytocin diminishes the capacity to think, reason, and remember.

Breast stimulation increases oxytocin in both women and men, and this is therefore a more readily available means of sexual enhancement than the administration of Syntocinon. The amount of oxytocin produced by breast stimulation in men and nonpregnant women is less than that which can be administered by a Syntocinon nasal spray, but you will not find many doctors willing to prescribe Syntocinon simply to enhance your sexual pleasure. However, since breast stimulation can also increase prolactin (which suppresses libido), relying upon breast stimulation to enhance sex is problematic. Since the ratio of oxytocin to prolactin produced as a result of breast stimulation is individually variable, breast stimulation is not a surefire catalyst for sexual pleasure.

Premenopausal women sometimes become attached to a man with whom they have had sex, even if the man isn't good for them, because the sexually induced secretion of oxytocin encourages this binding. After menopause, intercourse does not result in an oxytocin surge, thus permitting women to make a more rationale, and less instinctive, choice. Premenopausal women who wish to avoid being hormonally blinded should know that alcohol suppresses, and heat increases, oxytocin release. To put this into proper perspective, let's look at some real-world examples.

In women, alcohol temporarily increases testosterone and, hence, libido. However, since alcohol also suppresses oxytocin, women who consume it are more likely to engage in sex, but less likely to feel good about it afterwards. They're also less apt to feel attached to the man, and less likely to feel as if they're falling in love. Physiologically-hip, conniving men can to some degree circumvent this stumbling block by remembering the effect of heat. Lounging in a hot tub, and then cuddling in a warm bed—or, better yet, vacationing on a warm, exotic island . . . they don't have anything to do with romance and love, do they? Yes, they do, and I think that most people have an intuitive understanding of this.

Women often assume that men desire sex just for the physical pleasure it provides. No doubt, that's sometimes all the man is after. However, I think that many men realize that intercourse can make the woman feel attached to the man. Longing for love, men may desire sex as a means of fostering a romantic bond.

Who is the father?

Q: I have a question that's been troubling me for a little over 2 years. I'm the mother of 2 beautiful girls and I don't know who is the father of my second daughter.

This is the situation . . . I had sex on and off with my first husband for 7 months when I lived in California. My last monthly period was on Oct. 30, 1998 and ended on Nov. 5, 1998 (regular menstruation). I had sex on Nov. 11, 1998 and after that I left California and returned to New Jersey. I did not get my period in the beginning of December. I had sex again with an ex-boyfriend on Dec. 23, 1998. After that I did not have any further sexual contact with either man. On January 16, 1999 I found out I was pregnant. What confuses me is this . . . On my sonogram taken on February 3, 1999, it states that my LMP (last menstrual period) agrees with my gestation period — it states I am about 8.6 weeks.

My question is if you could please help me in this matter . . . and at least try to give me a clear understanding of who could be the father of my second daughter. This would take a huge load off my conscience. I would greatly appreciate your help in this matter. THANKS A MILLION!

A: Based upon the timing of your intercourse, the most likely father is your first husband. However, when you state that your LMP "agrees with my gestation period . . . it states I am about 8.6 weeks," that doesn't mesh because if your first husband impregnated you, then you would have been about 13.7 weeks along. As a rule, pregnancies are dated from the first day of the last normal menstrual period. Therefore, it is possible that you skipped a period and the ex-boyfriend impregnated you. In that case, you'd likely be about 6½ weeks along on February 3.

It'd be helpful to know the duration of your cycles (e.g., are they 28 days?), their regularity, and so forth. What would be even more helpful to know is the blood type of the two possible fathers, your blood type, and your daughter's blood type. With that information, it may be possible to exclude one of the men as a possible father. That would save you the expense of testing for a DNA match — which, of course, might cause the candidates for fatherhood to raise their eyebrows.

Phytoestrogen myth

Q: I heard a naturopathic doctor on television say that phytoestrogens can be anti-estrogenic or pro-estrogenic, depending on what a woman's needs are. Is what she said true? Anna

A: No. While it is true that phytoestrogens can either increase or decrease a woman's overall estrogenic effect, phytoestrogens have no way of knowing if a woman has just the right amount of estrogen, too much, somewhat too little, or very little. How did this myth about "depending on what a woman's needs are" get started? If a woman has an estrogen excess, adding phytoestrogens can indeed reduce her overall estrogen effect via the process of competitive inhibition, which I thoroughly explained in my book. If a woman has very little estrogen, phytoestrogens can indeed increase her estrogen effect. So far, so good for the naturopathic doc. Here's where her statement falls apart. If a woman's estrogen level is good or somewhat less than is optimal, adding phytoestrogens will reduce her overall estrogen effect, once again via competitive inhibition. Consequently, the woman who originally had just the right amount of estrogen now has less than she should, and the woman who had somewhat too little estrogen now has a worse deficit. Did phytoestrogens "balance" the needs of these last two women? Hardly. That's why I cringe whenever I hear this "balancing" baloney. I don't know if that doc truly believes it, or if she was just trying to simplify it enough to squeeze it in the ten seconds that seems to be the limit for sound bites during media interviews.

Q: I'm a 26-year-old healthy girl. I've been trying to figure out this problem which has been putting my sex life on pause. One day, in 1998, all of a sudden, my boyfriend told me that my vagina tastes too sweet and "different" from how I've always tasted. And I'm still having this problem! I've been checked, and they couldn't find a cause. Now in 2003, I also just had a baby, and after, I tasted normal for a little while, but all of a sudden, that "abnormal sweet taste" is back again! What could it be? Could it be my kidney or liver or something? (During my pregnancy, I was tested for all STDs, so I know I'm still clean in that way.) Ever since this taste came, it seemed to lower my sex drive, too. I usually don't get as wet as before, and when I do, the wetness is too thin and not as slippery like it once was. This is really disturbing my sex life SO MUCH! HELP!!!! ~Val

A: The taste of vaginal secretions is influenced by a number of factors, such as your diet, medications, smoking, overall health, some metabolic diseases, age, genetic makeup, sexual activity and baseline degree of sexual arousal, hormone levels, phase of the menstrual cycle, choice of contraceptive, whether or not you're breastfeeding, clothing, climate, emotions, hygienic practices, and vaginal pH (a measure of the vagina's acidity or alkalinity). I discuss this topic in more detail in The Science of Sex. Most people, including physicians, have serious misunderstandings about vaginal lactobacilli and yogurt.

First, it is important to know that taste is strongly influenced by smell. This is why foods may seem less flavorful when you have a cold and your olfactory epithelium is covered by a thick layer of nasal effluence (a.k.a., snot or mucus). Therefore, it isn't surprising that the taste of vaginal secretions is influenced by vulvar odor.

I will now discuss some of these factors in more detail:

Diet: This can influence vaginal taste directly and indirectly, and on both a short-term level and long-term level. Here is an example of a long-term effect: chronic overeating that leads to obesity, which leads to diabetes. The hyperglycemia (high blood sugar) and immune impairments present in diabetics can alter the population of microorganisms that live in the vagina (the vaginal flora), which leads to a higher (less acidic) vaginal pH. An example of a short-term dietary effect is eating asparagus. Asparagus contains a sulfur compound called mercaptan that is broken down into pungent chemicals by enzymes in the digestive tract. These pungent chemicals end up in the urine (traces of urine are commonly found in the vulva), and are so odoriferous that even a small amount of urine containing them can be instantly detected by some people (people differ in their genetic capacity to smell those chemicals). Ben Franklin, who was quite a ladies' man in addition to being a noted author, statesman, and scientist, once wrote (obviously in the days before spelling and punctuation were standardized), "A few Stems of Asparagus eaten, shall give our Urine a disagreeable Odour; and a Pill of Turpentine no bigger than a Pea, shall bestow on it the pleasing Smell of Violets." This is one of those "kids, don't try this at home" things. I once had to hospitalize a woman who'd chugged down a surprising amount of turpentine.

Contraceptive choice: The spermicide nonoxynol-9 is toxic to lactobacilli, which are bacteria that normally reside in the vagina. Hormonal contraceptives can also affect the vaginal flora. If a woman is allergic to latex, use of latex condoms or diaphragms can affect vaginal ecology.

Sexual activity: Both semen and saliva can reduce vaginal lactobacilli levels. While both are more alkaline than normal vaginal secretions, the primary effect of saliva is likely due to the fact that it is teeming with bacteria that do not normally reside in the vagina. Therefore, it is advisable to rinse the mouth with water before performing cunnilingus. Avoid antimicrobial mouthwashes such as Listerine^®.

Drugs: It is common knowledge that antibiotics affect the vaginal flora by killing bacteria, but many other drugs can alter the taste of vaginal secretions by other mechanisms. Vaginal lactobacilli are exquisitely sensitive to variations in temperature, moisture, pH, and vaginal glycogen levels. Consequently, vaginal ecology is affected by a wide range of drugs (prescription, nonprescription, or illicit), and even some herbs and supplements.

Hygienic practices: There are some obvious factors that may affect the vaginal flora and/or taste, such as wiping from front to back, retention of residual menstrual fluid, use of feminine hygiene products, and douching (even with vinegar or plain water). Vaginal flora can also be affected by less obvious things, such as the frequency and type of your bathing (e.g., showering or taking a bath), the type of soap you use, and how well you rinse. Most soaps are alkaline, and some contain antibacterial compounds such as triclosan. Hence, if soap residue remains in your vulva, it will affect the type and number of bacteria in that area. Using a low-pH soap without antibacterial agents reduces this risk. Swimming in a pool or using a hot tub can also change the vaginal ecosystem, especially if the water is chlorinated.

Miscellaneous: Vaginal flora (and therefore vaginal taste) can be altered by sexual lubricants, even if they do not contain a spermicide. Vaseline^® is a poor choice because it is not soluble in water, so it sticks around (literally!) far too long. However, even water-soluble sexual lubricants may alter vaginal ecology. Most of them contain a slew of chemicals, including preservatives such as methyl, ethyl, or propyl paraben. The function of preservatives is to inhibit the growth of microorganisms. Introducing preservatives into the vagina is not advisable. If you must use a sexual lubricant, consider using a lubricant that you make yourself just before sex by adding water to guar or xanthan gum powder, as I discuss in my book. It's far less expensive, and feels better, too. You can tailor its characteristics by adjusting the amount of water added.

The vagina normally has somewhat of a tart or tangy taste due to its acidic pH. If your pH is higher (more alkaline or less acidic), your taste would noticeably change. In view of your history, I think that both your hormones and vaginal pH are out of whack. Kidney or liver disease is possible, but less likely. Your doctor can perform various tests to investigate this matter.

Enlarged labia minora cause for concern?

I receive a surprising amount of e-mail from women who remain virgins because they're embarrassed about what they think are enlarged labia minora (the thin hairless inner lips that surround the vaginal opening, in contrast to the labia majora, which are the larger, fatty, hair-covered outer lips).

If you are one of those women, relax! Men often think that large labia minora are sexy and desirable, so what you have is a definite plus, not something to be ashamed of. I've performed thousands of pelvic exams, and I've yet to see any labia minora that are too large. Nor have I seen excessively large labia minora in textbooks. What you're worrying about simply doesn't exist.

If you're thinking about surgery to reduce their size, forget it. Why would you incur pain, possible numbness, and the other risks of surgery (not to mention its cost!) to lop off something that men adore?

A woman who read the above explanation still wasn't convinced, and she wrote to say that I was minimizing the problem just to make women feel better. Not so. I'm not one of those doctors who feels a need to assuage the anxieties of my patients even when they have reason to be anxious. If I thought large labia minora were a problem, I'd say so.