Main Dish

 Those words are easier said than done according to a staggering statistic that more than 60 percent of medical practitioners don’t ask their female patients about sexual health. Within the privacy of extended appointments at the First State Health & Wellness Integrative Health Center, we’ve recognized that women not only need, but want a place to vent, talk, and find answers to their most intimate concerns—not just physically but emotionally.

Intimate health is a core component of your overall well-being and to find balance, optimal health and contentment…we need to go there!

I had a frank conversation with our own Dr. Joanne Kakaty-Monzo, Board-Certified Fellow of the American College of Obstetrics & Gynecology and renowned vaginal health expert specializing in peri- and post-menopausal issues and sexual dysfunction, in hopes of empowering you to initiate a conversation with a trusted practitioner and to receive the support you deserve:

Liz: Let’s start with the basics: How do you define menopause?

Dr. Jo: “Many women begin to feel the effects of fluctuating hormones during perimenopause--the transitional time leading up to the cessation of menses. Menopause is when you haven’t had a menses for 12 consecutive months during these years.”

Liz: A lot of peri- and post-menopausal women complain that they experience pain, dryness, itchiness and spotting especially during intercourse. Some women are frustrated that they don’t reach orgasms like they used to. What is going on?

Dr. Jo: “As we age, our vaginal tissue changes. Multiple factors may be responsible for this change including menopause-related hormone changes, having given birth, or simply the aging process—all of which can leave us with symptoms that make intimacy difficult or uncomfortable. In the case of dryness, itching and pain during sex, it’s likely due to a woman’s estrogen levels decreasing during peri-menopause and into her menopausal years. It’s mostly estrogen that is believed to keep vaginal tissue healthy. When estrogen levels fall, vaginal tissue becomes thin, dry and looses its elasticity and this can worsen symptoms.”

Liz: Why would a woman who hasn’t had her period in two years still be experiencing hot flashes?

Dr. Jo: “Hot flashes or night sweats, also called Vasomotor Symptoms, are due to hormonal changes and can unfortunately last longer than the peri-menopausal phase. There are a variety of non-prescription herbal supplements available to help relieve symptoms, such as Evening Primrose Oil, Black Cohosh, Red Clover or over-the-counter Promensil. Functional nutrition is also helpful in identifying nutrition and lifestyle modifications that can help women find relief.”

Liz: I remember when Hormone Replacement Therapy (HRT) became undesirable. Can you remind us why? And what’s happened in the world of HRT since then?

Dr. Jo: “In 2002, a very large study conducted by the World Health Initiative raised concerns over hormone replacement therapy and the possible increased risk of cancer and cardiovascular events in women. At that time, physicians and patients began to significantly decrease their use of HRT, leaving us with a void in options for treating a range of peri- and post-menopausal symptoms including vaginal health, bone health, dementia and vasomotor symptoms.
Bio-identical hormones and localized estrogen were among the attempts to treat these symptoms, but nothing was tremendously successful without risk...until now.

Liz: Are there effective non-hormonal options for women who can not or will not use hormone replacements?

Dr. Jo: “There are! New procedures use a form of gentle radiofrequency energy to stimulate collagen production in vaginal tissue. This alleviates dryness, painful intercourse, laxity, orgasmic dysfunction, and urine leakage to help women renew the pleasure of sexual intimacy. There is minimal discomfort and no downtime. When I get patient phone calls post-procedure to tell me they no longer have pain or that they’ve finally been able to have sex for the first time in years, I’m thrilled! Knowing we’re making a difference, without medication or surgery, is why I chose to be a leader in introducing this technique on the Main Line.”

Liz: Is this radiofrequency technique widely available?

Dr. Jo: “While most gynecologists should be aware of this procedure, many do not perform it themselves. Instead they refer out to another physician, like myself, who specializes in the procedure and can spend about an hour with each patient. I am passionate about making sure patients are in good hands. I advise finding a highly-qualified practitioner who will do a full gynecological history and exam to be sure this treatment is right for you.”

Liz: How can women learn more?

Dr. Jo: “Schedule a consultation at the First State Integrative Health Center or attend one of my information sessions and let’s talk! I’ve been practicing women’s health for 25 years and this alternative to hormone replacement therapy to reduce peri- and post-menopausal issues is one of the most impactful solutions I’ve seen. It should be a consideration for all patients who complain of the symptoms we’ve been talking about – dryness, painful intercourse, laxity, orgasmic dysfunction and urine leakage.

Dr. Joanne Kakaty-Monzo, Director of Intimate Health Services at the First State Integrative Health Center, is a teaching attending for Main Line Health’s OB/GYN residency program and is on staff at all four Main Line Health Hospitals. She is the Chair of the Department of Obstetrics and Gynecology at Philadelphia College of Osteopathic Medicine, Philadelphia and Atlanta campuses.

Liz Abel, LDN, CNS, MS, MA, is a Licensed Integrative Nutritionist at the First State Health & Wellness Integrative Health Center in Wilmington and Rehoboth, Del. She leads a dynamic, team-based Functional Nutrition program that encompasses food, lifestyle, lab testing, natural supplementation, mindfulness and movement to support your health and well-being.
Call 302.384.7104, e-mail This email address is being protected from spambots. You need JavaScript enabled to view it. or visit FirstStateHealth.com to schedule your comprehensive intimate health or functional nutrition consultation today.