Sexual Health | Empower Health & Hormones

Sexual and Reproductive health care

Sexual and reproductive health services provide confidential, inclusive, and evidence-based care to support physical, emotional, and social wellbeing across the lifespan.

A broad range of services are available for individuals experiencing sexual and reproductive health concerns, including issues with desire/libido, arousal, orgasm, painful sex, menstrual problems (PMS, PMDD, dysmenorrhea), chest/breast problems, endometriosis, fibroids, pelvic pain, PCOS, vaginitis, bacterial vaginosis, urinary tract infection, yeast infection, infertility, and related conditions.

Comprehensive care includes:

Assessment and diagnosis: A thorough history, physical exam, and use of validated tools (e.g., Female Sexual Function Index, Female Sexual Distress Scale-Revised) help identify the nature and impact of sexual dysfunction, menstrual disorders, and pelvic pain.
Psychological and behavioral interventions: Cognitive behavioral therapy (CBT), mindfulness-based therapy, and sex therapy are first-line for desire, arousal, and orgasmic disorders, and are effective for distressing sexual symptoms.
Medical management:
- For low desire, FDA-approved options for premenopausal women include flibanserin and bremelanotide; off-label testosterone may be considered for postmenopausal women.
- Genito-pelvic pain (e.g., dyspareunia, vaginismus) may be managed with vaginal lubricants, topical estrogen, ospemifene, pelvic floor physical therapy, and, when indicated, treatment of underlying gynecologic conditions (e.g., endometriosis, fibroids).
- Menstrual disorders, PCOS, endometriosis, and fibroids are managed with hormonal therapies, pain management, and surgical options as needed.
- Infections (UTI, vaginitis, BV, yeast) are treated with appropriate antimicrobials.
- Infertility evaluation and management include hormonal assessment, imaging, and referral to reproductive endocrinology as appropriate.
Education and counseling: Patient-centered communication, education about sexual health, and support for relationship and psychosocial factors are integral.
Referral and multidisciplinary care: Complex cases may require referral to specialists in gynecology, urology, pelvic pain, reproductive endocrinology, or mental health.

To illustrate the multidimensional assessment required for sexual dysfunction, the following table summarizes key factors to consider:

A comprehensive, biopsychosocial approach ensures that care is tailored to each individual's needs and goals.

Sexual and Reproductive Health Concerns

Sexually transmitted infections (STIs) can be acquired through oral, anal, or vaginal sex, as well as through genital skin-to-skin contact. Many STIs are asymptomatic, so regular testing is the only reliable way to confirm infection and prevent complications.

Testing recommendations:

Chlamydia and gonorrhea: Annual screening is recommended for all sexually active women under 25 and older women with risk factors, and for men who have sex with men (MSM) at least annually, with more frequent testing (every 3–6 months) for higher-risk individuals. Testing should include all sites of exposure (urine/genital, rectal, pharyngeal).
Syphilis: Screen MSM, pregnant individuals, and others at increased risk at least annually; diagnosis is by serology (nontreponemal and treponemal tests).
HIV: At least once for all adults and adolescents, with annual or more frequent testing for those at higher risk.
Trichomoniasis: Annual screening for women with a vagina/neovagina who are at risk; not routinely recommended for asymptomatic men.
HPV: Pap/HPV testing for cervical cancer screening per guidelines; no routine screening for other sites.
Hepatitis B: Screen all adults at least once, with vaccination for those not immune.
Genital warts (HPV): Diagnosis is clinical; no routine screening.

Treatment: Most bacterial STIs (chlamydia, gonorrhea, syphilis, trichomoniasis) are curable with antibiotics, but antimicrobial resistance is a concern for gonorrhea. Viral STIs (HSV, HPV, hepatitis B, HIV) are managed with antiviral therapy or supportive care; only hepatitis B and HIV have effective preventive vaccines or pre-exposure prophylaxis (PrEP).

Prevention and follow-up: Consistent condom use, vaccination (HPV, hepatitis B), and PrEP for HIV reduce risk. All sexual partners should be notified, tested, and treated as appropriate.

Summary: Because most STIs are asymptomatic, routine, site-specific screening and prompt treatment are essential for sexually active individuals. Testing should be tailored to sexual practices and risk factors, and prevention counseling should be part of every sexual health visit.

A full range of birth control options and services is available, including the implant, patch, pill, shot, vaginal ring, diaphragm, condoms (internal/external), fertility awareness methods, intrauterine devices (hormonal and copper), spermicide/gel, emergency contraception, and permanent methods (tubal ligation, vasectomy). These methods are grouped as follows:

Long-acting reversible contraceptives (LARC): Implant and IUDs (hormonal and copper) offer the highest effectiveness and convenience, with minimal user action required after placement.
Short-acting reversible methods: Pills (combined or progestin-only), patch, shot (depot medroxyprogesterone acetate), and vaginal ring require regular use and prescriptions.
Barrier methods: Diaphragm, condoms, and spermicide/gel are available over-the-counter and provide additional protection against sexually transmitted infections (STIs) when using condoms.
Behavioral methods: Fertility awareness methods (cycle tracking, basal body temperature, cervical mucus monitoring) and withdrawal are nonhormonal, but require consistent, correct use and education.
Permanent methods: Tubal ligation and vasectomy are highly effective but irreversible.
Emergency contraception: Copper IUD (most effective), emergency contraceptive pills, and prescription vaginal gel are available for postcoital use.[1-4]

Effectiveness varies by method and user adherence. LARCs have the lowest failure rates (<1% per year), while short-acting methods (pill, patch, ring, shot) have higher failure rates with typical use (6–9% per year). Barrier and behavioral methods are less effective, especially with inconsistent use.[2-4] Safety profiles and contraindications are detailed in the U.S. Medical Eligibility Criteria for Contraceptive Use, which should be referenced to ensure safe selection for individuals with specific health conditions.[1]

Many birth control methods offer noncontraceptive health benefits, such as lighter and less painful periods, reduced menstrual migraines, improvement in acne, management of endometriosis, and protection against anemia and certain reproductive cancers.[3-5]

Patient-centered counseling is essential. The process should begin by reviewing the individual's goals, preferences, and medical history, then presenting all options with clear information on efficacy, side effects, administration, reversibility, and noncontraceptive benefits. Shared decision-making ensures the chosen method aligns with the patient's values, not just effectiveness.[1][6-8] Pain management options should be discussed for LARC procedures, and barriers to starting or stopping methods should be minimized.[6][8]

Up-to-date, medically accurate information should be provided through accessible resources such as Bedsider, and clinicians should address insurance coverage, cost, and privacy concerns, especially with digital fertility tracking tools.[6][8] All FDA-approved methods should be available without unnecessary barriers, and counseling should be inclusive and tailored to individual needs.

In summary, a wide array of birth control methods is available, and patient-centered, evidence-based counseling helps individuals choose the option best suited to their needs and health goals, including noncontraceptive benefits.

Would you like me to summarize the latest comparative effectiveness and safety data for each birth control method, including contraindications and noncontraceptive benefits, to help guide evidence-based counseling and individualized method selection?

Emergency contraception (EC) is a safe and effective way to prevent pregnancy after unprotected sex, contraceptive failure, or sexual assault. The sooner EC is used, the more effective it is. There are several options available:

- Levonorgestrel morning-after pill (Plan B and similar brands): This is available over the counter and should be taken within 3 days (72 hours) of unprotected sex. It is less effective for people with body weight above 160lb.

- Ulipristal acetate morning-after pill (Ella): This prescription-only pill is effective up to 5 days (120 hours) after unprotected sex and is more effective than levonorgestrel, especially for those with higher body weight. You should wait 5 days after taking Ella before starting or restarting regular hormonal birth control.

- Intrauterine devices (IUDs): Both the copper IUD (Paragard) and the 52-mg levonorgestrel IUDs (Mirena, Liletta) can be placed within 5 days of unprotected sex and are the most effective forms of emergency contraception, reducing pregnancy risk to less than 1 in 1,000. IUDs also provide long-term birth control after placement. The copper IUD is FDA-approved for EC, while recent studies show the levonorgestrel IUD is similarly effective.

We offer:
- Levonorgestrel morning-after pill (Plan B and generics)
- Ulipristal acetate morning-after pill (Ella)

If you think you need emergency contraception, contact us as soon as possible. We provide up-to-date, medically accurate information and help you choose the best option for your needs.

A full spectrum of pregnancy care services is available, including early prenatal care, pregnancy testing, referrals for comprehensive prenatal care, postpartum support, fertility and pregnancy planning, infertility support and referrals, pregnancy options counseling, and referrals.

Early prenatal care should ideally begin before 10 weeks of gestation, with a comprehensive needs assessment covering medical, social, and structural factors. This includes confirmation of pregnancy, screening for medical conditions, and counseling on healthy behaviors and risk mitigation. Early care improves outcomes and allows for timely identification and management of conditions such as diabetes, hypertension, and mental health concerns.

Referrals for full prenatal care are provided for individuals needing advanced obstetric management, co-management for medical or behavioral health conditions, or specialized services such as genetic counseling or high-risk pregnancy care.

Postpartum support includes routine postpartum visits to assess physical recovery, mental health, breastfeeding, contraception, and chronic disease management. Ongoing support for depression, anxiety, and social needs is recommended.

Fertility and pregnancy planning services include pre-pregnancy counseling, optimization of chronic conditions, genetic screening, immunization review, and education about healthy pregnancy. Infertility support and referrals are available for those experiencing barriers or difficulty conceiving.

Pregnancy options counseling is provided in a nonjudgmental, patient-centered manner, including discussion of parenting, abortion, and adoption.

Care delivery is tailored to individual needs, with flexible options such as telemedicine, in-person visits, and coordination with community resources to address social determinants of health.

In summary, comprehensive pregnancy care includes early and ongoing prenatal services, postpartum support, fertility and infertility care, pregnancy options counseling, and adoption referrals, all delivered in a patient-centered, evidence-based, and inclusive manner.

Pain with intercourse is a common complaint for women of all ages.

Research now shows that the majority of dyspareunia is caused by physical conditions that plays a large psychological influence on sexual health.

Dyspareunia, itself is not merely a disease but rather a symptom with many different causes.

Together, you and your sexual health care team will work collaboratively to develop an individual treatment plan to optimize your sexual health.

One of the most prevalent sexual health concern is hypoactive sexual desire disorder (HSDD), defined as chronic low sexual desire causing personal distress.

Research estimates that 1 in 10 women has HSDD. Causes can include hormone changes, medication side effects, trauma, pain, and even stress.

A thorough medical assessment including questionnaires, history taking, and physical exam are key in diagnosing HSDD.

Treatment options include medications, behavior homework assignments, and working collaboratively with a sexual health team.

Anorgasmia is defined as long term inability to achieve orgasm after adequate sexual stimulation causing personal distress in women.

Studies have revealed that approximately 15% of all women struggle with achieve orgasm and 10% report never achieving orgasm in their life.

Diagnosis focuses on ruling out medical conditions and blood tests to determine how your body’s endocrine system is functioning.

Treatment involves a multidisciplinary approach through medical interventions with vibration therapy, optimal sexual positioning/props, and medications; pelvic floor PT to increase blood flow, muscle relaxation, and rebuild nerve function; and sex therapy to initiate individual and partner behavioral assignments

Testosterone plays a key role in sexual health, mood, energy, and overall well-being. Testosterone deficiency can occur due to aging, hormonal imbalances, medical conditions, or certain medications. Early signs of low testosterone may lead to fatigue, low libido, erectile difficulties, decreased muscle mass, mood changes, reduced sexual desire, low energy, and diminished sense of well-being.

Low testosterone can result from a range of factors. Some of the more common secondary causes include certain medications, chronic inflammatory conditions, higher body fat, HIV/AIDS, and the natural aging process.

Our team provides thorough assessment and individualized treatment options to help restore hormonal balance, enhance sexual health, and improve quality of life for people of all genders.

Treatment includes correcting the underlying condition and/or testosterone supplementation through medications including topical gels, oral, injections, or pellets.

Vaginal dryness is a common concern that can affect individuals at any age, though it’s especially prevalent during and after menopause, breastfeeding or lactation, after pelvic surgeries or certain medical treatments. It may cause discomfort, irritation, urinary symptoms, or pelvic pain with intimacy, and can impact sexual well-being and quality of life.

Our team provides personalized, affirming care to identify the underlying causes and offer effective evidence-based treatment options, helping you feel more comfortable, confident, and connected in your body.