Pelvic floor: overactivity, dysfunction, and therapy

James Simon describes pelvic floor hypertonicity, hypotonic states, their sexual effects, and pelvic floor physical therapy roles.

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Most women go through decades of marriage, menopause and midlife without ever having an honest conversation with a doctor about their sex life. Not because they don't want one — but because most physicians were never trained to have it. This week on unPaused, Dr. Mary Claire Haver sits down with Dr. James Simon, a professor of obstetrics and gynecology at George Washington University, board-certified OB-GYN, reproductive endocrinologist, and certified sexual counselor with more than 800 published papers in menopause and sexual medicine. Dr. Simon is a past president of the International Society for the Study of Women's Sexual Health (ISSWSH) and one of the most published clinicians in modern menopause care.

Dr. Simon has spent his career treating what most doctors never address — the full picture of how sex, desire, pain and intimacy change for both women and men as they age. He treats couples together, and what he has witnessed across thousands of relationships is that the problems are rarely one person's fault, rarely unsolvable, and almost always rooted in something nobody warned them about.

Guest links:

James Simon (IntimMedicine Specialists)

James Simon (Instagram)

James Simon (YouTube)

Articles:

What if the Women’s Health Initiative had used transdermal estradiol and oral progesterone instead? (Menopause)

Erectile Dysfunction (StatPearls)

Should we be prescribing testosterone to perimenopausal and menopausal women? A guide to prescribing testosterone for women in primary care (British Journal of General Practice)

The Benefits and Harms of Systemic Testosterone Therapy in Postmenopausal Women With Normal Adrenal Function: A Systematic Review and Meta-analysis (The Journal of Clinical Endocrinology & Metabolism)

Other Resources:

Women’s Health Initiative

The North American Menopause Society Releases Its 2022 Hormone Therapy Position Statement (NAMS)