Dr Karen Toubi is board certified obstetrician and gynecologist at Rodeo Drive Women’s Health Center in Beverly Hills, California. She specializes in sexual medicine, cosmetic gynecology and menopause. She combines medical expertise with compassion, warmth and curiosity. Dr. Toubi spends the time to get to know her patients, explains and educates, so that they become partners in their own tailored care with the best possible outcome.
I interviewed Dr. Toubi to get expert tips on how to achieve optimal sexual health.
Posh Lifestyle & Beauty Blog: Dr. Toubi, can you tell us about your background and what sparked your interest in the field of female sexual wellbeing?
Dr. Toubi: I am a board certified obstetrician and gynecologist trained in NYC who loves caring for women. Like most other ObGyns, I was trained with a philosophy that women’s health has a strong emphasis on preventing pregnancy or helping people conceive. Sexual health as taught is generally all about preventing STDs and talking about safe sex. While these are important and should be given attention and education, as a woman and practicing gynecologist, I saw first hand how much deeper sexual health actually is and how we are failing our society when we ignore treating issues with arousal, libido, orgasm and sexual pain and pleasure. These are topics that most gynecologists don’t ask about, or know how to treat. I had to do better. I went to conferences, read journals and collaborated with other doctors in the growing field. I spent lots and lots of time educating myself and inhaling everything there is to learn. Slowly, the word got out that there is a doctor who is not only asking about real sexual health but is able to help their problems without recommending a glass of wine or “just more lube”.
Whether I am helping a newly married couple be able to have pleasurable penetrative intercourse or help a couple in their 60s have the best sex of their life after not being able to have sex for a while, the excitement is palpable and I know I am making a real difference in their lives.
Posh Lifestyle & Beauty Blog: How would you define female sexual wellbeing, and why do you believe it’s an important area for scientific and medical research?
Dr. Toubi: Female sexual wellbeing encompasses physical, emotional, and relational satisfaction in sexual experiences, covering aspects like sexual function, desire, pleasure, and overall sexual health.
Scientific and medical research in this field is crucial for improving overall quality of life by addressing mental health and self-esteem, fostering positive relationships, identifying health disparities for inclusive interventions, developing medical treatments for sexual dysfunctions, promoting preventive measures for reproductive health, and contributing to destigmatizing discussions and education around female sexual wellbeing.
Posh Lifestyle & Beauty Blog: In your experience, what are some of the most common challenges women face in terms of sexual health and satisfaction?
Dr. Toubi: Women encounter many challenges impacting sexual health and satisfaction, influenced by biological, psychological, and relational factors. These include changes in sexual desire due to hormonal changes or stress, painful intercourse from conditions like vaginismus, inability to achieve an orgasm, body image concerns affecting confidence, menopause-related changes, communication issues, history of trauma, relationship strain, and lack of education and societal shame promoting factors about sexual health.
Addressing these challenges necessitates a holistic approach involving open communication with healthcare providers, psychological support, relationship counseling, and potentially medical interventions. Recognizing and understanding these common challenges is essential for promoting overall sexual well-being in women.
Posh Lifestyle & Beauty Blog: Can you provide an overview of the current approaches to treating sexual dysfunction in women and where you see the most promise?
Dr. Toubi: There are so many different approaches depending on the type of sexual dysfunction. The most important thing to understand is where the root of the problem is. Is it a hormonal problem, neurological problem, relationship problem? Problem with the muscles of the pelvic floor? Treating sexual dysfunction starts with getting a thorough history and physical exam to really understand what is going on.
For perimenopausal and menopausal women, a healthy sex life can be achieved with a multi-layered approach. From hormone therapy to lifestyle choices, there are many options to help each woman find what works for her:
Medical Intervention & treatments:
Bioidentical hormone replacement therapy BHRT: involves supplementing the body with estrogen, progesterone and testosterone to restore optimal hormone function. The term “bioidentical” means that the hormone is the exact chemical structure as the hormones your body naturally produces.
Vaginal Estrogen Therapy: This treatment involves applying estrogen directly to the vaginal tissues, providing increased lubrication, tissue elasticity, and decreases urinary tract infections.
Ospemifene: Ospemifene is a non-estrogen oral medication that acts like estrogen in some tissues, specifically the vaginal lining.
Prasterone (Intrarosa): My personal FAVORITE!!! Intrarosa is a vaginal insert containing the hormone DHEA (dehydroepiandrosterone), which gets converted to estrogen and testosterone. This does everything estrogen does including extra support for the bladder and vaginal entrance.
Radiofrequency (RF) Treatment: RF technology is used to stimulate collagen production, increase nerve fibers and tighten vaginal tissues.
Soundwave Therapy: The non-surgical vaginal rejuvenation approach is hugely popular with women in their fifties and/or post-menopause to treat vaginal dryness and improve sexual responsiveness. Modalities such as Cliovana, a completely non-invasive, gentle treatment specifically for female sexual satisfaction focusing on the clitoris, improves blood flow, creates new blood vessels, and improves nerve endings to improve frequency and intensity of orgasms as well as improve lubrication and decrease pain.
Moisturizers and Lubricants: Unfortunately during menopause sex can become painful due to issues with lubrication (a common issue as women age), scarring, narrowing of the vagina, issues with pelvic floor muscles. So if it is a lubrication issue, there are clean over the counter lubricants that you have at home. Using a lubricant during sexual activity can reduce discomfort and increase pleasure. There are low dose over the counter hormonal creams as well as prescription hormonal creams that can be discussed with your provider.
Other options:
Lifestyles changes can have a positive effect on boosting sex drive:
Exercise: There is evidence to support that regular exercise, such as Pilates-based exercise programs, whose benefits include improved energy and metabolism, can help boost your libido.
Stress Management: Stress management techniques such as deep breathing exercises, meditation, yoga and tai chi can help reduce symptoms like mood swings and sleep disturbances. Physical connection is also a good stress reducer.
Hydration: During menopause, dryness is often an issue. This can be contributed to by the decrease in estrogen levels. Drinking 8 to 12 glasses of water a day can help with these symptoms. Adding electrolytes, or a pinch of himalayan sea salt to your water bottle is a great option. In addition, water can help prevent weight gain and aid in weight loss by helping you feel full and increasing metabolism slightly.
Gut Health & Sleep: Good gut health and sleep health significantly impact libido. Make sure your body is fueled with the proper nutrients and nutrition. Getting enough sleep is crucial to your overall health as it is when the body and brain rest, digest and heal. We often minimize sleep or have a lot of sleep disturbance in menopause. Setting the stage for a good night's sleep is key. An hour before bedtime, shut off the TV, dim the lights, get off your phone and plug it in far away from your bedside. Read a book and calm your brain so when your head hits the pillow, it is ready for sleep. Epsom salt baths or foot baths are a wonderful way to calm the body and the brain because it has magnesium which promotes relaxation. Taking a magnesium supplement before bedtime can also help as well.
Posh Lifestyle & Beauty Blog: What sparked the idea to explore sound-wave technology for female sexual wellbeing, and how does it theoretically work?
Dr. Toubi: Sound wave technology has emerged as a revolutionary non-invasive solution in various medical applications, and Cliovana™ stands at the forefront of innovation in sexual wellness. Utilizing sound wave technology, Cliovana enhances sensitivity, leading to increased orgasm frequency and intensity.
Cliovana™ creates long-term enhancement in clitoral responsiveness, resulting in consistently heightened arousal and better orgasms. Operating at the cellular level, Cliovana stimulates the body to naturally intensify what it does naturally. The procedure stimulates the body, particularly in the genital area, to enhance cellular regeneration, providing a proven and patented therapy for sustained improvement in women's sexual responsiveness. Leveraging soundwave therapy, a well-established approach for various health concerns worldwide, Cliovana draws from years of experience treating erectile dysfunction with similar techniques applied to the remarkably similar tissue of the penis.
Posh Lifestyle & Beauty Blog: Can you delve into the science behind sound-wave technology and its potential benefits for sexual health?
Dr. Toubi: In the medical realm, shockwaves find diverse applications, such as lithotripsy breaking down kidney stones and Radial pressure waves treating musculoskeletal conditions. Focused Shockwave therapy addresses erectile dysfunction. Cliovana for example, utilizes acoustic or sound waves to enhance women's sexual health. In the context of sexual wellness, acoustic waves, also known as radial shockwaves, achieve three non-invasive outcomes: increased vascularity, promoting the growth of new blood vessels; enhanced blood flow to the clitoral region, crucial for sexual arousal; and neurogenesis, stimulating nerve tissue development for heightened sensation. This technology facilitates painless improvements in sensitivity and arousal, leading to more frequent and intense orgasms.
Posh Lifestyle & Beauty Blog: What results or findings have emerged from your research or clinical studies involving sound-wave therapy for women?
Dr. Toubi: Soundwave technology has been used around the world for decades, even on the most sensitive tissues. Decades of proven effectiveness in penile tissue, which has similar physiology and arousal mechanisms as the clitoris, has resulted in a large foundation of knowledge on which to build a female-specific procedure.
Posh Lifestyle & Beauty Blog: How does sound-wave therapy compare to traditional treatments for conditions like low libido, sexual pain, or orgasmic disorders?
Dr. Toubi: A major difference of this type of treatment is that it is a 100% non-invasive treatment that is painless for women. There are no needles, probes, lasers, numbing creams, freezing or surgery. The application is a gentle soundwave therapy to the clitoris and surrounding areas.
Additionally, it is quick and easy. Only four sessions are needed at less than 10 minutes each, over the course of 2 weeks.
Posh Lifestyle & Beauty Blog: Can you share any patient success stories or transformations you’ve witnessed as a result of sound-wave therapy?
Dr. Toubi: Absolutely! I have had a couple women in their mid 40s where sex has just become less interesting and the feelings of intensity have been “blunted”. After the use of Cliovana, they have come to look forward to being together with their partners and feel like a veil has been lifted.
Posh Lifestyle & Beauty Blog: Are there any risks or considerations women should be aware of before exploring sound-wave therapy as a treatment option?
Dr. Toubi: Sound wave therapy is considered No risk per the FDA.
Posh Lifestyle & Beauty Blog: What is the accessibility of sound-wave technology in terms of cost and availability for the average person?
Dr. Toubi: Unfortunately, sound wave therapy is expensive. Not every office carries a sound wave device secondary to cost. In big cities, there should be a handful of physicians with a soundwave device.
Posh Lifestyle & Beauty Blog: How do you foresee sound-wave technology evolving in the future, and what impact could it have on female sexual health on a larger scale?
Dr. Toubi: The future of sound-wave technology in advancing female sexual health on a larger scale is promising. Ongoing research and innovation are expected to result in more refined and targeted applications, providing personalized solutions for individual needs. This progress could enhance the effectiveness of sound-wave therapies, addressing a broader spectrum of sexual health concerns in women. As technology evolves, increased accessibility and affordability may democratize access to these therapies, offering a diverse population additional options for improving sexual well-being. The future may see the development of sound-wave technologies designed for various aspects of female sexual wellness, aligning with increased awareness and de-stigmatization of sexual health discussions.
Posh Lifestyle & Beauty Blog: How can partners or spouses be supportive of women exploring treatments like sound-wave therapy?
Dr. Toubi: Practice open communication with your partner and/or spouse regarding your sexual wellbeing. When discussing matters of intimacy, honesty and open communication are crucial. Share your feelings and experiences honestly. Explain what you've observed about your libido and how it's affecting you. Discuss possible solutions together - such as sound-wave technology. Remember that this conversation may be challenging for both of you; approach it with empathy, patience, and willingness to work together towards mutually satisfying solutions.
Posh Lifestyle & Beauty Blog: Lastly, what advice would you give to women who might be hesitant to seek help or discuss their sexual wellbeing due to societal stigma or personal discomfort?
Dr. Toubi: As a sexual health expert, I believe every person is biologically hardwired for intimacy and connection and that all women can achieve a healthy sex life with a multi-layered approach. Women should be enjoying sex at all stages of their lives, and I would encourage women to take back their sex life, as this can have a profound effect on your overall health, wellness, and longevity.
If low libido is causing depression, negatively impacting your overall well being, causing low self-esteem and self confidence, and being detrimental to your relationships, then speak to your doctor. This is important.
