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See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog This Blog post is for mature women to read. If you feel embarrassed by sex or offended that I am addressing these genuine female concerns, please skip this Blog. Among the many questions I have received, I am sharing a few with you in case you also have these questions but are hesitant to ask when you visit your gynecologist's office. At BioBalance Health, our doctors conduct consultations with new patients and follow-up visits that last an hour. During these consultations, patients are free to ask questions about their health including sexual questions. The atmosphere in our office is open to all questions, and the doctors offer hour-long visits, fostering a supportive environment for discussing embarrassing sexual situations, asking awkward questions, and addressing concerns about sexuality and aging. I am going to offer some of the questions I have been asked and the answers that I give to my patients who ask. Question 1:" Am I normal to think about sex and fantasize about having sex all the time now that I have testosterone pellets?" Yes, that is normal and healthy to think about sex…humans are sexual beings and thinking about or planning to have sex with your partner is normal. After Testosterone pellets are inserted for the first time, they have magnified sexuality for a few weeks. After that the sex drive of a patient goes back to what was normal for them when they were at their prime. Testosterone is necessary for a person, women and men to have a sexual drive. Those women and men who have had a healthy sex life before their testosterone was lost can still have sex, on their usual schedule, but what we think of sex DRIVE, won't be there without T….just the habit of having sex will make them continue to have an active sex life. Question 2: "Before pellets I didn't have any discharge in my underwear, and I thought that was a benefit of menopause but now I experience wetness/slight white discharge Am I OK?" When women are mature and have fertility, (women between 12 years old and menopause) have some discharge clear or white in their underwear. It is from the vagina, and it is a way of the vagina cleansing itself. Without the hormones estradiol and testosterone, as in menopause and when a woman takes low dose birth control pills, the vagina dries up and doesn't "cleanse itself". Vaginal lubrication stops, so does vaginal discharge, and painful intercourse is a real problem for women after they are not producing estradiol or replacing it with HRT. Experiencing normal vaginal discharge is a small price to pay to comfortable sex and a good sex drive. If the discharge changes, please watch or read my last Healthcast #685 or blog #685 to determine if you need to see a Gynecologist. Question 3: A question women ask me before they experience replacement of testosterone and estradiol. "Do I have Alzheimer's disease? I'm only 50 and I can't remember things. I lose words and I am always late because I can't remember appointments." One of the most important benefits of taking testosterone by pellet insertion is that my patients usually get their brain back! It is rare that anyone who is having trouble with their memory before age 55 is really starting to have an early onset dementia. By taking Estradiol and Testosterone pellets my patients regain their normal brain function in the first 8-12 months. Those women who are still struggling with memory after taking Estradiol and Testosterone Pellets should be evaluated by a psychiatrist or neurologist to test them to see if they are having the beginnings of a type of dementia. The sooner a person takes TE hormone pellet replacement, the longer they will have a clear and functional mind. If a woman takes T and or E2 pellets, they can delay the genetic onset of dementia by 10 years. That means if genetically you were wired to lose your ability to think at age 70, then you should get a ten-year delay in the onset of your dementia. E + T pellets are the only treatment I know can preserve your ability to think 10 years longer than if you didn't take them within 10 years of losing your Estrogen and Testosterone (around age 45). Question 4: "Now that I have pellets, I have great orgasms but I produce a lot of fluid when I come. Is that normal?" Yes. Estrogen increases vaginal wetness, and lubrication for sex. Testosterone stimulates the sensitivity of the area around and inside the vagina. Testosterone pellets are the only form I have heard of that can cause vaginal ejaculation, or forceful production of fluid from the vagina. Not everyone experiences this phenomenon, and some women love it as do their partners, and other women dislike it because it makes sex messier than usual. It is a testosterone dose dependent action, and lowering the T dose in pellets can decrease the response to sexual stimulation. Question 5: "My husband can't keep up with my sex drive. I have the same drive as I had when I was younger, but he is not able to keep up with my libido. What can I do?" My response has several options because every sexual partnership is different. You can use vibrators or sex toys to stimulate yourself. He can use the same toys to engage in sexual activity with you. You can lower your dose of T pellets to decrease your sex drive. You can invite your husband to visit us or another Pellet practice to have his level of T and Free T checked and replaced if it is low and he is a good candidate. Question 6: "My husband likes me to give him oral sex. I like it, but what do I do with the semen he produces? The eternal problem: to swallow ejaculate or not. You can only decide this for yourself and if you are uncomfortable with this, then have a washcloth or Kleenex handy to handle the fluid. Question 7:" I have had pellets for a year now, and I have never been so happy, and I feel young again, but my gynecologist examined me and said I had an enlarged clitoris, and she told me to stop pellets because of that! I don't get it! It doesn't bother me; why is she so upset? What should I do?" Your GYN is clearly not educated in hormone therapy using T pellets. She also seems to be uncomfortable with her own sexuality if she cannot see the benefit of having a clitoris that is slightly larger than normal, so it is easy for a partner to access. She may be recalling something from residency, that we were taught: "An enlarged clitoris is a sign of an ovarian tumor, and these tumors secrete high levels of testosterone-like hormone. This is not the same as a slight enlargement of the clitoris that is normal with T replacement. She has not considered that you are receiving Testosterone to replace what you are no longer producing. When we no longer make testosterone at fertile levels, our clitoris shrinks so small that it can hardly be found. Testosterone reverses that change reviving the size and function of the clitoris. Honestly, the change is minimal, and the size of the clitoris varies based on a woman's genetics and testosterone levels before the age of 40. The natural shrinkage of the clitoris after menopause corresponds with low levels of testosterone, along with the loss of clitoral sensitivity, which can lead to a decrease in orgasms! We are sexual beings, and testosterone is essential for sexual function. The ignorance of your gynecologist is both sad and common. In the last 20 years, there has been no training for OBGYNs in sexuality or hormone replacement during menopause. There is complete ignorance regarding treating women with testosterone. As in the general population that has a subset of people who are sexually inhibited, the group of board certified gyns carry their own attitude into the treatment room. Clitoral orgasms are the most common type of orgasm in women. After menopause, they can disappear without testosterone stimulation. That will stop sexual pleasure completely. Most of my patients don't complain about having a visible clitoris, and they say "I can see my clitoris again and my husband can find it now! It makes sex great again." Question 8: "My internist asked me why I wanted to have sex now that I am old! I'm 45! I am changing doctors, but what was she thinking? Again, the training of normal sexuality in residency programs is minimal. She might also be sexually unaware or inhibited, as she revealed when she told you that it is not normal to have sex as we age (over 40); clearly, she does not view it as an important part of her life, so it shouldn't be an important part of yours! Question 9: "Now that I am having sex again, I am shooting fluid out when I climax! What is that and where does it come from? By the way, my husband loves it!" This phenomenon is called "female ejaculation," and it is a normal, yet uncommon, part of great orgasms. Women can produce fluid through transudation via the vaginal wall (which is incorrectly dubbed "vaginal sweating"). There are no sweat glands in the vagina; the fluid comes from the abdomen and is known as peritoneal fluid. When a woman orgasms, her vagina contracts, and this fluid squirts out of the vagina with force. The second source of fluid is the Skene's glands, which are small glands located on either side of the urethra (the opening that leads to the bladder). They don't produce a large amount in most women, but it is possible for them to "squirt" fluid with force. Most men find this gratifying, as an unspoken sign that they did a great job. Women may find it upsetting and ask me to decrease their testosterone levels to lessen the likelihood of "making a mess" when she has sex; however, this also decreases the orgasmic experience. I will keep collecting questions that my patients ask me in my office to offer a continued version of "Embarrassing Questions" in future blogs. I hope this helped you answer some of your unanswered questions!