- Female Sexual Medicine
- Menopausal Health
- Obstetrics and Gynecology
Honors & Awards
Women's Reproductive Health Research Scholarship, NIH/NICHD (2004-2008)
Excellence in Education, Stanford University School of Medicine (2008)
ACOG/Boehringer Ingelheim Research Award in Female Sexual Dysfunction, American College of Obstetricians and Gynecologists (2008)
Boards, Advisory Committees, Professional Organizations
Member, International Society For The Study Of Women's Sexual Health (2004 - Present)
Member, North American Menopause Society (2018 - Present)
NCMP, NAMS Certified Menopause Practitioner: North American Menopause Society (NAMS), Perimenopause / Menopause (2020)
Residency: Stanford University Obstetrics and Gynecology Residency (2004) CA
Internship: Stanford University Obstetrics and Gynecology Residency (2000) CA
Medical Education: Northwestern University Feinberg School of Medicine (1999) IL
Board Certification: American Board of Obstetrics and Gynecology, Obstetrics and Gynecology (2007)
M.D., Northwestern University, Medicine (1999)
B.A., Columbia University, Art History (1994)
Current Research and Scholarly Interests
Research interest in the role of the central nervous system in female hypoactive sexual desire disorder.
24-week Placebo-controlled Trial of Flibanserin Once Daily in Premenopausal Women With Hypoactive Sexual Desire Disorder
This trial is designed to assess the safety and efficacy of flibanserin in the treatment of premenopausal women with Hypoactive Sexual Desire Disorder (HSDD) that meets standard diagnostic criteria. Efficacy for flibanserin will be assessed vs. a parallel placebo group.
Stanford is currently not accepting patients for this trial. For more information, please contact Jennifer Howden, (650) 498 - 6128.
Independent Studies (6)
- Directed Reading
FEMGEN 195 (Spr)
- Directed Reading in Obstetrics and Gynecology
OBGYN 299 (Aut, Sum)
- Early Clinical Experience in Obstetrics and Gynecology
OBGYN 280 (Aut, Sum)
- Graduate Research in Reproductive Biology
OBGYN 399 (Aut, Sum)
- Medical Scholars Research
OBGYN 370 (Aut, Sum)
- Undergraduate Research in Reproductive Biology
OBGYN 199 (Aut, Sum)
- Directed Reading
Sexual Health and Religion: A Primer for the Sexual Health Clinician
JOURNAL OF SEXUAL MEDICINE
2014; 11 (7): 1607-1618
View details for Web of Science ID 000339071200003
Fertility issues in cancer survivorship.
CA: a cancer journal for clinicians
2014; 64 (2): 118-134
Answer questions and earn CME/CNE Breakthroughs in cancer diagnosis and treatment have led to dramatic improvements in survival and the need to focus on survivorship issues. Chemotherapy and radiotherapy can be gonadotoxic, resulting in impaired fertility. Techniques to help cancer survivors reproduce have been improving over the past decade. Discussion of the changes to a patient's reproductive health after cancer treatment is essential to providing comprehensive quality care. The purpose of this review is to aid in pre- and posttreatment counseling, focusing on fertility preservation and other strategies that may mitigate risks to the patient's reproductive, sexual, and overall health. CA Cancer J Clin 2014;64:118-134. (©) 2013 American Cancer Society.
View details for DOI 10.3322/caac.21205
View details for PubMedID 24604743
Sexual Health Issues in Women with Cancer
JOURNAL OF SEXUAL MEDICINE
2013; 10: 5-15
Sexual health issues for women who have cancer are an important and under-diagnosed and under-treated survivorship issue. Survivorship begins at the time a cancer is detected and addresses health-care issues beyond diagnosis and acute treatment. This includes improving access to care and quality-of-life considerations, as well as dealing with the late effects of treatment. Difficulties with sexual function are one of the more common late effects in women.This article attempted to characterize the etiology, prevalence, and treatment for sexual health concerns for women with gynecological cancer.A systematic survey of currently available relevant literature published in English was conducted.The issue of sexual health for women with cancer is a prevalent medical concern that is rarely addressed in clinical practice. The development of sexual morbidity in the female cancer survivor is a multifactorial problem incorporating psychological, physiologic, and sociological elements. Treatments such as chemotherapy, radiation therapy, surgery, and hormonal manipulation appear to have the greatest influence on the development of sexual consequences. Sexual complaints include but are not limited to changes in sexual desire, arousal, and orgasmic intensity and latency. Many women suffer from debilitating vaginal dryness and painful intercourse.Many of the sexual health issues experienced by cancer survivors can be addressed in clinical practice. A multimodal treatment paradigm is necessary to effectively treat these sexual complaints in this special patient population.
View details for DOI 10.1111/jsm.12034
View details for Web of Science ID 000314871200003
View details for PubMedID 23387907
- Improving women's sexual health: a quantitative evaluation of an educational intervention for healthcare professionals SEX EDUCATION-SEXUALITY SOCIETY AND LEARNING 2013; 13 (5): 535-547
- Female Sexual Function During Pregnancy and Postpartum JOURNAL OF SEXUAL MEDICINE 2012; 9 (2): 635-636
Is infertility a risk factor for female sexual dysfunction? A case-control study
FERTILITY AND STERILITY
2010; 94 (6): 2022-2025
To determine the impact of infertility on female sexual function.A case-control study.Academic infertility and gynecology practices.One hundred nineteen women with infertility and 99 healthy female controls without infertility between the ages of 18 and 45 years were included in this study.Anonymous survey and Female Sexual Function Index.Female Sexual Function Index scores, frequency of sexual intercourse and masturbation, and sex-life satisfaction.Twenty-five percent of our control group had Female Sexual Function Index scores that put them at risk for sexual dysfunction (<26.55), whereas 40% of our patients with infertility met this criterion. Compared with the control group, the patients with infertility had significantly lower scores in the desire and arousal domains and lower frequency of intercourse and masturbation. The patients with infertility retrospectively reported a sex-life satisfaction score that was similar to that of the controls before their diagnosis, whereas their current sex-life satisfaction scores were significantly lower than those of the controls.Women with a diagnosis of infertility were found to be at higher risk for sexual dysfunction on the basis of their Female Sexual Function Index scores compared with women without infertility. The interaction of sexual function and infertility is complex and deserves further study.
View details for DOI 10.1016/j.fertnstert.2010.01.037
View details for PubMedID 20206929
Radiofrequency Treatment of Vaginal Laxity after Vaginal Delivery: Nonsurgical Vaginal Tightening
JOURNAL OF SEXUAL MEDICINE
2010; 7 (9): 3088-3095
All women who have given birth vaginally experience stretching of their vaginal tissue. Long-term physical and psychological consequences may occur, including loss of sensation and sexual dissatisfaction. One significant issue is the laxity of the vaginal introitus.To evaluate safety and tolerability of nonsurgical radiofrequency (RF) thermal therapy for treatment of laxity of the vaginal introitus after vaginal delivery. We also explored the utility of self-report questionnaires in assessing subjective effectiveness of this device.Pilot study to treat 24 women (25-44 years) once using reverse gradient RF energy (75-90 joules/cm(2) ), delivered through the vaginal mucosa. Post-treatment assessments were at 10 days, 1, 3, and 6 months.Pelvic examinations and adverse event reports to assess safety. The author modified Female Sexual Function Index (mv-FSFI) and Female Sexual Distress Scale-Revised (FSDS-R), Vaginal Laxity and Sexual Satisfaction Questionnaires (designed for this study) to evaluate both safety and effectiveness, and the Global Response Assessment to assess treatment responses.No adverse events were reported; no topical anesthetics were required. Self-reported vaginal tightness improved in 67% of subjects at one month post-treatment; in 87% at 6 months (P<0.001). Mean sexual function scores improved: mv-FSFI total score before treatment was 27.6 ± 3.6, increasing to 32.0 ± 3.0 at 6 months (P < 0.001); FSDS-R score before treatment was 13.6 ± 8.7, declining to 4.3 ± 5.0 at month 6 post-treatment (P < 0.001). Twelve of 24 women who expressed diminished sexual satisfaction following their delivery; all reported sustained improvements on SSQ at 6 months after treatment (P = 0.002).The RF treatment was well tolerated and showed an excellent 6-month safety profile in this pilot study. Responses to the questionnaires suggest subjective improvement in self-reported vaginal tightness, sexual function and decreased sexual distress. These findings warrant further study.
View details for DOI 10.1111/j.1743-6109.2010.01910.x
View details for PubMedID 20584127
WOMEN WITH HYPOACTIVE SEXUAL DESIRE DISORDER COMPARED TO NORMAL FEMALES: A FUNCTIONAL MAGNETIC RESONANCE IMAGING STUDY
2009; 158 (2): 484-502
Lack of sexual interest is the most common sexual complaint among women. However, factors affecting sexual desire in women have rarely been studied. While the role of the brain in integrating the sensory, attentional, motivational, and motor aspects of sexual response is commonly acknowledged as important, little is known about specific patterns of brain activation and sexual interest or response, particularly among women. We compared 20 females with no history of sexual dysfunction (NHSD) to 16 women with hypoactive sexual desire disorder (HSDD) in a functional magnetic resonance imaging (fMRI) study that included assessment of subjective sexual arousal, peripheral sexual response using a vaginal photoplethysmograph (VPP), as well as brain activation across three time points. Video stimuli included erotic, sports, and relaxing segments. Subjective arousal to erotic stimuli was significantly greater in NHSD participants compared with HSDD. In the erotic-sports contrast, NHSD women showed significantly greater activation in the bilateral entorhinal cortex than HSDD women. In the same contrast, HSDD females demonstrated higher activation than NHSD females in the medial frontal gyrus (Brodmann area (BA) 10), right inferior frontal gyrus (BA 47) and bilateral putamen. There were no between group differences in VPP-correlated brain activation and peripheral sexual response was not significantly associated with either subjective sexual response or brain activation patterns. Findings were consistent across the three experimental sessions. The results suggest differences between women with NHSD and HSDD in encoding arousing stimuli, retrieval of past erotic experiences, or both. The findings of greater activation in BA 10 and BA 47 among women with HSDD suggest that this group allocated significantly more attention to monitoring and/or evaluating their responses than NHSD participants, which may interfere with normal sexual response.
View details for DOI 10.1016/j.neuroscience.2008.09.044
View details for Web of Science ID 000262959900012
View details for PubMedID 18976696
Severe vaginal pain caused by a neuroma in the rectovaginal septum after posterior colporrhaphy
OBSTETRICS AND GYNECOLOGY
2006; 108 (3): 809-811
Traumatic vaginal neuromas are a rarely documented finding in the setting of vaginal pain after posterior colporrhaphy. They arise as a result of trauma or surgery and are often mistaken for scar tissue.After a total vaginal hysterectomy and posterior colporrhaphy, a 32-year-old woman presented with debilitating vaginal pain, presumed to be secondary to scar tissue formation. Excision of the tissue from the rectovaginal septum revealed a traumatic neuroma. After the removal of the neuroma, the patient's vaginal pain resolved.Traumatic neuromas may be a cause of significant point tenderness and thickened tissue after vaginal surgery or repair of obstetric lacerations. If conservative treatment methods have failed, surgical excision of the neuroma can be considered.
View details for Web of Science ID 000247038500042
View details for PubMedID 17018512