Stanford doctor works to improve women's sex lives

Gynecologist Dr. Leah Millheiser, with a new patient, started Stanford's Female Sexual Medicine Program in 2008. Gynecologist Dr. Leah Millheiser, with a new patient, started Stanford's Female Sexual Medicine Program in 2008. Photo: Liz Hafalia, The Chronicle Photo: Liz Hafalia, The Chronicle Image 1 of / 15 Caption Close Stanford doctor works to improve women's sex lives 1 / 15 Back to Gallery

(12-03) 22:13 PST SAN FRANCISCO -- As a sixth-grade girl, Dr. Leah Millheiser spent most Sunday evenings attuned to the radio, transfixed by the scratchy, German-accented gospel of Dr. Ruth Westheimer.

It was the mid-1980s. Dr. Ruth vaulted into the popular consciousness with her late-night radio show, "Sexually Speaking." Listeners called in, seeking her frank advice on the full range of sexual conundrums. At home in Miami, Millheiser would tune in, while gabbing with a friend on the phone about whatever Dr. Ruth said.

It was "highly entertaining, but also informative," Millheiser recalled. She was fascinated.

Later, in medical school at Northwestern University, she was irked when a lesson on sexual dysfunction lasted less than two hours - and only discussed the issue in men.

In residency, she found it was more of the same. Years after Dr. Ruth made her on-air debut, doctors still weren't really discussing the sexual problems of their female patients, with one another or with the patients themselves.

Ignored no longer

From Millheiser's point of view, that was a problem, one she eventually endeavored to solve by starting Stanford University's Female Sexual Medicine Program in 2008.

"It was almost like women weren't very important," she recalled. "There was a bias in sexuality research."

If Dr. Ruth is sex medicine's gossipy granny, then Millheiser is its perky cheer squad captain.

As a gynecologist near me, Millheiser specializes in treating women with what is broadly known as female sexual dysfunction - everyone from postmenopausal women for whom sex is undesirable to cancer survivors whose sex lives have been complicated by medications, radiation and other facets of treatment.

Traditionally, sexual issues in women were often chalked up to a psychological problem. When Viagra hit the market in 1998, offering a solution to erectile dysfunction in men, it illuminated the lack of attention given to sexual dysfunction in women and prompted drug companies to begin searching for Viagra's feminine counterpart.

The following year, a study in the Journal of the American Medical Association suggested that 43 percent of women suffered from some form of sexual dysfunction. Since then, research has increasingly highlighted physical causes for those sexual problems, but treating them physiologically is still a relatively small medical specialty.

Sexual dysfunction

The definition and diagnostic criteria for female sexual dysfunction are controversial and poorly defined in medicine, but from Millheiser's point of view, sexual issues are certainly clinical ones for many women.

The term female sexual dysfunction is used to describe everything from a lack of libido to sexual pain or inability to achieve orgasm.

Millheiser offers her patients everything from advice on better lubricants to hormone therapy. And though she often refers them to a therapist to help address psychological issues that may be working in tandem with the physical ones, she often offers a bit of counseling herself.

"Women that I find in my practice, they're not going to go down without a fight when it comes to their sexuality," she said. "Being a sexual person is part of what makes them a woman. And they want answers and treatment."

Growing up, Millheiser's parents were always open about sex.

Her father, an orthopedic surgeon, was from the Bronx, N.Y.; her mother, a nurse, was from Portugal. They moved to Miami with their two young sons in 1972, right before Millheiser was born.

In Miami, Millheiser attended private school, spent summers sailing to the Bahamas and took in museums and the opera with her parents.

Her mother, Maria Millheiser, learned about the importance of being frank about sex as a young woman in Portugal, where women who were up front about their sexuality were generally disrespected.

"I know tons of friends that never had an orgasm in their life because of this background," she said. "I wasn't about to have my daughter go through life like this."

She hoped to instill in her daughter healthful - and safe - ideas about sex. Meanwhile, Dr. Ruth had become a huge influence.

A different direction

When Millheiser moved to New York after high school to attend Columbia University, her plan was to become an art curator or critic. Her interest in women's health, though, was nagging. Her senior year, she changed her major to pre-med. She graduated from Northwestern in 1999, the same year of the landmark study that found large numbers of women suffered from sexual dysfunction.

As a resident in obstetrics and gynecology at Stanford, she found herself confronting the same annoyance she had encountered as a medical student.

Women would visit their gynecologist, and sometimes mention difficulties with sex.

"You know what women would be told?" she said. " 'Why don't you go home, have a glass of wine, relax, use a little bit of lubricant.' For patients it's so disappointing when there's no real fix. I remember thinking there's got to be more."

At that point, there was still very little understanding of female sexual response. In men, sexual dysfunction was a quantifiable physical event. But what even qualified as "functioning" sexuality in women?

One study conducted by Millheiser focused on the role of the central nervous system in women who complained of a lack of sexual interest. Using functional magnetic resonance imaging, she illuminated specific patterns of brain activity that corresponded with sexual response. Many of her peers laud it as her best work.

Convinced of a need

By the end of the study, it had become evident to others at Stanford that there was a real need for a clinic that focused on treating women's sexual dysfunction. Dr. Mary Polan, then-chairwoman of OB/GYN at Stanford, recalled Millheiser placing posters all over campus for study volunteers. They were overrun with willing volunteers.

"She's had a lot of support in our department because people realize what an important part of a woman's life it is," said Dr. Lynn Westphal, a Stanford gynecologist who has known Millheiser since residency.

On a recent day in the clinic, Millheiser met a new patient, a woman in her 40s, who, after surviving breast cancer and then undergoing a double mastectomy and breast reconstruction, was having issues in the bedroom with her husband of 16 years. It had been more than a year since they'd had sex. She wanted to have sex, but had no sex drive to speak of and, on top of that, it was painful, in part because of medications she was on to keep her cancer from recurring.

The patient, referred by an oncologist, was shy to disclose details at first. Millheiser approached the conversation like two old pals chatting over lattes. Over 45 minutes, they covered such things as work life and how the patient's parents talked about sex growing up.

"Women are much more affected by contextual factors than men," she said. "Work, stress, the kids."

The blogger

The patient left with homework: recommendations for lubricant and moisturizers, daily exercises to help gradually make sex more comfortable and instructions for how to reconnect physically with her husband, as well as a referral to a sex therapist.

These days, Millheiser is less focused on research than on her clinical practice, and on blogging, which she does to reach women she can't through her practice.

She is married with two boys, ages 2 and 4, and lives in San Ramon. Every night after the kids go to bed, she plugs away at DrLeahM.com, which she started this year to address women's questions about sexual health. She also lectures frequently to educate other doctors, at Stanford and elsewhere.

"She's sort of an up-and-coming player," said Dr. Andrew Goldstein, president of the International Society for the Study of Women's Sexual Health.

Honest depictions

A lot has changed since Millheiser first used to listen to Dr. Ruth on the radio.

"There are now more honest depictions of sex in the media," said Millheiser, pointing to Oprah Winfrey talking about her "vajayjay" on television and Samantha Jones, resident sex kitten on "Sex and the City," dealing with menopause in the series' second film.

In the summer, Flibanserin, a drug to help postmenopausal women with low sex drives that Millheiser has consulted on in the past, was resubmitted to the Food and Drug Administration for approval after being rejected in 2010. If the FDA approves the drug, it would be the first in the U.S. to treat what's known as hypoactive sexual desire disorder. Meanwhile, the debate continues over what exactly constitutes sexual dysfunction in women. Some have questioned whether it exists at all.

Millheiser quashes such queries.

"It's really a real thing," she said. "Women are coming from all angles, saying, 'I need to have my sex life back.' "