An interview with Andrew Goldstein, MD, at the International Society for the Study of Women’s Sexual Health conference

Michael Krychman, MD

Dr. Goldstein, you are really considered a pioneer in sexual medicine. Tell us some of the take home messages about sexual medicine.

Andrew Goldstein, MD

Thank you,I'm happy to talk about this, because what I think we've learned so much in the past year and continue to learn more every year is we're really cracking open the black box around female sexual dysfunction. It used to be we didn't know what was causing problems like central pain disorders, or vulvodynia, or why some women have low sexual desire, low arousal. And instead we're really learning an amazing amount about the underlying pathophysiology of these disorders. So when I started my career 20 plus years ago, chronic vulvar pain was of unknown causes and we had no way to treat it. We now have many subcategories of vulvodynia, such as neuroproliferative or hormonally mediated, and we're actually understanding how to evaluate and treat it. Is there a myofascial component? What is the inflammatory component, and of course the hormonal component. So we are really figuring out the underlying causes. And we're now finding effective treatments for these disorders.

MK

Right, it's really exciting. There was also a buzz around the seminar here on “inflammation”. And it was kind of the talk of the conference: can you give us just a quick update about what you thought of that seminar and why it's so important?

AG

Inflammation is actually so central to both the cause and response of these insults. And this one session discussed the inflammatory response in the brain, from peripheral inflammation. There's almost a kind of inflammatory map on the brain using the same cells and same inflammatory cytokines that happened on the periphery: these things actually are happening in the brain. And so when we really do talk about the brain body interaction, the brain is mirroring the peripheral problems. And so the roles of inflammation, mast cells, neurogenic, inflammation, hypoxic inflammatory response, inflammation from lack of hormones affects not just the vulvodynia patient, but affects all menopausal women, and women who take different types of hormonal contraception. The role of inflammation is so important. And again, I think that's going to be the new field of study: Its important to address how we can potentially lower these inflammatory compounds such as , cytokines, inflammatory response, to either prevent disease or to act as a treatment disease that resulted from an inflammatory process.

MK

People are always concerned about finding a provider that's well qualified. I've been involved with sexual health issues for many decades, and ISSWSH really often looked upon as the premier organization go to learn, to collaborate with well-known experts and colleagues. What are your thoughts?

AG

What's amazing about this conference, and I am a member of many societies, is that this is one conference that is unbelievably multidisciplinary. Where can you find a conference where you have a neurosurgeon, an internist who's a specialist in mast cells or pain management, psychologists, sex therapists, gynecologists, urologists, physical therapists. There's a passion for sexual medicine to help women, and we understand that all of these fields actually have a role to play in women's health and women's sexual health. And so it doesn't matter what the letters are after your name, or what training you've completed, if you care about women and women's sexual health, you will find a home at ISSWSH.

MK

And I think the important message for people to realize. You could just be out of residency for six months, or 30 years in practice, everyone is still always learning, there is still collaboration, you can always go home with clinical pearls to really help patients.