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Sexual Health and Menopause

In the treatment of pelvic, vulvar, and vaginal pain, our experts believe that a biopsychosocial approach is most effective, addressing all aspects of functioning. The underlying causes of pain during menopause are often different than those affecting premenopausal people. Pain related to the reproductive organs such as the uterus and ovaries is much less common; however, muscle pain of the pelvic floor, abdominal wall, and pain related to nerve damage or altered nerve conduction as well as vaginal pain related to hormonal deficiency, is more prevalent. Menopause can be a challenge for those with pre-existing or new onset pain conditions as lack of estrogen can alter mood, sexuality, sleep, energy, coping, and nerve firing.  At the UCLA Menopause Program, our approach includes taking a thorough history and structured exam as well as utilizing a multidisciplinary team often involving a pelvic pain specialist, physical therapist, pain psychologist, pain management anesthesiologist, and sometimes a urologist or gastroenterologist.

Research

1. Investigating treatment of pain with vaginal penetration in premenopausal women (VBD Update Study) with plans to extend the studies to post-menopausal women who fail to respond to hormonal therapy.

2. Application of estrogen cream alone compared with estrogen plus testosterone cream for pain with penetration 

3. Effect of vibrator stimulation of pelvic floor muscle trigger points for pain reduction

Selected Publications (for full list see PUBMED:)

  1. Rapkin A. "A deep dive into devices for sexual health." Contemporary OB/GYN, April 1, 2024.
  2. Oughourlian T, Guistinna T, Antony K, Gupta A, Mays V, Mayer E, Rapkin A, Labus J. Symptom-associated alterations in functional connectivity in primary and secondary provoked vestibulodynia. Pain. 2022 Aug 15. doi: 10.1097/j.pain.0000000000002754. Online ahead of print. PMID: 35972459
  3. Lo L, Lamvu G, Alappattu M, Witzeman K, Markovic D, Rapkin A. Predictors of Mucosal and Muscle Pain in Vulvodynia: A Cross-Sectional Analysis from the National Vulvodynia Registry. J Pain. 2020 Jul 14: S1526-5900(20)30050-X. doi: 10.1016/j.jpain.2020.07.001. Online ahead of print J Pain. 2020. PMID: 32679255.
  4. Bhatt R, Gupta A, Rapkin A, Kilpatrick L, Hamadani K, Pazmany #, Van Oudenhove L, Stains J, Aerts L, Enzlin P, Tillisch K, Mayer E. Labus J.  Altered Gray Matter Volume in Sensorimotor and Thalamic Regions associated with Pain in Localized Provoked Vulvodynia: A Voxel-based Morphometry Study in Pain.  Pain. 2019 Feb 25. doi: 10.1097/j.pain.0000000000001532. [Epub ahead of print] PMID: 30817440
  5. Petersen N, Liang L, Ghahremari D, Goldman L, London E, Rapkin A. Emotion regulation in women with premenstrual dysphoric disorder.  Arch Womens Ment Health. 2016 Oct;19(5):891-8. doi: 10.1007/s00737-016-0634-4. Epub 2016 May 7.  PMID: 27155663
  6. Gupta A, Rapkin A, Gill Z, Kilpatrick L, Fling C, Stains J, Masghati S, Tillisch K, Mayer E, Labus J. Disease-Related Differences in Resting State Networks: A Comparison between Localized Provoked Vulvodynia, Irritable Bowel Syndrome, and Healthy Control Subjects. Pain. 2015 May;156(5):809-19. doi: 10.1097/01.j.pain.0000461289.65571.54. PMID: 25735001
  7. Berman S, London E, Morgan M, Rapkin A. Elevated Gray Matter Volume of the Emotional Cerebellum in Women with Premenstrual Dysphoric Disorder. J Affect Disord. 2013 Apr 5;146(2):266-71. PMID: 22868063
  8. Berman S, London E, Morgan M, Rapkin A. Elevated Gray Matter Volume of the Emotional Cerebellum in Women with Premenstrual Dysphoric Disorder. J Affect Disord. 2013 Apr 5;146(2):266-71. PMID: 22868063
  9. Rapkin AJ, Berman SM, Mandelkern MA, Silverman DHS, Morgan M, London E.Neuroimaging evidence of cerebellar involvement in premenstrual dysphoric disorder. Biological Psychiatry 2011; 69 (4);374-80. PMID: 21092938
  10. Lee M, Morgan M, Rapkin A.  Clitoral and vulvar vestibular sensation in women taking 20 mcg ethinyl estradiol combined oral contraceptives: A preliminary study.  Journal of Sexual Medicine
    2011; 8:213-218. PMID: 20955310
  11. Rapkin A, Morgan M, Biggio G, Sera M, Pisu M, Rasgon, N.  Neuroactive steroids after estrogen exposure in depressed postmenopausal women treated with sertraline and asymptomatic postmenopausal women.  Arch Womens Ment Health 2010; 13(1):91-98. PMID: 19728035
  12. Rasgon NL, Dunkin J. Fairbanks L., Altshuler LL, Troung C, Elman S, Wroolie TE, Brunhuber MV, Rapkin A.  Estrogen and response to sertraline in post menopausal women with major depressive disorder: a pilot study.  J Psychiatr Res 2007; 41(3-4): 338-343. PMID : 16697413
  13. Rapkin A.  Vasomotor symptoms in menopause: Physiologic condition and central nervous system approaches to treatment.  Am J Obstet Gynecol 2007; 196(2):97-106. Review. PMID: 17306645
  14. Morgan ML, Cook IA, Rapkin AJ, Leuchter AF.  Neurophysiologic changes during estrogen augmentation in perimenopausal depression.  Maturitas 2007; 56(1):54-60. PMID: 16835012
  15. Dunkin J, Rasgon N, Zeller M, Wagner-Steh K, David S, Altshuler L, Rapkin A.  Estrogen replacement and cognition in postmenopausal women:  Effect of years since menopause on response to treatment.  Drug Development Research 2006; 66:150-159. PMID: 15511602
  16. Yonkers KA, Brown C, Pearlstein TB, Foegh, M., Sampson-Landers C, Rapkin A.  Efficacy of a New Low-Dose Oral Contraceptive with Drospirenone in Premenstrual Dysphoric Disorder.  Obstet Gynecol 2005; 106(3):492-501. PMID: 16135578
  17. Morgan ML, Cook IA, Rapkin AJ, Leuchter AF.  Estrogen Augmentation in Perimenopausal Depression:  A Pilot Study.  J Clin Psychiatry 2005; 66(6):774-780.  PMID: 15960574
  18. Berkley KJ, Rapkin AJ, Papka RE.  The Pains of Endometriosis.  Science 2005; 308:1587-1589. PMID: 15947176
  19. Dunkin J, Rasgon N, Wagner-Steh KLW, David S, Altshuler L, Rapkin A.  Reproductive Events Modify the Effects of Estrogen Replacement Therapy on Cognition in Healthy Postmenopausal Women.  Psychoneuroendocrinology 2005; 30(3):284-296. PMID: 15511602
  20. Rasgon NL, Altshuler LL, Fairbanks LA, Dunkin J, Davtyan C, Elman S, Rapkin A. Estrogen replacement therapy (ERT) in the treatment of major depressive disorder in perimenopausal women.  J Clin Psychiatry 2002; 63(7 Suppl):45-48. PMID: 11995778
  21. Rasgon N, Serra M, Biggio G, Pizu G, Fairbanks L, Rapkin, A.  Neurosteroid-serotonergic interaction: Responses to an intravenous L-tryptophan challenge in women with premenstrual dysphoric disorder.  European Journal of Endocrinology 2001; 145:25-33. PMID: 11415849
  22. Rapkin AJ, Morgan M, Goldman L, Brann DW, Simone D, Mahesh VB.  Progesterone metabolite allopregnanolone in women with premenstrual syndrome.  Obstet Gynecol 1997; 90(5):709-714. PMID: 9351749
  23. Rapkin AJ, Shoupe D, Reading A, Mahesh V.  Decreased opioid tone in PMS: LH response to naxolone.  J Soc Gynecol Invest 1996 March-April; 93-98.
  24. Rapkin AJ, Reading AE, Woo S.  Tryptophan and neutral amino acids in premenstrual syndrome.  Am J Obstet Gynecol 1991; 165:1830-1833. PMID: 1750482
  25. Rapkin AJ, Kames LD, Darke LL.  Stampler F, Naliboff B.  History of physical and sexual abuse in women with chronic pelvic pain.  Obstet Gynecol 1990; 76(1):92-96. PMID: 2359571
  26. Kames LD, Rapkin AJ, Naliboff BD, Afifi S, Ferrer-Brechner T.  Effectiveness of an interdisciplinary pain management program for the treatment of chronic pelvic pain.   PAIN 1990; 41:41-46. PMID: 2352765
  27. Rapkin AJ, Edelmuth E, McGuire M.  Whole‑blood serotonin in premenstrual syndrome. Obstet Gynecol 1987; 70:533‑537. PMID: 3627623
  28. Rapkin AJ.  Adhesions and Pelvic Pain: A retrospective study, Obstet Gynecol 1986; 68(1):13‑15. PMID: 2941707