The Fosnight Center focuses on promoting and maintaining the sexual well-being of individuals through education, prevention, diagnosis, and treatment of conditions related to sexual health. We provide services and medical care to address a variety of conditions. We support sexual education, contraceptive management, and healthy relationships to empower individuals to make informed decisions about their sexual health.
Recognizing sexual health conditions helps individuals regain confidence, improve overall well-being, and enjoy healthier, more fulfilling relationships.
Confirming sexual health conditions empowers individuals to take control of their health, enhancing their quality of life and fostering emotional and physical intimacy.
Effective treatment of sexual health conditions promotes personal wellness, strengthens self-esteem, and supports a vibrant and satisfying lifestyle.
The pelvic floor is an intricate weave of muscles, ligaments, tendons, and fascia structures supporting the pelvic organs.
When there is abnormal tone, pain, shortening, weakness, spasm, discoordination, and impaired contractile properties, the pelvic floor can become hypertonic (high-tone) or hypotonic (low-tone) leading to a wide array of pelvic floor concerns.
Symptoms include urinary incontinence, fecal incontinence, dyspareunia (painful intercourse), decreased lubrication, and referred pain. Causes include but are not limited to pelvic/lower back trauma, medications, anxiety/depression, pregnancy, childbirth, pelvic and abdominal surgeries.
Research shows that female athletes are at increased risk for high-tone pelvic floors.
Diagnosis can be made on physical exam paying close attention to the core, pelvic floor, hips, and lower back.
Often, a pelvic floor PT will use a surface electrode to assess the resting tone of the pelvic floor muscles and evaluate muscle coordination and contractility.
Treatment options include pelvic floor physical therapy along with trigger point release, medications, mindfulness, and breathing techniques.
Pain with intercourse is a common complaint for women of all ages.
Research now shows that the majority of dyspareunia is caused by physical conditions that plays a large psychological influence on sexual health.
Dyspareunia, itself is not merely a disease but rather a symptom with many different causes.
Together, you and your sexual health care team will work collaboratively to develop an individual treatment plan to optimize your sexual health.
One of the most prevalent sexual health concern is hypoactive sexual desire disorder (HSDD), defined as chronic low sexual desire causing personal distress.
Research estimates that 1 in 10 women has HSDD. Causes can include hormone changes, medication side effects, trauma, pain, and even stress.
A thorough medical assessment including questionnaires, history taking, and physical exam are key in diagnosing HSDD.
Treatment options include medications, behavior homework assignments, and working collaboratively with a sexual health team.
Anorgasmia is defined as long term inability to achieve orgasm after adequate sexual stimulation causing personal distress in women.
Studies have revealed that approximately 15% of all women struggle with achieve orgasm and 10% report never achieving orgasm in their life.
Diagnosis focuses on ruling out medical conditions and blood tests to determine how your body’s endocrine system is functioning.
Treatment involves a multidisciplinary approach through medical interventions with vibration therapy, optimal sexual positioning/props, and medications; pelvic floor PT to increase blood flow, muscle relaxation, and rebuild nerve function; and sex therapy to initiate individual and partner behavioral assignments.
Vaginismus is vaginal tightness causing discomfort, burning, pain, penetration or insertion difficulties, or complete inability to have vaginal intercourse.
The vaginal tightness results from a limbic system protective mechanism response that signals the body to brace and protect against potential harm.
Vaginismus typically results secondary to a phenomenon called the cycle of pain.
Treatments include a multidisciplinary approach through pelvic floor PT, vaginal dilator training, medications, vaginal inserts, biofeedback, and cognitive/behavioral therapy.
Vulvodynia is an all-encompassing term associated with pain in the vulva and vestibule.
Pain can occur anywhere on the vulva, either localized or generalized.
The most common symptom is a burning sensation although other sensations such as a sharp, knife-like pain, dull ache, or pressure can happen as well.
Causes can include inflammatory or infectious processes, neurogenic, genetic, stress, or hormonally mediated.
A simple cotton swab test can be performed during a pelvic exam to assess the nerve sensitive of the vulvar skin.
Treatment involves simplifying hygiene practices, avoiding irritants, topical corticosteroids, medications, pelvic floor physical therapy, procedures/surgical interventions, and cognitive/behavioral therapy.
The menopause transition can be a time in a woman’s life where she may feel liberated or frustrated secondary to hormonal changes.
This new phase in life can encompass several stages including perimenopause, menopause, and postmenopause. The average age for a woman to start menopause is 51, however hormonal changes can happen up to 10 years prior to her final menstrual period.
Symptoms include irritability, fatigue, memory concerns, “brain fog,” hot flashes, night sweats, sleep disturbances, vulvovaginal concerns, and other physical changes.
Although menopause is not a specific medical condition, this natural transition process can lead to personal distress and need for therapy options.
Treatments include OTC medication, prescribed medications, as well as lifestyle and behavioral modifications.
In adult males, hypogonadism or low testosterone, can impair the normal body hormonal functions.
Early signs of low testosterone include depression, decreased energy, and decreased sexual desire. Over time, if not corrected, low testosterone can lead to erectile difficulties, development of breast tissue, obesity, decreased lean muscle mass, and even bone loss.
There are various reasons for low testosterone, however more common secondary causes include medications, inflammatory diseases, obesity, HIV/AIDS, and normal process of aging.
Diagnosis can be made via a thorough medical history and physical exam, along with blood, hormonal, and other diagnostic testing.
Treatment includes correcting the underlying condition and/or testosterone supplementation through medications including topical patches/gels, injections, or pellets.
Millions of American men experience erectile difficulties and the most common sexual health compliant reported by men.
Studies have shown that roughly 40% of men in their 40’s and 70% of men in their 70’s have erectile concerns. Ed is defined as the inability to achieve and/or maintain an erection sufficient for sexual activity.
Causes can include physical, psychological, or both. The most common physical cause of ED includes blood flow insufficiency – coronary artery disease, hypertension, and hyperlipidemia.
Other physical causes include diabetes, low testosterone, hormonal imbalances, Peyronie’s disease, tobacco use, sleep apnea, excessive alcohol use, obesity, medical treatments, Parkinson’s, and neurological disorders. Psychological causes include depression, anxiety, stress, performance pressures, and relationship discord.
Treatment includes identification of the cause as well as optimizing blood flow and nerve sensitivity with medications and pelvic floor physical therapy.
Cognitive/behavioral therapies work will as an adjunct therapy to improving medical comorbidities. Working together with a sexual team is essential to maximizing erectile potential.
See Sexual Pelvic Rehabilitation Program for more information. There are experimental therapies that include low intensity shockwave therapy and plasma rich protein.
Peyronie’s disease is caused by fibrous scar tissue involving the fascia structure surrounding the penile shaft.
This palpable scar causes a penile deformity in the erect state, including bending, curvature, narrowing, hinging, and shortening of the penis.
Painful erections and loss of sensation often occur which can lead to other sexual health concerns along with inability to penetrate during intercourse.
The exact cause of Peyronie’s is still being investigated however we do have strong evidence that shows trauma or injury to the penis may cause a proliferate fibrous reaction in the fascia sheath leading to the formation of a plaque.
Many other causes are being explored including genetics, inflammatory diseases, and autoimmune disorders.
Diagnosis can be made through a medical history and thorough physical including a pelvic exam. An artificial erection and penile ultrasound may be performed in the office to isolate the plaque location and measure degree of curvature.
Treatment options are based on several factors associated with the timing of the plaque, goal for penile function, and current comorbidities. Therapies include medications, intralesional injections, topical formulations, and surgical interventions.
A very common sexual health concern, premature ejaculation occurs when a man ejaculates sooner than he or his partner would like., typically within one to two minutes upon penetration. It is estimated that at least 1 in 3 men have experienced rapid ejaculation.
Diagnosis of early ejaculation is made mostly through a medical history.
Causes are thought to be mostly psychological, however hormone levels, concomitant erectile dysfunction, and aging are also contributions.
Treatment options include medications (both oral and topical), disease management, behavior homework assignments, setting realistic expectations, pelvic floor physical therapy, and working collaboratively with a sexual health team.
For men with delayed ejaculation, there is a prolonged delay in reaching ejaculation/orgasm during sexual activity and stimulation. Many more men are dealing with delayed ejaculation than thought in the past.
Causes include disease processes, medications, genital neuropathy, excessive alcohol use, hormone imbalances, depression, and pelvic floor concerns.
Treatment approach to delayed ejaculation includes isolating the cause and using a multidisciplinary technique to improve erectile ability, increase blood flow and nerve sensitivity through pelvic floor physical therapy, and cognitive/behavioral therapy.
A newer sexual health concern, genito-pelvic dysesthesia (GPD) or persistent genital arousal disorder (PGAD) is associated with spontaneous, unwanted, persistent genital sensations.
Symptoms can include pelvic pressure and/or discomfort, engorgement, pulsating, and throbbing that is not relieved with orgasm.
Causes are multi-factorial and individually based on each person’s history.
Treatment options include avoiding stress, relaxation techniques, medication adjustments, nerve blocks, neuromodulation, and pelvic floor physical therapy.
