[MUSIC PLAYING] Welcome to the University of Chicago Medicine At The Forefront Live. The title of our program today is "Menopause, Cancer, and Sexual Function-- What Women Need to Know." Gynecologist Stacy Lindau and Monica Christmas join us for an honest conversation about women and those who love them need to know about menopause, sexual function as you age, and how cancer can affect your sex life. Now remember, we're taking your questions. So start typing them into the comments section. We'll get to as many as possible over the next half hour. As always, we want to remind our viewers that our program today is not designed to take the place of a medical consultation with your physician. And we'll get to our questions here in just a moment. But first, if we can start off, you guys introduce yourselves, and tell us a little bit about what you do and your areas of interest. Dr Christmas, we'll start with you. OK. My name is Dr. Monica Christmas. I am a assistant professor here at the University of Chicago. I am in the section of minimally invasive gynecologic surgery. And I am the director of the menopause program. Great. Dr. Lindau? My name is Stacy Tessler Lindau. I'm a physician, professor, and scientist here at the University of Chicago. And I'm director of the program in integrative sexual medicine, which focuses on preserving and recovering sexual function for women with cancer and other common diseases that come with aging. All right. Let's get right into our questions. We'll start with our first one. What are the most common sexual challenges that women face as they age? I don't know who wants to jump in and take that one. I'll start. So I've been studying sex and aging for more than 20 years. We at the University of Chicago conducted the first comprehensive study of sexuality and aging to be done in the United States and published our results, now more than 10 years ago, in the New England Journal of Medicine. And I want to start with the fact that most people who are sexually active in later life enjoy good sex lives. One of the biggest challenges for older women is that we outlive our partners. So while our function might be there, our desire and interest might be there, we might not have a partner. Having said that, there are some really common sexual function problems that women experience with age. Vaginal dryness is a common problem. We don't talk about it a lot. But postmenopausal women know about it. Once there's dryness, sex can become painful. It's a correctable problem. But the pain might be due just to the dryness alone, or a muscle problem that can develop as a result of dryness. And low libido, or decreased interest in sex, is another common problem. We see this in men and women with aging. So what is it about aging that makes these changes happen? Well menopause is one. That's a big issue. And I'll let Dr. Christmas speak about menopause. Yeah. So in menopause, our ovaries stop making estrogen and progesterone, which are the hormones that our bodies like-- our vaginas like. And so with a decrease in estrogen, the tissues in the vagina become dry, as Dr. Lindau said. But also, there are structural changes in the vagina as well. The length of the vagina can shorten. It can become tighter. These are all things that we do have great treatments for, some of which include hormones, some of which are not. But I think it's important for women to know that there is help, and that you don't have to just kind of live with the discomfort. Yeah. If I could add, I think what's important is that age alone is not a cause of sexual dysfunction. There are changes that can occur with age, and many of them are addressable. But there's not good evidence to say that the number of years itself is a determinant of a person's sex life. And I totally agree with Dr. Christmas. If your sexual function is not what you want it to be, get help. You don't just have to accept it as fate. Well I'm glad you brought that up, because I think oftentimes people suffer in silence. Women will have something happened, and they'll determine that it's just the way it is. I'm going to live with it. Right. You don't have to. That's exactly right. And you shouldn't. You shouldn't. I mean, some people say when I've interviewed older adults at the national level or even very determined populations, some people say, I'm done with that part of my life. It's not important to me. I don't want to have sex. Even those people will say, if I'm having a problem or I decide I want to start my sex life again, I do think I should be able to talk to a doctor about it. But suffering in silence is really not necessary. And we doctors are, to some degree, unfortunately, to blame. We don't raise this topic, because we're not sure what to do about it. It takes time to address it. Some doctors-- we bring our own hangups to the practice of medicine. And I really encourage people to say to their doctor if you're having a problem, what can I do about my sexual function? What will this drug do? What kind of side effects will it have? And the more doctors are asked, the better we'll get at answering the questions. We don't like to be wrong. We don't like said I don't know. So patients need to ask. And these are very personal questions as well. So I would imagine that for some physicians, just like any other human being, it's a difficult topic sometimes to face. Is that accurate, you think? It is. And I think that it's sometimes not the only problem that a patient has. And so if you have what somebody deems as a real medical problem, most of the visit is spent on that. And it's a hard thing to broach. So one of the things that we provide on the WomanLab website is a list of questions that you can go into to ask your doctor. And I do think that helps them broach the topic so that it's a little bit more comfortable. And you can do it in a more expedient fashion, too. Because it might not be that they could get all of those questions answered. But then maybe they could give you a call back later and you could finish, or come back at another time. And speaking of answering questions, I want to make sure we do get to some of our viewer questions. We're already getting some. And I want to remind people to please type them in the comments if you do have any questions for either one of our physicians. We'll be happy to answer them. Our first question from a viewer-- "Please discuss bioidentical hormones." Who wants to take that one? That's you. That's all you. So the term bioidentical just really means that you are supplementing your hormones with a compound that's pretty identical to what your ovaries would naturally make. So most of the times, there is cute words that come before bioidentical. Like it's all-natural, or it's healthier or better for you. But the truth of the matter is that all hormones really carry the same risk. Many of the bioidentical hormones are not FDA-approved, and so there's a risk of really not knowing what you are getting. There are some actual bioidentical that are FDA-approved. So if you're really committed to wanting a bioidentical compound, there are some that a doctor could prescribe you. Otherwise you'd be getting them from a compounding pharmacy. And they make things sound good, because sometimes they'll say, oh, we're directing it at your hormone levels. We'll do this salivary testing. We'll do this. You can use a cream. It's safer than taking something that your doctor might give you. So it's really important to understand what those risks are. And if you have any contraindications that would preclude you from having traditional hormone replacement therapy, those same contraindications will apply for bioidentical as well. Well whenever I read or hear something online or wherever that's says safer than what your doctor may give you, that to me is a an immediate red flag. So that would concern me right off the bat. Consumers need to be skeptical, and need to ask questions. When you start any new medication, you need to understand what are the pros, what are the cons, what are the risks? And when it comes to products we buy over-the-counter-- and our group does some research on this-- we shouldn't assume that over-the-counter products are safer. Nutritional supplements, vitamins, herbs, may make you feel better, but it's important to know what's in them, and where they're coming from. And there are risks. Sometimes those products, including bioidentical hormones sold over the counter can interact with other drugs. And those drug-drug interactions can be a problem for your health. Could cause a sexual function problem. We got to be critically thinking consumers. Speaking of consumers, we do have a question from one of our viewers asking about over-the-counter medications or things they can buy for addressing vaginal dryness. And I don't know that we want to give up brand names. But are there things that people can buy without a prescription that will help? Yeah. There is a huge number of products sold over the counter to help with vaginal dryness. And there are really two main product types. There are moisturizers, and there are lubricants. And this may sound like a silly way to remember, but moisturizers are intended more for maintenance therapy. Moisturizer, maintenance, used on a regular basis. Lubricants are more for lovemaking. They are used to reduce friction during intercourse or penetration. One thing I will say about these products is, again, because they're really considered more cosmetic products, or the FDA might consider them more in a device category, interestingly, they are not subjected to the same rigor that prescription hormones are subjected to. And on the whole, people use these products without much problem. Sometimes we see skin irritation and things like that. So there aren't huge safety concerns that we know of, but they just aren't handled the same way that prescription drugs are. The last thing I'll say is that you have to be thoughtful about which product to use, especially for lubricants. Some are not compatible with condoms. Condoms are important, even for women post-reproductive age, to prevent sexually transmitted infections, say with a new partner. And so it's important for people to choose the right one. I'll just add one more thing too, though, with lubricants and moisturizers as well. Many of them have lots of additives and preservatives to them, in addition to having alcohol, too. A high alcohol content. And so I usually try to recommend lubricants as well as moisturizers that don't have those things in them. So you really want to be reading the labels. Many times on compounds or products from a health food store probably will fit the bill of not having the preservatives, and will match the normal PH of the vagina. Because using something that has a lot of either fragrance to it or additives can really cause more harm and more drying than help. And obviously, use common sense. If you are experiencing irritation on something like that, probably stop using it, and maybe come to see one of you. Great advice. I was going to add, one common problem on this topic-- soap. So hygiene obviously is important. And we are a hygiene-oriented society. But sometimes too much is not good. And especially post-menopause. Natural menopause, and menopause especially caused by medicines that we use to treat women who have had cancer, can thin the tissues in the vulva-- that's the outer anatomy-- and in the vagina. Washing with soap really adds insult to injury. Women might say I've been using that bar soap or that liquid soap for years. It was never a problem. But without estrogen, when the tissues are thin, the soap can be very, very drying. And just eliminating that can actually help address the drying. Eliminating pads also can help reduce drying. I think that's a great point. Because as we spoke about earlier, just a few minutes ago, as we age, we change. And people, their bodies undergo changes. And so things we used to do were fine not be fine now. That's right. So do you think that women really get the support they need from the medical community? Is that fair criticism, or what do you think? Listen. I think, and I bet you agree, that most people who choose medicine, or people who choose nurse practitioner or physician assistant professions, want to heal. We want to take the best care we can of our patients. And the pressures of practicing medicine and the business and the economy of medicine are real. And we aren't necessarily always set up with the time we need to address more sensitive topics. And I know from our research that it's more sensitive to talk to a patient about their income or their ability to pay their medical bills than it is to talk to them about their sexual function. That is a fact. Still, when we try to evaluate a sexual function problem, we need time. And here at the University of Chicago Medicine, fortunately, we have a practice where we do have the time we need to take a whole person care of people who are presenting with sexual function concerns. That's not something that can happen in routine community practice everywhere. And that's a reason why we're lucky. We in it we live in a society where we can have primary care, frontline community practice, and we can have specialty tertiary and quaternary care practice. We can complement each other. I think that's a great point. So these issues happen to women in the normal course of aging. But they can be magnified by their health challenges. What role does disease play in all of this? I'll focus on cancer. So 3/4 of the patients I see are women with cancer. Half of those are women with breast cancer. About quarter are women with gynecologic cancers. And the remainder are women with blood cancers like leukemia, lymphoma, colorectal cancers. Really any cancer type can affect a woman's sexual function. And by the way, prostate cancer is the most common cancer that men survive. And of course, can also affect a man's sexual function. We're better at addressing, preserving, and helping men recover their sexual function after prostate cancer treatment, or in the course of prostate cancer care, than we are in addressing these issues with women. That gives me hope because it suggests we can do better. We need the evidence base for that, and we need to proactively inform women. If you're being treated for cancer, ask your doctor the questions. If I choose this treatment versus this treatment, what's my likely sexual function outcomes? And like Dr. Christmas mentioned, we've also published on WomanLab 10 questions to ask your doctor about sex after cancer. And you should ask these questions before you get treated. We can help later, but the outcomes are the best if you're able to answer these questions and preserve your function as much as possible. You see women with other conditions. I really think that any medical condition affects how we think about ourselves. And that the medications that we take also can affect our energy level. So I don't think it just has to do with cancer. It could be high blood pressure. It could be diabetes. It could be depression or anxiety provoking illnesses as well. So I try to focus on what is most bothersome. And so many times, if we start to correct things like how much sleep you're getting-- that's one that's a big factor. That if you're not getting enough sleep, you're tired. Factoring in things like exercise, and then talking about nutrition. These are natural things that we can do that really do help us have an overall sense of livelihood, too. And I think those things help. What makes things more challenging, too, is that many times, it's not just the physical issues that we're going through. There are a lot of mental components to things as well. And that may be one reason that some doctors shy away from talking about this or speaking about this topic. But there are quick ways that you can talk to people about what's going on in their personal lives and help to give them resources to help alleviate those issues so that they can then fix the other issues. If I could pick up on one thing-- you're a minimally invasive surgeon. One of the symptoms that is a red flag for me in terms of a new sexual function concern for a woman is deep pain. Deep pain with intercourse. That can be a red flag for an undiagnosed gynecologic problem, and really should be taken seriously. Endemetriosis or fibroids. Right. Fibroids are really common. And a new symptom of deep pain with intercourse really warrants evaluation with a gynecologist. And most of those problems are also treatable. But sometimes sexual activity helps women identify health problems sooner. It's not uncommon that my patients tell me it was their partner who noticed a lump in their breast during sexual activity. So usually, sexual function problems don't indicate cancer. But we don't want to blow them off if we have a new symptom. Well the beauty of what you're saying is, I think on most of these instances, there is hope. There is. And certainly don't suffer in silence. There is hope. That's right. Which is good to know. So you opened the door on this one a minute ago, Dr. Lindau. It's its last day of Breast Cancer Awareness Month. And tomorrow starts-- today is the 31st-- and tomorrow starts Awareness Month for lung cancer, pancreatic cancer, and stomach cancer. There are a lot of awareness months. Right. One thing people may not know is that cancer treatment can cause significant challenges for a woman's sexual function, as you were talking about. Why is that? What happens that causes the issues there? Yeah. Well let's just let's talk first about breast cancer, because it is the most common cancer that women survive. And increasingly, it's a treatable, curable cancer. And we do great breast cancer care here at the University of Chicago Medicine. About 100,000 women a year in the United States alone undergo mastectomy, which is removal of one or both breasts to treat breast cancer. And increasingly, women are choosing mastectomy to prevent cancer. They haven't been diagnosed, but they know they're at elevated risk. It is exceedingly rare that we talk to women about what the implications are of having the breasts removed for their sexual function. But of course, for most women the breasts are-- and for their partners-- the breasts are an important sexual organ. So I do want to say to women who choose to undergo that procedure or need to undergo that procedure, it is a known consequence of having a mastectomy that you might experience changes in your sexual function. That's not unexpected. And it's perfectly legitimate to feel a sense of loss if that occurs. And it's also good to ask for help. That's one issue. The other is for many cancer types, we use chemotherapy and radiation. And these can effectively shut down ovarian function. As Dr. Christmas said, the ovaries make estrogen. They make progesterone. They also make testosterone. All hormones that we understand to be important for sexual physiology. And Tim, you mentioned women suffering in silence. If we don't tell women there is a chance you're going to experience some changes in your sexual function after treatment, they think it's in their head. They think it's just them. They blame themselves. Or they worry about their relationship. If we do tell them, they might not want to talk about it in the midst of talking about chemotherapy. But they carry that information and they say, you know, my doctor mentioned this, so it must not just be me. I'm not alone. I can get help when the time is right. And I think it's important to remember too that oftentimes, a partner is involved. So it's good to have your partner understand what you're going through, what's happening. And how does that work? When you work with the patient, do you work with partner at all? Yeah. We welcome partners, and we care for all women. I would say maybe 10% to 20% of our patients bring their partner to the visit at some point. Listen. It's very important to assess for the partner's sexual function and health. Because sometimes the problem is not that the woman is suffering a loss of physical sexual function or psychological aspects of her function. She may have a partner in his 60s who has erection difficulties. And that's a common problem that occurs with age in older men. And so if we don't address, we don't ask about, and we don't openly address the primary problem-- erectile dysfunction is very treatable-- then we may really go down the wrong path, and ultimately not effectively treat the couple. So I love it when partners come, and I also always make time to speak with my patient one-on-one. I know you do the same. It's really important. And women and men should expect if family members come to a visit that you should get at least a few minutes alone one-on-one with the doctor. Let's switch to menopause for a few minutes here, too. We're getting some questions. One of our viewers just wrote in and wonders, should women take hormones when they are going through menopause? Is that important? Is that something to avoid? What would you recommend? It's going to vary with each woman, honestly. And so I try to look at, well, what are the predominant symptoms that a woman has? How severe are they? How is it affecting her quality of life? And then we can talk about what are all of the treatment options for you, and what potentially might be risk. There are going to be some women that really can't take hormones. Either they've had a history of breast or ovarian cancer. Or they've had blood clots in the past. Whether it be a pulmonary embolism or a blood clot in their leg, hormones are going to be contraindicated in them. So then we can talk about those non-hormonal options or lifestyle modifications. In a healthy woman that does not have any contraindications, that's relatively close to initially going through menopause, really, hormones will be the most effective treatment option. And so to me, I love hormones. [LAUGHTER] Stacy may disagree. But I embrace them. I like them. There's lots of different ways that hormones can be administered. And so I am in favor of them. So I talk to patients about them. But I also respect the fact that some people may have concerns about them as well. So we can talk about it. Our web site does offer a lot of information about not only hormone replacement therapy, but also alternative treatments as well. So there is a wealth of resources out there. No one should suffer. That's the bottom line. Right. So how do we find this website? Shall we say it together? www.womenlab.org. And "womanlab" is W-O-M-A-N-L-A-B.org. Great. So what are some of the most common issues that you come across in your clinic? In my menopause clinic specifically? Yes, please. Probably 80% of women will experience hot flashes or night sweats. Everybody will not have them as severe. Some women will say, eh, you know, maybe a couple of times a week, I feel a little flushed. I stand by a window or I take my jacket off, and it's all over. And other women will have multiple hot flashes a day where they really can't function, especially if they do work where they need to be presenting or interacting with the public. So I would say predominantly, especially. And those are going to start-- they can start actually up to go through menopause. And I think we've been talking about menopause but didn't actually say what it was. We define menopause retrospectively. It's not having a period for a full year. Or having your ovaries surgically removed, or ovarian function loss due to medication. But it's defined by not having a period for a year. And a woman will start to experience symptoms up to 10 years before. In some cases, they actually stop having a period. In addition to hot flashes and night sweats, patients will also experience the vaginal symptoms that we described. Vaginal dryness, otherwise called vaginal atrophy. Decreased libido. There are estrogen receptors really all over our body. And so when you don't make estrogen specifically anymore, you start to feel it. There can be some cognitive decline, feeling like my memory is just hazy. You know, I'll walk into the kitchen and I forgot what I came in to get. Irritability. Irritability. I was going to say. That was my next one. Another big one is mood swings. Increased anxiety, really, that can become debilitating. I have several patients that really have said, I'm in danger of losing my job because I am interacting in a way that's really not me, but is offensive. And I've been warned about it, and I really just can't control it. After the fact, I realized that I spoke harshly or overreacted. But I don't feel like in the moment I can control it. And so, arthritic changes as well. Hair loss. It's a fun time. Metabolism issues. Weight gain. And the weight seems to deposit in this middle section, too. And honestly, I'd never thought of how it could even affect your employment. That's significant. I mean, if somebody's livelihood is taken away. We're getting a ton of menopause questions, by the way. So and we typically have about five minutes left. We may go a little long if you guys have a couple extra minutes, because I do want to get to as many questions as possible if that's all right. I also know you have other commitments, so we'll try to get to them as quickly as possible. The first one that we just got. "I have a blood deficiency and I'm on blood thinners. Looking for help now going through menopause." What are your thoughts there? So that's someone that actually probably should not-- if you're on blood thinners, I'm assuming that there's either some cardiovascular reason that you're on them, or have had a blood clot in the past, and so you are someone that I would not endorse hormones for. But as I said, depending on what your symptoms are, there are non-hormonal treatment options for managing those pesky hot flashes and night sweats. There are also non-hormonal options for managing vaginal dryness and vaginal atrophy. There are also non-hormonal options for managing mood swings. So we have, depending on what the symptoms are, we'll direct what your treatment should be. Dr. Lindau, I have one for you. And this is for someone who is a survivor. And they are struggling. And so they want to know who to turn to for help for, it looks like, both them and their partner, if I'm reading this correctly. Sow hat do people do in that case? So I'm assuming survivor, in this case, survivor refers to somebody with cancer who is past the active phase of treatment, perhaps. Look. Cancer survivorship is a mind, body, and relationship experience for people in a partnership. Most of us have family members. The sexual function concerns can start in consultation with a mental health professional, if you're seeing somebody like a psychologist for support, or a psychiatrist. The sexual function concerns can start with a consultation with somebody like me, a gynecologist. I'd be happy to see you. Or even with your primary care physician. What I'd recommend is if these-- or your oncologists, of course, if you're still seeing your oncologist. If these topics haven't come up before and you're worried about how to broach them, go to womanlab.org. Print out the list of questions you can ask your doctor about sex. These are legitimate questions. The national survivorship organizations say that we ought to be attending to this issue during the survivorship period. So it's legit. Print them out, bring them to your doctor or psychologist, mental health professional, and ask for help. You don't need a physician's referral to see us here at the University of Chicago. But if you're going to come in through gynecology, I think it would be valuable to make sure there aren't any other gynecologic problems that are not already addressed. And bring your partner. Great. We actually have a survivorship program within our department, too, that's very new. Interesting. Great. Well that's good to know as well. So another menopause. "I have symptoms of menopause for a year now, but afraid of the danger of cancer from hormone therapy. Severe sweating, hot flashes, and now anxiety. Are there supplements that can be taken to help?" Unfortunately-- Come see Dr. Christmas and talk about it. [LAUGHTER] It's a long conversation. Yes. I'm sorry. That's one of those million dollar question. It is. Right. The answer is probably-- well, the research answer, I'm going to say, will be no. So there are a number of large scale studies that have looked at, whether it be botanicals, vitamins, herbal treatments, and compared them with a placebo-- basically a sugar pill. And everybody seems to be better. So it goes to tell me that when we take something that we think is good for us, it's going to make us feel better. But usually it's short-lived, because really, those treatments are not efficacious for managing the symptoms that this particular woman has described. If it's not harmful, I don't ever stop a patient from taking them. And especially if you're feeling better. I think things like acupuncture-- I love yoga. Yoga help. Again, the studies don't show that it's beneficial. But how could exercise be bad for you? So I do think that there are some things that really do help. And many times, it's a combination of all of them. Cognitive behavioral therapy actually has been something that has been found to be efficacious in treating anxiety and vasomotor symptoms-- the hot flashes and the night sweats-- that are associated with menopause. So I don't know if that answers it at all. I think so. And I'm going to bundle two menopause questions. And I've got to ask you about PRISM. I know we're getting overtime, but we've got to talk about that just for a couple of minutes. So this viewer. I've been having hot flashes for 20 years. When will it ever end? And then the other question is, what is postmenopause, or when is postmenopause? So the first question, when will these symptoms ever end? For most women, the symptoms of hot flashes and night sweats do get better over time. From the last menstrual period, it usually, for most women, about four to five years of having symptoms, and then they subside. For a brown skinned women like myself, we're pretty lucky because we get an extension of that. It can be up to seven to ten years. I say that jokingly. But in terms of somebody that's having severe hot flashes gone through menopause, it always makes me wonder if there's something else going on. OK? So that's somebody that I would want to evaluate. Thyroid abnormalities can have manifestations of hot flashes or night sweats. There are a number of medications that you could be taking for other things like high blood pressure that could cause them as well. So that's somebody that I would want to see and evaluate to make sure that this is just hot flashes. And postmenopause? When is that? Postmenopause is just your life after menopause. [LAUGHTER] So there's not a hard and fast defiiniton. It is. You have your prepubescent time frame. You go through puberty. And then you're in the reproductive life frame. And then you're menopausal. Dr. Lindau, can you tell us about PRISM? First of all, what does it stand for? And what is it? Well, it's "prism," like the thing that casts a rainbow, rather than "prison," where you go if you've committed a crime. I just want to clear that up, because there has been confusion. That's important. Yes. And we like the rainbow image. For a variety of reasons but it's an acronym PRogram in Integrative Sexual Medicine. I am toying with the idea that I should be inclusive. But we are both integrative and inclusive. And we are a clinical practice here at the University of Chicago Medicine. We are interdisciplinary. Patients come in for an initial evaluation, an hour visit, typically. It's a talking and education visit. Education can solve a lot of problems, at least some fundamental problems. And then patients return for a second, usually 45 minute to one hour visit, where we do a comprehensive physical exam focused on sexual function. No evaluation for a female sexual function problem should be a sexual experience. I think that's very important to know. And we've seen some egregious cases that prompt me to say that. But it is a gynecologic exam focused on assessing the components of anatomy and physiology that can be addressed when a woman has sexual dysfunction problems. And then about a third of our patients benefit from referral to pelvic floor physical therapy. We have a great team of several pelvic floor physical therapists here with combined probably close to 40 years of experience. And maybe about one in five of our patients also benefit from psychotherapy. And we have specialized sex therapists here who understand cancer, sex therapy-- they can see couples. It is an interdisciplinary approach. My goal is to see you as few times as possible to get you back to where you want to be. I work in collaboration with the oncologists and with your primary gynecology provider. Fantastic. Final question for each one of you. Dr. Christmas, you can start us off. What's the single biggest thing that you want women to know? Wow. It's a big question. It is a big question. I think I have a easy answer, though. I want women to know that there's help, and that they should not be suffering alone. I think we both have said that throughout this talk today. But I think that's really the most important thing is to not be ashamed, not be afraid to come in and talk. And maybe if you get shut down by one person, that's not reason to try someone else. So Yeah. You are not alone. Information-- knowledge is power. And we've created this website here at the University of Chicago called womanlab.org so that women who are all over the planet with an internet connection can get access to our specialized expertise and knowledge. And we want you to get help. Sexual function is an important part of human function. It's not just icing on the cake. It's a core part of human function. And if it's not working, we are here to help. Fantastic. You guys were great. Well, thank you. So were you! Oh good, thank you. Well that's all the time we have today. We actually went over time, but that's OK, because this was important. We want to thank Dr. Lindau and Dr. Christmas for their help with the program and insight today. If you want more information, please visit our website site at uchicagomedicine.org. Or womanlab.org-- is it .org? Yes, it is. .org. Thank you. And you can call 888-824-0200. Thanks again for watching At The Forefront Live. We hope you have a great week.