One of the most important, yet often difficult to talk about areas in the whole health spectrum is the topic of sexual health. The reproductive system however, is an integral part of our body and it deserves proper attention where complete and balanced health is concerned.

This system starts to be given some attention starting from the time known as puberty, although little care is usually given to this system at this time to keep it working optimally. It’s importance is then usually greatly magnified when reproduction and fertility become a primary focus, especially for women. However for optimal health, our reproductive system needs to be taken care of properly at all times, whether before or after the fertile years.

Thus today, we are going to examine some common and very important women’s sexual health issues, especially with respect to fertility through an interview with obstetrician and gynecologist Dr. Mary Jane Minkin.

EVITA: Dr. Minkin it is a pleasure to have you here on Evolving Wellness! We know today that women’s reproductive health and sexual health in general, are two very important areas of health that are recently getting even more attention. Whether it is menopause, menstruation, birth control, fertility or STI’s – these are all widely talked about topics.

DR.MINKIN: As I tell my medical students regularly, women’s health is the most important topic in the world! (Of course I am a bit prejudiced.) – but thanks so much for asking me to speak with you.

EVITA: I know one of the greatest challenges perhaps for many women are fertility issues today. It seems like so many women first do everything they can to avoid a pregnancy and when the time is “right”, everything they can to have a pregnancy. What is your take on women’s fertility today? Have you found any specific correlations in your research where health factors and women’s fertility are concerned?

DR. MINKIN: Among gynecologists’ major responsibilities are keeping women from getting pregnant when they don’t want to be, and helping them achieve pregnancy when they would like to.

There are several things that women can do to optimize their reproductive capabilities. Always practice safe sex: sexually transmitted infections can really jeopardize your ability to have children. And not the ones that everyone is scared of: herpes is very aggravating, but it doesn’t make you infertile. A much less known and feared organism is Chlamydia; there are several million cases each year in the United States; and women can be infected and become infertile without having one symptom. So women should always be aware of STI’s.

Another factor that women need to be aware of is weight. It has been well known for years that anorectics do not easily achieve pregnancy; however, obese women can have difficulties ovulating; and also obese women can have terrible pregnancies. So women need to try to optimize their body weight before attempting to conceive.

And another item that women need to think about is their age. Although one should never just settle for a partner just to have a baby, if you are in a good relationship, your life is stable, your job is reasonable: if you are 35 years old, don’t wait for everything to be perfect (everything is rarely perfect!): go for it! If you are 22, you have tons of time; but at 35, if things are good, go for it.

EVITA: It is no surprise that a large amount of the female population today is using some kind of oral contraceptives. What are your thoughts about the links between oral contraceptives and reduced fertility rates, if any?

DR. MINKIN: Actually, oral contraceptives probably help maintain fertility; they certainly do not reduce it.

Some experts believe that birth control pills help reduce the chances of developing endometriosis; they certainly do reduce the risk of getting ovarian cancer. They reduce the chances of developing ovarian cysts.

So in general, the profile from pills is quite favorable. There is no reduction of fertility after stopping pills. I always advise my patients who are thinking about going off the pill to get pregnant to wait until they are OK about becoming pregnant: don’t expect it will take you longer to conceive – it probably won’t.

EVITA: So where health in general is concerned, what would you say are the top health benefits and health disadvantages to using oral contraceptives for women?

DR. MINKIN: I’ve listed some of the health benefits above; others include nicer periods (less flow, less cramping); reduced acne. Some pills, like Ortho Tri-Cyclen Lo, can help you have more predictable periods and less unexpected bleeding.

And for older women, in perimenopause, oral contraceptives can be quite helpful in reducing perimenopausal symptoms, too.

The major risk of any hormonal contraceptive is a slight increased risk of blood clots (thrombophlebitis) – but it’s a very small risk. And of course, smokers over the age of 35 should not be using the pill because of cardiovascular risks – but women shouldn’t be smoking anyway!

EVITA: When trying to conceive, many women go to extreme lengths and put a lot of stress and pressure on their bodies due to the medical treatments available today. Thus for women who are having a hard time conceiving, what would be your advice on how they can go about improving their chances naturally to avoid the unpleasant procedures and side-effects?

DR. MINKIN: Again, I’d refer you to a previous question talking about optimizing fertility. Eating healthily, not smoking, exercising (but not excessively) – these all help.

If a woman is 35, and has been trying to conceive, and hasn’t for about six months, she should check in with her gynecologist, who can start doing some simple tests to see what may be amiss. And if a woman is in her 20′s, she can give herself a year before looking for complex issues.

Here are the stats: 15-20% of couples conceive the first month of trying; 50% will conceive by 6 months; and 80% by a year. So most couples will conceive if they give themselves a year of trying – but if you are 35, I’d start doing some testing earlier.

Of course, all women who are trying to conceive should be taking a multivitamin with folic acid, to reduce the risk of birth defects.

And another thing which sounds dumb: you have to have sex to get pregnant. Some couples are really “busy” – and it seems they are too busy to schedule sex into their lives. I actually would strongly suggest that these folks not try to conceive: because having a child takes an enormous amount of time, and if you don’t have time to have sex, you don’t have time to take care of a child.

EVITA: I have recently also read your 10 healthy tips for women on how to stay healthy during the holidays and into 2009. (For the full list click here.) I was very impressed by them as most doctors in the area of conventional medicine are quick to recommend pharmaceutical approaches and your 10 tips are all very holistic and balanced where the body, spirit and mind are concerned. What in your opinion would be perhaps the most important 2 or 3 of these tips for women to start the New Year with?

DR. MINKIN: That’s a tough one: I’d love everyone to adopt the whole list! I guess I would go with my top three of proper nutrition, exercise, and stopping smoking, for smokers.

EVITA: Aside from the 10 tips that we talked about above, are there any other tips you have for women, whether young or old on how to maintain the best reproductive and sexual health possible naturally?

DR. MINKIN: Again, I’d probably list some of the things we’ve talked about already. And of course, for sexual health, I really would like to emphasize communication with your partner. Good communication is far more important than any hormone or supplement to a good relationship.

EVITA: Thank you so much Dr. Minkin thus for your time and valuable insight. I know many of our readers can benefit greatly by being more educated and learning more about how to have the best health possible in all areas, including reproductive and sexual health.

DR. MINKIN: Thank you so much, Evita, for asking me to chat about these important topics.

About Dr. Minkin

Mary Jane Minkin, M.D., is a clinical professor of obstetrics and gynecology at Yale University School of Medicine and has a private practice in New Haven, Connecticut.

Dr. Minkin is co-author, with Carol Wright, of “A Woman’s Guide to Menopause and Perimenopause”, “The Yale Guide to Women’s Reproductive Health” and “A Woman’s Guide to Sexual Health”, which is an update of the Yale Guide to Women’s Reproductive Health.

Dr. Minkin is lead author and co-author of articles in numerous peer-reviewed journals, and she also advises and gives lectures to the menopause support group PRIME PLUS/Red Hot Mamas.

For more information on Dr. Mary Jane Minkin or on women’s sexual health, check out

A Woman’s Guide to Menopause and Perimenopause (Yale University Press Health & Wellness) (Paperback) by Mary Jane Minkin M.D., Carol V. Wright Ph.D.

A Woman’s Guide to Sexual Health (Yale University Press Health & Wellness) (Paperback) by Mary Jane Minkin M.D., Carol V. Wright Ph.D.

The Yale Guide to Women’s Reproductive Health: From Menarche to Menopause (Hardcover) by Mary Jane Minkin, Carol V. Wright