UNMC urologist aims to 'bring sex back to the Midwest'

by Nicole Lindquist, UNMC public affairs | August 06, 2008

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Michael Feloney, M.D.
One can't watch an hour-long television show without seeing a commercial for erectile dysfunction. The "Viva Viagra" jingle is a tune that can get stuck in your head. Levitra and Cialis have become household names.

But what about female sexual dysfunction? Where are the ads for women?

If approximately one in four females experience some form of sexual dysfunction in their lifetime, according to Michael Feloney, M.D., assistant professor of urologic surgery at UNMC, then why aren't women being targeted by marketers in the same way men are?

Dr. Feloney believes it's because doctors don't ask and female patients don't tell.

"Both are uncomfortable talking about it," he said. "Women tend to have more types of sexual dysfunction, which are harder to diagnose and treat than male sexual dysfunction. Men typically have erectile dysfunction and there's an oral pill for treatment. There's no one pill marketed for women.

"Nowadays men don't have a problem talking about sexual dysfunction," Dr. Feloney said. "Bob Dole was on a commercial telling everyone, 'I have ED,' but male sexual dysfunction was not as talked about before Viagra and all the commercials."

Dr. Feloney is one of very few physicians in Omaha actively treating female sexual dysfunction, which is defined as any medical problem or phenomenon that prevents females from engaging in normal sexual activity. It can consist of dyspareunia or painful sex, hypoarousal or decreased desire for sex and anorgasmia or impaired ability to achieve orgasm.

Dr. Feloney believes he is the only doctor in the country to utilize ultrasound technology to treat painful sex caused by high tone pelvic floor dysfunction.

Physical therapy treatments, such as massage techniques, are available, but the options are often too painful for women. Using ultrasound technology allows Dr. Feloney, a urologist who is fellowship trained in urogynecology, to more accurately place his needle into the pelvic floor muscles when transvaginally injecting anti-inflammatories or antispasmodics, such as Botox. Doing so maximizes the medication's benefits, he said.

More about Dr. Feloney

In addition to his appointments at UNMC, Dr. Feloney has also had an appointment as a staff physician with the Department of Veterans Affairs, Nebraska-Western Iowa Health Care System since September 2006.

He completed his bachelor's degree in biology and psychology from Santa Clara University in 1994 and earned his medical degree from St. Louis University School of Medicine where he graduated cum laude in 1999. He went on to do his general surgery internship and residency in urologic surgery at the University of Oklahoma. He finished his fellowship in female pelvic medicine and reconstructive surgery at University of Medicine & Dentistry of New Jersey Robert Wood Johnson Graduate Hospital in 2006.

"Others are not able to pinpoint exactly where they're injecting the medications in the pelvic floor muscles," he said. "I can watch the needle and medication be delivered into the pelvic floor muscle."

He compares the procedure to inserting a central line.

"They used to get into whatever vein they could find. Now, they find the best one," he said. "If we use ultrasound guidance for other types of needle sticks, why not the vagina?"

Though Dr. Feloney has only performed the ultrasound-guided procedure a handful of times, he said the results have been "quite efficacious."

"The goal is to have only one medical treatment so that a physical therapist may be allowed to more efficiently carry out their treatment plan," Dr. Feloney said.

Currently, there is no published data regarding Dr. Feloney's technique, and he himself has not yet written about it. He plans to perform a research study comparing traditional transvaginal injections versus ultra-sound guided injections in the near future.

When asked why this topic intrigues him so much, Dr. Feloney said it's because there is a lack of doctors who are interested.

"I realized that when I did my fellowship in female urology, there are a lot of people out there studying female urology, but not a lot of people studying female sexual dysfunction. And there was really a lack of it in the Midwest," he said. "I wanted to bring sex back to the Midwest."

And he has, not only by treating females with sexual dysfunction, but their partners as well.

"Most doctors treating female sexual dysfunction are OB/GYNs and are not able to treat the male partners in the sexual relationship and probably don't involve the males at all," Dr. Feloney said.

"I wanted to bring sex back to the Midwest."

Michael Feloney, M.D.

"This is a problem because data suggest that if one partner has sexual dysfunction, there is a higher probability that the other partner also has sexual dysfunction.

"It's nice when the physician can treat both and help both work toward the goal of a better sex life."

According to Dr. Feloney, as people age they tend to have more sexual dysfunction and attribute it to aging or other health conditions. However, that is not always the case.

"People in their 90s can be sexually active though the frequency might change," he said. "You can still enjoy that part of life."

And he hopes the millions of women who experience sexual dysfunction will, with the help of treatment.

"Women with sexual dysfunction need to bring it to the attention of their doctors," he said. "It's OK to talk about these things. There are people out there who want to treat it and know how."