Bio

Clinical Focus


  • Obstetrics and Gynecology
  • Female Sexual Medicine
  • Gynecology
  • Menopausal Health

Academic Appointments


Honors & Awards


  • ACOG/Boehringer Ingelheim Research Award in Female Sexual Dysfunction, American College of Obstetricians and Gynecologists (2008)
  • Excellence in Education, Stanford University School of Medicine (2008)
  • Women's Reproductive Health Research Scholarship, NIH/NICHD (2004-2008)

Professional Education


  • Medical Education:Northwestern University Feinberg School of Medicine (1999) IL
  • Residency:Stanford University School of Medicine (2004) CA
  • Board Certification: Obstetrics and Gynecology, American Board of Obstetrics and Gynecology (2007)
  • Internship:Stanford University School of Medicine (2001) CA
  • M.D., Northwestern University, Medicine (1999)
  • B.A., Columbia University, Art History (1994)

Research & Scholarship

Current Research and Scholarly Interests


Research interest in the role of the central nervous system in female hypoactive sexual desire disorder.

Clinical Trials


  • 24-Week Placebo-Controlled Trial of Flibanserin Once Daily in Premenopausal Women With Hypoactive Sexual Desire Disorder Not Recruiting

    This trial is designed to assess the safety and efficacy of flibanserin in the treatment of premenopausal women with Hypoactive Sexual Desire (HSDD) that meets standard diagnostic criteria. Efficacy for flibanserin will be assessed vs. a parallel placebo group.

    Stanford is currently not accepting patients for this trial. For more information, please contact Jennifer Howden, (650) 498 - 6128.

    View full details

Teaching

2013-14 Courses


Publications

Journal Articles


  • Sexual Health Issues in Women with Cancer JOURNAL OF SEXUAL MEDICINE Krychman, M., Millheiser, L. S. 2013; 10: 5-15

    Abstract

    Sexual health issues for women who have cancer are an important and under-diagnosed and under-treated survivorship issue. Survivorship begins at the time a cancer is detected and addresses health-care issues beyond diagnosis and acute treatment. This includes improving access to care and quality-of-life considerations, as well as dealing with the late effects of treatment. Difficulties with sexual function are one of the more common late effects in women.This article attempted to characterize the etiology, prevalence, and treatment for sexual health concerns for women with gynecological cancer.A systematic survey of currently available relevant literature published in English was conducted.The issue of sexual health for women with cancer is a prevalent medical concern that is rarely addressed in clinical practice. The development of sexual morbidity in the female cancer survivor is a multifactorial problem incorporating psychological, physiologic, and sociological elements. Treatments such as chemotherapy, radiation therapy, surgery, and hormonal manipulation appear to have the greatest influence on the development of sexual consequences. Sexual complaints include but are not limited to changes in sexual desire, arousal, and orgasmic intensity and latency. Many women suffer from debilitating vaginal dryness and painful intercourse.Many of the sexual health issues experienced by cancer survivors can be addressed in clinical practice. A multimodal treatment paradigm is necessary to effectively treat these sexual complaints in this special patient population.

    View details for DOI 10.1111/jsm.12034

    View details for Web of Science ID 000314871200003

    View details for PubMedID 23387907

  • Female Sexual Function During Pregnancy and Postpartum JOURNAL OF SEXUAL MEDICINE Millheiser, L. 2012; 9 (2): 635-636
  • Is infertility a risk factor for female sexual dysfunction? A case-control study FERTILITY AND STERILITY Millheiser, L. S., Helmer, A. E., Quintero, R. B., Westphal, L. M., Milki, A. A., Lathi, R. B. 2010; 94 (6): 2022-2025

    Abstract

    To determine the impact of infertility on female sexual function.A case-control study.Academic infertility and gynecology practices.One hundred nineteen women with infertility and 99 healthy female controls without infertility between the ages of 18 and 45 years were included in this study.Anonymous survey and Female Sexual Function Index.Female Sexual Function Index scores, frequency of sexual intercourse and masturbation, and sex-life satisfaction.Twenty-five percent of our control group had Female Sexual Function Index scores that put them at risk for sexual dysfunction (<26.55), whereas 40% of our patients with infertility met this criterion. Compared with the control group, the patients with infertility had significantly lower scores in the desire and arousal domains and lower frequency of intercourse and masturbation. The patients with infertility retrospectively reported a sex-life satisfaction score that was similar to that of the controls before their diagnosis, whereas their current sex-life satisfaction scores were significantly lower than those of the controls.Women with a diagnosis of infertility were found to be at higher risk for sexual dysfunction on the basis of their Female Sexual Function Index scores compared with women without infertility. The interaction of sexual function and infertility is complex and deserves further study.

    View details for DOI 10.1016/j.fertnstert.2010.01.037

    View details for Web of Science ID 000283441400016

    View details for PubMedID 20206929

  • Radiofrequency Treatment of Vaginal Laxity after Vaginal Delivery: Nonsurgical Vaginal Tightening JOURNAL OF SEXUAL MEDICINE Millheiser, L. S., Pauls, R. N., Herbst, S. J., Chen, B. H. 2010; 7 (9): 3088-3095

    Abstract

    All women who have given birth vaginally experience stretching of their vaginal tissue. Long-term physical and psychological consequences may occur, including loss of sensation and sexual dissatisfaction. One significant issue is the laxity of the vaginal introitus.To evaluate safety and tolerability of nonsurgical radiofrequency (RF) thermal therapy for treatment of laxity of the vaginal introitus after vaginal delivery. We also explored the utility of self-report questionnaires in assessing subjective effectiveness of this device.Pilot study to treat 24 women (25-44 years) once using reverse gradient RF energy (75-90 joules/cm(2) ), delivered through the vaginal mucosa. Post-treatment assessments were at 10 days, 1, 3, and 6 months.Pelvic examinations and adverse event reports to assess safety. The author modified Female Sexual Function Index (mv-FSFI) and Female Sexual Distress Scale-Revised (FSDS-R), Vaginal Laxity and Sexual Satisfaction Questionnaires (designed for this study) to evaluate both safety and effectiveness, and the Global Response Assessment to assess treatment responses.No adverse events were reported; no topical anesthetics were required. Self-reported vaginal tightness improved in 67% of subjects at one month post-treatment; in 87% at 6 months (P<0.001). Mean sexual function scores improved: mv-FSFI total score before treatment was 27.6 ± 3.6, increasing to 32.0 ± 3.0 at 6 months (P < 0.001); FSDS-R score before treatment was 13.6 ± 8.7, declining to 4.3 ± 5.0 at month 6 post-treatment (P < 0.001). Twelve of 24 women who expressed diminished sexual satisfaction following their delivery; all reported sustained improvements on SSQ at 6 months after treatment (P = 0.002).The RF treatment was well tolerated and showed an excellent 6-month safety profile in this pilot study. Responses to the questionnaires suggest subjective improvement in self-reported vaginal tightness, sexual function and decreased sexual distress. These findings warrant further study.

    View details for DOI 10.1111/j.1743-6109.2010.01910.x

    View details for Web of Science ID 000281550700015

    View details for PubMedID 20584127

  • WOMEN WITH HYPOACTIVE SEXUAL DESIRE DISORDER COMPARED TO NORMAL FEMALES: A FUNCTIONAL MAGNETIC RESONANCE IMAGING STUDY NEUROSCIENCE Arnow, B. A., Millheiser, L., Garrett, A., Polan, M. L., Glover, G. H., Hill, K. R., Lightbody, A., Watson, C., Banner, L., Smart, T., Buchanan, T., Desmond, J. E. 2009; 158 (2): 484-502

    Abstract

    Lack of sexual interest is the most common sexual complaint among women. However, factors affecting sexual desire in women have rarely been studied. While the role of the brain in integrating the sensory, attentional, motivational, and motor aspects of sexual response is commonly acknowledged as important, little is known about specific patterns of brain activation and sexual interest or response, particularly among women. We compared 20 females with no history of sexual dysfunction (NHSD) to 16 women with hypoactive sexual desire disorder (HSDD) in a functional magnetic resonance imaging (fMRI) study that included assessment of subjective sexual arousal, peripheral sexual response using a vaginal photoplethysmograph (VPP), as well as brain activation across three time points. Video stimuli included erotic, sports, and relaxing segments. Subjective arousal to erotic stimuli was significantly greater in NHSD participants compared with HSDD. In the erotic-sports contrast, NHSD women showed significantly greater activation in the bilateral entorhinal cortex than HSDD women. In the same contrast, HSDD females demonstrated higher activation than NHSD females in the medial frontal gyrus (Brodmann area (BA) 10), right inferior frontal gyrus (BA 47) and bilateral putamen. There were no between group differences in VPP-correlated brain activation and peripheral sexual response was not significantly associated with either subjective sexual response or brain activation patterns. Findings were consistent across the three experimental sessions. The results suggest differences between women with NHSD and HSDD in encoding arousing stimuli, retrieval of past erotic experiences, or both. The findings of greater activation in BA 10 and BA 47 among women with HSDD suggest that this group allocated significantly more attention to monitoring and/or evaluating their responses than NHSD participants, which may interfere with normal sexual response.

    View details for DOI 10.1016/j.neuroscience.2008.09.044

    View details for Web of Science ID 000262959900012

    View details for PubMedID 18976696

  • Severe vaginal pain caused by a neuroma in the rectovaginal septum after posterior colporrhaphy OBSTETRICS AND GYNECOLOGY Millheiser, L. S., Chen, B. 2006; 108 (3): 809-811

    Abstract

    Traumatic vaginal neuromas are a rarely documented finding in the setting of vaginal pain after posterior colporrhaphy. They arise as a result of trauma or surgery and are often mistaken for scar tissue.After a total vaginal hysterectomy and posterior colporrhaphy, a 32-year-old woman presented with debilitating vaginal pain, presumed to be secondary to scar tissue formation. Excision of the tissue from the rectovaginal septum revealed a traumatic neuroma. After the removal of the neuroma, the patient's vaginal pain resolved.Traumatic neuromas may be a cause of significant point tenderness and thickened tissue after vaginal surgery or repair of obstetric lacerations. If conservative treatment methods have failed, surgical excision of the neuroma can be considered.

    View details for Web of Science ID 000247038500042

    View details for PubMedID 17018512

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