Hormonal

Sexual

Medicine

Hormones are the foundation of women's sexual health — governing desire, arousal, tissue integrity, and comfort. At IWish, hormonal medicine is not a one-size protocol. It is a precise, individualized science.

The Foundation

When Hormones

Change — Everything

Can Change

Estrogen, testosterone, progesterone, and DHEA each play critical roles in women's sexual health — affecting tissue integrity, lubrication, desire, arousal, mood, and pain thresholds. When these hormones decline or fall out of balance — whether from menopause, postpartum changes, thyroid dysfunction, or other causes — the effects on intimate health can be profound and wide-reaching.

At IWish, Dr. Bahnmiller approaches hormonal medicine as a subspecialist in sexual health — not a general hormone clinic. Every protocol is built on comprehensive lab evaluation, symptom mapping, and a treatment plan that integrates hormonal therapy with the full range of restorative and regenerative options available at the institute.

"Hormonal optimization is not about making women feel younger. It is about ensuring every woman's physiology supports the life — and the intimacy — she deserves."

The Foundation

Hormonal &

Non-Hormonal

Pathways

Bioidentical Hormone Therapy

Systemic · Topical · Pellet

Bioidentical estrogen, testosterone, and progesterone — structurally identical to hormones produced by the body — delivered via topical creams, troches, patches, injections, or pellet implants depending on your clinical picture and lifestyle.

  • Estradiol — tissue integrity, lubrication, bone density

  • Testosterone — desire, arousal, energy, and mood

  • Progesterone — hormonal balance, sleep, mood modulation

  • DHEA — precursor hormone; topical or systemic

Local Hormonal Therapies

Topical · Vaginal · Targeted

Local estrogen and DHEA (intrarosa) applied directly to vaginal and vulvar tissue — restoring mucosal health with minimal systemic absorption. Ideal for patients with contraindications to systemic therapy or those whose primary symptoms are local.

  • Local Estrogen

    • Vaginal estradiol cream, ring, or tablet

    • Effects: Hot flushes, libido, weight gain

  • Testosterone

    • Topical testosterone — clitoral sensitivity enhancement

    • Effects: Weight gain, strength, metabolism, vigor

  • DHEA

    • Prasterone (Intrarosa) — vaginal DHEA for GSM

  • Ospemifene — oral selective estrogen receptor modulator

Non-Hormonal Options

For Contraindicated or Preferring Non-Hormonal

For women with contraindications to hormonal therapy — including those with hormone-sensitive cancers — or those who prefer non-hormonal approaches, IWish offers evidence-based non-hormonal alternatives for desire, arousal, and tissue health.

  • Flibanserin (Addyi) — FDA-approved for HSDD

  • Bremelanotide (Vyleesi) — on-demand desire support

  • Non-hormonal topical compounding protocols

  • Laser and regenerative therapies as standalone

  • PRP

Integrated Sexual Medicine

Hormonal + Procedural + Surgical

Often the most effective outcomes come from combining hormonal optimization with regenerative therapies (PRP/PRF, laser) or surgical correction. Dr. Bahnmiller coordinates all these modalities as a single integrated protocol — something no hormone clinic alone can offer.

  • Hormone optimization + MonaLisa Touch for GSM

  • Testosterone + PRP for orgasmic dysfunction

  • Hormonal priming before or after surgical procedures

  • Ongoing monitoring and protocol adjustment

Is This You?

Signs That

Hormones May Be Involved

01

Is This You?

Persistent decline in sexual interest — not related to relationship factors — often driven by testosterone or estrogen deficiency.

02

Vaginal Dryness

Decreased natural lubrication causing discomfort during intimacy — a hallmark symptom of genitourinary syndrome of menopause (GSM).

03

Painful Intercourse

Tissue thinning from estrogen loss causes dyspareunia — often progressive and worsening without treatment.

04

Arousal Difficulty

Reduced genital blood flow and nerve sensitivity associated with hormonal decline — affecting the ability to become physically aroused.

05

Mood & Fatigue

Hormonal imbalance — particularly low testosterone and progesterone — frequently presents as fatigue, mood changes, and reduced motivation.

06

Orgasmic Changes

Diminished orgasmic intensity or difficulty reaching orgasm — often related to declining testosterone, nerve sensitivity, or tissue changes.

07

Recurrent UTIs

Menopausal tissue thinning alters vaginal pH and mucosal defenses — increasing susceptibility to urinary tract infections and urgency.

08

Postpartum Changes

Breastfeeding-induced estrogen suppression causes significant hormonal changes affecting sexual function, tissue health, and desire.

Our Approach

How We Build

Your Protocol

01

Comprehensive Lab Evaluation

A full hormonal panel — including estradiol, testosterone (free and total), DHEA-S, progesterone, FSH, LH, and thyroid function — giving us a complete physiologic picture before any treatment is prescribed.

02

Symptom Mapping & Physical Evaluation

A thorough history of sexual health symptoms, quality of life impact, prior treatments, and physical examination — correlating your lab values with your lived experience to guide clinical decision-making.

03

Individualized Treatment Protocol

A personalized protocol — hormonal and/or non-hormonal — with delivery method, dosing, and timing chosen based on your clinical picture, preferences, and any contraindications. No templates, no standard menus.

04

Integration with Procedural Care

When indicated, hormonal therapy is integrated with laser, regenerative, or surgical treatment — coordinated as a unified clinical protocol rather than siloed services.

05

Ongoing Monitoring & Optimization

Regular follow-up labs and symptom reviews — adjusting dosing and protocols as your physiology changes, ensuring your hormonal health remains optimized over time.

"Hormone therapy is not a trend. For many women, it is a medical necessity — and it deserves the same precision we bring to surgery."

Dr. Daniel Bahnmiller, DO · IWish at CSRH

Start With a

to Hormonal Evaluation

A full hormonal workup and consultation with Dr. Bahnmiller is your first step to understanding — and correcting — what's happening in your body.

Institute for Women's Intimate Surgery & Health

Expertise in Intimate Wellness & Surgical Precision.

Dr. Daniel Bahnmiller, DO

Women's Intimate Health & Cosmetic

Gynecologic Surgeon

Founder, IWish at CSRH

© 2026 IWish — Institute for Women's Intimate Surgery & Health. All rights reserved.

A Division of Columbia Shores Regenerative Health