PDF Summary:PCOS Repair Protocol, by Tamika Woods

PCOS Repair Protocol offers effective strategies for managing polycystic ovary syndrome (PCOS). In the first part, Tamika Woods explains that PCOS is a complex hormonal imbalance with multiple possible underlying causes, including insulin resistance, elevated stress hormones, stopping birth control, and inflammation. She emphasizes the importance of identifying the specific root factor contributing to your condition.

The second part outlines Woods' recommendations for tackling each variant of PCOS. For insulin resistance, she advises following a tailored diet, incorporating supplements like inositol and chromium, and finding enjoyable physical activities. To address inflammation, Woods suggests reducing stress through lifestyle changes, herbal remedies, and an anti-inflammatory diet. She also provides guidance on restoring nutrient levels after discontinuing birth control and managing Post-Pill PCOS.

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Woods emphasizes the importance of evaluating thyroid function. A condition known as hypothyroidism, which often accompanies PCOS, may present with symptoms that are similar to PCOS due to a sluggish thyroid gland. Furthermore, ailments such as Hashimoto's thyroiditis, often linked with PCOS, significantly increase the body's inflammatory reactions.

Ailments such as irritable bowel syndrome and a rise in small intestinal bacteria may also worsen ongoing conditions of inflammation. Woods emphasizes the necessity of comprehensive evaluations to accurately identify the specific source of inflammation linked to a person's PCOS.

Context

• Polycystic Ovary Syndrome (PCOS) is a hormonal disorder common among women of reproductive age, characterized by irregular menstrual periods, excess androgen levels, and polycystic ovaries.
• Diet, stress, and lack of physical activity can contribute to inflammation and hormonal imbalances, suggesting that lifestyle modifications may help manage symptoms.
• Elevated levels of DHT can shrink hair follicles, leading to a condition known as androgenic alopecia, or pattern hair loss. This can result in thinning hair on the scalp, which is more common in men but can also affect women with high androgen levels.
• Inflammatory conditions can affect the endometrium (lining of the uterus), impacting its ability to support implantation and further complicating fertility issues.
• Evaluating thyroid function typically involves blood tests that measure levels of thyroid hormones (T3 and T4) and thyroid-stimulating hormone (TSH). These tests help determine if the thyroid is underactive or overactive.
• In Hashimoto's, the inflammatory response involves cytokines and other immune mediators that can increase overall inflammation in the body, affecting ovarian function and androgen levels.
• Conditions like SIBO can lead to deficiencies in essential nutrients such as B vitamins and magnesium, which are important for hormonal balance and reducing inflammation.
• Genetic factors may predispose individuals to inflammatory responses, so understanding family medical history can be a key component of comprehensive evaluations.

Tackling the variant of PCOS associated with insulin sensitivity challenges.

Following a diet designed specifically for PCOS can assist in keeping glucose and insulin levels consistent.

Woods emphasizes the significance of when meals are consumed and the nutritional content of those meals as crucial elements in the successful control of insulin sensitivity issues linked to PCOS. The strategy extends beyond simply avoiding detrimental foods; it encompasses the creation of a nutritional plan designed to maintain consistent levels of blood sugar and insulin throughout the day. Ensure your meals throughout the day, including breakfast, lunch, and dinner, consist of proteins, fats that are good for you, and carbohydrates that don't contribute to inflammation. Woods provides comprehensive guidance and crucial tools to empower you to make informed choices regarding your nutritional intake.

Cutting out foods that contain a lot of fructose and additional sugars can significantly improve how sensitive the body is to insulin.

Woods sheds light on the exacerbation of insulin sensitivity problems that can result from excessive fructose intake. The consumption of high-fructose corn syrup found in numerous sodas and processed foods, as well as sweeteners that are labeled as "natural" like agave, coconut sugar, date syrup, and dried fruits, contributes to a significant fructose consumption that overtaxes the liver and has the potential to worsen PCOS symptoms by encouraging insulin resistance.

Cutting out all forms of carbohydrates when managing PCos could actually have harmful consequences. If you steer clear of mild starches like rice, potatoes, and oats, you may find yourself with a heightened craving for sweets that appear healthy or an urge to indulge in snacks high in fructose. The writer emphasizes the need to eliminate sweeteners high in added sugar and fructose, instead of avoiding all carbohydrates.

Woods recommends a thirty-day detoxification program designed to purge sugar from the system, which is intended to recalibrate insulin levels and blood glucose amounts in individuals suffering from insulin-resistant PCOS. During this time, you eliminate sweet drinks, added sugar (including "natural" sweeteners), and dessert foods. Including a portion or two of intact fruits like berries in your meals, combined with protein or a beneficial fat, can assist in managing your desire for sweets. Make sure your diet includes a balanced combination of protein, healthy fats, and a modest portion of starches to help maintain satiety and manage your appetite.

Other Perspectives

• While reducing fructose and added sugars may improve insulin sensitivity for some, it's not a one-size-fits-all solution; individual responses to dietary changes can vary greatly.
• Dried fruits, while high in natural sugars, also provide vitamins, minerals, and fiber, which can be part of a healthy diet and may not necessarily contribute to excessive fructose consumption if eaten in moderation.
• It's important to consider the quality of carbohydrates rather than just the quantity. Focusing on the glycemic index and glycemic load of foods can provide a more nuanced approach to carbohydrate consumption in PCOS management, rather than a blanket recommendation to avoid all carbohydrates.
• Some individuals may have metabolic conditions or dietary needs that require a more personalized dietary approach, and blanket recommendations to eliminate specific types of sweeteners may not be appropriate for everyone.
• There is limited scientific evidence to support the effectiveness of short-term detox programs in managing chronic conditions like insulin resistance and PCOS.
• Some individuals may have a psychological or emotional connection to certain foods, and cutting them out entirely could have negative effects on mental health.
• There is a risk that the advice to include berries could be misinterpreted, leading to overconsumption of fruits, which could still contribute to excessive sugar intake and caloric surplus, potentially undermining insulin sensitivity and weight management efforts.
• For some individuals, particularly those with certain metabolic disorders, a diet lower in carbohydrates and higher in protein and fats may be more effective for managing appetite and promoting satiety.

Incorporating substances such as inositol and chromium can also support effective glucose metabolism.

In her advice, Woods recommends adding supplements that enhance insulin sensitivity in the body. The publication underscores the vital role that nutrients such as inositol and chromium play. Inositol, a naturally occurring nutrient with a structure similar to B-vitamins, has been extensively studied for its potent insulin-sensitizing effects. Research shows that Inositol is more effective than Metformin in restoring ovulation, assisting with weight loss, and diminishing the body's resistance to insulin.

Chromium, a vital trace mineral for carbohydrate metabolism, helps sustain a feeling of satiety and reduces cravings for sweet snacks. Woods explains that chromium improves insulin's capacity to assist glucose in entering cells, which in turn increases insulin's efficiency and supports glucose utilization. Research suggests that adding chromium to one's diet can help reduce cravings for sugary and starchy foods, potentially aiding in better weight management and improving insulin sensitivity for those with PCOS.

Context

• Inositol is found in foods such as fruits, beans, grains, and nuts, although supplementation is often recommended for therapeutic effects.
• Chromium is thought to work by enhancing the activity of insulin receptor kinase, an enzyme that plays a role in the insulin signaling pathway, thereby improving the cellular response to insulin.
• Some clinical guidelines suggest considering inositol as a first-line treatment for PCOS-related insulin resistance, especially for those who experience side effects from Metformin.
• Chromium is an essential trace element that plays a crucial role in the metabolism of carbohydrates, fats, and proteins. It enhances the action of insulin, a hormone critical for the metabolism and storage of carbohydrates, fats, and proteins in the body.
• While chromium supplements are generally considered safe for most people, excessive intake can lead to side effects such as stomach upset or more serious issues like kidney damage. It is important to follow recommended dosages and consult with a healthcare provider before starting any new supplement, especially for individuals with underlying health conditions.

For effective management of insulin-resistant PCOS, it's essential to find physical activities that are both pleasurable and sustainable, without placing excessive strain on the body.

Woods emphasizes the significance of discovering enjoyable physical activities, which are crucial for managing insulin sensitivity. The author recommends participating in gentle exercise to improve insulin sensitivity, while cautioning against intense, high-impact exercise that could overwhelm the body, especially in those with adrenal-related PCOS. Instead, she recommends finding movement that you genuinely enjoy and can incorporate into your lifestyle long term.

The author suggests trying a variety of exercises such as walking, dancing, swimming, yoga, or light weightlifting. It's crucial to heed the cues your body provides and participate in activities that replenish your vitality instead of depleting it. Woods promotes a shift in mindset, emphasizing that physical activity should be engaged in not solely for weight loss but also for its positive effects on mood enhancement and stress reduction, as well as for its role in enhancing the body's sensitivity to insulin.

Context

• Sustainable exercise routines are more likely to be maintained over time, leading to consistent benefits in managing insulin resistance and overall health.
• Gentle exercises not only aid in physical health but also support mental well-being by reducing stress and anxiety, which can be heightened in individuals with PCOS.
• High-impact exercises can cause physical stress, leading to fatigue and burnout, which might be counterproductive for those already dealing with adrenal fatigue.
• Participating in group activities or classes can provide social interaction, which can enhance motivation and make the exercise experience more enjoyable.
• Dancing combines aerobic exercise with fun and creativity. It can improve coordination, balance, and flexibility while also serving as a social activity that boosts mood.
• Engaging in activities that replenish vitality aligns with a holistic approach to health, which considers physical, mental, and emotional well-being as interconnected. This approach encourages balance and sustainability in lifestyle choices.
• Focusing on non-weight loss benefits of exercise can reduce pressure and stigma associated with body image, promoting a healthier relationship with one's body.

Tackling the inflammation linked to PCOS.

For Adrenal PCOS, reducing stress through lifestyle changes and herbal supplements is the primary focus

Managing stress is an essential component in the recovery journey for women dealing with Adrenal PCOS. Woods explains that continuously elevated cortisol levels, a hormone closely linked to stress, may disrupt the balance of hormones involved in reproduction, potentially resulting in heightened production of hormones like DHEAS from the body's stress-response organs. Consequently, the author underscores the importance of establishing enduring habits that support personal well-being, with an emphasis on prioritizing relaxation and weaving stress-relief practices into your everyday routine.

Maintaining stable levels of cortisol by creating a calming morning routine and prioritizing adequate sleep is crucial.

Woods recommends starting each day with a calm routine to create a consistent daily pattern and minimize abrupt spikes in cortisol and adrenaline levels. Enjoying a calming cup of herbal tea is also suggested as an element of these practices. Incorporating these practices into the start of your day can markedly affect how you handle stress and improve your overall state of health before you address the day's obligations.

The writer underscores the importance of cherishing downtime and staying alert to your body's signals that it needs to recuperate. Individuals diagnosed with adrenal PCOS often display traits associated with a type-A personality, which can result in a propensity for excessive exertion. Woods emphasizes the necessity of turning down certain obligations, setting boundaries, and allocating time for relaxation and renewal to replenish your energy and alleviate ongoing stress.

Context

• Chronic high levels of cortisol can lead to health issues such as weight gain, high blood pressure, diabetes, fatigue, and difficulty concentrating.
• Incorporating mindfulness practices, such as enjoying a quiet moment with a cup of tea, can enhance mental clarity and emotional well-being, setting a positive tone for the day.
• Taking breaks can lead to increased productivity and creativity, as it gives the mind a chance to reset and approach problems with a fresh perspective.
• Practices such as mindfulness and meditation can enhance awareness of bodily signals, promoting timely rest and recovery.
• Individuals with a type-A personality are often characterized by high levels of competitiveness, ambition, impatience, and a sense of urgency, which can lead to stress and health issues.
• Turning down obligations helps in better time management, allowing individuals to allocate time for self-care and activities that promote relaxation and well-being.
• Regular relaxation can lower blood pressure, reduce muscle tension, and decrease the risk of stress-related illnesses, contributing to overall physical health.

Eschewing substances such as caffeine can aid in reestablishing robust adrenal health.

Woods points out that while caffeine might seem like a necessary energy boost, it can significantly exacerbate Adrenal PCOS symptoms. Consuming caffeine stimulates the adrenal glands, which in turn increases the secretion of cortisol and adrenaline. This can lead to a continuous cycle where a person experiences both fatigue and heightened alertness, finds their vigor waning as daylight progresses, and has difficulty falling asleep when it's time for bed.

The author recommends that individuals suffering from Adrenal PCOS should reduce or eliminate caffeine intake for a period to aid in the recovery of their adrenal function. Gradually decrease your consumption of coffee, opting instead for non-caffeinated drinks like herbal teas or coffee without caffeine.

Context

• Polycystic Ovary Syndrome (PCOS) is a hormonal disorder common among women of reproductive age, characterized by irregular menstrual periods, excess androgen levels, and polycystic ovaries.
• For those reducing caffeine, it's important to find alternative ways to boost energy, such as through balanced nutrition, regular exercise, and adequate hydration.
• Polycystic Ovary Syndrome (PCOS) is a hormonal disorder common among women of reproductive age, characterized by irregular menstrual periods, excess androgen levels, and polycystic ovaries.
• Herbal teas, such as chamomile or peppermint, can provide a calming effect and support digestion, offering a soothing alternative to caffeinated beverages.
• Abrupt cessation of caffeine can lead to withdrawal symptoms, which may include headaches, fatigue, and mood changes, highlighting the importance of a gradual reduction.

A key approach to managing Post-Pill PCOS is to restore the nutrients that have become deficient.

Woods underscores the need for a specialized approach to address Post-Pill PCOS, which typically includes a hormonal imbalance that usually resolves within a timeframe of twelve to twenty-four months. The author suggests multiple strategies to mitigate symptoms and hasten the return to regular menstrual cycles as your body naturally adapts. The main tactics involve lowering excess male hormones and replenishing the essential nutrients depleted by the use of hormonal contraceptives.

Eliminating dairy and reducing high-fructose foods can minimize post-birth control hormonal fluctuations

Woods recommends avoiding dairy products derived from cows as a strategy to significantly improve acne issues that arise when one stops taking birth control pills. Cow-derived dairy products, unlike those sourced from sheep or goats, contain the A1 casein protein that can initiate inflammatory responses within the body, potentially resulting in acne flare-ups.

Woods recommends that individuals with PCOS and insulin resistance should reduce their intake of foods rich in fructose, particularly those that contain sweeteners marketed as natural and added sugars. By reducing your intake of drinks, sugary treats, and products high in fructose, you can create a more favorable environment for hormonal balance and decrease the inflammation and irritation that worsen acne once you discontinue birth control pills.

Context

• Stopping birth control pills can lead to hormonal fluctuations that may increase oil production in the skin, making it more prone to acne. Reducing inflammatory triggers like cow's milk can help manage these effects.
• Casein is a type of protein found in milk, and there are different types, including A1 and A2. A1 casein, found in most cow's milk, can break down into a peptide called beta-casomorphin-7 (BCM-7) during digestion, which is thought to trigger inflammation in some individuals.
• High fructose intake is linked to an increased risk of developing metabolic syndrome, which includes conditions like hypertension and type 2 diabetes, both of which are concerns for those with PCOS.
• Many sweeteners marketed as natural, such as agave syrup or honey, are perceived as healthier alternatives to refined sugar. However, they can still have high fructose content, which may contribute to insulin resistance and inflammation.

Incorporating nutrients such as zinc and various B-vitamins, along with herbal remedies like dong quai, may aid in the body's restoration of balance.

Woods emphasizes the necessity of replenishing essential nutrients that might be depleted as a result of hormonal contraceptive use, suggesting particular dietary supplements for this purpose. Ensuring hormonal balance and healthy ovulation requires a diet enriched with essential nutrients, particularly a variety of minerals including magnesium and zinc, and a focus on vitamins such as those in the B-complex group along with selenium. She underscores the importance of zinc in managing acne once a person stops taking birth control medication.

Additionally, the author suggests adding herbal treatments from traditional Chinese medicine, like Angelica sinensis, to sustain a balance in hormone levels and encourage regular menstrual periods. Dong quai aids in maintaining a balance between follicle-stimulating hormone and luteinizing hormone, which may become unbalanced from the use of hormonal contraceptives, resulting in irregular menstrual cycles.

Context

• Zinc is crucial for immune function, DNA synthesis, and cell division. It also plays a role in skin health and can help reduce inflammation, which is why it may be beneficial for managing acne.
• Dong quai is thought to have phytoestrogenic properties, meaning it can mimic estrogen in the body, which may help balance hormones, especially in cases of estrogen deficiency.
• Selenium is an antioxidant that helps protect cells from damage. It supports thyroid function and the immune system, which can be compromised by nutrient depletion.
• B-vitamins are involved in energy production and the synthesis of neurotransmitters, which can influence hormone regulation and stress levels, indirectly affecting ovulation.
• It has anti-inflammatory properties that can reduce the redness and swelling associated with acne lesions.
• TCM often focuses on restoring balance within the body, using a holistic approach that includes herbs, acupuncture, and dietary changes to address underlying health issues.
• LH is another hormone produced by the pituitary gland, essential for regulating the menstrual cycle and ovulation. In women, a surge in LH levels triggers ovulation, the release of a mature egg from the ovary.

Tackling the underlying source of systemic inflammation is crucial for managing Inflammatory PCOS.

Woods underscores the necessity of identifying and addressing the root factors that sustain inflammation to successfully manage Inflammatory PCOS. This strategy involves changes to one's way of life, adjustments in diet, and, when required, the addition of particular supplements. Maintaining thyroid health, improving digestive system function, and embracing an anti-inflammatory diet are crucial elements in the recovery journey.

Prioritizing thyroid function, strengthening the digestive tract, and committing to an anti-inflammatory diet is crucial.

Woods underscores the significance of assessing thyroid function as a key component in addressing PCOS linked with inflammation. It's essential to rule out hypothyroidism, as its symptoms can mimic those associated with PCOS and it might contribute to the onset of insulin resistance. The author recommends a thorough examination of thyroid function, including checks for TSH, T3, and T4 levels, along with assessments for the presence of thyroid antibodies.

Ensuring the well-being of your digestive system is essential for keeping inflammation in check. Woods highlights the link between poor digestive health and commonly referred to as leaky gut, which plays a crucial role in triggering inflammation throughout the body. These problems frequently originate from a disruption in the equilibrium of intestinal microbiota.

People with any type of PCOS, particularly those who have the inflammatory variant, should adhere to a nutritional regimen designed to counteract inflammation. This strategy emphasizes minimizing the consumption of foods known to trigger inflammation, such as processed goods, grains with gluten, dairy items, and highly refined sweeteners, while concentrating on a nutrient-dense diet that combats inflammatory reactions. Foods rich in omega-3 fatty acids like fatty fish, chia seeds, and flax seeds, as well as cruciferous vegetables, dark leafy greens, berries, and spices like turmeric and ginger, are excellent choices.

Context

• The thyroid gland regulates metabolism, and its dysfunction can exacerbate symptoms of PCOS, such as weight gain and fatigue, due to its role in metabolic processes.
• The intestinal microbiota consists of trillions of microorganisms, including bacteria, viruses, and fungi, that live in the digestive tract. A balanced microbiota is crucial for digestion, nutrient absorption, and immune function. Disruptions can lead to dysbiosis, contributing to inflammation and conditions like leaky gut.
• Both spices have been used in traditional medicine for their anti-inflammatory and antioxidant effects, which may help alleviate symptoms associated with PCOS.

Incorporating supplements known for their anti-inflammatory effects, such as curcumin, can also reduce signs associated with inflammatory responses.

Woods advises incorporating specific nutritional supplements alongside dietary modifications to address inflammation-related concerns. The primary compound found in turmeric, known for its strong anti-inflammatory effects, has been thoroughly researched for its role in diminishing inflammation associated with PCOS. Improve the body's sensitivity to insulin and diminish indications of inflammation.

Other Perspectives

• There may be interactions between curcumin supplements and other medications, which could diminish the effectiveness of either or increase the risk of adverse effects.
• Curcumin's bioavailability is quite low, which means that the body doesn't absorb it well without the aid of certain enhancers like piperine, found in black pepper.
• The quality and purity of supplements can vary between brands, which may affect their efficacy and safety.
• Some studies on supplements and insulin sensitivity are limited by small sample sizes, short durations, or other methodological issues that can affect the reliability of their findings.

Sustaining recovery from PCOS while also preserving reproductive health.

Adopting a principle where 80 percent of the time you make healthy choices and 20 percent of the time you allow for indulgences can lead to sustainable lifestyle changes without feeling deprived.

Woods emphasizes the importance of implementing a flexible and sustainable approach to exert lasting control over the condition characterized by multiple cysts on the ovaries. The author acknowledges the significance of developing positive habits, yet she also comprehends the challenges involved in adhering to them unfailingly. She introduces an idea that highlights how a minimal fraction of the effort, particularly 20%, can result in a substantial share of the results, thus creating balance and preventing feelings of deprivation.

Maintaining a lifestyle that supports PCOS management most of the time allows for the occasional treat of preferred foods during other times.

Allocating the majority of one's efforts, specifically 80%, to choices that have a beneficial effect on managing PCOS, while permitting the remaining 20% for the occasional indulgence or pleasurable pursuits, indicates a well-rounded strategy for making lifestyle choices. Occasionally deviating from your regular routine or enjoying a treat should not induce feelings of guilt or trigger a series of unwise choices.

This approach fosters a more positive and balanced approach to eating, which also aids in controlling the inclination to overeat, a common issue with diets that impose strict limitations. It acknowledges that life is about balance and enjoyment, not rigid adherence to a set of rules.

Other Perspectives

• This approach may inadvertently encourage a cycle of restriction and indulgence, which can be psychologically unhealthy and may lead to disordered eating patterns in some people.
• There's a risk that the 20% indulgence could become a slippery slope, leading to more frequent or larger deviations from the management plan over time.
• The concept of not feeling guilty about treats assumes that everyone can easily return to their routine, but this may not be the case for everyone, as guilt can sometimes serve as a reminder to stay on track with their health goals.
• The concept of balance can be subjective and difficult to define, and what is balanced for one person may not be for another, potentially leading to confusion or misapplication of the 80/20 rule.
• In certain professions or activities, like aviation or engineering, strict compliance with rules is essential to ensure the safety and well-being of others.

Successful long-term management of PCOS involves replenishing depleted vital nutrients and meticulously monitoring the key signs of the underlying problems.

Woods advises regularly monitoring essential nutrients such as vitamin D, vitamin B12, and iron, as a deficiency in these can worsen PCOS symptoms and hinder recovery. Regular check-ups using laboratory analyses can help track progress and ensure that essential levels are maintained, potentially with the help of targeted supplements.

Continued use of certain supplements for a prolonged duration prior to transitioning to maintenance doses aids in establishing a balance in hormone levels.

The author recommends a tailored supplement regimen that tackles the root of PCOS, which usually leads to noticeable progress within a timeframe of three to four months. As you monitor improvements in your health and your medical evaluations reveal positive changes, such as an increased responsiveness to insulin or decreased levels of stress hormones. You can then shift to doses intended for ongoing maintenance.

Woods recommends a gradual approach that ensures a seamless shift while minimizing the effects of sudden discontinuation. The initiative aims to sustain your hormonal balance for a prolonged duration.

Other Perspectives

• Long-term supplementation without proper medical supervision could potentially mask underlying issues or lead to an imbalance in other nutrients or hormones.
• Some experts may argue that focusing solely on supplements might overlook the importance of a comprehensive treatment plan that includes diet, exercise, and possibly medication.
• Positive changes in medical evaluations can sometimes be misleading or temporary, and may not necessarily indicate a long-term or sustainable improvement in health.
• The timing of when to shift to maintenance doses is not clearly defined and could vary greatly between individuals, making it difficult to standardize treatment protocols.
• The concept of a "seamless shift" is subjective and may not accurately reflect the complexity of managing a condition like PCOS, where hormone levels can be unpredictable.

Keeping track of ovulation cycles is crucial for improving fertility without medical intervention in those suffering from PCOS.

Individuals with PCOS aiming for pregnancy need to understand their menstrual cycle intricacies to identify their peak fertility period. The regularity of the ovulation cycle is often disrupted due to hormonal irregularities linked to PCOS, making it challenging to pinpoint the timing of ovulation.

Being aware of the physical indicators that signal ovulation can help couples time their intimate moments perfectly when trying to conceive.

Woods explains that by attentively tracking basal body temperature (BBT) and observing cervical fluid changes, you can determine your unique ovulation patterns even with irregular cycles. By recognizing these patterns, you can schedule intimate moments to enhance the likelihood of becoming pregnant.

Other Perspectives

• BBT must be measured at the same time each morning before any activity, which may not be practical for everyone's lifestyle or sleep patterns.
• Stress, illness, and travel can also impact BBT readings, leading to inconsistencies and making it challenging to track ovulation.
• Some couples may find that focusing too much on scheduling intimacy reduces the spontaneity and emotional connection that can be important for a healthy sexual relationship.