Commentary

The High Prevalence of Sexual Concerns among Women Seeking Routine Gynecological Care

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BACKGROUND: Sexuality is an important part of health, quality of life, and general wellbeing. Studies indicate that less than half of patients’ sexual concerns are known by their physicians, and physicians are unaware of how common these sexual concerns are in their practices. Our objective was to determine the prevalence and type of sexual concerns among women seeking routine gynecological care.

METHODS: We mailed the survey in waves. Of 1480 women seeking routine gynecological care from the departments of Family Practice and Obstetrics and Gynecology at Madigan Army Medical Center between August 1992 and January 1993, 964 responded. The main outcome measures were self-reported sexual concerns and their experiences with discussing these concerns with a physician.

RESULTS: A total of 98.8% of the women we surveyed reported one or more sexual concerns. The most frequently reported concerns were lack of interest (87.2%), difficulty with orgasm (83.3%), inadequate lubrication (74.7%), dyspareunia (71.7%), body image concerns (68.5%), unmet sexual needs (67.2%), and needing information about sexual issues (63.4%). More than half reported concerns about physical or sexual abuse, and more than 40% reported sexual coercion at some point in their lives.

CONCLUSIONS: Our results suggest that sexual health concerns are prevalent for women seeking routine gynecological care. Sexual health inquiry should be a regular and important part of health care maintenance.

Sexuality is an important part of the total person; integral to health, quality of life, and general well-being. It affects the way we relate to ourselves, our sexual partners, and all other people.1 A healthy attitude about sexuality can provide numerous benefits, including a link with the future through procreation; a means of pleasure and physical release; a sense of connection to others; a form of gentle, subtle, or intense communication; enhanced feelings of self-worth; and a contribution to self-identity.2

Sexuality also carries risks, especially for women, including unwanted pregnancy, sexually transmitted diseases, and the potential for exploitation. These types of concerns are a common threat to sexual health and have been reported in 50% to 70% of marriages3,4 and in 75% of couples who seek marital therapy.5

As primary health providers, family physicians are in a good position to identify and address patients’ sexual concerns, thereby promoting their overall health and well-being. Physicians, however, frequently do not recognize these concerns during the clinical encounter. Available studies suggest that less than half of patients’ concerns are recognized by their physicians, and it is believed that physicians are generally unaware of the nature and frequency of sexual concerns among their patients.6,7

The purpose of our study was to describe the frequency and type of the sexual concerns among women attending military outpatient clinics for routine gynecological care. The military medical center was a convenient facility serving a relatively diverse population of American women. Our study also extends the work of previous prevalence studies in clinical settings of sexual concerns by providing a larger sample size.

Methods

We included women who sought routine gynecological care at the Department of Family Practice (DFP) and the Department of Obstetrics and Gynecology (OB/GYN) at Madigan Army Medical Center (MAMC), a large military medical center located in Pierce County, Washington. Beneficiaries of health care at MAMC include active duty service members, active military reserve, retired military members, their families, and eligible employed or retired civilian service members. The DFP and OB/GYN Clinics are the main providers for routine gynecological care of the Madigan military beneficiaries.

We obtained approval for this study from the Human Subjects Review Committee of the Clinical Investigation Department of Madigan Army Medical Center and the Human Subjects Review Committee of the University of Washington.

Our target population consisted of all women who sought routine gynecological care between August 1992 and December 1992 at the DFP (n=525) and between December 1992 and January 1993 at the OB/GYN department (n=1059). We excluded women who were younger than 18 years, unable to understand English, geographically unavailable for follow-up, or who had cognitive dysfunction rendering them unable to complete the questionnaire.

We collected data through waves of questionnaires mailed to all 1584 eligible women. Ninety-six women could not be located, and 8 women were ineligible because of language barriers or cognitive dysfunction. In total, 985 women who sought care in the OB/GYN department and 495 women who sought care from the DFP were located and otherwise eligible for the study (total sample size=1480 women).

Our survey instrument included 95 questions addressing sociodemographic characteristics, aspects of the patient’s sexual history, sources of knowledge about sex, their sexual concerns, and their interest and experience with addressing these concerns with physicians. The 27 types of sexual concerns queried were drawn from the sexuality literature and were measured on a 5-point Likert scale (1=never; 5=always).

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