Click here to access articles on sexual health published in OBG Management in 2012.
As health-care professionals, we are well trained in the importance of taking a detailed, targeted history and incorporating appropriate assessments to determine a treatment plan, which often includes prescriptions, a medical procedure, or a referral. Our extensive training allows us to make and implement expert decisions.
At the same time, I’ve found that the most valued aspect of our job is the relationships we develop with our patients. We know details that probably no one else knows about them. This is likely most true for us clinicians whose practices address women’s sexual health. A deep level of trust develops over time.
As part of that relationship of trust, we have unique opportunities to influence not only a woman’s health but also her overall quality of life. What I found over the years is that many women don’t necessarily need any prescription or referral or procedure. What they do often need is guidance, direction, and encouragement.
Some of my greatest achievements in delivering health care have not happened in a delivery room or because of a medication I prescribed. Instead, they have occurred in the office where, for example, I see a woman who took my recommendations 1 year ago to change her diet and begin exercising. Now, 30 lb lighter, she feels like a new person. This is one example of a knowledgeable physician applying “extensive training and expert decisions” to incorporate low-tech treatments with great success.
So what does this have to do with vibrators in a doctor’s office? Well, without many FDA-approved medications to treat sexual dysfunction, we are left with over-the-counter possibilities and such “low-tech” options as counseling and guidance.
Sexual dysfunction is common among our patients
According to the National Health and Social Life Survey, 43% of women are affected by some aspect of sexual dysfunction, and 22% associate that dysfunction with personal distress. The distress was highest for women aged 45 to 64. Additional correlates included poor self-assessed health, low education level, depression, anxiety, thyroid conditions, and urinary incontinence.1 Sexual complaints among women diagnosed with cancer can be as high as 90%.2
Does this describe anyone in your practice? We can agree that women’s sexual issues are common, whether we acknowledge that in our practice by querying women on their sexual health or not (and many of us are not).
We’re not talking to our patients about their sexual health enough. In a 2012 survey of more than 1,000 ObGyns about whether they talk with their patients about sex,3 investigators found that:
- 63% routinely ask whether their patient is sexually active
- 40% routinely ask if the patient is having any problems regarding sex
- 29% ask about sexual satisfaction
- 28% ask about sexual orientation or identity
- 14% ask about sexual pleasure.
Whatever the reason, talking about sexual health is easier for some people than for others, and that goes for both clinicians and patients.
What are our treatment options if sexual dysfunction is identified?
Unfortunately, the therapeutic armamentarium for women’s sexual health is limited—perhaps a contributor to many clinicians’ reluctance to broach the topic. Pharmacologically, we have no FDA-approved treatments for female sexual dysfunction except localized estrogen treatment for vulvovaginal atrophy and the Eros device for arousal and orgasmic disorders.
There are off-label options of testosterone, buproprion, or sildenafil citrate, but many practitioners and patients are reluctant to consider these options specifically because they are off label.
Over-the-counter. These options are available for women, and can be helpful. For patients with discomfort due to vaginal dryness, it is important to educate them on the benefits of vaginal moisturizers and lubricants. Many women don’t know about these options, and far fewer understand the difference between these products (ie, water-based vs hybrid vs silicone lubricants).
Patients are more likely to comply with treatment when products are available in the office
Here in my small Midwestern city, there are 15 moisturizers or lubricants on the shelf at Rite-Aid; 38 at Walgreens. My patients are unlikely to sort through the options, and many tell me they use “whatever my husband bought for me.” I’ve had a menopausal patient report using K-Y Intense. For an atrophic postmenopausal vagina, that product is very uncomfortable. She was now downright scared to try additional options.
This is the patient to whom I explain lubricant options by placing on her hand dabs of water-based, hybrid, and silicone products. I let her note the differences in feel and consistency, allowing her to determine which is most acceptable to her. My office offers a small selection of each of those products so she can leave the appointment with the selection of her choice—no label reading or comparison shopping in the aisle of Walgreens as her neighbor walks by; no accidental purchase of products that increase rather than relieve her discomfort.