(Created March 2010)
Female sexual concerns and dysfunction are commonplace and affect the lives of many women worldwide. Yet many women suffer in silence, reluctant to broach the subject with their health care providers. Unfortunately, providers often fail to ask about sexual health concerns. One reason for this communication gap is a lack of adequate formal medical sexual training for health care providers in the assessment and management of female sexuality and sexual dysfunction. There has also been an historic paucity of effective medication options for treating female sexual dysfunction. Existing and potential future technologies may increase the interest of both patients and health care providers in addressing female concerns and sexual dysfunction. In general, frontline health care providers need to gain greater competency addressing sexual health concerns to help improve their patients’ quality of life.
To address this need for improved competency, ARHP hosted a series of consensus meetings of clinical and behavioral science experts in sexuality. The explicit aims of this consensus process were:
(1) To supplement expert guidelines with recommendations specifically designed to fill a practice gap for frontline women’s healthcare providers on sexual function, health, and wellness; and
(2) To develop open-access assessment and practice tools for professional societies and advocacy groups.
Through small group work and large group discussions during the consensus meetings, panelists identified a number of myths that hinder ideal care for female sexual health. By making health care providers aware of these myths, they will be better prepared to address them and more effectively screen and treat patients who are experiencing difficulties around their sexual health.
Myths held by health care providers (and possibly patients) include:
- Pandora’s Box: There is a myth that asking about sexual health is akin to opening Pandora’s Box. Several experts pointed out that while there may be a slight increase in the time needed to ask questions, often the problem is simple (e.g., drug side effect or vaginal dryness) and a few questions may lead to diagnosis and treatment. If the provider discovers that the problem is complex, he or she can refer the patient for specialty care;
- Patient reluctance: There is a myth that patients don’t want health care providers to inquire about sexual health. The experts noted that most patients do want providers to ask about sexual health. Panelists also pointed out that in some instances, patients who finally find a health care provider who does ask them about their sexual health are often angry that no one asked them sooner. In addition, patients who find they can’t discuss the topic with their provider may switch providers;
- “Not my job”: A myth exists that sexual health is not an area for primary care providers to address. Panelists hypothesized that this myth reflects a larger problem—that of placing sex and sexual health in a different, unique, or untouchable category than other health problems, such that patients/clients feel the topic is not one they can or should talk about (e.g., urogenital atrophy often goes untreated because it is considered a “sexual” issue);
- Ageism: There can be a myth among patients and providers that people no longer engage in sex after a certain age (e.g., a patient who states, “I haven’t had an orgasm in 7 years, but I’m 42 and so that’s to be expected”); and
- No treatments available: The myth that there are no effective treatments available for female sexual dysfunction is pervasive. Panelists pointed out that a number of disorders, such as vaginal atrophy, can be effectively treated. There is an FDA-approved product, conjugated equine estrogen cream, which is available for the treatment of moderate to severe vulvovaginal atrophy, yet many providers are unaware of this new indication. In addition, some individuals (especially patients/clients, but providers as well) may be unnecessarily concerned about using local estrogen for treatment of vaginal atrophy because of the concern about potential systemic effects.
For more information on this topic, refer to the other Sexual Health Fundamentals fact sheets, The Top 10 Things You Need to Know about Female Sexuality, Talking with Patients About Sexuality and Sexual Health, Sex Therapy for Non-Sex Therapists, and Clinician Competencies for Sexual Health.
Sexual Health Fundamentals is a publication of the Association of Reproductive Health Professionals (ARHP) for health care professionals, educators, and researchers working in the field of reproductive health. This fact sheet is part of the Sexual Health Fundamentals for Patient Care Initiative, which was guided by principles established by a consensus committee of renowned experts in female sexuality, led by co-chairs Michael Krychman, MD, and Susan Kellogg Spadt, CRNP, PhD. The goals of this initiative are to assist “frontline” members of the reproductive health care team with expert, evidence-based guidance on sexual function, health, and wellness, and to provide freely available needs assessment tools for professional societies to customize for their specific constituencies. Sexual Health Fundamentals are available at www.arhp.org/factsheets.