A new report discusses shortfalls in doctor-patient communication around sexual matters.
Researchers discovered women’s sexual health issues are only touched on, if discussed at all. Experts believe avoiding this important topic could mean missing an important link to overall wellness.
Investigators came to these conclusions after evaluating the results of a comprehensive national survey of U.S. obstetrician-gynecologists regarding communication with patients about sex.
The report, “What We Don’t Talk about When We Don’t Talk about Sex,” uncovers the shortfalls in doctor-patient communication around sexual matters and examines the barriers that may be limiting the range of dialogue in a typical evaluation of a woman’s general health.
The study is published in the Journal of Sexual Medicine.
University of Chicago researchers discovered that although nearly two-thirds of OB-GYNs routinely inquire about patients’ sexual activity, other aspects of female sexuality are not regularly addressed.
Only 40 percent of physicians surveyed regularly check for sexual problems or dysfunction. Even fewer (29 percent) ask patients about satisfaction with their sexual lives and only 28 percent confirm a patient’s sexual orientation.
Study authors believe that an improved discussion on sexual health is needed, requiring stronger physician guidelines for conducting a thorough sexual history.
“As a practicing OB-GYN, many of my patients say I’m the first physician to talk with them about sexual issues,” said Stacy Tessler Lindau, MD, the study’s lead author.
“Sexuality is a key component of a woman’s physical and psychological health. Obviously, OB-GYNs are well positioned among all physicians to address female sexual concerns. Simply asking a patient if she’s sexually active does not tell us whether she has good sexual function or changes in her sexual function that could indicate underlying problems.”
Experts say a detailed discussion of sexual health is necessary; sexual function concerns are highly prevalent among women.
Recent studies estimate that roughly a third of young and middle-aged women and about half of older women experience some sort of sexual problem such as low desire, pain during intercourse or lack of pleasure.
For most, sexual dysfunction is more than physical and the impact of sexual dysfunction can be far-reaching. In addition to strained relationships, many women experience worry, shame, guilt and feelings of isolation.
If the physician doesn’t ask, patients are hesitant to bring up the topic.
“Many women are suffering in silence,” Lindau said. “Patients are often reluctant to bring up sexual difficulties because of fear the physician will be embarrassed or will dismiss their concerns.
“Doctors should be taking the lead. Sexual history-taking is a fundamental part of gynecologic care. Understanding a patient’s sexual function rounds out the picture of her overall health and can reveal underlying issues that may otherwise be overlooked.”
Investigators reviewed whether factors such as gender, age, race, medical school location, immigration status, religious affiliation or type of practice play a role in the likelihood an OB-GYN will broach sexual matters.
Not surprisingly, female doctors are more likely to address sexual activity with female patients. Doctors who see more patients for gynecology vs. prenatal care tend to screen for sexual dysfunction more frequently than their colleagues. OB-GYNs ages 60 and older are less likely to delve into a patient’s sexual orientation or identity.
Researchers discovered that fewer than a third of all OB-GYNs surveyed routinely ask patients about their sexual orientation. Assuming heterosexuality can alienate a lesbian or bisexual patient and result in misinterpretation of symptoms and misdiagnosis.
“One explanation for the findings may be a deficit in physician training about diagnosis and treatment of female sexual problems,” said first author Janelle Sobecki, MA.
“Like patients, physicians may worry that raising the topic could offend or embarrass the patient. Physicians, especially OB-GYNs, are better positioned than patients to open the door for discussion.”
For many women grappling with a sexual problem, the underlying cause may be treatment for another medical condition. Drugs regularly prescribed for conditions from depression to breast cancer can have a negative effect on sexual function in some women, including low libido. Patients may be better able to tolerate these side effects if they know to expect them.
An emerging area of concern for Lindau — a specialist in maintaining sexual function in cancer survivors — is prevention measures for patients at high risk for developing breast cancer.
Drugs such as aromatase inhibitors and tamoxifen, which interfere with the activity of estrogen and therefore reduce breast cancer risk, are becoming more widely used, including among younger women.
“Women are not being counseled on the potential sexual side effects of these treatments, and we have limited data to appropriately counsel them,” Lindau said.
“For men with prostate cancer, in comparison, the impact of treatment on sexual function is typically discussed as part of deciding which therapy to try.”
One reason doctors may feel more comfortable discussing sex with men is the availability of FDA-approved treatments for erectile dysfunction, while medical treatments for female sexual dysfunction are limited.
The good news is that women are seeking and demanding more information about their personal health, oftentimes turning to the anonymity of the Internet as a first resource.
Ideally, Lindau adds, these women are empowered by reputable online and other media sources to know that they are not alone in their concerns and will gather the courage to begin a conversation with a physician.
“If you have a doctor you trust who has not brought this topic up, give it a try,” Lindau adds. “If you are waiting for the doctor to start the conversation, it may never happen. Communication is key.”