Add Sex Therapist to Your Ob/Gyn Repertoire

The impact of sexual dysfunction on a relationship is significant. When both parties believe sex is good, it adds 15% to 20% of additional value to a relationship. However, when sex is bad or nonexistent, it can drain 50% to 70% of all positive value from a relationship.

Women going through menopause can experience significant sexual dysfunction, and if this is accompanied by distress, than an intervention, be in clinical or behavioral, is needed. Before referring a patient for psychotherapy, there are several things that OB/GYNs can do in the office setting to help patients with sexual dysfunction begin to think differently about sex, said Sheryl A. Kingsberg, PhD, at a plenary session on low libido at the 25th Annual Meeting of The North American Menopause Society. This particular session was held October 15.

Kingsberg, who is professor of reproductive biology and psychiatry at Case Western Reserve University School of Medicine, Cleveland, Ohio, explained how OB/GYNs can provide office-based "sex therapy" to patients with general sexual problems. Essentially, it involves making the following points and discussing them with your patients.

- Redefine “normal” sexual activity

Monogamy doesn't equal monotonous. Encourage patients to try different positions or have sex in places other than the bedroom. Instead of having sex at night, plan sex in the morning when energy is high. An additional benefit of morning sex is that it boosts the immune system.

- Alter sexual behaviors that are no longer possible or satisfying

Some positions may become impossible-or at least very uncomfortable and possibly unsafe-as the body ages. People tend to not be as flexible or have the coordination or muscle strength needed to comfortably engage in certain sexual positions.

- Expand sexual behavior repertoire

Encourage patients to try new things, and they don't all need to be related to intercourse (although that is the goal). Women should engage in behaviors or activities that make them feel better about themselves, such as going to the gym, wearing makeup, or putting on underwear or clothing that makes them feel sexy. Remind patients to think about how to incorporate seduction and foreplay into their everyday, be it an unexpected kiss or touch, a suggestive note or text message, a shared shower, or foregoing pajamas for the night. Simple things like planning a date night or going away for the weekend can help shake up a routine. As with many things in life, a little effort can go a long way.

- Improve communication with partner

Remind women/couples that it's okay to say what you like and don't like. It's also okay to ask to try something that you are curious about. Most couple's have a desire discrepancy (one person wanting more sex than his or her partner), and couples will need to compromise. And consider the importance of undivided attention when you are together. Connection can start with something as simple as eye contact.

- Give permission to self-explore

It's very important that women learn what feels good to them, especially women who experience painful sex. Masturbation or self-stimulation can help a woman learn how her body responds to increases in stimulus intensity, from increasingly pleasant, then up to a peak value beyond which pleasantness falls off through indifference to increasing unpleasantness. Give your patients permission to self-stimulate, and remind them that there is no reason to feel shame or guilt over it.