Talking about female sexual dysfunction in specific patient populations

Despite the prevalence of female sexual dysfunction, many women never talk to their providers about it and providers often don’t take the lead in asking patients about their sexual health during a routine clinical visit. Learning strategies to better elicit such information from women is important to first understand the types of sexual dysfunction and associated distress a woman may be experiencing and then to help guide women about options to manage the particular dysfunction.

As discussed in a separate article, simply asking patients about their sexual health and any difficulties they may be experiencing is the most important thing a provider can do to initiate effective communication on sexual dysfunction. Asking specific questions about a woman’s sexual history, experience, and emotions associated with sexual encounters in a nonjudgmental and open way provides a safe way for women to talk about an issue that can be fraught with unease.

For particular groups of women, reluctance to talk about sexual difficulties may be enhanced by perceived societal judgements and misconceptions. Older women, for example, may feel that sexual dysfunction is a normal part of aging and so refrain from discussing it with their providers. Providers, too, may hold unrecognized misconceptions about specific populations of women and therefore not recognize the need to address potential sexual dysfunction in these women (Table).¹

For all women, including these specific populations, effective communication about sexual dysfunction is essential to ensure that any sexual difficulties creating distress in women are addressed. “We are all sexual beings, and women remain sexual throughout their lives, irrespective of age, sexual orientation, gender identity, race or ethnicity,” said Stephanie S Faubion, MD, Director, Office of Women’s Health, Mayo Clinic, Rochester, Minnesota, who recently wrote an article focusing on talking about women about sexual dysfunction.²

She emphasized the need to remain nonjudgmental when asking women about their sexual health to assure patients feel comfortable sharing their concerns.

When initiating a conversation with older women, for example, providers can place the issue of sexual health in the context of getting older by saying something like “Some studies show that as women get older, they may have less desire for sex or decreased lubrication, which makes intercourse uncomfortable. Have you noticed any changes?” ¹

When talking to a non-heterosexual woman, providers should ask about sexual encounters that include penetration either by male partners or fingers/vibrators/dildos.¹   

Overall, Dr. Faubion emphasized that “just opening the door with a question and genuine interest gives the patient permission to discuss their concerns.”

References

1.    Female sexual dysfunction. Practice Bulletin No. 119. American College of Obstetricians and Gynecologists. Obstet Gynecol 2011; 117:996–1007. http://mail.ny.acog.org/website/FSDResourceGuide.pdf

2.    Faubion SS, Parish SJ. Sexual dysfunction in women: Can we talk about it: Cleveland Clinic Journal of Medicine. 2017;84(5):367-376.