Female Sexual Dysfunction
Obstacles to Routine
- Physician discomfort with the subject. There are several reasons for this. Physicians sometimes worry that patients will misconstrue the questioning. However, studies have shown that patients expect and want their doctor to ask. It is important, of course, to ask at the appropriate time i.e. during the history-taking and not in the course of the pelvic examination. One study involving gynecology nurses found that virtually all the nurses were comfortable discussing sexuality if the patient brought up the issue, but only half were comfortable bringing up the topic themselves. While similar studies have yet to be conducted with physicians, there is no reason to suspect that the proportions would be different. Unfortunately, there is only one way to become comfortable discussing sexual issues and that is to do it regularly.
- Perceived lack of time. With some studies showing that half the population has sexual issues at any given time, physicians worry that asking everyone about sexual issues will slow down their office pace considerably. However, asking about sexual issues saves time in the long run since the underlying issues are dealt with. Each physician can decide for him/herself to what depth he or she wants to deal with sexual concerns and can develop a list of resources.
- Perceived lack of expertise. However, one doesn't have to be a psychologist to deal with sexual dysfunction. As a physician, one should be able to rule out and treat physiological causes. In addition, one should be able to assess psychological factors at least to the extent of being able to refer appropriately.
- The fact that there is usually "no quick fix". Male sexual dysfunction is perceived to be simpler to diagnose and treat. (This is not necessarily true.) Female sexual dysfunction is often multi-determined. The good news is that you usually don't have to resolve all the components in order to effect improvement; a change in one area may lead to a situation that is, not perfect, but at least "good enough".
Last Modified: September 5, 2006
