Normalizing the diagnosis and treatment of female sexual dysfunction

In this interview, Alexandra Dubinskaya, MD, discusses how urologists can improve upon managing female sexual dysfunction.

Unlike male sexual dysfunction, female sexual dysfunction is not often treated or even asked about in patient visits. This happens for several reasons, including neglect to bring up the issue of sexual dysfunction, lack of knowledge and time to diagnose and treat sex related conditions.

In the following interview, Alexandra Dubinskaya, MD, discusses how urologists can improve upon managing female sexual dysfunction. Although not all doctors may feel comfortable treating this condition, there are ways to provide better care to these individuals, who already have a difficult time recognizing it themselves. Dr. Dubinskaya is a female pelvic medicine and reconstructive surgery fellow at Cedars-Sinai Medical Center in Los Angeles, California.

What are the stigmas associated with female sexual dysfunction?

The first thing I would say is that female sexual health is an orphaned topic. There is no place for it in any of the already-formed medical specialties. There is no place for female sexual health in internal medicine; however, primary care providers do treat male sexual dysfunction and are comfortable prescribing [sildenafil citrate] Viagra. There is no place for it in OBGYN, and a majority of OBGYN programs do not offer female sexual health in their curriculum. Also, because OBGYN is considered to be a primary care field, there are so many boxes that need to be checked during visits that there is literally no time to address sexual health and vaginal health. You would think in urogynecology [that] sexual function and dysfunction are considered [to be] outcomes of the surgeries and [that] urogynecologists know everything about it, but that's not always the case. General urology traditionally addresses general urological conditions and male sexual function. And, again, female sexual function is being left behind. So, female sexual health is up for grabs. Providers who care enough, who feel passionate, are stepping up. They are learning everything that's already out there, collaborating with each other and are interested in helping women. Women’s sexual health is a new, growing field.

Another stigma is that women are afraid of talking about sexual health. I have yet to encounter women who wouldn't be willing to talk about sex. Women are usually so excited that finally somebody asked them about their sexual life . It is believed that sexual health is an awkward topic, but it's only as awkward as you make it. There is a notion that female sexual health is complicated. However, as long as you are honest with yourself and with your patients, and say, "Okay, I am familiar with this issue, and I know what to do with it. This other issue, I'm not so sure about, but I know the people who I'm going to refer you to. They'll help you." It's also fine to not want to deal with female sexual function, but as long as you can tell the patient, "Hey, you have a sexual health concern. I'm not the provider who can address this, but I know someone who can. I'm going to give you his/her information," I think that would help a lot of women tremendously.

How do these stigmas impact the management of patients with this condition?

There are barriers that are faced by patients and providers. Female sexual dysfunction is being underreported and women feel left alone in their struggle, afraid to speak up or ask questions about their sexual health. Providers are limited by the short appointment time, by the fear that female sexual function is too complex, and by the general lack of knowledge on this subject.

What advice would you give to patients in terms of overcoming these stigmas at both an individual and societal level?

I think it's always important to ask, to search for answers. And even if you meet one provider who would say, "Oh, you have pain with sex? Have a glass of wine; you'll be fine," you shouldn't stop there. There are plenty of doctors who [are] actually capable of helping. The more you ask, the more likely you will find a provider who will help you. Also, we as a doctors feel uncomfortable when we don’t have answers to the questions our patients ask. By asking questions, patients are prompting us to search for answers and to learn more. So, I think it's very important to keep asking [and] keep speaking up for yourself. By learning from social media, from books, women can expand their awareness about female sexual health and overall sexual health literacy. This will help women to advocate for themselves and potentially advance the development of new treatment modalities.

What is the urologist’s role in destigmatizing female sexual dysfunction?

Treat female sexual dysfunction the same way you treat and approach male sexual dysfunction. Make it a priority and ask questions. The same way we ask men, "How's your erection?" you can ask women, "How is your lubrications? How's your orgasm? " Be a little more open and acknowledge that sexual health is a very important part of overall health. Discuss sexual health with your female patients, and you will be their favorite doctor, and they will never leave your practice. Also, get to know a sexual health expert in your area who you can call, email, ask for help, or refer patients.

Is there anything else you feel our audience should know about this topic?

Female sexual dysfunction is treatable. Some conditions cannot be cured but can be managed. Anyone who wants to learn more should check out the International Society for the study of Female Sexual Health, ISSWSH - one of the best societies I know! Also, it is okay to not want to take care of women’s sexual health. In that case, make sure you have the information of a local sexual health specialist that you can hand to your patient.