Abstract
Background: Although sexual health can be considered a vital sign for overall health, several barriers prevent women from receiving proper medical counseling, support, and/or care for their sexual health needs and concerns.Methods: Experts in sexual health compiled research and experience on the impediments to women receiving adequate assessment and treatment for their sexual health. Specific solutions and a roadmap for overcoming such barriers and improving patient–clinician communication are presented.Results: Social stigma around female sexuality remains in Western culture and as a result, women often avoid and/or are embarrassed to discuss their sexual health with their health care professionals (HCPs). Moreover, midlife women are typically unaware or have misconceptions about conditions that may adversely impact their sexual life, such as genitourinary syndrome of menopause and hypoactive sexual desire disorder. Without understanding there may be underlying medical conditions, there is also a lack of awareness that safe and effective treatments are available. Lack of training, tools, time, and limited treatment options impede HCPs from providing women with necessary sexual health support. Educating women, training HCPs, and providing communication tools to HCPs can facilitate effective dialog between patients and HCPs. More specifically, HCPs can be trained to initiate and maintain a sexual health conversation in a manner that is comfortable for women to convey sexual health needs and concerns, and for HCPs to correctly identify, diagnose, and treat the sexual problems of their female patients.Conclusions: Solutions exist to address the barriers currently impeding patient–clinician interactions around sexual health.
Highlights
The concept of sexual health has evolved significantly since the definition offered by the World Health Organization in 1975.1 different definitions of the term continue to exist today, the general principles of ‘‘autonomy and pleasure and lack of coercion and lack of violence and a positive contribution to one’s overall well-being,’’ tend to thread across most definitions, offering useful guideposts for clinicians and researchers alike.[2,3] the assertionIMPROVING PATIENT–CLINICIAN SEXUAL COMMUNICATION that sexual health is a vital sign for overall health is a foundational principle guiding the issues raised in this article
Social stigma around female sexuality remains in Western culture and as a result, women often avoid and/or are embarrassed to discuss their sexual health with their health care professionals (HCPs)
In the REal Women’s VIews of Treatment Options for Menopausal Vaginal ChangEs (REVIVE) survey, 40% of women expected HCPs to initiate a conversation about their symptoms[26]; and in another recent survey, two-thirds of menopausal women agreed that HCPs should inquire regularly about sexual health.[27]
Summary
The concept of sexual health has evolved significantly since the definition offered by the World Health Organization in 1975.1 different definitions of the term continue to exist today, the general principles of ‘‘autonomy and pleasure and lack of coercion and lack of violence and a positive contribution to one’s overall well-being,’’ tend to thread across most definitions, offering useful guideposts for clinicians and researchers alike.[2,3] the assertion. The International Urogynecological Association (IUGA) and International Continence Society (ICS) stress that sexual concerns should be addressed routinely and in a recent report suggested an educational process similar to the above to be used in women with pelvic floor dysfunction, given that most pelvic floor dysfunctions are believed to negatively affect sexual health.[53] The ACOG Committee Opinion on sexual health, meant to increase awareness of the importance of addressing women’s sexual health in routine practice, provides a listing of questions to be utilized during sexual history taking.[54] We advocate that all HCPs of any specialty should be able to initially address sexual health issues, or if not comfortable doing so, have a streamlined, care-path referral in place as part of their routine practice. Increasing HCPs’ familiarity with appropriate International Classification of Diseases (ICD) codes for FSDs (Table 3) will help address the barrier to care caused by HCPs avoidance of assessing sexual concerns because of lack of awareness that there are corresponding billing codes they can use for ensuring insurance coverage and payment of visits and treatments for patients with sexual health-related concerns. When patients are empowered this way, they may feel more competent to manage their own health and may be more likely to follow through with treatment.[55]
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