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The Awkward – But Important – Questions You Should Be Asking Your Female Patients

By the Alliance for Advancing Women’s Health

When is the last time you asked a patient about her sex life? Not simply if she were sexually active or trying to get pregnant, but whether she is satisfied with her sex life or has concerns about her sexual functioning. If the answer is, “I don’t remember,” you may be missing important insight into your patients’ health as well as an opportunity to improve her overall quality of life and well-being.

In fact, the authors of a recent paper published in the Journal of Women’s Health propose that sexual health, by which they mean healthy sexual functioning, should be considered a vital sign for overall health. Despite its centrality to a woman’s well-being, the authors assert, sexual health is too often overlooked by healthcare providers.

Surveys of both women and healthcare providers confirm this: in one survey of women, 73% of respondents said their primary care providers asked about sexual health only a few times or almost never,[i] and a survey of OB/GYNs found that only 40% routinely asked about sexual concerns and only 29% asked about sexual satisfaction.[ii] Even though healthcare providers  have reported feeling a responsibility to discuss sexual health with their patients,[iii] many healthcare providers may not feel they have the time or resources to address such a sensitive subject with their patients.

Another key issue the authors raise is most healthcare providers receive limited formal training on sexual health. Despite the growth in sexual medicine over the past few decades, training lags behind the science and clinical knowledge in the field. In fact, time devoted to teaching sexual health and function in medical schools has decreased.[iv] Additionally, sexual medicine objectives are included in only a few residency programs, and those that do include them define them broadly.[v]

Limited training means healthcare providers are less aware of the guidelines and tools available to help them screen patients for common sexual health conditions like hypoactive sexual desire disorder (HSDD), the most common female sexual dysfunction. Healthcare providers may also be unaware of educational resources for patients and/or feel they don’t have any therapeutic options to treat sexual health conditions, making them less likely to raise the topic with patients. After all, if you don’t have any solutions to offer, why raise the question?

The paper’s authors acknowledge there are numerous, complex barriers to improving women’s sexual health, but propose that a necessary first step is to foster more open and informed conversations about sexual health between women and their health care providers. They recommend healthcare provider training should combine basic information about female sexual health with best practices for counseling patients on sexual health. For example, these best practices include:

  • Legitimizing the importance of assessing sexual function and normalizing the discussion by including questions about sexual health as part of the routine medical history. For example, the American College of Obstetricians and Gynecologists (ACOG) suggests using the Brief Sexual Symptom Checklist for Women, which asks whether women are satisfied with their sexual function and if not, what problem is most bothersome, how long it has lasted, and if they would like to discuss it with their healthcare provider.
  • Using open-ended questions during conversations about sexual concerns rather than yes/no questions, which may hinder a woman from elaborating about her concerns or accurately describing her symptoms
  • Beginning conversations on sexual health without any assumptions about sexual activity, sexual orientation, relationship status or any other topics that could make the patient feel judged
  • Using plain language, props and/or illustrative aids, and describing sexual anatomy and physiology in simple terms
  • Providing credible and accurate educational information and resources to women

The ultimate goal, as the authors describe it, is for healthcare providers to have the competency and confidence “to initiate a direct and concise conversation about sexual health in a space that ensures privacy and comfort.” Healthcare providers’ ability and willingness to do so is a critical first step to achieving better sexual health outcomes for women. For more information on how to have these conversations and for additional resources please visit the the Alliance for Advancing Women’s Health (AAWH), a new collaborative initiative that’s working to improve clinical interaction by elevating awareness and advancing healthcare provider education and training.

[i] Fairchild PS, Haefner JK, Berger MB. Talk about sex: Sexual history-taking preferences among urogynecology patients and general gynecology controls. Female Pelvic Med Reconstr Surg 2016;22:297–302.[ii] Sobecki JN, Curlin FA, Rasinski KA, Lindau ST. What we don’t talk about when we don’t talk about sex: Results of a national survey of U.S. obstetrician/gynecologists. J Sex Med 2012;9:1285–1294.

[iii] Hoekstra T, Lesman-Leegte I, Couperus MF, Sanderman R, Jaarsma T. What keeps nurses from the sexual counseling of patients with heart failure? Heart Lung 2012;41:492–499.

[iv] Shindel AW, Baazeem A, Eardley I, Coleman E. Sexual health in undergraduate medical education: Existing and future needs and platforms. J Sex Med2016;13:1013–1026.

[v] Andrews WC. Approaches to taking a sexual history. J Womens Health Gend Based Med 2000;9 Suppl 1:S21–S24.

AMWA Admin

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