Monday, August 31, 2015

Identifying female patients' sexual health concerns

- Jennifer Middleton, MD, MPH

Talking with patients about sex can be uncomfortable for physicians, yet many of our patients have concerns about their sexual functioning. "Sexual Dysfunction in Women: A Practical Approach" in the current issue of AFP provides pragmatic advice to enable family physicians to assist these women.

The authors differentiate between sexual health concerns and dysfunction, discuss three categories of sexual dysfunction, and describe treatment options. They suggest using the PLISSIT (Permission, Limited Information, Specific Suggestions, Intensive Therapy) model when discussing sexual health with women and give examples of supportive, normalizing statements to use with patients (Table 5).

All of this excellent advice is of little use, though, if female patients' concerns are not voiced. Few women will initiate a discussion about sexual concerns with a physician, and many women will not seek care at all for sexual concerns due to embarrassment. Also, the greater the age difference between female patient and clinician, the less likely female patients will bring up sexual health issues. Most women will not ask questions about sex to physicians.

Physicians, then, need to directly solicit concerns. Most women, regardless of age, are willing to answer questions about their sexual functioning, and many would like for their physicians to ask them questions about this area of their health. A multi-specialty survey of physicians, however, found that few physicians initiate conversations about sexual health. We must overcome our reticence to discuss sex with our female patients; the questions in Table 3 of the AFP article referenced above provide a starting point for these conversations. Automated patient history software is another potential solution; in one study, patients were more comfortable disclosing sexual health concerns when giving their history on an electronic tablet compared to verbally giving their history to a physician.

Regardless of how we do so, inquiring about sexual functioning is important for women of all ages. A study in the current issue of Annals of Family Medicine examines the factors associated with sexual activity and satisfaction in older women; those authors found that the majority of partnered women remain sexually active throughout the life span. As a healthy sex life correlates highly with quality of life measures, especially as people age, family physicians need to be willing to discuss sexual issues with their patients.