Woman survives earthquakes, epidemics, the horrors of disease, and all the agonies of the soul, but for all time (her) his most tormenting tragedy has been, is, and will be the tragedy of the bedroom.” –Kenneth Reamy (1984)
Thanks to a host of new medications and the increased number of patients seeking professional help for their problems, Sexual Dysfunction has become again the hot topic. And not just with you and I. Changes in cultural attitudes and demographics show the commonness of sexual concerns in all ethnic groups across all ages. These changes open the door for solutions, and that door often leads to the family practitioner or other health care providers. So my question is: Are healthcare providers ready, willing and able to deal with these new developments in their patients?
On Being Able
Health professionals are commonly seen by the public as experts in human sexuality and are often the first stop for a patient with sexual function complaints. So it’s no surprise that many of us would consider sexuality training for health professionals imperative. However, the extent to which health professionals currently receive exposure to training in human sexuality remains a bit ambiguous. According to Bouman and Arcelus in the International Journal of Geriatric Psychiatry, (2000) many training programs fail to teach a broad range of human sexuality issues and that expert supervision and clinical training opportunities are lacking. Medical school is the place where physicians become aware of the needs of patients, yet training around a large aspect of what it means to be a human being sex and sexuality is conspicuously lacking. D. Schnarch in the Journal of Sex and Marital Therapy, (1981) maintains that it is naive to assume that increased sexual knowledge, personal liberal attitudes, and permissiveness toward others will reduce physicians’ anxiety in talking about sex with their patients. Many persons who are sexually knowledgeable and uninhibited in their sexual techniques are surprisingly inhibited and anxiety-ridden about discussing their feelings, preferences, and concerns with their intimate partners which makes it even less likely that the subject will be discussed with a physician. Even people who can discuss sex with their partners may not be equipped to discuss a patient’s sexuality in a frank, forthright and professional manner. According to Schnarch, the ultimate goal of sex education in medical schools has been to increase the delivery of sexual health care and information from physicians to patients. He writes that medical education (and society at large) rarely provides role-models and demonstrations of how professional discussions about sexuality are conducted. Even rarer are sex education courses in which students practice talking with patients about sexuality and in which this ability is assessed as a desired course outcome. Curricula relating to human sexuality have focused primarily on issues related to homosexuality.
advertisement Clearly the more receptive and willing a doctor is, the better they can effectively talk about sexual topics. And there are many reasons why a medical professional may not willingly deal with a patient’s sexual concerns. In an older population of patients, physicians may subscribe to larger social norms, which devalue sexuality among the aged, viewing them as asexual or not capable of sustaining a sexual relationship. According to a study conducted by Bouman & Arcelus (2000), psychiatrists were less likely to take a sexual history in their elderly male patients, claiming that it to be inappropriate and not indicated as compared to middle-aged men. In addition, the physician may experience anxiety when confronting his or her own unresolved sexual issues or conflicts in the face of the patientâs complaints. Physicians may be particularly sensitive to community standards and to what is acceptable for them to discuss with their patients without offending the patient or, indeed, risk the loss of the patient to another doctor (Houge, D., 1988). Kenneth Reamy (1984), in his discussion of sexual counseling for the “non-therapist,” writes that to be an effective counselor, a physician must have a sense of his or her own sexual self-awareness and sexual comfort in addition to knowledge, sexual physiology, psychology, sociocultural norms, and the effects of drugs, illness, pregnancy, and aging. A recent issue of the magazine Sex Over 40 published the results of a telephone survey of 500 Americans over age 25 that revealed both men and women fear discussing sexual problems with their doctors because of concerns that physicians would be embarrassed with the topic. This study conducted for the Partnership for Women’s Health at Columbia University in New York found that 68 percent of those polled worry that their physicians would be uncomfortable discussing sexual issues, with 75 percent of women expressing such concerns compared to 61 percent of men.
We’ve Only Just Begun
The field of medicine is only just beginning to address female sexual function complaints and obtaining an adequate scientific knowledge base in order to effectively deal with these problems. Certainly, this lack of understanding and knowledge may contribute to many doctors’ lack of willingness to deal with the sexual issues. Go home and have a glass of wine or This is just what you have to expect about getting older (having children, getting married, etc.) are common responses women typically report that they have received when they do try to bring up their sexual function complaints. Women expect leadership from physicians in raising the issue of sexual health, and they look for empathy, warmth, confidentiality, and professional competence in discussions with their doctor about sexual matters. Women want more frequent and more routine physician inquiry about sexual concerns, and they want a more open, clear, comfortable, and empathic discussion of these issues (Hogue, D., 1988, Metz, 1988). Although the physicians are aware that sexual problems exist in many of their patients, most prefer to ask only when there appears to be a “psycho-social” problem. This may be a reasonable approach, in part, given the many areas of concern the doctor needs to explore. Therefore, it is critical that physicians recognize the signs of “psycho-social” problems in sexual areas. What signs, for example, does the incest victim present in the clinic? How does a woman in conflict describe her relationship? Physicians must be taught to recognize psychosocial red flags so that they can pursue psychotherapy referrals when indicated. However, it is just as crucial that doctors consider our ever-growing understanding of the physiological parameters of sexual function and dysfunction as well. It is clear that sexual function complaints affect the quality of life and general wellness of millions of women. However, while the research presented above outlines what is presently known about medical school sex education and the treatment of sexual concerns in a medical setting, little of this research was particularly focused on the female patient, and little or no research addressed the patientâs experience of seeking help for her sexual concerns with her physician.
Certainly there is a lack of research on the subject of the female patients experience seeking help from the physician or any medical professional. It is crucial that further research is carried out in this area, as well as more timely evaluations of what is actually going on in medical schools and post-doctoral professional training around sexual topics. More than ever, with potential treatments available, women are going to come forward seeking help and will hopefully feel more and more entitled to full sexual lives. As the common first stop for these complaints, it is crucial that medical professionals be aware of the psychosocial aspects of sexual function complaints and make appropriate referrals. They must also educate themselves about the medical etiologies and potential treatments available for women with sexual function complaints. Women want and need to address their sexuality as a basic part of their general health and wellness. The generation of women who participated in the sexual revolution and womenâs movement, advocating for Our Bodies Ourselves, are now advocating for their right to sexual satisfaction as a basic part of who they are alone and in relation to others. The inflow of patients with sexual function complaints will only increase and it is time physicians come on board and address sexual health just as they would any other aspect of womens health. It is time physicians start to acknowledge womens sexuality with the same importance their patients do. This will mean further training; further self exploration including values clarification and a great deal of effort and practice. (February, 2008) To discuss this article, or to ask Dr. Berman questions about it, go to Dr. Bermans Bulletin Board at http://www.hisandherhealth.com/ubb/ultimatebb.php?/forum/1.html REFERENCESBouman, W.P., Arcelus, J. (2000). Are psychiatrists guilty of ageism when it comes to taking a sexual history? International Journal of Geriatric Psychiatry, 16, 27-31. Houge, D (1988). Sex problems in family practice. Family Practice Research Journal. 4(3), 135-140. Laumann, E., Paik, A., Rosen, R. (1999). Sexual dysfunction in the United States. JAMA, 281, 537-544. Lief, H. (1964). Sexual attitudes and behavior of medical students: Implications for medical practice, in EM Nash, L. Jessner, DW Abse (Eds), Marriage counseling in Medical Practice. Chapel Hill, University of North Carolina Press:NC, pp. 301-318. Nease, D., & Liese, B. (1987). Perceptions and treatment of sexual problems. Family Medicine, Nov., 468-470. Nusbaum, M., Gamble, G., Skinner, B., Heiman, J. (2000). The High Prevalence of Sexual concerns among women seeking routine gynecological care. Journal of Family Practice, 49(3), 229-232. Reamy, K. (1984). Sexual counseling for the non-therapist. Clinical Obstetrics and Gynecology, 27(3), 281, 781-788. Schnarch, D. (1981). Impact of sex education on medical students projections of patient attitudes. Journal of Sex and Marital Therapy, Summer, 141-154. Verhulst, J. (1992). The sexuality curriculum in residency training. Academic Psychiatry, 16, 115-117. Weerakoon, P., & Stiernborg, M. (1996). Sexuality education for health care professionals: A critical review of the literature. Annual Review of Sex Research, 7:181-217.