Gynecologists and other doctors are not talking enough with their female patients about sexual problems and sexuality in general, leaving many women to suffer in silence, a new study concludes. Based on a survey of obstetrician-gynecologists across the United States, the researchers found that less than half of them routinely ask their female patients about sexual problems. At the same time, the researchers noted from past studies that about a third of young and middle-age women have some sort of issue related to sexual intercourse, such as pain, low desire or lack of pleasure.
Such sexual dysfunction not only can lead to worry, shame, guilt and feelings of isolation for a woman, but can put a real strain on relationships, the researchers said.
"Patients are often reluctant to bring up sexual difficulties because of fear the physician will be embarrassed or will dismiss their concerns," lead study author Dr. Stacy Tessler Lindau said in a statement. "Doctors should be taking the lead."
Let's talk about sex
Lindau, an associate professor of obstetrics and gynecology at the University of Chicago Medicine, and her colleagues gauged sex talk in the doctor's office by surveying more than 1,150 practicing U.S. physicians who listed OB-GYN as their primary specialty. They answered questionnaires by mail between October 2008 and January 2009. The doctors were asked to indicate how often (routinely, sometimes, rarely or never) they discussed the following with their patients: sexual orientation; sexual satisfaction; pleasure with sexual activity; and sexual problems or dysfunction.
Sixty-three percent indicated they routinely assessed patients' sexual activities. However, only 40 percent said they routinely asked about sexual problems. Fewer still asked about sexual satisfaction (28.5 percent), sexual orientation or sexual identity (27.7 percent), and sexual pleasure (13.8 percent). [10 Surprising Sex Statistics]
About 25 percent of the doctors said they have expressed disapproval of patients' sexual practices; these were primarily doctors who were foreign medical graduates or ones who considered religion the most important part of their lives, the researcher said. Those who indicated a Roman Catholic religious affiliation were significantly less likely than others in the survey to ask patients about sexual activity.
Doctors who see more patients for gynecological purposes than for prenatal care tended to screen more frequently for sexual problems than their colleagues did, according to the survey.
Talks about sexual orientation were also lacking, with less than one-third of those surveyed doing so. Older doctors (in their 60s or older) were the least likely to delve into a patient's sexual orientation or sexual identity.
"OB-GYNs, because of the depth and specialization of expertise and training in female genital tract and reproductive health across the life course, are well positioned among physicians to address sexuality issues with female patients," the researchers wrote today (March 22) in the Journal of Sexual Medicine.
So why don't they?
"One explanation for the findings may be a deficit in physician training about diagnosis and treatment of female sexual problems," said study researcher Janelle Sobecki, a second-year medical student at Wayne State University. "Like patients, physicians may worry that raising the topic could offend or embarrass the patient."
But sex talk may be just what a female patient needs. Past research has suggested general adult sexual education is lacking. "Most adults just don't have the basic education about their bodies, the bodies of their sexual partners, relationships, sexual behaviors," Michael Reece, a professor of health at Indiana University, told LiveScience in 2011. "We really have this deficit, I would say, across the country."
The take-home? "If you have a doctor you trust who has not brought this topic up, give it a try," Lindau said. "If you are waiting for the doctor to start the conversation, it may never happen. Communication is key."