While researching the female sexual response cycle for my previous blog article, I came across a unique study on patient and provider statistics regarding female sexual health issues. Some of the results were very shocking to me, so much so, I felt that this entire article should be devoted to discussing the survey and the important message of self-empowerment and education that all women should glean from it.

    Of the 20% of survey respondents who saw a doctor, many were met with some challenges regarding their care, evidenced by the responses in the provider portion of the survey. Only 37% of doctors reported they are very or extremely comfortable discussing the topic of sexual health issues, including sexual desire and dysfunction, with their female patients.  When asked how knowledgeable they were about varying types of female sexual dysfunctions, the providers’ responses were concerning.  The percentage that answered not at all knowledgeable or not very knowledgeable for each disorder is as follows:

• Dyspareunia (difficult or painful sexual intercourse) - 14%
• Vaginismus (painful contractions of the vagina) - 30%
• Orgasmic Disorder - 38%
• Hypoactive Sexual Desire Disorder - 41%
• Sexual Arousal Disorder - 44%
• Sexual Aversion Disorder - 59%

    In my opinion, these are shockingly high numbers!  Did you know less than one-fifth (16%) of health care providers are even aware of Rosemary Basson’s model of female sexual response and over one-quarter are not aware of any of the female sexual response models,  even the outdated linear model from the 1960’s? I’m not surprised so many of us don't feel confident approaching our health care providers with questions about our sexual health. What I find most troubling is that when providers were asked what type of impact they feel sexual dysfunction has on their female patients in areas of sex life, relationship with romantic partner, self esteem, emotional/mental health and physical health nearly 20% felt that it had a positive to very positive impact in these areas…Seriously??? Doctors responded that they believe female sexual dysfunction has a POSITIVE impact on their patients. Really? My friends and I found that harder to swallow than the over-cooked chicken on our salads at lunch. :)

    Delving further into the providers portion of the survey I discovered even more concerning responses.   Only 4 out of 10 providers felt confident or extremely confident in their ability to diagnose female sexual dysfunction in their patients and over one-half of the doctors reported they are not very to not at all confident in their ability to provide appropriate care to female patients experiencing symptoms of FSD. The most common medications and treatments for female sexual dysfunction (FSD) prescribed by the surveyed providers are:

• lubricants - 75%
• antidepressants - 73%
• other hormonal treatments - 46%
• testosterone - 36%
• herbal remedies - 19%
• OTC medications - 15%
• Viagra - 6%

     Not only do I find it troubling that lube is the “go-to” treatment, I also found this information to be very confusing. The prescribed treatment for FSD 73% of the time are anti-depressants, yet in the very same survey, 58% of providers reported that SSRIs and 40% reported tricyclic antidepressants as a contributing factor to female sexual dysfunction, more so than any other type of medication. I can’t help but wonder, why do nearly three-quarters of the doctors continue to prescribe such medications for treatment when many believe the very same medications contribute to FSD in the first place? You wouldn't treat a burn with a blow torch, would you?  As a matter of fact, the fourth most common side effect among all anti-depressants is reduced sexual desire or difficulty reaching orgasm!  Why do many providers continue to perpetuate a vicious cycle? Is this why only 29% of patients reported improvement after provider prescribed treatment?

Commonly prescribed antidepressants include:

Tricyclic:

•     Amitriptyline
•     Amoxapine
•     Desipramine (Norpramin)
•     Doxepin
•     Imipramine (Tofranil)
•     Nortriptyline (Pamelor)
•     Protriptyline (Vivactil)
•     Trimipramine (Surmontil)

SSRIs:

•     Citalopram (Celexa)
•     Escitalopram (Lexapro)
•     Fluoxetine (Prozac)
•     Paroxetine (Paxil, Pexeva)
•     Sertraline (Zoloft)

     I have a circle of friends, there are ten of us, and we meet for lunch every other month to catch up.  Instead of enjoying their company, I found myself frequently distracted from the conversation. I kept seeing percentages from this survey applied to our group. I wondered which seven have suffered from some form of female sexual dysfunction, six of them in the last year? Did I miss something during one of our lunches, I remember hearing about two instances? Which five think that they should be having sex a few times a week, and which three actually do? How about the three that think weekly is a healthy number, but only two really have sex that often?  Which two are good with once or twice a month, but who skips a month here and there? In a few minutes I got over the gossiping in my head and started to ponder some more serious numbers.

      When I applied the percentages to our group of ten (10), eight (8) of us at the table feel that our sexual health is either important or very important yet we all are having less sex than we feel, in our own minds, is healthy.  I then started to become concerned, thinking  “these are my friends and I care for all of them, why is it that, at best, only two of them have seen a doctor about their sexual health problems?”  How were they getting help for their problems? It was at that moment that I decided to speak up, and after explaining why I was distracted I started to get some honest answers from my friends. I found that their experiences and opinions were very close to the survey results. When confronted with sexual health issues seven (7) of them felt more stress, six (6) experienced depression, four (4) had sleep problems, three (3) experienced weight gain/loss, and two (2) of us had difficulty concentrating. All of these can seriously affect your overall health and wellbeing.

     My friends, like many survey respondents (over 1/3 or 35%) are turning to one another online for answers about, and insights into, the most sensitive issues regarding their sex life, how their bodies work and why they sometimes don’t. Of course, not everybody wants to share their most intimate details in forums for everyone to see but we are certainly grateful for those who do, there are thousands more readers than posts, most can empathize with the author and need the same questions answered. But, many times the information supplied is based on outdated research, misinformation, and even wives’ tales. Another  1/3 (32%) of women turn to their spouse or partner, but how do they know what the right answer is either?  So I had to ask, why no doctor visits?  Embarassment was the number one reason, followed by not enough time during the visit, as well as some of the negatives brought to light in the provider portion of the survey which I shared with my friends and will discuss next.

     Some of these statistics may be bad, but how did they get that way? Most doctors are familiar with and very confident treating a broken bone. Most likely because 99.9% of people with a broken bone go to a doctor and expect the treatment to work. However, with female sexual dysfunction, only 20% of suffering women seek treatment from a doctor (2 from our group of 10).

With the low demand placed on doctors for FSD treatment, continuing education and research inevitably suffer. Maybe it’s not so laughable that 20% of doctors think female sexual dysfunction positively affects women’s lives, how can they not when only one in five afflicted women seek treatment?  We, as women, aren’t using our voices to best communicate our symptoms, our needs, and our fears to health care providers. I know there is a certain level of embarrassment we must all overcome when speaking to our doctors face-to-face about intimate topics but you need not be ashamed. Only by demonstrating to our health care providers that our sexual health is important to us, will it become more important to them.

    THIS is exactly why we need to be more proactive when it comes to our sexual health!  Empower yourself with knowledge. Do research on your symptoms. Learn what doctors treat which conditions and takes notes. Compile a list of questions to ask your doctor and ask him or her to further explain their answers if you disagree. You don't have to accept a treatment recommendation with which you are not comfortable. If you don't feel you are being heard, get a second opinion...a third if needed!

    Second, spread the word. The next time you have five women around you, tell them that you know four of them are having sex less frequently than they themselves think is healthy, but only one has ever asked their doctor about it. Then share what you have learned from this article and help each one of those women to become empowered over their own sexual health and better the medical community.

Respectfully,

Lisa

P.S.     Since we feel that having real facts and asking good questions are the best steps you can take to become an empowered caretaker of your sexual health, any information provided on our site will always be based on substantiated scientific/historical research with sources. Knowledge is power.

For the complete survey results discussed in this article please go to:

Association of Reproductive Health Professionals - Women’s Sexual Health Survey

Details of the Survey:

HealthyWomen in partnership with the Association of Reproductive Health Professionals (ARHP), commissioned Harris Interactive to conduct an online survey to explore health care providers’ attitudes, behaviors, and perceptions regarding female sexuality and sexual dysfunction.  Additionally, the research was augmented with a previous study conducted among female consumers on the same topic. The specifics of each survey are listed below.

Provider Survey:

• 304 health care providers participated (200 physicians & 104 nurse practitioners/physician assistants/nurse midwives)
• Surveys were weighted to reflect the composition of the US population. Doctors by gender, years in practice, region, and specialty. NPs/PAs/NMs by education, gender, ethnicity, and income.
• Conducted online September 15-28, 2009. Survey length 15 minutes.

Consumer Survey:

• 1,200 women aged 18-50 who reside in the US participated.
• Surveys were weighted as need by age, race, education, income, and region to reflect the composition of the female US population aged 18-50.
• Conducted online March 4-13, 2009. Survey length 16 minutes.