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Sexual Wellness: What Doctors Need to Know

By James H. Morgan, DO

MorganYou may have experienced the following scenario: You’re wrapping up an examination or consultation with a female patient. At the very end, she mentions she has one more question. She begins to tell you how she has lost the desire for sexual intimacy with her partner. She may describe trouble with arousal, lubrication, orgasm or pain with intercourse.

If you’re like many physicians, including gynecologists, she has just asked you about a subject you may feel ill-prepared to address. Now what?

A Taboo Topic for Patients

Women rarely discuss intimacy or sexuality with each other or their physicians. Still, 44 percent of women will experience some form of interruption to their sexual health at some point, according to a 2008 study published in Obstetrics and Gynecology, and it can have a significant impact on their relationships. This interruption may be the result of one or many factors, including:

  • Medication 
  • A medical condition or surgery 
  • A birth or other life event 
  • Menopause 
  • Depression 
  • Fatigue

Unfortunately, there is a misperception that these problems are imagined. Some believe they are an inevitable product of aging or just an excuse for women to avoid sexual activity. However, they are very real.

Several studies have shown that unless specifically asked about their sexual health, women are reluctant to talk to their physicians about sexual issues. The studies have concluded that the patient is afraid she will embarrass the physician and place him or her in an uncomfortable or awkward position.

Diagnosing and Treating Sexual Problems

Sexual health problems can be complicated, confusing and difficult to assess and discuss. Occasionally, patients will have multiple issues contributing to the overall problem, which can make diagnosis more difficult. Fortunately, there is a good chance that your patient's problem is fairly common and an equally good chance that it can be treated or alleviated.

Treatment plans may include:

  • Testosterone, progesterone and bioidentical estrogen 
  • Consultative services of a vaginal/pelvic floor physical therapist, certified sex therapist and/or a cognitive behavior therapist

Occasionally, these modalities may not be enough and minimally invasive surgery may be necessary.

Increasingly, courses are being developed to prepare health care providers to screen all patients for sexual issues and to provide care or make a referral to someone trained to manage these issues. Until these courses are widely available and you are comfortable with managing these problems, or have the time available, referral to a sexual medicine practitioner is recommended.

About the Study of Sexual Wellness

To become an expert in sexual wellness, Dr. Morgan identified leaders in this relatively new discipline and studied one-to-one with these leaders through preceptorships. Dr. Morgan chose to add the specialty of sexual wellness to his practice at Meritas Health Pavilion for Women (formerly Heartland Women’s Health Care). His practice gives patients an easily accessible option where they can discuss their sexual concerns with a provider who is trained and comfortable broaching issues of a sexual nature.

What Patients Can Expect

Your patient’s first visit may last 45 to 60 minutes. She will undergo a thorough history and physical exam and may also require additional blood work or testing. A treatment plan is not usually determined at the first visit, so a follow-up appointment is often scheduled to allow time to review test results.

James H. Morgan, DO

Dr. Morgan is a graduate of the University of Health Sciences College of Osteopathic Medicine, where he also completed his residency. Dr. Morgan is board certified in Obstetrics and Gynecology and is a Fellow in the American College of Osteopathic Obstetricians and Gynecologists. He is a member of the International Society for the Study of Women's Sexual Health; the Sexual Medicine Society of North America; the American Association of Sexuality Educators, Counselors and Therapists; and the North American Menopause Society.

To learn more, call 816-452-3300.