Women who have had success with treatment for sexual health problems have spoken about the inner resolve they needed to seek professional help. None of us found it easy to take this step. Each of us felt very much alone, although this was not the case. As many as 43% of American women have experienced sexual difficulties, according to a survey published in the 1999 Journal of the American Medical Association.
Although women's sexuality and health has been studied for many decades, the scientific study of women's sexual health in the field called sexual medicine is only about 5 years old. Since medical schools are just beginning to consider including sexual medicine in their coursework, your physician may or may not be aware of the latest research or even how to effectively evaluate your sexual health difficulty.
Women can increase the chances of getting the best possible care by being aware of their own sexual health and available treatment options. It is for this reason that we have come up with the following recommendations, based on the shared experiences of many women.
Step One: Find an understanding and knowledgeable healthcare provider
Some women prefer female doctors or nurse practitioners, but the important issue is finding a provider who has the expertise to help you.
While your primary care physician or gynecologist may be able to treat some sexual health problems, your provider may refer you to a sexual medicine specialist or to a sex therapist certified by the American Association of Sex Educators, Counselors, and Therapists (AASECT). You may ask for a referral or get a recommendation for a specialist from another woman who is being treated for a similar condition. You may find a provider in your area who is a member of a professional society affiliated with sexual health (International Society for the Study of Women's Sexual Health at www.ISSWSH.org, or AASECT at www.aasect.org )
Step Two: Prior to the first office visit
While a conversation between a woman and her provider is a good place to start, there are advantages to preparing for this by getting as much information as possible about the new and current options for treatment that are related to your concerns. You can do this by:
- Talking with trusted friends
- Looking in the women's health section at your local bookstore
- Reading credible magazine articles about women with similar symptoms
- Searching the Internet for legitimate information sites
- Checking information in medical journals by doing a PubMed™ search (directions at www.TWSHF.org).
Although an annual exam should involve a discussion about your sexual health, there may not be sufficient time to fully address your concerns. In this case, you may want to schedule a specific appointment. Writing down the details of your sexual difficulty will give you a clearer picture and prepare you to give concise answers to the questions you will be asked, such as when your difficulties first occurred or whether this is a recent or a long-standing problem. Also, was there a particular event associated with this difficulty, such as the start of a medication, childbirth, a physical injury, pelvic surgery, or emotional stress?
Looking at the brochure, "Are You a Woman Experiencing Female Sexual Difficulties?" (at www.TWSHF.org) may help you find the words and definitions needed to explain your situation to your provider. You can also find a diagram showing female anatomy at www.TWSHF.org under "Resources" that you can print out and take with you to your visit.
Also, if you have informed your partner of your sexual difficulties, let him/her know that you are requesting help. In some cases the treatment may involve your partner, and hopefully, he or she will be a part of your support team.
Not having a partner does not mean that your sexual concerns should not be addressed. Sexual health problems may occur whether or not a person is in a relationship. Although going through treatment may be more difficult without a partner, many women do not let that stop them. Create a support network with a close friend, family member, or psychotherapist.
Step Three: You have the name of a provider you are considering seeing
Call the office to request written information about the first visit, or ask the office nurse about the procedures that will be involved and how long the office visit will last.
Step Four: The office visit
Remember to bring your written notes, including any questions, and a list of any medications you are taking, both prescription and over-thecounter. You may also want to write down instructions given to you by your provider.
Most women agree it is tough to talk about sexual difficulties. A provider's response can make the initial conversation easier or more difficult. One suggestion we like is to bring along an article about your problem or reference an educational brochure on this topic from www.TWSHF.org; this may be a way to start the conversation.
Some providers may refer a patient to a psychologist or medical doctor for an evaluation. Centers that treat sexual health problems generally have patients undergo a psychological as well as a physical assessment during the first visit, since a multi-disciplinary approach to sexual health difficulties is preferred.
Step Five: Treatment plan
After your assessment, your provider will put together a treatment plan for you. Consider asking the following:
- If a medication is being prescribed, ask why, what are the side effects, and how long until it takes effect? If this medication does not work, are there others that might be recommended?
- If talk therapy is recommended, ask how many sessions may be needed.
- If a procedure/surgery is being recommended, ask why, and what are the risks and benefits? Are there alternatives? How long will it take to see results? What is the success rate? Ask if you may speak with several patients who have had this procedure or surgery done at least a year ago. A second opinion is recommended from a physician in another city or one who is not connected in any way to your physician.
Step Six: After your visit
If the treatment or medication is not having the result you expected, then contact your provider. Quick fixes are not the standard for many sexual health problems. Sometimes women have found that their plan of care needed to be adjusted. Be patient and work closely with your provider.
If you have been referred for treatment, your gynecologist or primary care physician should be kept informed of your progress; you may want to check periodically to see that this is happening.
Keep a diary of your progress and review it before return visits to refresh your memory on the progress that is being made or concerns you may be having.
If you feel that your provider is not taking your concerns seriously or you sense that he/she does not have the expertise needed to help you, ask for a referral to a provider who specializes in female sexual health. Help is available.
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