Sexual Dysfunction: A Need For Difficult Discussions

By Misti Crane
The Columbus Dispatch, Ohio.

You might think that once you’ve been in the stirrups in your gynecologist’s office, anything would go conversation-wise.

But many women don’t bring up their sexual troubles, experts say. And not all doctors are stellar at starting the conversation.

Another problem is that there’s no little blue pill that promises everything will be better for women in the bedroom.

Meanwhile, they go without help for all kinds of sexual problems, from diminished libidos to painful sex.

Sexual problems are common and can arise and change throughout a woman’s life, said Dr. Margery Gass, an OB-GYN and consultant at the Cleveland Clinic Center for Specialized Women’s Health.

Aging, hormonal changes, stress, relationship trouble, illness (including depression and gynecologic and breast cancers) and a history of negative sexual experiences all can contribute.

Sexual problems in reproductive years can be linked to contraception, childbirth and breast-feeding, the last of which drops estrogen levels. Menopause also brings a precipitous decrease in estrogen, which can lead to vaginal dryness and uncomfortable sex, said Gass, executive director of the North American Menopause Society.

Research has shown that as many as 43 percent of women will experience some sort of sexual problem at some point in their lives, and that most think they’ll embarrass their doctor if they bring it up, said Dr. Brett Worly, an OB-GYN who focuses on sexual health at Ohio State University’s Wexner Medical Center.

“This is something that’s really common, and it’s really difficult to talk about,” said Worly, who recently lectured on the topic.

Sexual-health problems are complex, though. They can arise from physical problems, but also often are deeply linked to psychological obstacles and the health of relationships.

“It’s really complicated, and it’s variable for each individual,” Worly said.

On top of that, what constitutes a healthy sex life is not some static, easily definable thing. It’s different for each woman.

There is help out there, though, and finding it usually starts with one of those conversations that aren’t happening often enough. The American College of Obstetricians and Gynecologists offers these sample starters for a talk between a woman and her doctor:

–“I am having some concerns about my sex life.”

–“I do not enjoy sex like I used to.”

–“I am feeling sad lately; my partner is complaining I never want sex.”

–“Lately, I have been having trouble with intimacy. What can I do?”

–“I am just not interested in sex. Do you have any advice?”

–“Getting older has affected my love life. Is there a fix?”

A gynecologist or primary-care doctor might be well-equipped to help, or might refer patients to a sexual-health specialist or counselor, depending on their needs, Gass said.

Decreased libido often is linked to relationship difficulties, including unexpressed sexual preferences and unbalanced levels of desire for sex between partners. Counseling for both partners sometimes can help, Gass said.

Although no product is approved by the Food and Drug Administration for sexual dysfunction, per se, there are products that can help with vaginal dryness. And creams, vaginal tablets and rings that contain estrogen can help during menopause, she said.

There’s been a general move away from long-term systemic hormone replacement because it carries an increased risk of cancer and cardiovascular disease.

When women discuss sexual problems with their doctors, they also should consider whether medications, such as antidepressants, might be interfering, Worly said. If that’s a possibility, there could be alternatives that would improve matters.

Worly said women often can find help with sexual complaints if they rethink their expectations of how sex unfolds. It’s not as simple as desire plus arousal plus orgasm equals fulfillment for women, he said. “Different women are different.”

Carol Ellison, an author, psychologist and sexual-health expert in California, said that when she works with women and their partners, she often challenges them to rethink their definitions of successful sex.

“It’s creating mutual erotic pleasure in whatever form it takes to the end that you feel good about yourself, your partner and have a good time,” Ellison said.

“The problems really stem for men and women in the idea that they have to function in a certain way. Men are paying more attention to their erections than they are to their partner and her pleasure, and women are (saying) … ‘This is taking so long.’??”

In therapy, Ellison talks about sexual choreography and intentionally setting a mood that leads to a pleasurable experience.

“Playing music, sharing a meal, sharing an alcoholic beverage, being in a hot tub together, going for a walk together, dancing together … there are paths to creating mutual pleasure a step at a time. Sometimes it takes a while,” Ellison said. “You can allow orgasm, but you can’t sort of try. It’s like sneezing or yawning or that sort of thing. It’s more allowing the process to occur and getting out of the way of it.”

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