Women's Sexual Health - A Topic Worth Discussing

Whether we talk about it openly or just with our significant other, sexual health is an important part of quality of life and happiness in relationships for many of us. Sadly, sexual health problems are common, with more than 40% of women experiencing issues at some point during their life. Anxiety, fear and shame often keep women from seeking help, and unfortunately, due to personal bias and cultural taboos, many healthcare professionals have been unwilling or unable to assist their patients. In fact, it wasn’t until July 2017 that The American College of Obstetricians and Gynecologists, an organization of which I am a member, formally addressed the issue. Better late than never, I guess.

But as a physician who has worked in this very specialized area of medicine for nearly 15 years, I know that this is a topic that deserves attention. Women’s sexual health is as important an issue to most women, and often their partners, as any other component of health, because it’s so much bigger than what happens in the bedroom.

OK, so now that we are talking about it? What exactly is sexual health? Dr. Ruth was talking about “good sex” 30 years ago, and “good sex” is an important part of sexual health but not the only part. Sexual health, which extends into a woman’s overall reproductive health, can be affected by culture, biology, anatomy, education, relationships and many other factors. Perhaps it’s best to look at some the various factors that can affect or prevent sexual health. With patients in my office, we divide this to three key components: Pain, Parts and Performance.

Pain. Aches and pains in any part of the body can limit one’s ability to live life to the fullest, and this is especially true for women who experience pain in the pelvis, as this area is extremely sensitive but also provides stabilization for many bodily functions and movements. Endometriosis or fibroids can be the source of pain. The female organs share space with bowel and bladder, which on their own can cause pain. Discomfort or outright pain can come from problems with skin of the vulva such as Lichen Sclerosus, Lichen Planus, and changes to the vulva and vagina from menopause or infection. There are many factors that contribute to pain and finding the right medical partner to help identify and correct issues is critical for getting back to normal function.

Parts. We know what the parts are but changes due to birth trauma or other trauma, like sports injuries, can cause abnormal appearance, sensation and pain. The evil effects of gravity, childbirth and time can cause a loss of support of the pelvic tissues resulting in prolapse. Sometimes the parts are completely normal; however, you may want to improve tone and appearance. We electively alter ourselves to be more confident with our bodies all the time, be it as simple as makeup and hair color, why not extend that option to other parts of the body?

Performance. Sometimes everything seems to be in working order, but, well, things just don’t work. Low libido, no libido, orgasmic dysfunction fear of unwanted pregnancy and fear of STD’s all fall in this bucket. Understanding one’s lack of desire and addressing the underlying cause is important to regaining sex drive.

The good news is there is help. Disorders of the vulva and vagina can be properly evaluated, diagnosed and treated to decrease or eliminate pain. Pelvic organ prolapse and urinary incontinence can be treated with medication, physical therapy and surgery. The changes associated with menopause respond well to medications and new laser treatments. Elective cosmetic surgical procedures can help with issues of self-image or changes from childbirth. Other surgical procedures can repair abnormal anatomy caused by childbirth or other trauma. Functional problems such as low libido and orgasmic disorders can respond to medication, behavioral therapy and sex therapy.

In the appropriate situation, with consenting adults, when desired, sex should be good. When it is not, there are options. Talk to your healthcare provider or look for a center for sexual health.

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Eric Feinberg, MD is a Board Certified Obstetrician and Gynecologist with more than 20 years experience in gynecology and pelvic surgery. For nearly 15 years, Dr. Feinberg has been in practice with Gaston Womens Healthcare. His true passion lies in gynecologic surgery, specifically Urogynecologic and pelvic reconstructive surgery.