Discussion of sexual issues

[Dr. Pacik]

Most of us are aware that doctors spend little to no time discussing sexual issues with patients. In the June issue of the J. of Sexual Medicine the following is noted: We conclude that among Swiss gynecologists, sexual problems are regarded as an important issue in gynecological outpatient care, but addressing patients’ sexuality is not yet part of routine practice. Swiss gynecologists seem to be most likely to consider hormonal changes (although not so much those due to oral contraceptives) to necessitate discussion of sexual health issues, while psychosocial transitions or stress seem to be considered less important. Kottmel A, Ruether-Wolf KV, and Bitzer J.

Do gynecologists talk about sexual dysfunction with their patients? I would be interested in what the others have to say about this. Additional interesting abstracts from articles relating to sexual dysfunction can be found on our VaginismusMD Facebook. Please join us on Facebook for these discussions. https://www.facebook.com/pages/VaginismusMD/174325825994423

[Heather34]

Hi Dr. P. This is a very important topic. Pre-procedure, I brought up my sexual issue of vaginismus with the one gynecologist I visited and it was a very negative experience. Now, going on 3 years post-procedure and vaginismus free, I have had varying experiences with gynecologists discussing sexual issues. Two of whom I visited did not bring it up and I did towards the end of our appointment and provided them with a handout about vaginismus and your treatment program and we discussed this. My current gynecologist is amazing and did discuss sexual health prior to me mentioning anything at all and asked more questions than the standard: “Are you sexually active”. I really liked that she took the lead and asked me many questions about this and it definitely opened the door for good dialogue and conversation about a sensitive topic.

[hereisnowhy]

When I first began to feel the symptoms of dyspareunia (that eventually led to vaginismus), I went to a gynecologist office and had a terrible experience. They were not helpful in the LEAST and just made me feel like a freak and they didn’t care whether or not I could have painfree intercourse. It wasn’t so much what they said, but what they DIDN’T say. I did not feel supported at all. I did not see another gynecologist for years, I just visited by PCP. My PCP wasn’t of much more help – when she ruled out endometriosis, she didn’t seem to have any other suggestions besides relax my muscles. Throughout my late teen / early adult life to present, I was always asked the “are you sexually active?” while visiting my PCP, and the only things that were discussed was protection from STD’s and pregnancy, but nothing about how my body actually handles sex. In the doctors’ defense, I never had issues until 4.5 years ago, so I was happy to just gloss over the sex questions. Once vaginismus started, I was heartbroken that my gynecologist and PCP were not of much help at all. When I finally found a pelvic floor healthcare team, they actually cared about what I was saying, and sexual health was brought up a LOT. I wish more doctors would be willing to listen to women’s concerns about their sexual health and help them find answers instead of telling them to just relax. There are many doctors out there who are willing to do this, but the ones that aren’t really bring the morale of their vaginismus and dyspareunia patients down!

[Heather34]

I agree completely hereisnowhy. I think the more that doctors, as students, are taught about vaginismus and the more it is discussed, the more and more sensitive they will become and may bring it up with their patients. One of our Forum members, who is also a physician, wrote an excellent post about this topic:

From lotus1000:
“I am a physician as well as a patient of Dr. Pacik’s. When I first diagnosed myself, I went to multiple doctors to ask for help. I was told to “get drunk”, or “relax and just get it over with.” Ignorance on their part was very damaging to my self-esteem and made me feel extremely hopeless. My whole journey with vaginismus has made me, I think, a better doctor who is more attuned to sexual issues with my patients. Coming from a traditional culture, I was never accustomed to asking patients about their sexual issues, and I would often change the topic when they would bring anything up about sex or sexual issues. Now, whenever I sense anything, I will dive into it with them and try to explore it, trying my best to be mindful of what my tone and facial expressions are. I have not yet had any vagnismus patients, as far as I know, but I’m sure I will at some point.”