5603681683_845729d4b2_mThe World Health Organization describes sexual dysfunction as the multiple ways in which a personal cannot participate in a sexual relationship as he or she wishes. More specifically, female sexual dysfunction (FSD) is defined as disorders of sexual desire, arousal, orgasm, and pain, which causes a woman personal distress. In my professional experience, women usually present with more than one type of sexual dysfunction and the cause is often multifactorial.  This includes psychological, biological, medical, interpersonal, and sociocultural factors. For example, a woman presents with no sexual desire. After a detailed medical assessment, further information reveals that she is postmenopausal, she is worried about finances as their first child will be going to college, her job is stressful,  and she experiences severe pain with attempted penetration – even during a routine gynecological exam. It is no wonder that her sexual desire has diminished. As a result of these symptoms, she cannot become aroused with stimulation and the thought of any sexual activity causes her personal distress.

“I told my healthcare provider that I have no desire since menopause. She told me it was a natural part of aging and there were no treatment options.”

This is a true story and I felt sorry for my patient because there are safe, effective treatment options available. Based on research, we know that a woman’s testosterone level starts to decline in the mid to late 20s and continue to decline at a slow, steady rate throughout life. In addition, the surgical removal of one’s ovaries results in an immediate 50% reduction in the amount of testosterone produced.  There are several different treatment options including local vaginal estrogen or testosterone, and transdermal, injectable, and subcutaneous testosterone therapy. For more information, go to www.melissadahir.com.

“Shouldn’t my healthcare provider know how to treat issues with sexual functioning?” 

Not all healthcare providers are trained in this area of medicine. Unfortunately the formalized training of doctors, nurse practitioners, and physician assistants does not include in-depth education of sexual medicine and vulvar pain disorders.  In 1999, a survey of medical schools in North America revealed that less than half offered education in sexual dysfunction. In fact, I will be the first to admit that I did not have the knowledge or skills to treat these sensitive issues when I first started practice.  I read several books about female sexual medicine, but it was not enough. In the fall of 2006 I was accepted for an internship with national experts at the Pelvic Health and Sexual Institute in Philadelphia. The internship was life changing because the educational experience included in-depth didactic course work in addition to hands- on training with patients. I have also been fortunate to train with other experts in this field of medicine through the International Society for the Study of Womens Sexual Health and the International Society for the Study of Vulvovaginal Disease.

“How do I know if my healthcare provider can treat issues related to sexual functioning?” 

When looking for a qualified healthcare professional, it is best to look at their extended medical training. In addition, the International Society for the Study of Women’s Sexual Health (ISSWSH) offers a list of medical providers nationally and internationally with an interest in female sexual medicine. More importantly, a healthcare provider with the credentials of IF, or ISSWSH Fellow will ensure they are an expert in the field of sexual medicine.

To find an ISSWSH Fellow in your area, go to www.isswsh.org.