From Our 2012 Archives
Many Gynecologists Don't Talk About Sex
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Study: Just 28% Ask Patients About Sexual Orientation
Reviewed by Brunilda Nazario, MD
March 22, 2012 -- Many gynecologist aren't asking women enough questions about their sex lives or sexuality, and this may compromise care.
According to a new study in The Journal of Sexual Medicine, 63% of more than 1,150 ob-gyns said they typically ask women about their sex lives. That said, these doctors don't ask about other aspects of their sexuality. For example, just 40% of the doctors asked women questions about sexual problems and/or dysfunction, 29% asked about sexual satisfaction, and only 28% routinely confirmed a women's sexual orientation.
"The most alarming finding here is how many of us rarely or never talk about sexual orientation," says study author Stacy Tessler Lindau, MD. She is an associate professor of obstetrics and gynecology at the University of Chicago Medicine. "This is unfathomable."
As a result, women who are lesbian or bisexual may feel stigmatized. "Even when a physician knows a patient is a lesbian, they may wrongly assume that she is not interested in childbearing or contraception," Lindau says.
Many Barriers Exist
The new study did not look at why doctors don't broach the subject of sex. But "there are a number of barriers that impact an obstetrician's ability to raise the topic, from a paucity of treatments for sexual dysfunction in women, to not wanting to embarrass or offend a woman, to simply not having enough time," she says.
Some of the onus may fall on women. "If you have a concern about your sexual function or are having pain during sex or not experiencing pleasure, raise the topic, " she says. "If your doctor is unwilling or unable to discuss the matter, ask for a referral."
There are not-so-awkward ways to bring it up. "Ask what to expect after having a baby," she says. "You don't have to admit there is problem."
Women's health expert Donnica Moore, MD, agrees. She is president of Sapphire Women's Health Group in Far Hills, N.J. "If your doctor is not bringing it up and it is an issue for you, you should bring it up," she says.
There aren't always easy answers. "A women's sexuality depends on more than one small piece of real estate," she says. "There are so many factors that go into sexuality, sexual response, sexual frequency, and comfort that it is very challenging to figure out if this is a sexual health issue, a sexual dysfunction issue, or a relationship issue."
Jill Rabin, MD, is the chief of ambulatory care in obstetrics and gynecology at Long Island Jewish Medical Center in New Hyde Park, N.Y. She says the new study calls attention to a very important health matter: "If someone's libido is not where it used to be or where they are comfortable with it, this could represent many things including overactive bladder, heart disease, depression, or diabetes."
Not asking about sex could mean that doctors miss an opportunity to diagnose a treatable condition. "There are psychological and medical conditions that we may have missed if we don't ask about sex and sexuality," she says.
SOURCES: Sobecki J.N. Journal of Sexual Medicine, 2012, study received ahead of print. Stacy Tessler Lindau, MD, associate professor of obstetrics and gynecology, University of Chicago Medicine, Chicago.Jill Rabin, MD, chief of ambulatory care, obstetrics and gynecology, head of urogynecology at Long Island Jewish Medical Center, New Hyde Park, N.Y. Donnica Moore, MD, president, Sapphire Women's Health Group, Far Hills, N.J.