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Bridging the Gap in Female Sexual Health
At the 2023 conference of the French Urology Association, Charlotte Methorst, MD, a urologist from Paris, and Carol Burté, MD, a sexologist and andrologist from Nice, highlighted significant concerns in the realm of female sexual health. Their session underscored the necessity for medical professionals to engage more actively in this area.
Methorst observed a notable gap in the discussion of sexual health in medical consultations, a subject many patients, particularly women, are eager to explore. Burté reinforced this, pointing out the infrequency with which women initiate conversations about sexual dysfunction (19%) and the even rarer occasions on which healthcare workers broach the topic (9%). Recognizing the prevalence of this issue, which affects 40% of women and can influence their quality of life and relationships, is crucial. Furthermore, sexual dysfunction may signal other underlying health conditions.
Effective Detection and Assessment Methods
For identifying sexual dysfunction, the primary tool is the Female Sexual Function Index, consisting of 19 questions that address six aspects of sexual dysfunction. These include desire, subjective arousal, lubrication, orgasm, satisfaction, and pain or discomfort. Additionally, the Sexual Complaints Screener for Women, evaluating sexual health over the past six months, is another valuable tool, as explained by Burté.
Clinicians are encouraged to delve into a patient’s sexual, medical, and psychological history, employing the biopsychosocial model. This comprehensive approach includes understanding the patient’s past experiences and current contributing factors, such as stress and fatigue. By identifying these factors, healthcare providers can offer tailored information and discuss the most suitable therapeutic strategies.
Choosing the Right Treatment Path
Methorst and Burté emphasized the multifactorial nature of sexual dysfunction in women, necessitating an integrative treatment approach. This could range from simple advice and lifestyle modifications to sex therapy and medications. In sex therapy, cognitive-behavioral therapy (CBT) plays a vital role, helping patients and therapists overcome biases and dysfunctional patterns and adopt new strategies for improving sexual health.
Exploring Medicinal Options
While certain vasoactive drugs like phosphodiesterase 5 inhibitors and prostaglandin have shown limited success, medications targeting the central nervous system for stimulating sexual desire, such as bremelanotide and flibanserin, are not approved in France due to their questionable risk-benefit ratio. However, topical hormone treatments, especially estrogen and dehydroepiandrosterone, are frequently used for conditions like recurrent cystitis in postmenopausal women and urinary incontinence. Burté recommends creams over pessaries for their better tolerance.
Additionally, hormone replacement therapy (HRT) and tibolone are prescribed for postmenopausal women. The use of testosterone, important for sexual desire, is suggested by an international consensus (2019, 10 learned societies) and the International Society for the Study of Women’s Sexual Health, particularly in the postmenopausal period, with or without HRT.
Both doctors stressed the importance of collaboration within a network of medical professionals, including sexual health specialists, to provide comprehensive care for female sexual dysfunction.
