Let’s be honest: sexual health is an important part of overall health.
Sexual desire and relationships impact a woman’s (and man’s) sense of self. Many people say they see their sexuality as a key part of who they are individually and within their relationships.
Sexual health, however, sometimes gets off track.
And, unfortunately, once it’s off track, it can stay off track in a vicious cycle.
Women who have depression or anxiety are more likely to have sexual health concerns, and women with sexual health concerns are more likely to have depression and anxiety.
Chronic health conditions such as heart disease, diabetes, obesity or arthritis can interfere with a woman’s ability or a couple’s ability to have a good healthy sexual relationship. Common midlife conditions such as pain with sex, low desire and relationship issues also play a part.
Never fear, you can have the sex life you want and deserve.
Supporting sexual health
Recently, I saw a woman for her second visit and it made my day. She finally had been able to have sex without pain.
We treated the cause of her pain using vaginal estrogen for menopause-related dryness, medication to heal outside skin damaged by lichen sclerosis and a referral to the pelvic floor physical therapists in order to treat pelvic floor muscle pain.
She felt like herself again and loved having that closeness back with her husband.
Supporting sexual health is an important concern. According to the World Health Organization, “…the purpose of sexual health should be the enhancement of life and personal relationships and not merely counseling and care related to STDs and preventing unwanted pregnancies. Sexual health should involve: the capacity to enjoy and control sexual and reproductive behavior in accordance with a social and personal ethic; a freedom from fear, shame, guilt, false beliefs and other psychological factors inhibiting sexual response and impairing sexual relationships; and freedom from diseases and issues which interfere with sexual and reproductive functions.”
All health care providers have a responsibility to talk about sex and follow these recommendations by:
- Creating better climates to talk about sex
- Increasing access to information and education about sexuality
- Making it easier to get care for sexual concerns
- Evaluating and researching programs to help us be better in how we teach about sexual health
Being sexually healthy means:
- Understanding that sexuality is a natural part of life
- Recognizing and respecting the sexual rights we all share
- Having access to sexual health information, education and care
- Making an effort to prevent unintended pregnancies and STDs and seek treatment when needed
- Being able to experience sexual pleasure, satisfaction and intimacy, when desired, in a safe and healthy way with mutual consent
- Being able to communicate about sexual health with others, including sexual partners and health care providers
There are ways to get the conversation going. At Spectrum Health Midlife, Menopause & Sexual Health, we have a sexual health conversation tool called the “SexDeck.” It is a card deck with each card being about one of the 27 most common reasons for low sexual desire or low libido.
They are grouped in the categories of Interpersonal, Physical and Psychological:
- Interpersonal: lack of intimacy, lack of respect, emotional abuse
- Physical: pain with sex from menopause and dryness, pain from history of pain and tight pelvic muscles, medical conditions such as diabetes or arthritis
- Psychological: depression or anxiety, history of sexual abuse, poor self-image
Many patients have sexual health concerns, but only 20 percent bring it up with their health providers. Many doctors do not bring up the subject because they have not been trained to discuss or treat sexual health issues. This needs to change.
Test your sexual health knowledge
True or false? Pain with sex is all in her head.
False. The brain is an important part of sex drive, but pain is not made up. And pain makes pleasurable sex, especially intercourse, impossible.
True or false? After menopause, women do not care about having sex.
False. Many women want to stay sexually active after menopause but might not know that the cause of pain and dryness is a treatable medical condition.
True or false? There are medications to help women have more desire.
True. Hormone medications can help with sex drive. The FDA has approved Addyi for treatment of low sexual desire. This anti-depressant is thought to be helpful and several drugs are in development that could also likely be very helpful as well.
True or false? Everyone has high sexual desire except me.
False. If you have low desire, you are not alone. Almost half of women have low desire sometime in their lifetime.
True or false? There is something wrong with a couple if they do not have sex anymore.
False. If a couple does not want to have sex, and neither partner is in distress or upset about the lack of sex, it is not a problem. The problem can come when one wants sex and the other does not.
True or false? All doctors are comfortable talking about sex.
False. Unfortunately, our medical education is not great about including lessons about sexual health. Also, it is a challenging topic for some physicians to discuss. As we take care of patients, it is important to be honest, and if we are not comfortable talking about sex, it is our job to refer to other health care providers who are comfortable.
True or false? It is bad to talk about sexual health concerns with your doctor or other health care provider.
False. It is so important to ask your sexual health questions. If you feel your doctor is not comfortable or not helpful, ask for a referral to a provider who is.
True or false? There are many causes of low sex drive.
True. Women say all the time “I lost it” thinking that once desire is low, it can’t be improved, or that it is an all-or-nothing situation. There are many causes and many solutions.