NAMS Video on Sexual Health Concerns

North American Menopause Society recently had a video interview with Dr. Sheryl Kingsberg, who is a clinical psychologist by training and has a division of behavioral medicine in ob-gyn at University Hospital's Cleveland Medical Center. She provides psychological help to women with many women's health issues.

She notes that there is a lack of training in medical school and in ob-gyn residency regarding sexual function and dysfunction. There is a lack of recognition of the prevalence of sexual dysfunction. There is so little training in sexual health.

Many patients are embarrassed to address concerns with their provider. The top four concerns in sexual health are problems with desire, arousal, orgasm and pain. The two that impact perimenopausal and menopausal folks most are problems with desire and problems with pain with sexual activity. In perimenopause and menopause 10% of folks have problems with desire and 60-80% have problems with pain with sexual activity.

How can we encourage providers to address these issues? Providers are uncomfortable asking about sex. First and foremost providers need to realize that addressing sexuality is part of healthcare and should be addressed. Letting patients know that many, if not most, perimenopausal folks have difficult with sexual activity. Asking if they are having problems normalizes the situation and opens the conversation. This helps to create a safe environment that's confidential.

Many patients and providers may feel that there are no treatment options. There are treatments. Pain with sexual activity can be treated with local estrogen therapy, pelvic floor physical therapy, moisturizers, lubricants and cognitive behavioral therapy in various circumstances. Problems with lack of desire can be addressed with cognitive behavioral therapy and off-label testosterone use.

Not all providers are experts in every area but they can at least identify the problem and then refer appropriately.