Allied Health Care Collaboration in Sexual Medicine

Written by on December 31, 2012 in Features - No comments

Regina and Joe have a problem. They met on a dating site and over the past two years they have grown together as a couple. For the most part, the blending of their lives was easy and they considered themselves fortunate to have found each other. But, something was happening that neither of them wanted to talk about with each other and certainly not with their friends. They were sure everyone was having more sex than they were. Their sexual relationship had stalled six months into the relationship. Intercourse was feeling physically uncomfortable for Regina.   They had a wedding date set for the following summer and they both felt pressure to resolve the problem. Regina silently blamed herself and wondered if something was wrong with her “down there.”  It was a depressing and anxiety provoking situation for both of them.  Joe didn’t know what to do. He tried flowers and a weekend getaway. He read somewhere that “Acts of service” might help, so he took out the garbage and mopped the kitchen floor.

Regina thought about seeing a physician or a psychologist but her primary care doc had never asked her about sex in the past and she couldn’t imagine talking to a therapist without euphemisms for fear of embarrassing herself and the therapist. The fact is, many patients are reluctant to talk about sex if their Dr. doesn’t ask.  People are better adept at discussing sexual prowess than sexual problems. It is important for physicians to put their patients at ease in order to get an accurate history of their symptoms.

Primary care physicians are trained in the psychosocial as well as the biochemical causes of disease placing them in a great position to assess patients with sexual dysfunction.  Practical aspects in a medical evaluation for a reported sexual dysfunction would include assessing the integrity of the hormonal milieu, nerves and blood flow combined with a good medical history of overall health. A careful review of current medications, supplements, alcohol use and recreational drugs is important because of their potential impact on sexual function.

It is important to recognize that sexual dysfunction is not an isolated problem within the individual, but is strongly affected by the quality of the relationship with their sexual partner. Part of the medical  evaluation would also include questions regarding the patients’ intrapersonal and interpersonal conflicts, their sexual history, life stressors and sexual preference. Etiologically relevant are questions about partner sexual dysfunction and adequate stimulation.  Sometimes the devil is in the details. One way to get a thorough sexual history is by using printed forms.  An AASECT certified sex therapist in your community would be pleased to collaborate with you in the development of these forms for your practice. (www.aasect.org)

Primary care physicians can give their patients “permission” to discuss sexual concerns by including a Screening Checklist for Sexual Function on their intake forms.  A simple form for example, was created by Dr. Sandra Leiblum, PhD.

Please check all of the problems you are currently experiencing:

  • 1 Problems with little or no interest in sex
  • 2 Problems with decreased subjective arousal or feelings of sexual excitement
  • 3 Problems with decreased vaginal lubrication (dryness)
  • 4 Problems with persistent genital arousal
  • 5 Problems reaching orgasm
  • 6 Problems with pain during sex
  • 7 other: _____________________________

Which problem is most bothersome? (circle one) 1   2   3   4   5   6   7

Healthcare providers can order appropriate laboratory tests to evaluate sexual dysfunction. For erectile dysfunction it is important to rule out diabetes, thyroid disease, anemia and hyperlipidemia. It is also important to evaluate testosterone levels (total and free), FSH, LH and prolactin levels if the testosterone levels are low. Hormone testing is equally important when a woman presents with sexual dysfunction as a starting point in the treatment process.

Sexual dysfunction can be extremely complex and requires the expertise of multiple providers from different disciplines: gynecologists, urologists, internists, family physicians endocrinologists, psychiatrists, sex therapists and physical therapists.  It is helpful for a healthcare provider to develop referral relationships with providers they trust will be comfortable and competent in the treatment of a patients sexual concern.

Two less understood complimentary fields of sexual treatment is Sex Therapy and Physical Therapy.

A Certified Sex Therapist is licensed in psychology, medicine, social work, counseling, nursing or marriage and family therapy. Certified sex therapists hold an advanced clinical degree in psychotherapy training and follow a code of ethics. They are trained to understand the complexity and co-morbidity of sexual dysfunction.  Often, as a precursor to treatment, sex therapists refer to primary care physicians and others in the allied health field for a diagnostic evaluation for potential organic factors that may be influencing a patients’ sexual experience. Working collaboratively, sex therapists provide evaluations and recommendations for treatment that reflect biological, psychological and/or relationship factors. They also provide psychotherapy, sex therapy and sex education for couples and individuals.

A specialty in the area of physical therapy is a licensed physical therapist specializing in the musculoskeletal management of sexual dysfunction. Treatment focus can be pelvic floor rehabilitation in men and women addressing muscle weakness, muscle pain and spasms. Therapeutic tools consist of biofeedback with internal vaginal or rectal sensors, vibrators, partner “work” and home management strategies.

Regina would be best served in her community when her health care providers are working together in concert.  When her physiology, psychology, interpersonal relationships and sociocultural influences are considered, she can rest assured she is getting the gold standard in treatment.

By Rebecca H. Dnistran, MA

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