Treating Female Sexual Dysfunction

Posted on: 26 March 2008 by Gareth Hargreaves

Dr Fran Reader is a Consultant in Reproductive Health Care at Ipswich Hospital Trust.

Dr Fran Reader is a Consultant in Reproductive Health Care at Ipswich Hospital Trust. As part of this role she is the clinical lead for the Trusts psychosexual service. She is also Editor of the Journal of Family Planning and Reproductive Health Care.

Dr. Reader please tell us about your current clinical role

I work in a psychosexual clinic. I also work with women who are referred to the hospital with an unplanned pregnancy and need help to decide what they want to do with the pregnancy and with women who are having difficulty in deciding which method of contraception is the best method for themselves, either for medical or social reasons.

Do you work on your own or as part of a team in the psychosexual clinic?

We work as a team of five counsellors. Two of us are psychosexual counsellors (we are both doctors), two are nurse counsellors and one has no medical background. After assessment I may ask a colleague to work with a client with childhood or bereavement issues before they see me for psychosexual counselling. Alternatively, one of the counsellors may pick up a psychosexual problem when they see a client and refer them on to see me.

How are clients referred to the clinic?

Most referrals are from GP's or other hospital specialists such as gynaecologists, urologists and cancer specialists. The main clinic is primarily GP referrals but patients can come by open access through the sexual health clinic. About 15% of clients come through the sexual health clinic's open access and the remainder through the referral route. We try and make the best of the NHS mantra of brief therapy so that for the majority of patients, the work is within 6 sessions because of the volume of referrals. We do, however, occasionally take on individuals or couples for longer term work.

Do you feel that clients have an expectation of brief therapy before they come in for treatment?

They do, because they get a leaflet about our service before they come in. We don't send them an appointment straight away. We send an invitation to have an appointment and that will include a leaflet about the service from which they will understand about the way we work. They are invited to return the form and then we send them the appointment. Previously the high rate of failures to attend encouraged us to establish this way of working. Sometimes GP's or doctors think that clients should have a particular form of therapy but it may not be what they themselves think or they may feel quite ready to begin the work.

Do you feel that women find it as difficult to talk about sexual problems as men?

I would say yes. It is very individual, with some women being able to talk about sexual problems just as some men are. Reticence, however, is different. Men who are reticent find it difficult, if not traumatic to have a sexual problem and talk about it, whereas for women it is not so much a macho issue - it is about being 'not nice'.

Do women spontaneously approach you with a sexual problem?

No, it is something you pick up because you have a nose for it. It is how a woman copes with being examined or because she is having difficulty in settling with a method of contraception, and you feel it is her way of expressing that she has a difficulty with her sexuality and ambivalence about her fertility. Doctors who train with the Institute of Psychosexual Medicine are taught to be sensitive to body language. Being able to feed back what you feel coming from them will often trigger patients to talk more because the intimate experience of an examination may be a way in to intimate revelations. With a female sexual problem, women will frequently disclose to female health professionals. It could be a midwife, health visitor, practice nurse. Health professionals, who make intimate examinations as part of their professional role will often pick up on sexual problems. They are helping women to talk and are then asking, "May I share that with your GP?" Her GP may not have been part of the disclosure but is the medium through which the referral comes to me.

In your experience, which are the most common sexual problems women present with?

Certainly the most common problem is low interest either because of loss of desire or because of a wish to avoid some aspect of sexual behaviour - often after various life events such as childbirth or the menopause. Dyspareunia (pain during intercourse) is also common; this may have a physical or psychological origin. With low libido, I think there are some women who are more asexual and are happy with that situation. There is, however, an expectation that it should not be like that, some of which may come from media attention on the subject of sexual appetites but it also comes from men. I also think there is another group of women who have always had a problem initiating sex and who don't have much of a sense of "I want to have sex for me". However, if the man initiates, they will usually enjoy sex and be turned on, but are not aware of wanting sex for themselves. It can put a lot of pressure on the man in that situation but there are ways of addressing that without the woman having to feel that she is failing in some way. I think it is a lot more common than we acknowledge - that many women do not get randy!

Dr Reader, are there any issues we have not had time to explore that you feel are relevant to this discussion?

I think there are still such huge gaps in our knowledge and that further research is needed to learn about female hormones. We need to learn what drives the female response, how it alters with childbirth, with ageing and in various disease conditions like under-active thyroid.
 

The Impotence Association is there to help.  Telephone their helpline on 0208 767 7791 or visit their website at www.impotence.org.uk

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