Women’s Sexual Health Still A Taboo?

As a Clinical Associate Professor, I teach a small group of students from Monash University for Problem Based Learning (PBL). I always look forward to meeting the new intake when the semester begins. This year, I was proud when I realized that eight out of the eleven medical students teach are actually women. This is a stark contrast to the days when I was in matriculation in Cambridge where only one in three candidates were women.

Historically and in many parts of the world, women’s participation in medicine has been significantly restricted. Despite the medical degrees granted by institutions for centuries, Elizabeth Blackwell only become the first woman to graduate from medical school in the United States in 1849, after a great struggle. Despite the number of female medical students outnumbering the male counterparts, gender inequality is still prominent within medical specialties, especially in the surgical fields.

In conjunction with the celebration of International Women’s Day 2016, with the official theme of “Planet 50-50 by 2030: Step it up for Gender Equality”, we address the issues of why sexual health research and therapy is predominantly male orientated and female sexual health is still a taboo in the 21th century?

Dear Dr. G,

I know you are a Urologist and don’t usually deal with women patients or readers. However, I am writing to you, as I really don’t know whom else to turn to.

I am 40-year-old woman, and have been married for 15 years. We have two beautiful teenagers aged 13 and 15.

My husband and I have known each other for more than 20 years. He is my best soul mate and we get along very well.

The problem is, we really have issues in the bedroom. My husband thinks I have problems in achieving sexual arousal and have been avoiding sexual intercourse.

I have been to see the doctors, including the specialists. Some doctors felt uncomfortable to talk to me about my arousal and libido issues, others tell me it is all in my mind or possibly due to hormonal imbalance.

Why is the discussion of female sexual health such a taboo? Isn’t female sexual health part of medical education and essential knowledge for patient treatments?

As this lack of arousal and libido is bothering me and has put a strain on our relationship, I would really like to resolve the problem.

I understand there is a pink pill (equivalent to the blue pills for men) in development. Is it real? Is it safe? Is there such a magic tablet to solve all these problems?I look forward to your answers.

Joanne

Female sexual arousal disorder (FSAD) is also known as Candace Syndrome. This is a known medical condition, characterized by persistent and recurrent inability to attain sexual arousal or maintain arousal during sexual intercourse. This can potentially lead to decrease libido and intimacy avoidance. Generally, Female Sexual Arousal Disorder is considered as Female Sexual Dysfunction.

Its diagnosis and treatments are still contested amongst the experts.

Like men, many women experience problems with sexual function at some point, and this can occur at any stage of their lives. For some women, this is a life long condition; in others the condition is only noticed with certain sexual partners later in life. Although male sexual health can be discussed with less embarrassment since the introduction of the blue pills, female sexual health indeed is still a taboo subject, even amongst healthcare providers.

In men, the sexual responses can be gauged by the degree of erectile rigidity, interval of intercourse and sexual climax. In women, the brain mainly controls the sexual response, which is arguably the biggest sexual organ in human. The female sexual response involves a complex interplay of hormones, emotions, beliefs, lifestyle and relationships. The understanding of such complex interconnections is unachievable with current medical knowledge, making the perfect diagnosis and treatment of female sexual dysfunction almost impossible.

While the real etiology of female sexual dysfunction is largely unknown, medical conditions such as poorly controlled diabetes, thyroid problems and hormonal imbalance can contribute towards it. Chronic uses of medications such as anti-depressants and anti-epileptics can also result in the worsening of sexual functions.

Currently, there is no approved medication that can treat women with sexual dysfunction. Cognitive and behavioral therapies, including sensate exercises allowing couples to touch each other without the expectation of sex are often used. Many may argue that it is unfair men get pills while women need therapy.

In reality, there is a great deal of research to treat female sexual dysfunction. In 2014, fibaneserin was put out to be the “female pink diamond”. This treatment is supposed to target the neurotransmitters involved with low sex drives. After the initial rejection of the drug by the FDA, the pharmaceutical company concerned resubmitted further research material for consideration.

Many clinicians highlight the media culture that frequently hypes up sex and stigmatizes the lack of desire as a medical condition. In reality, when it comes to sexual desire and function, the spectrum of what is considered normal or abnormal is greatly variable. The Professor of Psychiatry from the New York University School of Medicine even ran a campaign against “medicalizing” sex, as this is considered counterproductive in medical therapy.

Oscar Wilde once said: “Women are made to be loved, and not understood.” When it comes to sexual health for women, we may never understand the real physiology of sex, but a great deal of love is often the real solution of the problems. On that note I wish Happy International Women’s Days to all the ladies.