Diagnosing and treating female sexual dysfunction: a survey of the perspectives of obstetricians and gynaecologists
Megan E. McCool A C , Christian Apfelbacher A , Susanne Brandstetter A , Miriam Mottl B and Julika Loss AA Medical Sociology, Department of Epidemiology and Preventive Medicine, University of Regensburg, Dr Gessler Strasse 17, 93051 Regensburg, Germany.
B Women’s Hospital – Klinikum am Gesundbrunnen, SLK-Kliniken Heilbronn GmbH, Am Gesundbrunnen 20-26, 74078 Heilbronn, Germany.
C Corresponding author. Email: megan.mccool@klinik.uni-regensburg.de
Sexual Health 13(3) 234-240 https://doi.org/10.1071/SH15187
Submitted: 20 September 2015 Accepted: 16 February 2016 Published: 14 April 2016
Abstract
Background: Female sexual dysfunction is highly prevalent and it has a major effect on quality of life. However, responding to this healthcare need is challenging for physicians due to limited time, insecurities about how and what to ask, and lack of knowledge of therapy options. In Germany, additional barriers such as poor training during residency, lack of sexual therapists, and limited options for continuing education result in an under-diagnosis and under-treatment of female sexual dysfunction. This study aims to better understand the perspectives of German obstetricians and gynaecologists (OB/GYNs) in terms of diagnosing and treating patients with female sexual dysfunction. Methods: In November 2014 all Bavarian-based OB/GYNs working in outpatient care were sent a 23-item questionnaire by mail. A reminder was sent 4 weeks later. A non-response survey was also performed. Results: Out of 1291 distributed questionnaires, 235 were completed and returned (18%). The greatest challenges to OB/GYNs caring for women with sexual dysfunction were: (1) long waiting times for referrals; (2) too little time with patients; and (3) insufficient training during residency. Only one out of five OB/GYNs brought up the topic of sexual function routinely; initiating a conversation about sexual function was significantly associated with perceived communication skills (P = 0.001) and perceived medical competence (P = 0.008). Conclusions: There are several barriers to diagnosing and treating female sexual dysfunction in a German outpatient setting. Further surveys of patients, psychologists, therapists and health insurance providers are needed to provide more perspectives on this particular health issue.
Additional keywords: barriers to care, outpatient care, sexual history taking.
References
[1] Basson R, Berman J, Burnett A, Derogatis L, Ferguson D, Fourcroy J, Goldstein I, Graziottin A, Heiman J, Laan E, Leiblum S, Padma-Nathan H, Rosen R, Segraves K, Segraves RT, Shasigh R, Sipski M, Wagner G, Whipple B. Report of the international consensus development conference on female sexual dysfunction: definitions and classifications. J Urol 2000; 163 888–93.| Report of the international consensus development conference on female sexual dysfunction: definitions and classifications.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c7ltVOjuw%3D%3D&md5=bce9032215d27ef649311635fff182dcCAS | 10688001PubMed |
[2] Nicolosi A, Buvat J, Glasser DB, Hartmann U, Laumann EO, Gingell C. Sexual behaviour, sexual dysfunctions and related help seeking patterns in middle-aged and elderly Europeans: the global study of sexual attitudes and behaviours. World J Urol 2006; 24 423–8.
| Sexual behaviour, sexual dysfunctions and related help seeking patterns in middle-aged and elderly Europeans: the global study of sexual attitudes and behaviours.Crossref | GoogleScholarGoogle Scholar | 16850339PubMed |
[3] Beutel ME, Stobel-Richter Y, Brahler E. Sexual desire and sexual activity of men and women across their lifespans: results from a representative German community survey. BJU Int 2008; 101 76–82.
| 17941926PubMed |
[4] Pontiroli AE, Cortelazzi D, Morabito A. Female sexual dysfunction and diabetes: a systematic review and meta-analysis. J Sex Med 2013; 10 1044–51.
| Female sexual dysfunction and diabetes: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 23347454PubMed |
[5] Beier K, Hartmann U, Bosinski H. Bedarfsanalyse zur sexualmedizinischen Versorgung. Sexuologie 2000; 7 63–95.
[6] Atlantis E, Sullivan T. Bidirectional association between depression and sexual dysfunction: a systematic review and meta-analysis. J Sex Med 2012; 9 1497–507.
| Bidirectional association between depression and sexual dysfunction: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 22462756PubMed |
[7] Traa MJ, De Vries J, Roukema JA, Den Oudsten BL. Sexual (dys)function and the quality of sexual life in patients with colorectal cancer: a systematic review. Ann Oncol 2012; 23 19–27.
| Sexual (dys)function and the quality of sexual life in patients with colorectal cancer: a systematic review.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC38%2FptVamtQ%3D%3D&md5=fa3d8cf2bca96c5f287180091cc126fbCAS | 21508174PubMed |
[8] Hartmann U. Sexuelle Funktionsstörungen. Betrachtungen aus der Perspektive der ambulanten Praxis. 1. Gynäkologische Praxis 2009; 33 115–28. [in German]
[9] Berman L, Berman J, Felder S, Pollets D, Chhabra S, Miles M, Powell JA. Seeking help for sexual function complaints: what gynaecologists need to know about the female patient’s experience. Fertil Steril 2003; 79 572–6.
| Seeking help for sexual function complaints: what gynaecologists need to know about the female patient’s experience.Crossref | GoogleScholarGoogle Scholar | 12620442PubMed |
[10] Roos AM, Thakar R, Sultan AH, Scheer I. Female sexual dysfunction: are urogynecologists ready for it? Int Urogynecol J Pelvic Floor Dysfunct 2009; 20 89–101.
| Female sexual dysfunction: are urogynecologists ready for it?Crossref | GoogleScholarGoogle Scholar | 18853081PubMed |
[11] BundesPsychotherapeutenKammer. BPtK-Studie zu Wartezeiten in der ambulanten psychotherapeutischen Versorgung. Berlin: National Board for Psychotherapy Germany; 2011 [in German].
[12] Ahrendt HJ, Friedrich C. Prävention und Therapie sexueller Störungen. J für Frauengesundheit. 2009; 1 11–26. [in German]
[13] Versorgungsatlas Frauenärzte. January 2015. Report No. Munich: Frauenärztliche BundesAkademie GmbH; 2015 [in German].
[14] Pauls RN, Kleeman SD, Segal JL, Silva WA, Goldenhar LM, Karram MM. Practice patterns of physician members of the American Urogynecologic Society regarding female sexual dysfunction: results of a national survey. Int Urogynecol J Pelvic Floor Dysfunct 2005; 16 460–7.
| Practice patterns of physician members of the American Urogynecologic Society regarding female sexual dysfunction: results of a national survey.Crossref | GoogleScholarGoogle Scholar | 15838588PubMed |
[15] Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A. Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care 2005; 14 26–33.
| Making psychological theory useful for implementing evidence based practice: a consensus approach.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2M%2FmsVSltg%3D%3D&md5=24433350259016aed3fe707d53c2a279CAS | 15692000PubMed |
[16] Dunn KM, Croft PR, Hackett GI. Sexual problems: a study of the prevalence and need for health care in the general population. Fam Pract 1998; 15 519–24.
| Sexual problems: a study of the prevalence and need for health care in the general population.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1M7ns1KktA%3D%3D&md5=17ec515ccee250a560de19902a069872CAS | 10078790PubMed |
[17] Fisher E. Common sexual problems in general practice. Aust Fam Physician 1986; 15 6–7.
[18] Littmann SK, Arnot P. Sexual dysfunctions: a survey of Toronto health professionals. Psychiatr J Univ Ott 1987; 12 35–40.
| 1:STN:280:DyaL2s3jt1CitA%3D%3D&md5=c88402f9a411dff886ac2968c40ff104CAS | 3295929PubMed |
[19] McCool ME, Zuelke A, Theurich MA, Knuettel H, Ricci C, Apfelbacher C. Prevalence of female sexual dysfunction among premenopausal women: A systematic review and meta-analysis of observational studies. Sexual Medicine Reviews 2016; in press.
[20] Kingsberg SA. Attitudinal survey of women living with low sexual desire. J Womens Health 2014; 23 817–23.
| Attitudinal survey of women living with low sexual desire.Crossref | GoogleScholarGoogle Scholar |
[21] Hartmann U. Sexuelle Funktionsstörungen. Betrachtungen aus der Perspektive der ambulanten Praxis. 2. Überblick. Gynäkologische Praxis 2009; 33: 311–22 [in German].
[22] Deutsche gehen häufiger zum Arzt (2010) Deutsches Aerzteblatt. Cologne: Deutscher Aerzte-Verlag GmbH. Available from: http://www.aerzteblatt.de/nachrichten/39723/Deutsche-gehen-haeufiger-zum-Arzt [verified 19 January 2010] [in German].
[23] Bachmann G. Female sexuality and sexual dysfunction: are we stuck on the learning curve? J Sex Med 2011; 3 639–45.
| Female sexuality and sexual dysfunction: are we stuck on the learning curve?Crossref | GoogleScholarGoogle Scholar |
[24] Schlueter P. Psycho-Ziffern mit Zeitfalle. Aerzte Zeitung. 2013; 2013 21 Available from: http://www.aerztezeitung.de/praxis_wirtschaft/aerztliche_verguetung/article/848113/neuer-ebm-psychoziffern-zeitfalle.html [in German].
[25] Burd ID, Nevadunsky N, Bachmann G. Impact of physician gender on sexual history taking in a multispecialty practice. J Sex Med 2006; 3 194–200.
| Impact of physician gender on sexual history taking in a multispecialty practice.Crossref | GoogleScholarGoogle Scholar | 16490012PubMed |
[26] Deutsche Gesellschaft für Sexualmedizin SuSeV. (2015) Dortmund [in German].
[27] Fortbildungen der FBA. Munich: Frauenärztliche BundesAkademie GmbH; 2012. Available from: http://www.fba.de/gesamtuebersicht.html [verified 6 March 2015] [in German].
[28] Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, Ferguson D, D’Agostino R. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 2000; 26 191–208.
| The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c3ksVejug%3D%3D&md5=55f7ca1b9b39942db56f0c5c400e2c02CAS | 10782451PubMed |
[29] Wiegel M, Meston C, Rosen R. The female sexual function index (FSFI): cross-validation and development of clinical cut-off scores. J Sex Marital Ther 2005; 31 1–20.
| The female sexual function index (FSFI): cross-validation and development of clinical cut-off scores.Crossref | GoogleScholarGoogle Scholar | 15841702PubMed |
[30] Templeton L, Deehan A, Taylor C, Drummond C, Strang J. Surveying general practitioners: does a low response rate matter? Br J Gen Pract 1997; 47 91–4.
| 1:STN:280:DyaK2s3islKkuw%3D%3D&md5=dec9eae0a1d5b3cdd848877d80940561CAS | 9101692PubMed |