By Dr. Diana Bitner and Brooke Meinema, DPT
People frequently ask me, “What is sexual health?”, “Why should we talk about it?” and “Why do you talk about it?” Over the last 26 years of being a physician and taking care of women and their families, I have learned exactly how great a role sexual health plays in the overall health and sense of wellbeing of women. Even the World Health Organization states sexual health is a human right, not only to be safe from sexually transmitted disease and safe from sexual abuse, but also for the “possibility of having pleasurable and safe sexual experiences…”
Many patients tell me that when they lose their sexual desire, they feel they are old, broken, alone, and have shame. We know that 80% of women have some level of sexual dysfunction over their lifetime, and only 20% will bring it up with a healthcare provider for fear of being dismissed, or shame about the subject. Many healthcare providers know that sexual health is important, but there are also many who are not trained to talk about sex, and although they have learned the basics of sexual function and desire, do not feel they have the time in an office visit to address it. Only 20% of patients even bring up sexual health with their providers. Sex is important and we must talk about it for the benefit of all involved!
In the most general sense, what is health? I believe a way to define health is wellbeing in the physical, mental and spiritual senses. Health is being functional in all three of these areas in order to have the quality of life, and the aging experience that we desire. Deliberate wellbeing is the pursuit of health, and sexual health involves three major aspects of general health: physical, psychological, and interpersonal. Sexual wellbeing is possible with healthy and open conversations – between partners but also between patients and providers. Sometimes it just takes an open conversation and redirection to resolve any sexual health issues, but at times, specialized care such as counseling, psychotherapy, medical treatment, or sex therapy is needed. We start with a general understanding and move into more options as needed.
During our Live Event on 3/19/2020, we talked about sexual health in the i’move Physical Therapy practice space very deliberately in order to make the connection for people between sexual health and physical wellbeing. The i’move mission statement is “We’ll help you be your best.” They provide evidence-based care to avoid injury, rehabilitation from injury or surgery, and functional treatment which considers each person as an individual. To offer even more options, i’move is adding a Women’s Health practice to include pelvic floor physical therapy. Together with true Women’s Health, more ‘good’ can be done when we share our expertise and show women that good function is possible.
As a healthcare provider, I share with i’move the mission of wanting to know all about each of my patients, but more than that, to have each of my patients know themselves better after our visit. By sharing goals, understanding barriers, knowing what is difficult, and some aspects of everyday life, we can best support people in their journey. We can support people in their sexual health by sharing knowledge regarding the basics of sex drive, how to start a conversation with a partner, and about options for treatment of issues.
Even for many OB/Gyn doctors, sexual health is difficult to discuss. Partly because of lack of training, and partly due to lack of comfort with the conversation or not knowing what questions were appropriate. For me, I began to feel more comfortable because of education at ISSWSH-the International Society for the Study of Women’s Sexual Health. The result has been more comfort with the conversation and patients who again have hope for their sexual health and intimate relationships.
Every aspect of health is interrelated to each other. This is especially true of the physical psychological and interpersonal components of sex drive. Research shows that even one factor of one component can make someone not want to have sex. Knowing why there is a problem can be very significant and can lead to improving the problem. My unique SexDeck© was invented to take the mystery out of low sex drive and make the conversations between patient and provider or patient and partner easier to initiate and result in better outcomes.
The SexDeck© is a card deck of the 27 issues which can affect sex drive. That’s right – there are 27! The cards are categorized by which of the components of sex drive that they fall into. The front of each card lists the issue, and the back of the card has the reason for the issue and what options could lead to improvement. Of the 27 cards, 10 cards are issues that apply to our physical well-being and could be discussed with either a healthcare provider or physical therapist. The joint topics include Incontinence (bladder or bowel), Depression/Anxiety, Physical Inactivity, Distraction, Painful Sex, Chronic Pain or Physical Limitations, Fatigue, Poor Self-Image, History of Pain with Sex, and Insufficient Intimacy. There are reasons for each of these issues which could derail someone’s libido, and all deserve understanding and problem-solving.
In future blogs, I will address each of the components or aspects of sex drive as well as the issues or groups of issues that can affect sex drive. Achieving good health can take a village and we are happy to part of yours.
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