Women's Sexual Health

In this episode of BackTable Urology, Dr. Aditya Bagrodia and Dr. Ashley Winter discuss women’s sexual health.

First, Dr. Winter explains her role as a urologist in providing hybrid sexual health consulting for men and women. Then, the doctors discuss basic sexual history intake questions for women. Although there are many screening questionnaires, Dr. Winter prefers to use the Female Sexual Function Index because it evaluates sexual desire, arousal, pain and orgasm ability. She also makes sure to ask about issues indirectly related to sex, such as lower urinary tract symptoms, recurrent UTIs, and pelvic pain.

Performing a complete physical exam is important in patients presenting with sexual dysfunction. Dr. Winter explains her usual genital exam, paying close attention to any abnormalities regarding the clitoris, labia majora/minora, and vestibule. She also performs a pelvic floor exam. She does not usually order a hormone panel, but may check TSH and HbA1c to rule out diabetic neuropathy.

Next, Dr. Bagrodia and Dr. Winter delve into the evaluation and management of specific sexual dysfunctions. Low libido, or hypoactive sexual desire, is a common issue for women. It can be a result of menopause, oral contraceptive use, cystectomy, postpartum concerns, vulvar disorders, selective serotonin inhibitors, history of breast/cervical cancer, or history of abuse/trauma. For patients in the last category, Dr. Winter encourages collaboration with social workers and therapists. She mentions that the American Association of Sexual Educators, Counselors, and Therapists (AASECT) is a great resource for finding these professionals. For peri/post-menopausal women, she recommends prescribing a testosterone gel. Additionally, non-hormonal treatments for low libido include flibanserin and bremelanotide.

For issues regarding sexual arousal, Dr. Winter emphasizes proper education and screening for diabetes first. If arousal is inhibited because of a lack of lubrication, then correction of estrogen levels may be necessary. Estrogen supplementation, or topical/vaginal estrogen, can be used to treat problems with arousal, as well as recurrent UTIs and genitourinary syndrome of menopause (GSM). Dr. Winter notes that these low doses of estrogen preparations are unlikely to actually raise blood estrogen levels and cause systemic side effects.

Finally, in patients who complain of pain with sex, Dr. Winter recommends education about lubricants and pelvic floor physical therapy.