First national survey of OB-GYN sex history screening practices confirms narrow focus
How often does your doctor ask about your sexual life?
Unfortunately, the answer may be: not often enough. Leaving the subject off the check-up checklist could mean missing an important link to overall wellness.
Results of a comprehensive national survey of U.S. obstetrician-gynecologists regarding communication with patients about sex have found that too often doctors aren't having "the talk" with their patients. And when the topic of sex does find its way into a doctor's office or exam room, chances are the discussion only skims the surface.
The report, "What We Don't Talk about When We Don't Talk about Sex," uncovers the shortfalls in doctor-patient communication around sexual matters and examines the barriers that may be limiting the range of dialogue in a typical evaluation of a woman's general health. The study is being published today in the Journal of Sexual Medicine.
The survey, conducted by a team of University of Chicago researchers, found that while nearly two-thirds of OB-GYNs routinely inquire about patients' sexual activity, other aspects of female sexuality are not routinely addressed. Only 40 percent of those surveyed routinely ask questions to assess for sexual problems or dysfunction. Far fewer, 29 percent, routinely ask patients about satisfaction with their sexual lives and 28 percent routinely confirm a patient's sexual orientation.
Given the well-established link between a sexual function and overall health, the study's authors say their findings point to a clear need for stronger guidelines for doctors on conducting a thorough sexual history.
"As a practicing OB-GYN, many of my patients say I'm the first physician to talk with them about sexual issues," said Stacy Tessler Lindau, MD, associate professor of obstetrics and gynecology at the University of Chicago Medicine, and the study's lead author. "Sexuality is a key component of a woman's physical and psychological health. Obviously, OB-GYNs are well positioned among all physicians to address female sexual concerns. Simply asking a patient if she's sexually active does not tell us whether she has good sexual function or changes in her sexual function that could indicate underlying problems."
There is strong evidence of a high prevalence of sexual function concerns among women. Recent studies estimate that roughly a third of young and middle-age women and about half of older women experience some sort of sexual problem such as low desire, pain during intercourse or lack of pleasure.
For most, the concerns go beyond physical - in fact, the impact of sexual dysfunction can be far reaching. In addition to strained relationships, many women experience worry, shame, guilt and feelings of isolation. If the doctor doesn't ask, patients often assume the topic is not welcome for discussion.
"Many women are suffering in silence," Lindau said. "Patients are often reluctant to bring up sexual difficulties because of fear the physician will be embarrassed or will dismiss their concerns. Doctors should be taking the lead. Sexual history taking is a fundamental part of gynecologic care. Understanding a patient's sexual function rounds out the picture of her overall health and can reveal underlying issues that may otherwise be overlooked."
The study also takes a close look at whether factors such as gender, age, race, medical school location, immigration status, religious affiliation or type of practice play a role in the likelihood an OB-GYN will broach sexual matters. Not surprisingly, female doctors are more likely to address sexual activity with female patients. Doctors who see more patients for gynecology versus prenatal care tend to screen for sexual dysfunction more frequently than their colleagues. OB-GYNs age 60 and older are less likely to delve into a patient's sexual orientation or identity.
Generally, less than a third of all OB-GYNs surveyed routinely ask patients about their sexual orientation. Assuming heterosexuality can alienate a lesbian or bisexual patient and result in misinterpretation of symptoms and misdiagnosis. The report suggests this remains an important area for further research.