Women's sexual health gaining new attention with medicine and therapy

What causes a woman to lose her desire for sex? Is it hormone levels or her relationship?

Maybe it's both, but who's going to help her sort out what she has been going through?

A sex therapist might help her improve communication with her partner but can't tell her what her hormones are doing. A physician can look at her hormone levels but rarely has time to discuss her relationship in depth. Often that leaves women who have sexual concerns lost in the middle, wondering if the problem is in their head or somewhere else.

But a handful of women's sexual health centers around the country are bringing these two spheres -- mind and body -- together.

The centers are still few and far between -- some patients fly halfway across the country to reach one -- but an increasing number have emerged.

The Mayo Clinic in Rochester, Minn., has opened one of the newest of these centers. Its Women's Health Clinic opened in July 2005 and has been drawing patients from as far as San Francisco. The co-directors, both longtime physicians at Mayo, are an internist and a gynecologist. Together, they lead a multidisciplinary staff that includes other Mayo physicians, a sex therapist with a doctorate in psychology and registered nurses who provide nutrition and lifestyle counseling.

"I think we're unique in having a team with very strong medical grounding, plus a holistic view on health for women, plus a sex therapist with 20 years of experience," said Co-director Lynne Shuster, MD.

In addition to treating sexual health concerns, the clinic provides menopause management.

Dr. Shuster, an expert on hormone therapy, said the clinic sees a lot of patients who want relief from menopause symptoms but aren't sure they should be taking hormones.

She presents all options to patients. "Some of them leave with the decision to take hormone therapy, and many of them don't."

The clinic's physicians also have improved their awareness of sexual medicine. They have attended courses taught by experts in the field and brought well-known researcher, Rosemary Basson, MD, to the Mayo Clinic to provide training.

Women need these kinds of clinics, but there aren't nearly enough of them, according to Hilda Hutcherson, MD, a gynecologist and co-director of the New York Center for Women's Sexual Health in New York City. She wrote the 2003 book, What Your Mother Never Told You about Sex.

"There are lots of women with sexual problems, and they need doctors with the time and empathy to deal with these types of problems," she said.

That view is shared by gynecologist Christopher Jayne, MD, director of the Center for Women's Sexual Health in Houston.

He points to findings published in 1999 that 43% of women ages 18 to 59 have some form of sexual dysfunction compared with 31% of men. The study, authored by University of Chicago sociologist Edward O. Laumann, was published in the Feb. 10, 1999, issue of the Journal of the American Medical Association.

"It really was a landmark publication for us," Dr. Jayne said. "Until that number came out, we didn't have anything to hang our hat on."

The findings helped him persuade the Texas Medical Center to support the idea of opening a women's sexual medicine center in Houston in 2003.

Until then, no one in the Texas Medical Center, the largest medical institution in the world, was treating female sexual dysfunction, he said. Even today, to Dr. Jayne's knowledge, the center he leads is the only one of its kind on the Gulf Coast.

Most of his patients are referred by physicians who don't have the time to address women's sexual health problems effectively, he said. "The average ob-gyn sees a patient for 15 minutes."

According to Dr. Shuster, many physicians also feel that they lack competence in addressing these issues.

"Many [physicians] are at a loss when a patient asks them about a problem," Dr. Shuster said.

She has found that "physicians are relieved and thrilled that there is a place they can send their patients."

Challenges remain

More women's sexual medicine centers might be needed, but not many physicians are rushing to open them. One reason might be that these problems involve longer visits.

Unlike the typical office visit, doctors can spend an hour or more talking with such patients, Dr. Hutcherson said, "and that's not profitable." Also, "it's really, really difficult to get reimbursed [by insurers] unless a woman has a pain disorder."

Another factor is that most medical schools provide little training in sexual medicine, according to Irwin Goldstein, MD, former director of the Institute of Sexual Medicine at Boston University School of Medicine. "It's just not on the radar screen."

As a result, "a lot of physicians are not that comfortable talking about sexuality," said Annette Owens, MD, who directs the Charlottesville Sexual Health and Wellness Clinic in Charlottesville, Va.

Some physicians, including Dr. Jayne, have increased their expertise by earning certification as sex counselors from the American Assn. of Sexuality Educators, Counselors and Therapists, which is based in Ashland, Va.

Dr. Owens, who chairs AASECT's sex counselor certification committee, said there had been a noticeable increase in inquiries in the past few years from physicians and other health care professionals.

An additional challenge to the field is the lack of research funding for women's sexual medicine.

Laura Berman, PhD, who leads the nation's most prominent women's sexual medicine center -- the Berman Center in Chicago -- said the FDA's decision in 2004 to reject Procter & Gamble's testosterone patch, Intrinsa, had a chilling effect.

"After the Intrinsa patch got squashed, most of the companies doing work on products have gone radio-silent," said Dr. Berman, a sex therapist. "They feel that the regulatory environment is not supportive."