Centrality of Sexuality to Wellbeing and Assessment of Sexual Health

By Marek Jantos Ph.D.

When asked about the importance of sexuality, 94% of adults indicated that sexual pleasure significantly adds to their quality of life (Marwick, 1999). Yet, the prevalence of sexual problems in the general population and the level of personal dissatisfaction with sexual wellbeing is high (Phillips, 2000).

If sexual pleasure is indeed so fundamental to happiness and quality of life, it is not surprising to find that almost 90% of women, diagnosed with vulvodynia, attend therapy, motivated by the desire to increase the frequency of sexual activity in their relationships (Jantos & Burns, 2008). Without diagnosis and assistance, vulvodynia patients and their partners experience higher levels of sadness, depression and frustration (Jantos & White, 1997; Jantos & Burns, 2007; Desrosiers et al., 2008). Research consistently highlights the fact that vulvodynia significantly undermines the quality of life of women and couples (Arnold et al., 2006, Sargent & O’Callaghan, 2007). In comparison with other vulvar medical problems, the impact of chronic vulvar pain on general wellbeing and sexual function far exceeds that of other problems (Ponte et al., 2009) and is more disabling than other pelvic pain conditions (Meana et al., 1997; Reed et al., 2000). The disorder diminishes a women’s sense of wellness, impacts on relationships and gives rise to isolation and loneliness (Sargeant & O’Callaghan, 2007; Desrosiers et al., 2008; Jantos & Burns, 2007).

In 1975 the World Health Organization defined sexual health as the “integration of the somatic, emotional, intellectual, and social aspects in ways that are positively enriching and that will enhance personality, communication and love” (World Health Organization, 1975, p. 2). Yet, sexual health is one of the last frontiers of wellness to be studied and one of the last disciplines of human physiology to be scientifically investigated (Markos, 2005). The psychological, physiological, relational and social threads that weave together in human sexuality are often overlooked (Schrover & Jensen, 1988). The centrality of sexual health to wellbeing needs to be further recognized within the health care system (Parish & Clayton, 2007).

Sexual health can be easily overlooked in health training and medical practice. In part this may be due to patients and doctors being hesitant to communicate about sexual issues, fearing that raising matters of sexuality may cause the other party embarrassment. To avoid the risk, sexual health assessment can be easily neglected.

The need to address sexual health matters, especially in relation to women’s sexuality, is highlighted by the prevalence of problems reported in research studies. Estimates of sexual difficulties among women range from 19-50% in “normal” patient populations, and increase to 68-75% when sexual dissatisfaction is included (Phillips, 2000). The high prevalence of sexual problems noted in survey samples is not reflected in patient notes and medical reports. In one study, general practitioners had recorded sexual problems in only 2% of their case notes; while in another study, where physicians were trained to take a sexual history, 53% of patients were noted as having problems. It is evident that when clinicians make inquiries of patients about their sexual health, the prevalence of reported problems increases significantly. In order to detect patient concerns and difficulties, explicit questions need to be asked by the clinician during routine health assessments (Schultz et al., 2005).

The most common female problems identified in surveys relate to: low desire (77%); low sexual arousal (62%); inability or difficulty achieving orgasm (56%); and vaginal dryness (46%) (Berman et al 2003). The specialists most frequently approached with these problems were: gynecologists (42%); general practitioners (24%); psychiatrists (12%); and urologists (3%) (Berman et al., 2003).

Several surveys have sought to assess the extent of the health care provider’s involvement in assessing sexual wellbeing. Findings indicate that both patients and health care providers expressed an unwillingness to raise matters of sexual importance. In a survey of almost four thousand women, 40% expressed a reluctance to seek help from a physician in relation to sexual complaints, even though 54% expressed a desire to do so (Berman et al., 2003). In exploring reasons why patients fail to raise sexual issues, a study found that 75% believed that their physician would dismiss their sexual health concerns, or that such issues would embarrass them (Marwick, 1999). These beliefs appear to be validated, in part, by reports showing that, when patients raised concerns about their sexual health, the physician was unprepared to hear them and they were met with embarrassed silence, misinformation, surprised or shocked reactions, personal discounting or belittling (Berman et al., 2003).

The health care providers, on their part, also cite various reasons for avoiding sexual issues during medical screening. The most common of these include: lack of training, insufficient knowledge, lack of information about treatment options, discomfort with sexual language, apprehension that inquiries of a personal nature may offend the patient, and their own personal feelings of embarrassment (Parish & Clayton, 2007). Yet, 91% of patients were of the view that questions about sexuality were appropriate in the context of health care (Parish & Clayton, 2007).

With such misgivings on the part of the patient and the physician, sexual health issues are neglected and very few doctors ever take a patient’s sexual health history (Parish & Clayton, 2007). From a health perspective, such unease is not conducive to the early identification of chronic pain disorders such as vulvodynia (Nuns & Mandal, 1996). Physicians and allied health professionals need to be more proactive in creating an environment where the patient’s sexual wellbeing can be discussed (Phillips, 2000).