Critics have argued that libido problems are more a matter of mismatched sexual appetites in the couple, which would be better addressed with couples counseling.
A small number of doctors specializing in women’s sexual health are trying to address what they describe as an almost total lack of support for those suffering from common issues such as low libido, difficulty reaching orgasm, and pain during sexual intercourse.
In terms of comparison with men’s sexual function, we are behind and it is really frustrating, said Dr. Stephanie Finn.Although help for male sexual dysfunction has been widely available since the erectile dysfunction drug Viagra came on the scene, approved for use in 1999, women’s sexual health in certain areas has largely remained ignored or shrouded in secrecy.
When was the last time your doctor asked you about your clitoris? Probably never, and that’s fascinating, isn’t it? We ask men all the time about their penises and their condition, their sexual functioning, and other things.I believe that, in general, there is a lack of interest in the sexual functioning of women, and I am pleased to say that I think that is starting to change, Dr. Finn says.
Finn, who initially was a family doctor, discovered that many of her patients needed help with their sexual problems, so she decided to focus on sexual medicine and opened her clinic about a year ago.Part of that work is simply teaching women about their bodies. It is very common for women to practically not understand their own anatomy, Finn stated.
I have had female patients who had no idea where their clitoris was. Some would tell me: “Oh, I’ve always wondered about that,” and sometimes I am a bit surprised by that response from 50-year-old women.
Finn offers her patients the option to hold a mirror while she gives them a guided tour of their genitals, or she uses a 3D model to show them that the clitoris is actually an organ shaped like a small spike, with only the clitoral bulb visible from the outside.
A study published in the Journal of Sexual Medicine in 2023 found that the apex of the clitoris has around 10,000 nerve endings, much less compared to the approximately 7,800 that the tip of the penis has.
A Culture of Shame
Part of that lack of knowledge about their own bodies and the reluctance of women to seek help for sexual health issues is related to cultural shame, explained Dr. Stephanie Hart, from the small town of Okotoks in the province of Alberta, another family doctor who also received training from the International Society for the Study of Women’s Sexual Health.
In North America, there is the idea that vaginas are dirty. For some women, it’s simply because they are disgusted by bodily fluids, including those that come from the vagina, but for others, it’s a matter of morality: You know, ‘sex is shameful’. It’s a very common attitude that I see in people. And it’s no wonder that people have sexual dysfunction when they feel this way about it.
Despite the difficulties women have in talking about their sex lives, these clinics are very busy. Hart says he sees 250 new patients each year in his office, of which between 75 and 80 percent are women, but he is referred about 400 clients. So every six months, I’m three months behind.For her part, Dr. Finn said she sees about 15 new patients each week at her clinic in Oakville.
Most women do not have access to a doctor specializing in sexual health. The existing clinics where women have traditionally sought care for their sexual health focus on contraception and infections, Hart said.
This type of clinic sends patients to him when they present issues such as pain during sexual intercourse or low libido, says Hart, just like specialists such as gynecologists who also send him patients.
Help for Low Libido
Carolina Jara, 57, says she used to be a very sexually active person, but since entering menopause, her libido has declined.My libido went somewhere. I don’t know, maybe back to my country, joked Jara, who is originally from Peru and now lives in Vancouver.
She explained that she is concerned about how this situation might affect her relationship with her husband, with whom she has been married for eight years. And this aspect is not something that can be taken lightly.He still wants to, but I don’t get excited. I haven’t had an orgasm in years, so I feel it more like a duty, like something I don’t necessarily enjoy.
There are two medications approved for use that can be used to increase sexual desire in women: a pill called flibanserin and an injectable medication called bremelanotide.Unlike Viagra, which is used as needed and works by increasing blood flow to the penis, both medications affect brain chemicals that influence mood and sexual appetite. Flibanserin must be taken daily and has been shown to have potential serious side effects.
Critics have argued that libido problems are more a matter of mismatched sexual appetites within the couple, which would be better addressed with couples counseling.A non-medical tool to address low libido or difficulty reaching orgasm is a type of sex toy sometimes referred to as clitoral suction devices.
We have wonderful studies that show that the use of these devices improves blood flow to the clitoris and the pelvic base, Finn stated. We know they can make a huge difference for women when trying to reach orgasm.
Pain During Sexual Intercourse
Sexual health problems do not only affect older women, explained Dr. Finn, whose patients range in age from teenagers to octogenarians.Talia Steele, 34, suffered for years from pain during sex, stemming from a series of issues that began with a common urinary tract infection.
Finally, she underwent surgery to resolve the issues, but all those medical examinations and injections, combined with her history of painful sexual intercourse, have had lasting effects.
There’s always a bit of anxiety, a feeling of never being able to fully live in the moment, always thinking about what’s happening, said Steele, who is married and also lives in Vancouver.
Although I don’t have that pain, those feelings and thoughts still enter my brain sometimes, and it can be a challenge to try new things or step out of my comfort zone, she added.One of the challenges in obtaining care for women’s sexual health issues is that there is no established medical specialty.
In the case of women who experience pain during sexual intercourse, for example, we send them to the gynecologist, who will tell them: ‘Well, it’s not endometriosis.’ That could be the end of the road if the doctor doesn’t know other options that could help.
Hart says her mission is to teach other doctors how to help, starting by asking patients the right questions.For example, being able to ask a patient as a doctor if she feels pain during sexual intercourse and knowing what to do if she answers yes. Because patients don’t always provide that information if they don’t know there’s something that can be done about it, explained family doctor Stephanie Hart.
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