Dr. Goldstein how should a woman advocate for herself to improve her sexual health? Dr. Irwin Goldstein, MD, has authored more than 325 publications in the field of sexual dysfunction, with 20 consecutive years of funding by the National Institutes of Health in this area. He is Editor-in Chief of The Journal of Sexual Medicine, the official journal of the International Society for Sexual Medicine.
I would advocate that a woman who comes into our office for a sexual medicine evaluation to insist upon getting an appropriate evaluation. The appropriate evaluation for sexual health problems is not an awful lot different than the appropriate evaluation for any other medical problem because in effect, sexual medicine is application of medicine to men and women who have sexual problems.
The appropriate evaluation would involve a psychological evaluation with a certified sex therapy or psychologist, mental healthcare provider, a detailed history and that would involve sexual history, medical history, and psychosocial history, would involve a detailed physical examination with attention of course to genitals, but not exclusively attention to genitals.
And the genitals that we are interested in, in sexual medicine are not necessarily deep inside the vagina, such as a cervical pap smear examination, but specifically what we call at the vestibule, which is the part of the vulva that engages and includes the clitoris, the hood of the clitoris, the tissue just off the base of the clitoris called the frenulum, the two labia minora, the urethra that the woman urinates through, the hymeneal tissues, the skin in the region, there are minor vestibular glands, there is Bartholin’s duct opening in the region, which is an awful lot of very important tissue that is engaged in sexual activity that the sexual medicine doctor needs to examine.
Above and beyond the history and the physical and the psychological evaluation, one would engage blood tests for hormones. One should involve or could involve sensation testing in the region compared to other regions such as the fingers and then vascular testing.
Women who are in menopause or women who have hypertension or cigarette smoking or diabetes may have blood vessel blockages going to the genitals. Clearly men who have those medical conditions have similar blockages.
So a woman who wants to be empowered and validated for her sexual problems should not be short-changed; it shouldn’t be a quick in and out, "Well, here’s a pill," it should be a detailed evaluation.
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