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When you’re ready to talk about sex—and whether all the body parts involved are functioning well—Dr. Ksenija Stefanovic is ready to listen. And she’s finding that more and more people want to talk. Women, especially—who haven’t always spoken up about sexual matters—are becoming more vocal.
Stefanovic, a urology and internal medicine physician, is codirector, with Fred Govier, M.D., of the 2-year-old pioneering Sexual Health Clinic at Virginia Mason Medical Center, the only center of its kind in the Seattle area. She and the staff at the clinic—which also includes two psychologists—see about 100 patients a month: men with prostate cancer, women with kidney stones and bladder issues, and couples with complaints about sex not being good enough anymore. Some patients are referred by their family doctors, and others come directly to the clinic on their own.
The clinic works with them all, but Stefanovic and another local expert in the field, Mia Swartz, M.D., of Athena Urology in Issaquah (who is a urogynecologist, an emerging specialty field of doctors who are both urologists and gynecologists), are finding that there is a pent-up desire on the part of women for a safe place to talk about sexual issues, even though many have difficulty doing so. A 2009 national survey commissioned by Healthy Women and the Association of Reproductive Health Professionals found that 70 percent of the 1,200 women (ages 18 to 50 years) surveyed had some type of a sexual problem. These problems included lack of desire, pain with sex and difficulty achieving orgasm, but only 18 percent of the women reported talking to their health care providers about these issues.
Helping women feel comfortable questioning their doctors is a gradual process. Swartz believes that television advertising around male erectile dysfunction, as well as ads about female bladder problems, are raising awareness overall that these problems can be discussed and treated with less cringing by female patients.
Stefanovic and Swartz note that problems women bring up fall into a few broad categories. One of those is lack of desire or a low libido, which are actually not the same thing. Desire is the complicated melding of the emotional wish for sexual contact and the body’s ability mechanically to make sex happen. Libido is the biological drive for sex. Desire can be present when libido is lacking, Stefanovic explains.
Mechanical issues with sex, sometimes including pain with intercourse, form another broad category. Many of these issues do have solutions, the two doctors say.
For instance, a common reason for women’s decreased libido is side effects from drugs, especially those often taken for depression. Stefanovic says some options available to such patients include skipping medicine on weekends or other times when sexual encounters are likely (though this should be done under supervision of a physician); switching to a medication with fewer side effects; prescribing sildenafil (Viagra), which helps some women; or recommending over-the-counter aids, such as gingko biloba.
Swartz says that some mechanical problems with sex have relatively s