Medicalisation

Merging of marketing and medical science: female sexual dysfunction

BMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c5050 (Published 30 September 2010)
Cite this as: BMJ 2010;341:c5050

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I doubt that there is a huge number of women who experience sexual problems who will obtain this book by Ray Moynihan.

However, there are many other helpful books and research based articles that are written for health professionals, who are concerned about the large number of women who are currently suffering silently from these problems. Often women with sexual problems are not asked for a sexual history and so they may not be haveing the opportunity to be screened for disease states that may be linked to these problems eg diabetes, vascular disease etc.

Porterbrook NHS Clinic in Sheffield www.porterbrookclinic.org.uk has a large number of downloadable useful literature, as does the BSSM, baseuk.org and the Sexual Dysfunction Association.

There is help available for our patients.

Competing interests: None declared

Ruth A Hallam-Jones, nurse / psychotherapist

independent

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Difficulties with sexual function can be a multifactoral aspect of womens' lives and the topic remains a sensitive and controversial one. Recently two large pharmaceutical companies have raised the profile and awareness of women's sexual difficulties by conducting research, providing educational resources and developing medication to help alleviate symptoms for some of these women. There have been recent announcements to the press that one company is withdrawing its development of Flibanserin and the other has decided to withdraw active projects that sought to extend the indications and possible scope of hormonal therapy. This highlights the fact that women's sexual difficulties are complex and an area which merits further understanding.

In reaction to these changes, the British medical press has tended to emphasise the negative aspects of women's sexual problems, particularly in relation to the medicalisation of FSD . Whilst BASE acknowledges the social, cultural and relational influences upon women's sexual behaviour and pleasure, we are aware that a consequence of the press attention may be that women's sexual concerns are overlooked as medical attention is re- focused on the assessment and treatment of men who experience erectile dysfunction (ED).

Whilst BASE supports the ongoing treatment of ED, it regrets any move that discourages dialogue with women, thus preventing them from expressing their views. BASE also acknowledges that a high percentage of women who have had positive experiences with addressing their sexual difficulties may be constrained by their embarrassment in discussing the topic openly.

Susan Quilliam - BASE Advisory Board, co-author of Joy of Sex and well known agony aunt, comments: "As an agony aunt, I receive thousands of letters every year from women who are suffering from sexual problems but feel they cannot get the help they need. So these developments need to be a wakeup call not only to the medical profession but also to the lay person. As a starting point, we women need to be willing to initiate conversations with our healthcare professionals when we have a sexual problem. On a wider stage, not only women but also their concerned partners and families, women's health organisations, and the media all need to draw attention to the problem and lobby both the government and the medical profession for more support, more funding, more research, more training. If the commercial sector is pulling back, we must step forward. We must speak out - both in the consulting room and in the public arena. "

It is estimated that female sexual problems affect between 6%-17% of women and some research puts the figure much higher. Despite this, it appears that far less attention is paid to women's sexual function in a primary or secondary care setting. This level of prevalence indicates that there could be a need for the assessment and treatment of women along the lines of men being assessed and treated for erectile dysfunction. Provision of treatment options may require further research, education and training of healthcare professionals.

Mary Clegg, Chair of BASE says "sexual functioning difficulties provide the ideal scenario for the NHS to practice holistic and multidisciplinary care for patients where integration of medicine and psychology can be used to achieve better outcomes. In other words, let's offer good assessment for patients, address their needs in a confident manner and provide them with treatment options that suit THEM".

Since many female patients may not be aware of treatment options available to them, many do not mention their sexual difficulties. Equally there could be reticence on the part of healthcare professionals in different disciplines in primary and secondary care to address sexual functioning routinely. The British Society for Sexual Medicine has recently published guidelines for the management of sexual difficulties and this may help to address these issues. They advocate raising the subject of sexual function as a routine part of patient/doctor dialogue.

Prof Kevan Wylie from the British Society for Sexual Medicine and lead author of the guidelines who is also the Principal Academic Advisor to BASE said:

"The importance of a good sex life and reliable sexual function to general health and well-being is not always discussed or acknowledged in our society. During medical consultations, both patients and doctors often shy away from discussing sexual symptoms and this leads to an incomplete assessment of patients' sex lives and a failure to legitimise their needs and requests for healthy sex lives. Patients, especially those at high-risk of developing a sexual disorder, should be routinely asked at general health check appointments whether they have any concerns and whether they would like to have some advice about how these could be overcome."

BASE supports initiatives that empower women to make choices about their sexual health care. Further, it believes that many healthcare professionals need to be more confident in addressing sexual concerns, more understanding of the complexity of women's sexual expression and the key influences upon it. This should be supported by further training in this important area.

For more information please contact BASE on info@baseuk.org or telephone 01264 334192. www.baseuk.org

Mary Clegg Chair BASEUK.org

Competing interests: None declared

Mary Clegg, Chair

Prof K Wylie, Dr. Sharron Hinchliff, Susan Quilliam, Ruth Hallam-Jones

British Association of Sexual Educators

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Highlighting women's sexual concerns may assist drug company research and marketing but it also serves to promote Ray Moynihan's' forthcoming book. [1] Female sexual problems are not a creation of the pharmaceutical industry. Women's sexuality is multidimensional and women with problems have needed help for decades using a holistic approach as ably described by Goldbeck-Wood [2]. There is no quick fix.

1. Moynihan R. Merging of marketing and medical science: female sexual dysfunction BMJ 341:doi:10.1136/bmj.c5050

2. Goldbeck-Wood S. Female sexual dysfunction is a real but complex problem BMJ 341:doi:10.1136/bmj.c5336

Competing interests: None declared

Wendy J Vanselow, medical consultant psychosexual health

The Royal Womens Hospital Melbourne Australia

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