Maria Sophocles, MD: The Challenges, Symptoms of Sexual Dysfunction

Sexual dysfunction is both prevalent issue in women, and a considered taboo topic in clinical settings. These facts can coexist, but it’s more likely the latter drives the former, Maria Sophocles, MD, said.

Sophocles, the medical director of Women’s Healthcare of Princeton, recently sat down with MD Magazine® to discuss the most prevalent and high-priority issues in women’s health. Where better to start than sexual dysfunction—a condition which she believes 4 of every 5 women don’t want to discuss with their physicians, and perhaps vice versa.

MD Mag: What are the obstacles clinicians face in addressing and treating sexual dysfunction in patients?

Sophocles: So, the biggest obstacles to treating female sexual dysfunction, as an OB/GYN or a primary care physician, are really the sociocultural barriers of communication. Over 80% of women do not bring up sexual dysfunction at their visits; over 80% of physicians do not ask. So there is a little bit of a, ‘Don't ask, don't tell’ problem. Women are, to use a cliched term, suffering in silence. They're not talking about it, they often feel it's just them, there's something wrong with them, they're broken. They may not be talking about it with their friends, they may not feel comfortable broaching it with the clinician.

So the biggest obstacles are really both the patient's themselves and the physician—whether they're uncomfortable discussing sex, or they're not sure the answers they would give if a patient said, ‘I have a sexual problem.’ Or they feel uncomfortable, because the patient's gender with respect to their gender. These are the biggest problems.

Time is sometimes an issue. Patients will cite that the doctor felt rushed, and ‘it was all the doctor could do to ask me about heart disease or menstrual issues.’ Doctors cite time as a big issue, but I find the main reason it's not discussed is the clinicians not comfortable discussing it, and the patient's not comfortable asking.

MD Mag: What symptoms are most commonly associated with sexual dysfunction?

Sophocles: Symptoms that are most associated with sexual dysfunction are pain: pain with intercourse; pelvic pain; women who suffer from pelvic pain conditions; whether they're undiagnosed or diagnosed; endometriosis; fibroids; pelvic floor; muscle dysfunction. These comorbidities tend to result in pain with intercourse.

Other comorbidities are more behavioral health-related: depression; lack of self-esteem; marital problems. These can lead to female sexual dysfunction, with perfectly normal anatomy and physiology.