Women's sexual disorders get medical attention in new Stanford program

Mar 19 2008

Medicine is finally opening the bedroom door to women. When the male erectile dysfunction drug Viagra was approved by the U.S. Food and Drug Administration in 1998, many middle-aged men experienced a new lease on life, or at least on life in the bedroom.

The women who were their partners, however, were not included in this revolution, even though many were old enough to be starting their own sexual decline.

Although many groups began calling for a “female Viagra,” they met skepticism. Long after the term “female sexual dysfunction” was coined in 1997, some doubted its existence; a 2006 article in PLoS-Medicine flagged the dysfunction as an example of disease mongering by pharmaceutical companies.

Now the new Female Sexual Medicine Program at Stanford Hospital & Clinics has put that attitude aside.

“Five years ago, when I suggested we start this program, people said ‘Why? There are so many other important things in medicine,’” said Leah Millheiser, MD, an instructor in obstetrics and gynecology at the Stanford School of Medicine, and founder and director of the program. “My response was that if this is such a common problem, and it’s relatively easy to treat, why are we keeping it in the closet?”

Female sexual dysfunction affects 43 percent of women, yet it continues to be one of the most underdiagnosed medical problems in the United States. It is classified by four disorders: lack of sexual desire, the inability to become aroused, lack of orgasm (or sexual climax) and painful intercourse.

“These problems are underdiagnosed, underreported and undertreated. They deserve a lot of attention,” said Jonathan Berek, MD, professor and chair of Stanford’s Department of Obstetrics and Gynecology.

Millheiser said she started the Female Sexual Medicine Program after recognizing there were no other programs or fellowships available to medical students in the Bay Area on how to manage women’s sexual dysfunction. This multidisciplinary program integrates gynecology, urology, primary care, mental health, pelvic-floor physical therapy and sex therapy. It also includes clinical research—to understand how sexual well-being is affected after a woman is diagnosed with cancer or undergoes chemotherapy.

“We have an opportunity at Stanford to develop a program in an area that is frequently overlooked by practitioners in California and throughout the country,” said Berek. “We can and will be a leader in this very important area.”

Millheiser said there is often a strong disconnect between how a woman feels about sexual function and what she tells her physician in a typical 15-minute, once-yearly gynecological visit. The purpose of the program is to provide women with the education and therapy they need to take back control of their sexuality and sexual function.

“There is a ‘don’t ask, don’t tell’ policy about sexual dysfunction in managed care, as many physicians simply do not receive the training for discussing sexual dysfunction,” said Millheiser. “If a patient doesn’t feel her doctor is open to the topic of sexual dysfunction, she may not relay that information. A sexual complaint can be a marker of serious underlying disease, which is why it’s so important for a patient to tell her doctor so it can be further explored.”

According to the National Institutes of Health, sexual dysfunction in women can result from a variety of medical conditions such as diabetes, heart disease, nerve disorders or hormone problems. Medication, work-related stress and anxiety may also affect desire and function.

Cultural or religious beliefs may also impact sexual behavior, Millheiser said. For example, being told sex is bad or evil may imprint messages in a woman’s mind that won’t allow her to experience sexual pleasure, even while in healthy relationships. “The brain simply won’t allow you to relax,” she said. “We want to remove these barriers and have these women view sex as a normal part of a healthy relationship.”

Millheiser said the program, which is housed in the gynecology practice at the Blake Wilbur Building, has drawn patients of all ages who are seeking basic answers about sexuality. In addition to her work at Stanford, she also lectures around the nation and is a regular contributor on radio and television programs such as “The View from the Bay” on ABC-7 News.

“Women are becoming more empowered about sexual dysfunction,” said Millheiser. “They are seeing sex as a quality-of-life issue, not just a health issue.”