Citation

Lamont J. J. Obstet. Gynaecol. Can. 2012; 34(8): 769-775.

Affiliation

Hamilton ON.

Copyright

(Copyright © 2012, Healthcare & Financial Pub., Rogers Media)

DOI

unavailable

PMID

22947409

Abstract

Objective: To establish national guidelines for the assessment of women's sexual health concerns and the provision of sexual heath care for women. Evidence: Published literature was retrieved through searches of PubMed, CINAHL, and the Cochrane Library from May to October 2010, using appropriate controlled vocabulary (e.g., sexuality, "sexual dysfunction," "physiological," dyspareunia) and key words (e.g., sexual dysfunction, sex therapy, anorgasmia). Results were restricted, where possible, to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no language restrictions. Searches were updated on a regular basis and incorporated in the guideline to December 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. Each article was screened for relevance and the full text acquired if determined to be relevant. The evidence obtained was reviewed and evaluated by the members of the Expert Workgroup established by the Society of Obstetricians and Gynaecologists of Canada. Values: The quality of evidence was evaluated and recommendations made using the use of criteria described by the Canadian Task Force on Preventive Health Care (Table). Summary Statements and Recommendations Introduction Summary Statements 1. Sexual concerns are prevalent in the population. (II-1) 2. Many women have to look outside medicine for solutions to their sexual concerns. (II-1) 3. Many health care providers have the ability to deal with sexual health issues. (II-3) 4. Health care providers need a better understanding of female sexual issues/problems. (II-3) Chapter 1: Sexuality Across the Lifespan Summary Statements 5. Children are sexual from birth. Expression of sexuality is a developmental process. (II-2) 6. Most discourse on adolescent sexuality focuses on the potential for adverse consequences such as exploitation, sexual assault, unwanted pregnancy, and sexually transmitted infections, and has generally neglected to communicate to girls that expression of sexuality and sexual experimentation are normal and healthy. (II-2) 7. Age-appropriate sexual expression is a positive part of the development of adolescent girls. Negative, coercive, and discriminatory experiences can detrimentally affect sexual well-being. (II-2) 8. Variations exist in same-sex and opposite-sex sexual behaviour; same-sex and opposite-sex sexual behaviour is not equivalent to self-definition as heterosexual or lesbian or bisexual. Some women who have sex with women may be reluctant to define themselves as lesbian because women who identify themselves or who are identified by others as lesbian or bisexual may experience social discrimination. (II-2) 9. Women express their sexuality in a variety of ways and in a variety of situations, including with a partner and through masturbation. (II-2) 10. Masturbation and self-pleasuring can be important for self-knowledge and as a sexual outlet in themselves for women who have and those who do not have a partner. (III) 11. Relationship factors have a major influence on a woman's sexual well-being. (II-2) 12. Pregnancy and breastfeeding, as well as experience with infertility, can affect sexual functioning. (II-2) 13. Decline in frequency of sexual activity at menopause does not alter women's potential for desire, arousal, orgasm, sexual pleasure, or sexual satisfaction. (II-2) 14. Psychological, relationship, social, cultural, and biological factors affect women's sexual well-being as they age and experience menopause. (II-2) 15. Most women with a partner continue to engage in sexual activity. Women often cease sexual activity not because of lack of interest but because they do not have a partner. (II-2) 16. Women's sexuality may be affected by biological events (e.g., puberty, childbirth, menopause, and aging), by their own psychology/psychological health, by their ethnicity and culture, and by their sexual orientation. (III) 17. Whether or not women's sexual desire and activity continue through periods of pregnancy, childrearing, menopause, and aging may dependent on the presence of a partner, a partner's sexual function, the quality of the relationship, and both partners' general health. (III) 18. There is considerable variation in the patterns of girls' and women's sexual expression and experience. (II-2) Recommendations 1. Health care providers should encourage adolescents to use condoms consistently, and to take other steps to promote sexual health and prevent sexually transmitted infections (e.g., human papillomavirus vaccination), even while they are in a relationship. (II-3A) 2. Health care providers should be well informed about the variability of normal patterns of sexual development before evaluating sexual concerns that pertain to children and adolescents. (II-3A) 3. Health care providers should balance concern about adverse sexual consequences for girls with positive messages about adolescent girls' expression of their sexuality. (II-3A) 4. Health care providers should consider the effect of the relationship when assessing a woman's sexual well-being. (III-A) 5. Health care providers should strive to make their offices open and welcoming environments for women of all sexual preferences and practices (III-A) 6. Health care providers should discuss sexuality at the early prenatal visit, before discharge from the hospital postpartum, and at the postnatal check-up. (III-A) 7. Health care providers should communicate that they are open to discussing sexual concerns; educate patients about normal fluctuations in sexual interest and frequency; discuss the range of non-coital sexual activities if intercourse is difficult, painful, or prohibited for medical reasons; and emphasize the importance of the quality of lovemaking rather than coital frequency to sexual satisfaction. (III-A) 8. Health care providers should provide advice to support sexual adjustment and deal with challenges to sexual function during pregnancy and childbirth (e.g., suggest adapting coital position to accommodate changing body shape, suggest topical lubricant to reduce dyspareunia postpartum). (III-A) 9. Health care providers should help women deal with their concerns related to breastfeeding and sexual activity. This should include providing reassurance about the hormonal causes of erotic feelings during breastfeeding and informing women that if they are distressed by milk ejection during orgasm, this can be reduced by emptying the breast before sexual activity. (III-A) 10. The health care provider should enquire about both the woman's functioning and her partner's functioning in assessing changes to sexual activity with menopause and aging. (II-1A) 11. Changes in sexual functioning should be treated only if the woman expresses distress about these changes. (II-3B) 12. Health care providers should recommend the use of a lubricant or estrogen (local or systemic) for problems arising from vaginal dryness. (II-1A) 13. Health care providers should discuss safer sex, particularly with newly single women. (II-2A) 14. Health care providers should understand that all women are sexual and acknowledge that women have sexual needs. (III-A) 15. Health care providers should have an understanding of and respect for diverse individual patterns of sexual behaviour and orientation across the lifespan. (III-A) 16. Couples should be encouraged to include sexual pleasuring without penetration in their activities if penetration is impossible. (III-A) 17. Health care providers should recognize the need for sensitivity to a woman's life stage, to her individual situation, and to her sexual orientation when they assess sexual health concerns. (III-A) Chapter 2: Classification, Causes, and Assessment of Women's Sexual Dysfunction Recommendations 18. Health care providers should regard the identification and management of a woman's sexual health issues as important and legitimate elements of her clinical care (II-2A) 19. Health care providers should ensure they have and apply the skills and knowledge necessary to assess and manage a woman's sexual health problems. (III-A) 20. Health care providers should provide a clinical environment in which women feel they can discuss their sexual concerns. (III-A) 21. Health care providers should establish a list of clinical sexual health resources in the community for referral when necessary. (III-A) Chapter 3: Management of Sexual Concerns Summary Statements 19. Effective management of sexual concerns requires a biopsychosocial approach that includes both medical and counselling skills. (II-3) 20. A limited problem-focused approach, sometimes called the 20-minute hour, can be used to assess and manage sexual concerns effectively without disruption of the office schedule. (II-3) 21. The PLISSIT (permission, limited information, specific suggestions, intensive therapy) approach can be used to determine the level of intervention required. (II-3) 22. Involvement of the partner can often enhance outcomes in managing sexual health concerns. (II-3) Recommendations 22. All health care providers should include screening questions regarding sexual well-being as a standard of practice. (II-3A) 23. Health care providers who lack confidence in taking a biopsychosocial approach to counselling on sexual health concerns should seek additional training. (III-B) 24. Health care providers should involve the woman's partner in the assessment and treatment of sexual health concerns when it is appropriate and safe to do so. (III-A) Chapter 4: Health Concerns that Affect Female Sexuality Summary Statements 23. (ABSTRACT TRUNCATED)

Language: en