5 Questions: Ettinger on women's sexual health

An occasional feature in which a medical expert answers five questions on a science or policy topic of interest to the Stanford community

Leah Millheiser Ettinger

1 Erectile dysfunction seems to be a household term; Bob Dole has talked about impotence on national TV. Why don’t we hear more about female sexual dysfunction?

Ettinger: Male erectile dysfunction became a household phrase once Viagra came along. The publicity explosion that followed Viagra’s debut really opened the door to exploring female sexual health in the public forum. There have been some exciting advances in research and treatment of female sexual dysfunction over the past several years, especially in the areas of desire and arousal. Once these treatments are made available to the public, I believe that we are going to see a response similar to the Viagra phenomenon.

2 Why haven’t we yet seen a Viagra-type breakthrough for women? Is it because of the complicated biology of women?

Ettinger: In the most general sense, female sexual dysfunction is broken down into disorders of desire, arousal, orgasm and pain. It is important to keep in mind that what is normal for one woman may be abnormal for another. Therefore, a diagnosis of dysfunction can’t be made until a woman experiences distress resulting from her problem. There isn’t a “magic pill” to treat all four disorders. Viagra treats only one aspect of male sexual dysfunction, and that is erectile disorder.

3 Some women were raised to believe sex was a bad thing or, at the very least, not something they should think or talk about. Has our culture made it difficult for women to come forward with their sexual problems?

Ettinger: What a woman is taught about sex early on in life can certainly affect her sexual expression and behavior as she matures. For example, if a woman is taught at a formative age that sex is a “bad” thing, then she may associate it with guilt or avoid it altogether. It is important for a woman to know that if she has concerns about her sexual function that are causing her distress, there is help available. The best place to start would be with her ob/gyn or primary care clinician. If they don’t have the resources available to evaluate and treat her, then they can refer her to a clinician in the community who does.

4 I imagine some people consider female sexual dysfunction an unimportant health issue.

Ettinger: I think that the skepticism comes from not knowing how to diagnose and treat female sexual dysfunction. Most medical schools and residency programs do not devote educational time to this area in their curricula. The increasing interest in the media regarding female sexual health as well as the advances in research have really brought this issue to the forefront of clinician training. We are seeing clinicians who have been in practice for years coming back to be educated on this topic.

5 How do you respond to people who think that this kind of thing should be worked out in a bedroom, not a doctor’s office?

Ettinger: Both approaches are often necessary. There are medical problems that can cause orgasmic disorder. When this is the case, it can’t be solved in the bedroom alone.