The urologist’s role in destigmatizing women’s sexual health

In this video, Rachel Pope, MD, MPH, discusses the urologist’s role in destigmatizing women’s sexual health. Pope is an associate professor of obstetrics and gynecology and director of Female Sexual Health at University Hospitals in Cleveland, Ohio.

Transcript:

It's been a while now that urologists have normalized talking about erections and about men's sexuality. And so just as easily as a urologist might ask how their patient's erections are, they should be asking how sexual function is for their female patients, asking about any pain, asking about sensation, and then especially honing in on the time of menopause. We see from research that menopausal transition is a time for women where sexual dysfunction starts to really increase. Genitourinary syndrome of menopause, unfortunately, causes vaginal dryness and pain. And then there are just anatomical changes that make penovaginal intercourse uncomfortable. It's important for urologists to know that and to be aware of it. If they're treating a male with erectile dysfunction, ask about their partner. Whether that partner is male or female, it's really important to include that component of your care. If a patient is getting a penile prosthetic, if their partner is a female and is menopausal, and they have not had penile penetrative intercourse for years, it's not necessarily going to be all that easy when they start to engage in intercourse again. So it's really important to destigmatize that conversation [and] use those sorts of openings of conversation, like, "OK, now you've got a prosthetic, let's talk about how it's going to work," and let that be a bridge to the female that might be involved in that relationship. I would also say that there are a lot of urological conditions that are related to sexual pain and dysfunction. Women who have recurrent UTIs and women who have obstructed outlet for urination often also have hypertonicity of their pelvic floor muscles. Knowing that and looking for it on physical exam can really clue a person in and get them help because if they have hypertonic pelvic floor muscles, they probably are going to be having pain with intercourse as well. The patient just might not bring that up unless the urologist asks about it. There's a huge potential role for urologists out there for female sexual health. That's really exciting because gynecologists like me shouldn't be the only ones asking about it. I would love to see the orthopedic surgeons also asking, "How are things sexually? Because you have a new hip, [and] that actually might be a problem when you try to have intercourse next time." I would like to see it normalized and for us to really take the lead in destigmatizing it, because we're all adults and we should be able to give our patients that sort of information that's empowering as well.

This transcript was edited for clarity.