Let’s talk about sex!


By Maggie F. Wilkins, MSN, Nurse Practitioner, UNC Department of Obstetrics and Gynecology

Sexual health is an important part of adult life and yet it is not often discussed in mainstream society or health care (unless you are a man, in which case there is no shortage of Viagra and Cialis commercials encouraging you to rise to the occasion). In fact, very little is known about the relationship between female sexuality and chronic health conditions such as pelvic floor disorders (PFDs), which includes urinary leakage, pelvic organ prolapse, and accidental bowel leakage. What we do know is that many women don’t seek treatment for PFDs – usually because of a combination of embarrassment and not knowing that there are available treatment options. The additional layer of embarrassment in talking about sex in general keeps even more women from seeking treatment for sexual dysfunction. Studies have shown that patients see an average of 7 providers before their issues are adequately addressed.

Even in our field of Urogynecology, which arguably has a higher focus on women’s quality of life than most specialties in medicine, improvements still need to be made in addressing women’s sexual health. We can do better and this is something I am hoping to change!

People often ask me how I ended up in this field of health care, and their undertones seem to assume it must have been by chance or bad luck. However, the truth is this area of healthcare is very purposeful for me – and it is for most other providers in Urogynecology. I was drawn to our field because it focuses on women’s quality of life – and undoubtedly, a fulfilling intimate relationship with another person is part of the ideal picture.

Whether or not we want to acknowledge it, we are hard-wired for human connection. In infancy, when children don’t bond with their parents or there are problems in the parent-child caregiver relationship, this can lead to a serious medical condition known as failure to thrive; these children do not grow and develop normally compared to other children of the same age, and these complications can be permanent. I point this out to highlight that we NEED human connection and a sense of love and belonging to thrive – even as adults. Sex is important and arguably can be seen as the foundation of human connection.

Women are complicated, we know that. On average, it takes a woman 12-14 minutes to achieve an orgasm, even when she is doing it herself and knows the fastest and best route, and this is in the absence of complicating PFDs. And when you add in the additional interplaying pieces of emotional intimacy, desire, physical arousal and lubrication, satisfaction, pain, etc., it becomes even more complicated. But this doesn’t mean it is any less important. There are treatment options, and they can be very effective in addressing sexual health issues. The first step is to rule out and treat underlying causes, which includes PFDs such as urinary incontinence, pelvic organ prolapse, accidental bowel leakage, and vulvovaginal atrophy. This alone may or may not fix the problem, but it is the first step! After that, other options include physical therapy, bibliotherapy, sensate focus exercises (planned loveplay), therapy or relationship counseling, and herbal or prescription medications.

Thank you for your interest in bladder health week and this blog on sexual health. I hope you will join us in person Wednesday at the Arts Center. I welcome any questions that evening or if preferred, I look forward to seeing you in my clinic.

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