Clinically Speaking

In 2017, Jessica Pettigrew, CNM, Senior Instructor, started to ask the patients in her OB/GYN clinic a new question: Do you have any sexual concerns you’d like to address?

“When I asked about sexual concerns before the end of the visit, patients would say ‘no.’” said Ms. Pettigrew. “I’d leave the room to let them dress, and when I’d come back, they’d tell me about it,” says Pettigrew, who is now the Co-Director of the Women’s Sexual Health Consultation Service at University of Colorado School of Medicine.

As Pettigrew saw this happen time and again, it become clear that women were not getting the sexual health services they needed. Women of all ages and life stages needed reliable information about sexual health and the opportunity to receive treatment when needed.

“Many issues affect women’s sexual health and satisfaction, including biopsychosocial factors and relational issues,” said Helen L. Coons, PhD, Clinical Director of the Women's Behavioral Health and Wellness Service Line in the Department of Psychiatry, and Co-Director of the Women’s Sexual Health Consultation Service. “Women need a service that brings medical care, cognitive behavioral therapy and sex therapy together, and that’s what the Women’s Sexual Health Consultation Service does.”

Anoshe Afghahi, MD, Assistant Professor of Medicine-Medical Oncology, saw the same unmet need, especially for women who were in treatment for cancer or recovering after treatment. The three providers worked collaboratively across departments for a year to bring their vision to life. In July 2019, the Women’s Sexual Health Consultation Service began providing services.

Meeting an Unmet Need

Sexual health is an important part of health and wellbeing, and often an important part of close and sustaining relationships. But education and treatment to support healthy sexuality is difficult for many women to find. The little help that is available is often for young, heterosexual women with no illnesses or disabilities. That leaves a lot of the population behind.

“All women should have the opportunity to address sexual health concerns as part of their health care,” said Saketh R. Guntupalli, MD, Associate Professor and Director of the Division of Gynecologic Oncology. “Especially for women with cancer or other illness that affects their sexual lives, a service like this improves the quality of their care.”

Unproven therapies are filling the vacuum of sexual health services for women. For example, a number of “testosterone clinics” have recently popped up in Denver, claiming to help women address sexual problems with the use of testosterone pellets. This treatment is not FDA approved and can even be harmful. “Women need a source of reliable information and sound treatments rather than unproven or dangerous therapies. We sometimes have to manage the fallout from these ‘treatments’ and then address the issues with approved, safe and evidence-based approaches,” said Ms. Pettigrew.

How the Service Works

The Women’s Sexual Health Consultation Service is primarily offered one day each month at the CU Advanced Reproductive Medicine office in the Stapleton neighborhood of Denver. Services are also offered at the OB-GYN clinic at the Anschutz Outpatient Pavilion and the Department of Psychiatry’s Women’s Behavioral Health and Wellness Outpatient Program. Given the popularity of the service, the team is hoping to expand hours and availability in the upcoming year.

The service addresses a range of concerns like difficulty with orgasm, changes due to aging, or medical conditions that have made sexual relationships difficult. The evidence shows that for sexual health, it is best to treat physical, psychological and relational concerns together. The service is interdisciplinary; medical and psychological clinicians work together in an integrated setting to provide a range of services including sexual education, medical treatment of gynecological conditions, medications, physical therapy, and sex therapy for individuals or couples.

The service is run jointly by the Department of Obstetrics and Gynecology and the Department of Psychiatry. The Sexual Health Consultation Service team also works in partnership with other departments that serve women who may have a need for the service.

College of Nursing students from the Nurse Practitioner program have worked with the Women’s Sexual Health Consultation Service as part of their education. Given the sensitive nature of the service, Ms. Pettigrew wondered if patients would object, but none of them did. “They were open to the next generation learning about this and seeing the value in sexual health care,” she said.

Having the Conversation and Making Referrals

Having a conversation with women about sexual health is a simple, low-tech way to improve women’s health care. Women often don’t know that sexual health is something that matters for their health and may not initiate a conversation with their doctor, so it’s important for clinicians to take the lead.

“Just having the conversation can be therapeutic and really improve women’s lives, relationships and wellbeing,” said Ms. Pettigrew. “When a woman living with chronic illness or a cancer survivor is asked about this part of their life and health, it’s validating for them to know they are not alone and their sexual health is, in fact, important.”

Clinicians who are not used to having this conversation may feel awkward at first, but there are some simple questions to open up the discussion:

• Do you have any sexual concerns you would like to discuss?
• Many women with this condition (or medication) notice some changes in their sexual function or sexual desire. Have you notice any changes?
• Many women recovering from cancer treatment struggle with their sexual relationships or sexuality. Have these issues come up for you?

When clinicians frame sexual health problems as common and normal, they create space for a conversation that can improve both the experience and outcomes of care. Clinicians can refer women to the service by having them contact the Stapleton location at 303-724-8089.