(137) MULTIDISCIPLINARY PERSPECTIVES ON FEMALE SEXUAL HEALTH: HOW CAN WE DO BETTER?
Authors: Pankove R , Longhini K , Wittmann D , Mehta A 
Published: June 2024

Abstract

Introduction
Sexual dysfunction is a pervasive yet overlooked concern in the care of women with chronic urological conditions.

Objective
The purpose of this study is to evaluate the challenges and opportunities that urologists and sex therapists encounter when treating and referring female patients with chronic urological conditions and sexual health concerns.

Methods
All participants were recruited by email to participate in semi-structured interviews about their current practices, perceived barriers and facilitators, and preferences for further training. The interviews were recorded, transcribed, and inductively coded by two independent researchers. Excerpts were then analyzed using qualitative description to identify themes.

Results
We conducted 22 interviews involving 6 urologic oncologists, 7 urogynecologists, and 9 sex therapists, and determined themes affecting care for women with chronic urological conditions and sexual concerns: (Table 1). Lack of Training All participants indicated lack of education on the association between female sexual dysfunction and chronic urological conditions. Urologists were hesitant to discuss sexual health, citing a lack of counseling skills and treatment familiarity. Sex therapists, particularly those unaffiliated with academic centers, either did not inquire about or could not identify urological conditions in patients. Participants universally supported more focused training. Insufficient Communication Urologists were unlikely to proactively initiate the conversation about sexual health concerns with patients, primarily due to lack of time, need to focus on primary urological issues, older patient age, or the patient's low priority of sexual health. They saw merit, however, in using standardized questionnaires to facilitate discussions. Urogynecologists avoided treating sexual dysfunction to maintain a balanced surgical and clinical caseload. Sex therapists faced communication challenges with patients who normalized their symptoms or were overwhelmed by the chronicity of their condition. Integrated Care All participants considered multi-disciplinary collaboration with one another, and with gynecologists and pelvic floor physical therapists to be beneficial. Referral Dynamics All participants identified cost, insurance coverage, lack of understanding of each profession's capabilities, and patient reluctance as barriers to referral. Urologists were motivated to refer to sex therapists when they exhausted treatment options, when patients expressed interest in seeing a sex therapist, or when urologists had a trusted list of sex therapists for referrals. Sex therapists were more inclined to refer if they knew the urologist was collaborative, possessed a good bedside manner, showed interest in female sexual medicine, and had good marketing.

Conclusions
Participants faced personal, professional, and patient-centered obstacles when addressing the sexual concerns of women with chronic urological conditions. Future interventions should aim to mitigate these factors and promote cross-disciplinary partnership to enhance the overall quality of sexual health care.

Disclosure
No.