Marilyn C. Jerome, MD, FACOG, a practicing gynecologist at Foxhall OB-GYN Associates in Washington, DC, explored how to encourage open dialogue with patients on healthy sexuality and pleasure and how health care providers can address patients’ sexual function and satisfaction.

1. Sexual Function in a
Gynecology Practice
Marilyn C. Jerome, MD
Foxhall Ob-Gyn Associates

2. Speaking to different ages
• Younger women
• Fertility
• Child bearing women
• Perimenopause
• Menopausal women
• The older women

3. How to start the discussion
• Comfortable environment
• Intake forms: asking the correct questions
• Trust
• Time
• Clues
• Open-ended questions
• Sexual dysfunction comes with discussion of menopause, birth
control, etc.

4. Environment
• Visuals
• Pamphlets
• Comfort: Why would you talk to me about it?

5. Intake forms
• Items on your problem list: painful intercourse,
decreased sex drive
• Open ended questions: What would you like to
talk about today?
• Sexual orientation
• Do you feel safe at home?

6. Intake forms

7. Questions

8. Visuals

9. Reading materials

10. Visuals

11. Visuals

12. Younger women
• Inability to have penetration
• STD’s
• Contraception
• Painful intercourse
• Inability to have orgasm
• Multiple partners
• Decreased libido

13. Trying to conceive
• Understanding the physiology
• How to manage contraception
• Avoiding toxins
• Positions, lubricants, etc.

14. Childbearing
• Physical changes after pregnancy
• Vaginal laxity
• Decreased interest
• Exhaustion
• Breastfeeding

15. Peri-menopause
• Decreased testosterone levels: decreased libido
• Anatomy
• Having sex after taking a break
• STD’s
• Contraception

16. Decreased libido
• It is complicated
• Relationship issues
• Physical issues
• Emotional issues
• Biological issues: testosterone decreases after 40
• Treatments: supplements, testosterone, new
injectable drug: Vyleesi, Addyi

17. Menopause
• Vaginal dryness
• Painful intercourse
• Decreased libido
• Lack of orgasm

18. The older adult
• Erectile dysfunction
• Difficulty with positions
• Learning other techniques of sexual satisfaction

19. Using sexual aids
• Dilators
• Vibrators
• Lubricants
• Moisturizers
• Enhancing interest

20. It’s complicated
• Relationship issues: “I don’t find my husband
attractive anymore”
• Relationships outside marriage
• Pain: pelvic floor physical therapy
• Marriage counseling
• Sex therapists

21. Biggest problem
• So much to discuss, so little time!!!