Research Needed for Women’s Sexual Health

In “Leaving No-Woman’s Land” (Issues, Fall 2024), Jewel Kling, Sara Collina, and Lindy Elkins-Tanton provide a resoundingly accurate description of the current state of women’s sexual health. As a women’s health internist specializing in sexual health, I regularly meet women struggling with sexual health concerns who have been neglected, ignored, and gaslighted by the medical community. They often present with low libido, trouble with arousal or orgasm, or pain with sex. For many who report such sexual health concerns to their clinicians, the clinicians too often tell the women the conditions are normal or all in their heads.

As Kling, Collina, and Elkins-Tanton recount, many factors have led the medical community to leave women’s sexual health in the dark, preventing women from accessing comprehensive, compassionate care. One factor is the lack of medical education in women’s sexual health at the medical school, residency, fellowship, and attending (independent physician) level. I personally did not learn about women’s sexual health until my women’s health fellowship, eight years into my medical training. In addition, there is insufficient insurance reimbursement for sexual health-related visits and too few medications approved by the US Food and Drug Administration for female sexual dysfunction. There are two FDA-approved medications for hypoactive sexual desire disorder—low desire/libido—but they are approved only for premenopausal women. There are no approved treatments for low libido in postmenopausal women compared with the 26 or more approved medications for treating male sexual problems. Finally, and critically, there is a paucity of women’s sexual health research.

I spend most patient visits explaining that there is insufficient research on women’s sexual health to enable me to counsel women on the true benefits and risks of treatments. Therefore, I am often stuck performing anecdotal medicine, treating the patient in front of me based on stories and experiences of other patients and colleagues, as opposed to clear, well-formulated science. In most other fields of medicine, patients are provided with well-formulated treatment plans based on the gold standard type of medical research: randomized controlled trials (RCTs). RCTs provide an unbiased, clear relationship between a treatment and its effectiveness, allowing clinicians to provide their patients with efficacy rates and true benefit versus risk data—information vital to informed decisionmaking by both clinicians and patients.

In women’s sexual health, due to lack of funding for RCTs, clinicians often must rely on “observational” research that does not allow us to know the true unbiased effectiveness of a treatment or intervention. This kind of research leads us to make treatment decisions without being able to confidently guarantee outcomes to our patients. This leaves women’s sexual health management in a vacuum, where different medical professionals recommend different treatments based on sparse science. This frustrates me as a sexual health doctor because it often confuses patients, leads to misinformation about treatments, and can impact the patient-clinician relationship and trust as patients may receive contradictory recommendations from other medical professionals or from social media.

The US Department of Health and Human Services’ commitment to provide $100 million for women’s health research is a helpful start, and I am hopeful this will ultimately lead to more evidence-based recommendations and FDA-approved treatments for women’s sexual health disorders. I also encourage medical educators to include women’s sexual health at all levels of medical education. Without this, students and clinicians will be unable to provide sufficient care to their patients and women will continue to suffer with sexual dysfunction.

Talia Sobel