AUSTIN, Texas -- Vibrators may still be considered a taboo subject, even among healthcare professionals, but more gynecologists need to be talk about their medical use among certain patients who might benefit from them, according to Lauren Streicher, MD, of the Feinberg School of Medicine at Northwestern University in Evanston, Illinois.
Acquired orgasmic dysfunction is common among patients with a variety of comorbidities, including women with vascular disease, neurologic disease, chemotherapy, and those taking selective serotonin reuptake inhibitors (SSRIs), explained Streicher, an associate clinical professor of obstetrics and gynecology, in a talk at the American College of Obstetricians and Gynecologists (ACOG) annual meeting.
"If a guy has prostate cancer, the first visit [clinicians] say, 'Okay, you have prostate cancer, here's how we're going to treat it and as a result of this treatment, you might have erectile dysfunction.' They just say it. Women are never told 'If you have this treatment, you might go into menopause and your vagina might dry up,'" Streicher told MedPage Today.
Treatments for acquired orgasmic dysfunction can include counseling, sex therapy, treatments to increase blood flow (hormone therapy), certain nutraceutical treatments, pelvic floor physical therapy, and prescribing a vibrator.
Streicher cited a study that examined 500 women, ages 18-88, with chronic anorgasmia. One group was given psychotherapy and complementary medicine and the other group was prescribed clitoral vibrator stimulation. In the second group, 93% of women had an orgasm triggered by clitoral masturbation.
Vibrator use is also common, according to a 2009 study that found over half of 3,800 women, ages 18-60, said they used a vibrator. Streicher emphasized how important it is for gynecologists to normalize vibrator use when talking to their patients.
"When I teach medical students, I tell them, 'Don't ever, ever say to a patient: Do you have a vibrator? Say to them: When you use your vibrator...' That way, if they have a vibrator, they're just relieved and if they say 'I don't have a vibrator,' you say 'Really? Everybody else does,'" she stated.
Streicher detailed how biologically, a female orgasm involves the neurologic system, the vascular system, and the pelvic muscles. Therefore, any comorbidities impacting these systems -- vasculopathy; neuropathies or neurologic diseases (multiple sclerosis, spinal cord injury, pelvic floor dysfunction) -- can be associated with acquired orgasmic dysfunction.
Notably, certain types of vasculopathy can decrease vaginal lubrication due to endothelial dysfunction, lead to impaired vaginal and clitoral engorgement, and impaired neurologic function, such as decreased genital sensation and clitoral neuropathy, she said.
Streicher said she is currently conducting a study based on the theory that the same population of women who have diabetic neuropathy also have clitoral neuropathy, which can include reduced clitoral sensation, a higher vibration perception threshold, and anorgasmia. Notably, about one out of three women with diabetes have anorgasmia, she said.
But most doctors are unaware of how to approach this conversation with patients, either saying nothing, or asking "Are you sexually active?" Streicher pointed out that most women think that means "Are you having vaginal intercourse and do you need contraception?" However, few doctors are discussing the full range of sexual dysfunction these patients may experience.
"I guarantee you, ask a patient if she has sexual problems, she might tell you if she has pain, but she's not going to talk about orgasmic dysfunction," Streicher said.
"You need to do the talking for the patients," she told MedPage Today. "Tell them, 'A lot of women with diabetes have sexual concerns, like maybe they have low libido or they can't have an orgasm or maybe it's hard for them to get aroused or maybe they have painful sex. Are any of those a concern of yours?' Then the patient can just nod.