Too many times after an obstetric-gynecologic exam, Horowitz was headed out the door when a female patient offhandedly pretended to remember to ask a question.
Typically, it was a question about sexual health: lack of libido. Painful sex. Vaginal dryness. No orgasms.
“For many years, I said the same thing that many doctors still say to women: ‘Well, you’re busy. You’re a wife. You’re a mother. It’s hard to feel sexy when the laundry needs doing,’” explained Horowitz of Royal Oak Beaumont Hospital. “I always felt I was shortchanging them.”
Several years ago, Horowitz, a 32-year veteran ob-gyn, decided to tackle the issues directly and boost her training in female sexual health.
“I started asking patients and the responses were overwhelming in terms of the problems that they were having,” said Horowitz, the founder of the Center for Sexual Wellness in Farmington Hills.
Despite the countless ways sex saturates our culture — from overt mentions in music and on TV to ads touting male performance boosters — talking about sex mechanically and medically can be awkward, especially for women.
Studies show that anywhere from 40 to 75 percent of women have a sexual health concern, regardless of age. And other studies show doctors rarely ask about the issue or delve into details to answer patients’ questions. Horowitz said she used to be one of those doctors.
Now, “nothing makes me gasp, nothing really rattles me when it comes to talking about sex,” Horowitz said.
Among the questions she hears are: “I’m having pain during sex” or “I’d rather go to bed with a book.”
“What’s wrong with me?” they ask.
If they’ve come to one of Horowitz’s past seminars, the women asking the questions know they’re not alone. Last year, Horowitz partnered with a restaurant owner for a dinner and sexual health seminar linked to the popularity of the erotic book Fifty Shades of Grey. She says she wants to stage another session when the movie of the same name is scheduled to be released early next year.
Elana Gottfried, a certified sex therapist and clinical social worker with the Center for Relationship and Sexual Health in Royal Oak, specializes in treating women who worry about low sexual desire, or have chronic pelvic pain associated with intercourse.
“Awareness about sexual health has definitely risen, but it’s still a hard topic to bring up,” said Gottfried.
When women seek her out, says Gottfried, the problems “have been going on for a long time, and they haven’t sought help because of embarrassment or shame or a (bad) experience with a doctor’s bedside manner.”
What women need to understand, said Sallie Foley, a psychotherapist and sex therapist educator at the University of Michigan, is that there is treatment and therapy available to alleviate the typical difficulties.
Historically, men’s sexual health issues have dominated research, said Foley, the former director of the University of Michigan Center for Sexual Health and co-author of Sex Matters for Women: A Complete Guide to Taking Care of Your Sexual Self.
Medical professionals “had mapped all the nerves and named them in the male reproductive system by the 1930s,” said Foley.
“It took until the 1990s for a similar mapping of women’s genital area,” said Foley, who credits one of her University of Michigan colleagues, ob-gyn researcher, Dr. John DeLancey, for the work.
Earlier this month, about 60-plus health care groups and university researchers signed an open letter to the U.S. Food and Drug Administration, urging the government agency to approve the first-ever drug to treat the most commonly reported form of female sexual dysfunction, hypoactive sexual desire disorder (HSDD) or low sexual desire.
There are 26 approved drugs for men’s lax libido, the signers said, and zero for women.
Although most women recognize male sexual disorders, such as erectile dysfunction, only a fraction of women know there’s a diagnosis for the sexual dysfunction they may have experienced, a recent survey showed.
Only 14 percent of more than 1,000 U.S. women between the ages of 30 and 50 knew about HSDD, according to the April survey commissioned by the nonprofit HealthyWomen and a pharmaceutical company developing a treatment for the condition.
Lack of sex can create tensions in romantic partnerships, shutting down intimacy and communication, and impairing women’s self-esteem as they blame themselves for the breakdown, said Foley. Many women don’t realize low sexual desire can stem from medical conditions and even common medications.
And the multitasking nature of women’s lives — managing jobs, children, households, volunteer work, etc. — also affects the timing and desire for intimacy.
“There’s this idea that women want to be magically carried off into the bedroom” to spark arousal, explained Foley. But even when women don’t initially feel in the mood, said Foley, they may want to make time and effort for sexual intimacy.
“Don’t expect it to look like Madonna in one of her musical videos singing ‘I want it. I want it,’” said Foley, referring to a lyric in the Michigan-bred pop star’s 1989 song “Hanky Panky.”
“Instead, think that once I start being touched and touch my partner,” said Foley, “my body will remind me of how much I want it.”
And their partners, said Foley, need to realize that mutual seduction and satisfaction starts in places other than the bedroom.
“I always say to couples that foreplay involves everything, including emptying dishwashers,” said Foley. “It’s about your partner respecting you, helping you, connecting with you.
“People change their rules in permanent partnerships, and they have to talk to each other about resentments and the work that relationships take.”
“It’s work to have a good sex life,” said Foley, “but it’s good work to do.”