Women's Sexual Function and Dysfunction. Irwin Goldstein MD

Patient outreach and education

Lillian Arleque

Introduction

Until recently, when women complained of sexual health problems to their physicians, their only treatment option was referral to a mental health professional (see Chapters 17.2 and 17.3 of this book). As a result of this historical reliance on a psychologic model for treatment, many women suffering from sexual health problems are unaware that their symptoms may actually be caused by a physical problem (see Chapters 13.1-13.3, 14.1, and 14.2). Recent findings have demonstrated that in many cases of female sexual dysfunction, there is both a psychologic cause and an underlying physiologic cause, and that with proper medical and psychologic intervention a significant number of women have been able to regain their sexual function completely. Therefore, it is incumbent upon health-care professionals to reach out to women to make them aware that their sexual health is an integral component of their physical health and well-being, and to educate them about symptoms and possible medical and psychologic treatments for female sexual dysfunction (see Chapters 17.4, 17.5, and 18.1).

The purpose of this chapter is to provide health-care professionals with suggestions and information on how to effectively inform and educate women and their partners about the symptoms as well as the possible cures for female sexual dysfunction. A number of possible models and educational strategies are presented so that the reader may replicate and/or enhance or expand upon each suggestion. Many of these strategies and ideas utilize technology that makes patient outreach and education a dynamic and interactive process.

Key factors necessary for outreach and education

When designing and planning for patient outreach and education, it is important to be cognizant of key components that will contribute to their effectiveness and success. It is also important to be aware that many women are hesitant to broach the subject of sexual health with their health-care professionals out of embarrassment or as a result of experiences when their concerns were patronizingly minimized and/or they received inadequate treatment (i.e., exclusively psychologic management that was not successful). Accordingly, it is critical for health-care professionals to feel comfortable in asking their patients questions regarding sexual health thus giving patients the opening to discuss any issues and concerns they may have. Moreover, by posing questions on sexual health, health-care professionals can better care for their patient’s physical health and well-being and/or refer them to other resources for treatment.

Educational environment

All education should take place in a safe and secure environment. Whether a woman is sitting in a health-care professional’s office in a one-on-one situation or attending an off-site seminar on female sexual dysfunction, it is crucial that she feel comfortable and safe in discussing the details of her sexual function or hearing a lecture on the physiologic intricacies of a women’s body and sexual response.

Provide ample time for questions and concerns

The subject of sexual health and dysfunction is extremely difficult for many women to discuss; in fact, many women are so sensitive about the issue that they may not have discussed their problems even with their partners. For this reason, all outreach and education programs need to provide patients or participants with ample time to express their feelings and articulate their questions and concerns. Women need to believe that they are listened to, acknowledged, and respected, especially when they are talking about the most intimate details of their lives.

Provide resources for active involvement and self-directed learning

Since the Internet has many sites focused on health, women who are suffering from sexual health problems may have already become actively involved in educating themselves through online searches. The purpose of their research is often to locate information and resources to assist them in understanding and articulating their sexual health concerns as well as finding health-care professionals to treat their problems. Therefore, all outreach and educational programs on female sexual dysfunction should include information on additional resources available to women, so they may continue to be actively involved in seeking information and solutions. These may include bibliographies, websites, newsletters, outreach programs, etc. Furthermore, as self-directed learners, they will need the opportunity to seek feedback and to interact with their health-care professionals to determine and clarify their understanding of their issues and concerns. This can be accomplished through patient visits, telephone conversations, e-mail, and on-site and off-site educational seminars.

Outreach and education strategies

Newsletters

Printed

A quarterly newsletter is an excellent tool that provides useful and up-to-date information to patients as well as other interested individuals and health-care professionals who are seeking education and knowledge about women’s sexual health. Investing significant time, discussion, and preparation prior to its initial publication in order to determine intended outcomes and a target readership are critical to the newsletter’s long- range success and effectiveness. Having a stated purpose and specific outcomes will assist the editors of the newsletter in decision making regarding future content. In addition, determining a target readership will enable the editors and writers to maintain focus on the needs and level of understanding of the readers. For example, if the primary audience is lay people, the articles need to be informative and “translated” into appropriate language. If it is necessary to include complex vocabulary in order to present a concept, it is helpful to provide definitions within the context of the article and/or to provide a glossary of terms within the newsletter. The ultimate value of the newsletter, as an educational tool, is contingent upon its ability to meet the informational needs and knowledge level of the reader.

The content of the newsletter may vary, but a standard format is more effective, as it creates consistency and a sense of predictability for the reader. For example, a newsletter could start with a message from the physician. A message about sexual medicine education from the health-care professional responsible for education could also be included as well as summaries from recent sexual medicine information sessions. Other possibilities are announcements of upcoming events devoted to sexual medicine issues, and highlights of recent sexual medicine meetings. Along with the standard format, “special features” may be included that enhance the educational value of a newsletter. Summaries of research, book reviews, patient stories, articles by experts in the field, in-depth articles focusing on specific sexual health problems, interviews, a listing of resources such as a bibliography, recent publications, and related websites are all ways to educate and reach out to interested individuals through the newsletter.

Before the Internet, a newsletter was typically a printed document that was mailed through the postal service. The cost of doing a printed newsletter four times a year may be substantial, especially if the printing and mailing are done by an outside company. However, given the sophisticated, yet user-friendly and relatively inexpensive software that is available, printing and publishing a newsletter can be a viable educational tool for even the smallest health-care practice. In-house printing can be easily accomplished by software with a newsletter template allowing two- or three-column design. In addition, a number of paper companies offer high-quality and colorfully designed papers for two- or four-sided newsletters that ensure a professional appearance yet utilize inexpensive black-and-white printing.

The most efficient and timely way to send a printed newsletter is by first-class mail, which is also the most expensive. On the other hand, using bulk mail through the US postal service can minimize mailing costs. However, this approach can add significant amounts of time to the process, as the items to be mailed need to be sorted and grouped by zip code. Delivery time is not guaranteed, and it may actually take 2-3 weeks for some people to receive their newsletter. Consequently, if the choice is bulk mail rather than first class, and there are announcements in the newsletter pertaining to upcoming events, it is important that ample time be given for the mailing process.

Electronic

Another way to minimize the expense of publishing a newsletter is to use e-mail as a delivery mechanism. In addition to the environmental benefit of saving paper, an e-newsletter enables one to reach a significant number of individuals in a more cost-effective manner. People interested in receiving the newsletter via e-mail can register through the practice website. Furthermore, current patients and interested individuals who have participated in on-site informational sessions or offsite seminars can also be invited to register for the newsletter via e-mail. Utilizing the Internet to “distribute” the newsletter, however, does not necessarily eliminate the need for a printed version, as there are still people who do not have access to or chose not to use e-mail. Accordingly, when offering a newsletter as a resource tool, it is important to provide people with the choice of receiving it through e-mail or traditional mail.

Information sessions and seminars

Effective communication

All effective communication is tailored to and delivered with the “receiver” in mind. Based on that premise, it is clearly the responsibility of the “speaker” to design and present concepts in a manner that will ensure that individuals understand as well as remember the information presented to them. Consequently, when health-care professionals are planning to educate and/or reach out to women regarding female sexual dysfunction, it is important to consider and utilize strategies for effective communication.

Since most adults rely on visual forms of communication rather than oral communication as their primary source for learning new concepts and remembering information, it is critical to incorporate written documentation as well as visual representations of data and information to support verbal instruction and explanation. In most situations, patient education is presented orally, whether it is in a one-on-one setting with the health-care professional or in a group program. This oral information can be supported with graphic representations such as pictures, diagrams, graphs, and flowcharts to illustrate concepts. Written information can also be enhanced by similar types of graphic representations, thus aiding the comprehension and retention of the data. Furthermore, since the terminology describing sexual health issues and diagnosis may be unfamiliar to patients and other lay people, a glossary of specific vocabulary used by health-care professionals would enable individuals to feel competent and comfortable enough to engage in discussion and articulate their concerns, as well as read, with comprehension, additional literature on the topic of female sexual dysfunction.

Information sessions

Information sessions typically attract small to middle-sized groups and are usually held in a clinical setting such as a hospital conference room, auditorium, or practice waiting room. Since the meetings are usually no longer than 2 h, it is more effective to plan a series of sessions, thus providing participants with the opportunity to attend several sessions and experience a more in-depth discussion of a focused topic at each session. Current patients and their partners often attend these sessions, and this venue can be utilized to enhance and clarify the education that was presented during their office visit. Advertising for on-site informational sessions entails little or no expense and can be accomplished through the practice website, within the office, through hospital newsletters, in local newspapers and any other available publication resource.

Successful model - information sessions

The instructional design of an information session may consist of the following: a lecture by a health-care professional who is an expert in the session topic, the opportunity to hear a patient speak of her experience, and a question-and-answer period. This format provides education, clarity, and concept reinforcement for patients and their partners. It gives them an opportunity to ask questions and meet other patients in a nonthreatening and safe environment. It also gives nonpatients the opportunity to learn about female sexual dysfunction and to meet health-care professionals who treat sexual medicine issues.

Off-site educational seminars

The off-site educational seminar is a comprehensive educational program designed to attract a large group of people. The seminar is held in a nonclinical setting, usually a hotel or a conference center that is centrally located to major roads with ample parking. With a concerted advertising effort, off-site seminars will often attract current patients and their partners, individuals who are seeking more information about female sexual dysfunction, and health-care professionals who desire to learn about treatment options for their patients.

Because the intent of this seminar is to reach a larger and wider population beyond the practice and into the community at large, planning for an off-site seminar is significantly more time-consuming than an informational session. Moreover, because the printed material informing the public about the seminar is a reflection of the practice, it is strongly recommended that all promotional materials be professional yet eyecatching. Preparation for the seminar should also include a marketing plan that incorporates both free and paid advertising. Brochures and flyers announcing the seminar can also be distributed to local and regional physician practices by utilizing a professional mailing list. A well-designed brochure to promote the seminar can include educational information on female sexual dysfunction that will heighten the awareness of anyone who has the opportunity to read it and thus be of value as an outreach tool well past the program date. Needless to say, promotional materials, advertising, and mailing can be costly, but educational grants and other creative financial approaches can be used to defray expenses.

Successful model - off-site seminar

An example of a successful model is as follows. The seminar program begins with a 1-2 h lecture by a physician who specializes in sexual medicine. The purpose of this educational lecture is to explain the background science, the symptoms, up-to-date supporting research, and current treatments for female sexual dysfunction. The physician establishes a strong science foundation for the participants, and, of equal importance, the lectures are designed to use slides and language that are appropriate for the layperson.

After the lecture, a panel with five to six volunteer patients provides participants in the seminar with the opportunity to hear individual women describe their stories of dealing with their personal sexual dysfunction. The effective selection of women for the panel includes patients of varying ages with a wide range of problems and solutions, thus enabling participants to hear real-life experiences to which they can relate. One very powerful strategy for the patient panel is to have each patient sit with her sexual medicine physician in front of the participants.

In addition to facilitating the discussion and helping the patient to feel at ease, the physician can provide a brief history of the patient’s story, ask clarifying questions, and contribute specificity to patient remarks during the interview. If the volunteer patient feels comfortable, a brief question-and-answer session after each interview gives participants the opportunity to gain additional insight and knowledge from the prior discussion.

After the patient panel and a break, participants return to a room set up for focus groups. An effective strategy for the focus groups is to assign a specific topic to each group and to include a health-care professional as well as the patient from the panel who spoke on that topic to act as facilitators. Participants of the seminar are then invited to select the group that is the most relevant to them. Utilizing focus groups as a seminar strategy allows for more specific discussion and interaction on a particular issue and provides participants with a comfortable and secure setting to ask additional questions as well as a feeling of security that encourages the sharing of information and personal experiences.

The last segment of the seminar is the expert panel. Members of the panel may include health-care professionals who specialize in sexual medicine or who treat women with female sexual dysfunction, such as physicians, psychologists, physical therapists, nurses, or any other specialist who could contribute knowledge and information that would enhance and extend the understanding of the participants.

Patient-to-patient support

E-mail can also be used as a strategy for physician-to-patient and patient-to-patient education and outreach. Many health-care professionals are now asking patients for e-mail addresses; as a result, they can now communicate directly with their patients for education and clarity and to provide patients with e-mail addresses, with permission, of other women with similar experiences. For example, although the physician provides education and direction about the therapy, a patient concerned about using a particular therapy can communicate through e-mail with another willing patient to ease her concerns and anxiety. This strategy provides the level of anonymity that a patient desires yet enables her to gain from the knowledge and personal experiences of another woman.

Brochures and pamphlets

Publishing software makes it possible to create brochures and pamphlets for distribution within the office. These bi-fold or trifold documents can be utilized to provide current patients with information to enhance and extend their understanding of female sexual dysfunction. For example, a pamphlet or brochure describing the symptoms and risk factors of female sexual dysfunction would contribute to the patient’s knowledge base and could be easily taken home by the patient for reference. Because they are printed in the office, they can be easily updated with current information and resources.

Websites

Any individual or group seeking to provide education and outreach programs on the topic of female sexual dysfunction must have a website. The Internet has become the first step in the research/education process for both lay people and health-care professionals. A typical practice website includes contact information for making an appointment and directions to the location. It may also include the mission statement and goals so that future patients will know that the approach of the health-care professionals in the practice is in alignment with their personal philosophies. It may provide the background information and credentials as well as the achievements and affiliations of the healthcare professionals in the practice. These components enable women to feel confident that their health-care needs would be met and that any information on the site is credible and reliable.

On the other hand, a more comprehensive website designed to educate patients, health-care professionals, and researchers looking for information and resources on female sexual dysfunction can be an excellent and versatile tool for education and outreach. Visitors to the website can read summaries of state-of- the-art research as well as information about upcoming programs and seminars. A section of frequently asked questions might give more specific information about various aspects of female sexual dysfunction. For example, an individual may learn the symptoms of female sexual dysfunction or what tests are used to diagnose it. The website can also lead Web researchers to other sites and resources, enabling individuals to learn about organizations such as the International Society for the Study of Women’s Sexual Health (ISSWSH) and upcoming professional conferences. It is critical to be continually cognizant of the level of understanding of the visitors to the website. While many health-care professionals may use the site as a tool, there may also be many lay people visiting the site for information. Consequently, providing a glossary of terms will enable all visitors to comprehend and understand the content on the site.

Patient support groups

The website can also provide for patient-to-patient support groups through a chat room. Health-care professionals can also arrange for focus/support groups within the practice. In this venue, a healthcare professional facilitates and guides the discussion between patients with similar issues and concerns. This opportunity enables individuals to ask questions both of the health-care professional and other patients, providing both clarity and support.

Media

Utilizing various media outlets as a tool for education is another inexpensive yet extremely effective strategy that can reach out to a large number of women. When a health-care professional is considered an expert in a specialty, print and media journalists often contact him or her for interviews for magazine and newspaper articles as well as television and radio interviews. Health care professionals can also write articles for large and small print publications and websites that target women readers.

Summary

Because of the past treatment focus totally on a psychologic model, women need to be educated that new findings have demonstrated that female sexual dysfunction is often caused by a physiologic problem that is treatable. The first step that health-care professionals can take to alleviate the emotional suffering and physical distress that many women are experiencing is to develop outreach and education programs that heighten women’s awareness and understanding of sexual health problems as well as informing them of possible treatments.