Contradictions in the medical encounter: Female sexual dysfunction in primary care contacts

Abstract

Background. Over the past two decades, primary care physicians have been encouraged to participate in the management of sexual disturbances. Women with type 2 diabetes, often treated by GPs, are at high risk of experiencing sexual dysfunction. Objective. Very few qualitative studies have described the impact of sexual dysfunction on the diabetic women experiencing it. Our aim was, therefore, to explore the effects, if any, of type 2 diabetes on 'womanhood and intimacy' and investigate whether women wish to receive medical attention for their sexual disturbances. Methods. We used a purposeful sample of middle-aged and older women (44-80 years) diagnosed with type 2 diabetes (n=33). Methods triangulation was employed: focus group interviews were combined with observer data and a structured, anonymous questionnaire. We performed content analysis, with co-researcher control for systematic bias during the coding process. Results. Personal characteristics, such as age, sex, experience and attitude of the doctor, the speciality considered to be appropriate (GP versus gynaecologist) and circumstances (time and privacy) in the primary care setting appeared to significantly influence women's willingness to discuss-if at all-sexual matters with physicians. Conclusion. GPs should aim to create an open atmosphere to encourage discussion of female sexual dysfunction in the consultation room. However, women with sexual problems might benefit more from peer help through patient or women's organizations. The role of GPs might therefore consist of supporting these services and identifying female sexual dysfunction in type 2 diabetes, a problem that middle-aged and older women have difficulty communicating.