Managing Women with Sexual Dysfunction: Difficulties Experienced by Malaysian Family Physicians
- 85 Downloads
Recognizing barriers to managing sexual issues makes it more likely that effective ways to overcome them will be found. In Malaysia, where discussion of sexual issues is taboo, sociocultural factors may influence how physicians manage patients with these types of problems. This article focuses on the challenges encountered by 21 Malay family physicians when women experiencing sexual problems and female sexual dysfunction (FSD) attended their clinics, an uncommon occurrence in Malaysia, despite their high prevalence. This qualitative study employed a phenomenological framework and conducted face-to-face in-depth interviews. Three main barriers to managing women with sexual problems were identified that can hinder assessment and treatment: insufficient knowledge and training; unfavorable clinic environments; and personal embarrassment. Some barriers were associated with physician characteristics but many were systemic. These were further evaluated using social cognitive theory. Professional attitudes appear important as those physicians with an interest in managing women’s health seemed to make greater effort to explore issues further and work to gain trust. Physicians who appeared indifferent to the impact of FSD showed greater reluctance to find solutions. Systemic issues included unfavorable clinical settings, lack of training, and lack of local evidence. Any strategy to address FSD needs to be underpinned by appropriate policies and resources.
KeywordsFemale sexual dysfunction Physicians Primary care Sexual health DSM-5
Special thanks to Dr. Paul O’Halloran, Prof. Hatta Sidi, and Brigid McCoppin for their valuable contribution to some parts of this study.
- Abdolrasulnia, M., Shewchuk, R. M., Roepke, N., Granstaff, U. S., Dean, J., Foster, J. A., … Casebeer, L. (2010). Management of female sexual problems: Perceived barriers, practice patterns, and confidence among primary care physicians and gynecologists. Journal of Sexual Medicine, 7, 2499–2508. https://doi.org/10.1111/j.1743-6109.2010.01857.x.CrossRefPubMedPubMedCentralGoogle Scholar
- Academy of Medicine of Malaysia. (2000). Clinical practice guidelines in erectile dysfunction. Retrieved May 15, 2017 from http://www.acadmed.org.my/index.cfm?&menuid=28.
- Alarcão, V., Ribeiro, S., Miranda, F. L., Carreira, M., Dias, T., Gracia e Costa, J., & Galvão-Teles, A. (2012). General practitioners’ knowledge, attitudes, beliefs and practices in the management of sexual dysfunction: Results of the Portuguese SEXOS study. Journal of Sexual Medicine, 9, 2508–2515. https://doi.org/10.1111/j.1743-6109.2012.02870.x.CrossRefGoogle Scholar
- Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
- Bekker, M., Beck, J., Putter, H., van Driel, M., Pelger, R., Nijeholt, A. L. A., & Elzevier, H. (2009). The place of female sexual dysfunction in the urological practice: Results of a Dutch survey. Journal of Sexual Medicine, 6, 2979–2987. https://doi.org/10.1111/j.1743-6109.2009.01460.x.CrossRefPubMedPubMedCentralGoogle Scholar
- Chan, A., Shagar, L., & Aravinthan, R. (2015). Worrying factors for divorce. The Star Online. Retrieved May 20, 2016 from https://www.thestar.com.my/news/nation/2015/06/11/worrying-factors-for-divorce/.
- Dyer, K., & das Nair, R. (2013). Why don’t healthcare professionals talk about sex? A systematic review of recent qualitative studies conducted in the United Kingdom. Journal of Sexual Medicine, 10, 2658–2670. https://doi.org/10.1111/j.1743-6109.2012.02856.x.CrossRefPubMedPubMedCentralGoogle Scholar
- Federal Constitution. (2010). Article 160: Malay definition. Kuala Lumpur: Percetakan Nasional Malaysia Berhad.Google Scholar
- FMT Reporters. (2015, June 10). Nagging wives, rough sex ups Muslim divorces in S’gor. Free Malaysia Today. Retrieved May 20, 2016 from http://www.freemalaysiatoday.com/category/nation/2015/06/10/nagging-wives-rough-sex-ups-muslim-divorces-in-sgor/.
- Liamputtong, P. (2013). Qualitative research methods (4th ed.). Melbourne: Oxford University Press.Google Scholar
- Low, W. Y. (2004). Impact of sexual health course on Malaysian university students. Medical Journal of Malaysia, 59, 443–449.Google Scholar
- Luszczynska, A., & Schwarzer, R. (2005). Social cognitive theory. In M. Conner & P. Norman (Eds.), Predicting health behaviour (2nd ed., pp. 127–169). New York, NY: Open University Press.Google Scholar
- Minichiello, V., Aroni, R., & Hays, T. N. (2008). In-depth interview: Principles, techniques and analysis (3rd ed.). Armidale: Pearson Education Australia.Google Scholar
- Ministry of Health. (2010). Country health plan. 10th Malaysia plan 2011–2015. 1 care for 1 Malaysia. Putrajaya, Malaysia: Ministry of Health. Retrieved May 23, 2016 from http://www.moh.gov.my/images/gallery/Report/Country_health.pdfMOH.
- Muhamad, R. (2017). Female sexual dysfunction: Meanings and experiences in West Malaysia. Unpublished doctoral dissertation, La Trobe University, Melbourne, Australia.Google Scholar
- Nicolosi, A., Glasser, D. B., Kim, S. C., Marumo, K., & Laumann, E. O. (2005). Sexual behaviour and dysfunction and help-seeking patterns in adults aged 40–80 years in the urban population of Asian countries. BJU International, 95, 609–614. https://doi.org/10.1111/j.1464-410X.2005.05348.x.CrossRefPubMedPubMedCentralGoogle Scholar
- Pauls, R. N., Kleeman, S. D., Segal, J. L., Silva, W. A., Goldenhar, L. M., & Karram, M. M. (2006). Practice patterns of physician members of the American urogynecologic society regarding female sexual dysfunction: Results of a national survey. International Urogynecology Journal, 16, 460–467. https://doi.org/10.1007/s00192-005-1286-5.CrossRefGoogle Scholar
- Ribeiro, S., Alarcão, V., Simões, R., Miranda, F. L., Carreira, M., & Galvão-Teles, A. (2014). General practitioners’ procedures for sexual history taking and treating sexual dysfunction in primary care. Journal of Sexual Medicine, 11, 386–393. https://doi.org/10.1111/jsm.12395.CrossRefPubMedPubMedCentralGoogle Scholar
- Sidi, H., Puteh, S. E. W., Abdullah, N., & Midin, M. (2007). The prevalence of sexual dysfunction and potential risk factors that may impair sexual function in Malaysian women. Journal of Sexual Medicine, 4, 311–321. https://doi.org/10.1111/j.1743-6109.2006.00319.x.CrossRefPubMedPubMedCentralGoogle Scholar
- Weiss, D., Freund, A. M., & Wiese, B. S. (2012). Mastering developmental transitions in young and middle adulthood: The interplay of openness to experience and traditional gender ideology on women’s self-efficacy and subjective well-being. Developmental Psychology, 48, 1774–1784. https://doi.org/10.1037/a0028893.CrossRefPubMedPubMedCentralGoogle Scholar
- World Health Organization. (2006). Sexual Health Report of a Technical Consultation on Sexual Health (28–31 January 2002, pp. 1–30). Retrieved May 15, 2016 from http://www.who.int/reproductivehealth/topics/gender_rights/defining_sexual_health.pdf.
- Zainab, I., Wan-Ibrahim, W. A., & Asyraf, H. A. R. (2014). Marital breakdown in Muslim Community in Malaysia. Middle-East Journal of Scientific Research, 20, 1440–1444. https://doi.org/10.5829/idosi.mejsr.2014.20.11.21072.CrossRefGoogle Scholar