SBHPP Speaker - Aleece Fosnight
By: Aleece Fosnight, PA-C, CSC-S, CSE, NCMP, IF

People often ask me; how did you get into sexual medicine? My answer is not quite as simple. For me, it was during my PA training at the University of Kentucky when trying to find a Master’s thesis topic. The majority of my classmates focused on orthopedics, hypertension, diabetes, etc., and for me, I needed something more. That’s when the Viagra commercial hit. While talking to my mom over the phone, a Viagra commercial came on the television, and I said, “That’s it! If there is a blue pill for men, there must be a pink pill for women.” WRONG. At that time, circa 2010, there was not a single FDA approved medication on the market for women’s sexual health. And guess what…it pissed me off. Why was it ok that we were learning about penises, prostates, and male ejaculation, and the mention of a clitoris or female orgasm was nowhere to be found? And what we were learning on the female reproductive system was focused on contraception, pregnancy, and STI prevention. Pleasure was nowhere to be found. Now, don’t get me wrong – we still have a long way to go in our medical training to include all of sexual health – but for me, women deserve more respect and acknowledgment on their body being more than just for male sexual pleasure and popping out babies.

During my clinical year, I had the amazing opportunity to complete my urogynecology rotation in England at a sexual medicine clinic as well as attend the World Association for Sexual Health (WAS) conference in Glasgow, Scotland. To say that I was blown away is an understatement. I had found my purpose and passion in my PA career, and it included a taboo topic here in the US. A topic engulfed with shame, embarrassment, and double standards. Pushing through obstacles was not new for me, but I knew that this was one big battle I was willing to fight for. Looking for a PA job in sexual medicine is like trying to find a needle in a haystack. However, the universe was looking out for me when a urologist that I used to work with while in high school called me up and offered me a job focusing on female urology and female sexual health. (By the way – did you know that sexual medicine falls under the urology specialty?) What? Insert dream job. Of course, I accepted and was thrilled to start my journey in sexual medicine.

If anyone knows me, they know that I am always looking for more and love learning! So, after my first year as a urology/sexual medicine PA, I realized I was still a long way from where I wanted to be as a clinician practicing sexual medicine. Looking for additional training and certification programs, I came across the organization, AASECT (American Association for Sexuality Educators, Counselors, and Therapists). Under AASECT’s continuing education tab was a postgraduate certificate program at the University of Michigan that provided all of the requirements to become certified as a sexuality counselor. Boom! Just what I was looking for! Application sent in and started their program in 2013. This innovative level of learning took my PA training to the next level, exploring sexual health concerns through a biopsychosocial lens and working with a sexual medicine team. This definitely upped the ante with my passion for treating sexual health disparities. And in 2020, I left a hospital-based outpatient clinic to open up a private practice devoted to sexual health.

Now that you know my story let’s explore more about sexual medicine and how you can implement simple techniques into your practice to validate and offer treatment options to your patients with sexual health concerns.

Let’s talk about the numbers. The PRESIDE1 (Prevalence of Female Sexual Problems Associated with Distress and Determinants of Treatment Seeking) study surveyed more than 30,000 US women aged 18 years and older regarding sexual function. This study found that 43% of women experience a sexual health concern compared to 31% of men. In a 2009 national survey, 80% of women believed that sexual health was an important part of their overall health and 73% of women prefer that their health care provider be the one to bring up the topic. This is where we come into the equation. We know that patients find topics health care professionals bring up to be more validating than if they are the ones to bring up that topic. If the provider doesn’t bring it up, then it must not be important, and the patient feels as if their concern is not relevant. The American Sexual Health Association (ASHA) defines sexual health as the ability to embrace and enjoy our sexuality throughout our lives. It is an essential part of our physical and emotional health.

One way to bring up the conversation is through the PLISSIT model. The “P” stands for permission, referring to giving the patient permission to open up about their concern. For example, “The majority of my patients going through menopause have low libido. Is this happening to you?” The “LI” stands for limited information, meaning you provide some pathophysiology information on why their concern is occurring. For example, “During menopause, the ovaries begin to shut down which causes sex steroids to lower in your body which can lead to lower libido.” The “SS” stands for specific suggestions, allowing the provider to give a handful of treatment options. For example, “There are a few treatment options that we could explore to treat your low libido, including hormone testing, specific medications that address low libido for women, and intimacy building exercises with your partner.” And lastly, the “IT” stands for intensive therapy, meaning pulling in additional resources or referrals out to provide a holistic treatment plan for the patient. For example, the provider may suggest a sensate focus exercise to improve the connection between the patient and their partner and/or refer to a sex therapist if there is unresolved past trauma that is hindering the patient from moving forward with their low libido management.

matter what you do as a provider, the most critical takeaway from this blog is to ask the question. Remember, most patients want you to bring up the topic. So, be prepared to answer their questions by validating their concern, using the PLISSIT model intervention, and referring to a specialist in your area when their concern may be outside your scope. Or, if you are interested in learning more about what you can offer to your patients in the area of sexual health, visit the AASECT (American Association of Sexuality Educators, Counselors, and Therapists) website, www.aasect.org, to find a certificate training.

References:

  1. Fosnight, A. Sexuality Counseling for Women’s Health Providers. Women’s Health, An Issue of Physician Assistant Clinics. July 2018. Vol 3,3; p 325-338.
  2. Obstetrics & Gynecology: November 2008 – Volume 112 – Issue 5 – p 970-978, doi: 10.1097/AOG.0b013e3181898cdb. The PRESIDE Study.

See Aleece Fosnight, PA-C, CSC-S, CSE, NCMP, IF speak at a 2021 Skin, Bones, Hearts & Private Parts conference in Destin • Myrtle Beach • San Antonio • Atlanta • Las Vegas