Cuts to sexual dysfunction services risk leaving thousands of people without help for problems that can affect their wellbeing, relationships and ability to conceive, the Guardian can reveal.
Experts say funding cuts to sexual health clinics and clinical commissioning groups have led to the decommissioning of services that tackle sexual dysfunction. This, they say, is leaving men and women with dwindling support for problems ranging from erectile trouble to pain during sex – a situation that not only impacts people’s quality of life, but could mean they miss their chance to start a family.
They say the situation could be particularly problematic for women.
“Whereas many men’s distressing issues relate to erectile problems, for which there are pills like Viagra, there isn’t that option to just have a quick fix, buy a pill, for women, and their treatment options are sometimes less clear, more complicated and require more time and more discussion than a GP can offer – meaning specialist services are often needed,” said Dr Kirstin Mitchell, a researcher on intimate and sexual relationships at the University of Glasgow.
Problems with sexual function are far from rare. Data from the most recent national survey in Britain, the Natsal-3 study, conducted in 2011 and 2012, revealed 42% of men and 51% of women reported having at least one sexual problem which lasted three months or more in the past year, ranging from a lack of interest in sex to pain during sex and difficulties climaxing. About 11% of men and 13% of women who were sexually active avoided it because of problems related to their own or their partner’s sexual function.
While researchers say mild and temporary problems are normal, many people experience severe problems, with further analysis suggesting erectile problems in men and pain for women are particularly distressing. A quarter of women who experienced pain during sex had difficulties that were so severe they met the threshold for a clinical problem – about 2% of women in Britain.
“Not everyone wants to have penetrative sex, but [for] most people, if it is nice, it is very fulfilling,” said Dr David Goldmeier, the chair of the sexual dysfunction specialist interest group of the British Association of Sexual Health and HIV (BASHH).
For those who cannot, the impact can be profound. “It impairs their ability to make relationships, to keep them once they have got them if they can’t have penetrative sex, and to conceive,” he said.
Anna (not her real name), 52, said her experience of vulval pain began when she first had sex in her early 20s and found it agonising. She was referred by her GP to a gynaecologist, who took biopsies but concluded she should just have more sex and get used to it. “The problem didn’t go away. I lost my relationship, I had a low libido because of the association with pain,” said Anna.
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Later, another gynaecologist carried out surgery to try to resolve the problem, but this left Anna with scar tissue. “I still had no ability to have intercourse – by this time it was affecting me very much, my identity as woman, as a sexual being,” she said. “I was carrying an enormous amount of shame about it, and also hopelessness.”
Eventually, aged 40, another gynaecologist removed the scar tissue, allowing Anna to have sex with far less pain. “I missed my window to have children because I didn’t actually meet my last partner until a few months after that surgery at the age of 40,” she said.
Goldmeier said it can take women months or years to seek help for sexual dysfunction, if at all, with services patchy and getting worse. One difficulty is that treatment for sexual dysfunction can be complex, particularly for women, and while it can in some cases include medication, it can also require other approaches, including psychosexual care.
According to the Natsal survey, more than 80% of people seeking clinical help for health-related sexual problems said their first port of call would be their GP, but Goldmeier said many GPs did not have the time or training to discuss such matters. The problem, he said, was compounded by it becoming increasingly difficult for GPs to know where to refer a patient. Some sexual dysfunction services are commissioned by clinical commissioning groups but these services can crop up in several different hospital departments, including gynaecology and urology.
Such provision varies from area to area and is highly reliant on there being a doctor with a particular interest in the subject. Dr Jillian Pritchard, a consultant in genitourinary medicine and sexual health in Surrey, said that when that doctor moved on, or retired, such services could vanish. Meanwhile, funding cuts have put many existing services at risk.
Help through sexual health services run by local authorities is also patchy. A recent survey of BASHH members found 42% of respondents said they had seen provision of psychosexual health care reduced. Evidence from an ongoing inquiry into sexual health also painted a bleak picture. Among the submissions, a team of consultants from Cornwall said services, including those for patients with psychosexual problems and genital pain, were among those at risk of being lost due to cuts to sexual health services by local authorities. “There is no other capacity within the existing healthcare system to manage these highly symptomatic and often distressed patients,” they warned.
A spokesperson for the Department of Health and Social Care said provision of services was at the discretion of local commissioners.
“Around the country, money has been taken away, so I don’t know where these women are meant to go,” said Goldmeier.
Isley Lynn, a playwright who created a stage production based on her own experiences of vaginismus, an involuntary tightening of muscles around the vagina which can make penetrative sex impossible, said she feared cuts to services could have a profound effect on women’s ability to receive a diagnosis and get help.
“It took me four or five trips to a medical professional to get a diagnosis,” she told the Guardian. In the end, it was a university campus nurse who told Lynn, then 20, she had vaginismus.
“Because my hit rate in terms of getting an accurate diagnosis was so low, my main fear is that you cut any of that and people like me might not get even that hit rate,” said Lynn.
