They're the questions a patient rarely asks until her hand is on the doorknob, and she's ready to leave her doctor's office.
"Sexual issues are not as easy to treat as a yeast infection," said Dr. Renee Horowitz, who last fall opened the Center for Sexual Wellness in Farmington Hills.
The Bloomfield Hills resident, who has spent 27 years in the field of obstetrics and gynecology, said she opened the Center because of a long-time interest in helping women with sexual problems.
Horowitz said those issues are complex and involve not only physical but psychological and emotional factors. Figuring them out is very time-consuming, and "in a 15 to 20 minute office visit, you just can't get to it."
Horowitz said she has worked with women as young as 20 and old as 60. She gives patients a questionnaire to establish a baseline of information, and generally, the office visit lasts about an hour. Once the results of blood tests are in, she follows up "to see what we can try."
Causes of sexual problems vary, and "for every person, it's so different," Horowitz said. But one thing many women share is a hesitancy when it comes to talking about what's going wrong in the bedroom.
"First of all, it's very private, it's very personal," Horowitz said. "They think they're the only ones (experiencing their problem). And they're not given permission to talk about it, because doctors don't bring it up."
Educating women about 'normal'
Horowitz said just asking patients a few simple questions could open the door for women to talk about problems that interfere with their most intimate relationships. She sees education as part of her job, because "it's important to educate women about what is 'normal'."
Some problems, she said, aren't problems at all. "If you and your partner are fine and have a celibate relationship, that's okay," she said.
For those who want an active sexual relationship, issues like pain or lack of desire may have simple causes. Some patients have benefited from being taken off birth control pills, which affect hormone levels. And taking that spinning class seven days a week can damage the pudendal nerve and interfere with sexual pleasure.
Why should women overcome embarrassment and pursue solutions to sexual problems?
"I think if you have a healthy sex life, you are happier in your relationship. You are happier with yourself, and when you are happier with yourself, you take better care of yourself," Horowitz said. "It helps our mental state, and it can be a form of exercise, although I doubt cardiologists would say it's enough."
To learn more about the Center for Sexual Wellness, visit centerforsexualwellness.com, follow the Center on Twitter, @CSW_Michigan or on Facebook, fb.com/CSWMichigan