117: Medical Approaches to Women’s Sexual Concerns with Dr. Ashley Fuller

After accumulating nine years of experience working as an obstetrician and gynecologist at Swedish OB/GYN Specialists First Hill, Ashley Fuller transformed her practice into gynecology and sexual health. She claims that she was better able to pursue her passion for women’s sexual health by removing the obstetrics branch of her practice. In her practice she offers checkups, gynecological surgery, and regular exams including pap smears and STD screenings. She aims to help women with sexual and gynecological problems evaluate treatment options and make the best choices for their needs and lifestyles.

Gynecologists are often Ill-prepared for Sexual Health Problems
In her previous practice as an OB/GYN, Dr. Fuller would have women present with sexual health problems such as low libido. While managing women’s sexual health is an important part of gynecological practice, the treatment of sexual health issues related to the vulva are not covered with any depth in residencies or medical training programs. Because of this oversight, Ashley says that when women asked her about sexual health problems, she frequently didn’t know how to help them. In an effort to fulfill this need of her patients, Ashley shifted her focus from obstetrics and gynecology to gynecology and sexual health.

Evaluating Low Libido in Premenopausal Women
While menopause does affect libido, when a premenopausal woman presents with low libido, Dr Fuller begins by having her patient fill out the Decreased Sexual Desire Screener (DSDS), a worksheet that asks about SSRI use, possible relationship problems, painful sex, stress and fatigue, and several other common causes of sexual dysfunction in women. Ashley points out that not all of the possible causes are physical, and in those cases, she often refers patients to a therapist or sex therapist. Some causes of sexual dysfunction are physical, and in those cases, medication, hormone treatments, or other tangible interventions may be neede