Introducing Cochrane UK’s special blog series #theproblemwithsex, which aims to lift the lid on sex and chronic health conditions, on the lack of good evidence for treatments, challenges around talking about sex, and on what can be done to change things for the better.
We have a problem with sex. Lots of problems, actually. It’s easy to think that sex is everywhere in the media. Sex sells, right? But I get the impression that there’s very little discussion about the sexual problems (let’s not talk in general terms about ‘dysfunction’ – a terribly clinical word with a whiff of judgement about it) experienced by many, many people, associated with long-term health conditions and treatments.
What do we hear about sex and cancer, diabetes or mental health problems? When does the person attending an appointment to discuss their medication or latest test results get to talk about sex, which might be uppermost on their mind but the thing they feel least able to mention? If they do, will their health professional be ready for that conversation, or even initiate it? Where might that discussion go? Are there evidence-based treatments that could be considered?
Why are we talking about sex?
At Cochrane UK, we started talking about all this eighteen months ago, when we saw a Cochrane review on interventions for sexual problems among people with chronic obstructive pulmonary disease (COPD). Cochrane Reviews are systematic reviews. In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. pull together the best available evidence on a topic, after extensive searching for The term research means different things to different people, but is essentially about finding out new knowledge that could lead to changes to treatments, policies or care. published across the globe. This review found just two relevant studies, involving 48 men suffering from erectile problems. The review authors highlighted two very important things in summing up this work. Firstly, that there isn’t any reliable evidence to tell us what might help improve sex for people with COPD, and what might make things worse. Secondly, at the moment, help for such patients can only rely
- “on Clinical trials are research studies involving people who use healthcare services. They often compare a new or different treatment with the best treatment currently available. This is to test whether the new or different treatment is safe, effective and any better than what is currently used. No matter how promising a new treatment may appear during tests in a laboratory, it must go through clinical trials before its benefits and risks can really be known. which have not involved people with COPD”
- “on expert opinion”
This needs to change. This review did involve patients, and they made it clear that sex matters. There are helpful suggestions for what future The term research means different things to different people, but is essentially about finding out new knowledge that could lead to changes to treatments, policies or care. needs to address, a wish list that provides a stark contrast to what’s available now.
Let’s focus on what matters to people
Since then, we’ve seen Cochrane reviews published on other health conditions, and it’s the same old story. They have shown up huge gaps in the evidence on treatments for sexual problems and a failure to address things that matter to people. Like vaginal dilator therapy, which is standard British practice for women having pelvic radiotherapy but for which a Cochrane review finds no evidence from randomized trials and highlights other problems with research in this area including the lack of a “globally useful, validated tool for measuring the harm inflicted by encouraging dilation” (we have a fantastic blog on this review, and what’s happened since, here. Or like the limited research on vaginismus, uncovered by this review, which defines Something done with the aim of improving health or relieving suffering. For example, medicines, surgery, psychological and physical therapies, diet and exercise changes. success as penetration, with no consideration of anything other than the mechanics of it.
We need to break the silence, so that people can have honest discussions with their health professionals and therapists about the treatments on offer; so that there is clarity about the gaps, and so that future The term research means different things to different people, but is essentially about finding out new knowledge that could lead to changes to treatments, policies or care. can explore the wide range of possible treatments and focus on Outcomes are measures of health (for example quality of life, pain, blood sugar levels) that can be used to assess the effectiveness and safety of a treatment or other intervention (for example a drug, surgery, or exercise). In research, the outcomes considered most important are ‘primary outcomes’ and those considered less important are ‘secondary outcomes’. that matter to people.
Breaking the silence on #theproblemwithsex
We really want to hear what you’ve got to say too, so please follow the series #theproblemwithsex and join in the conversation, here on Evidently Cochrane, with @CochraneUK on Twitter and on Facebook. I’m on Twitter @SarahChapman30
References may be found here.
Sarah Chapman has no conflict of interest to disclose.