Dr. Melissa Mauskar discusses initiating and normalizing the conversation about genital skin conditions with dermatology patients.
Melissa Mauskar, MD, is Assistant Professor of Dermatology and Obstetrics/Gynecology at UT Southwestern Medical Center, Dallas, Texas.
“Over the past several years, there have been several studies highlighting the fact that dermatologists don’t often talk to their patients about sex in general. And we often see patients with conditions like psoriasis or atopic dermatitis (AD) that affect all of their skin, not just what we can see, but also the parts that patients don’t like to talk about, specifically the vulva or the penis and the genital area,” says Melissa Mauskar, MD, Assistant Professor of Dermatology and Obstetrics/Gynecology, UT Southwestern Medical School, Dallas, Texas.
Dr. Mauskar and two other vulvovaginal specialists—Aruna Venkatesan, MD, Clinical Professor of Dermatology, Stanford; and Kalyani Marathe, MD, Associate Professor, Department of Pediatrics and Dermatology, University of Cincinnati—presented, “Having the Difficult Conversation: Addressing Sexual Disorders with Your Patient,” at AAD/VMX 2021, with the goal of addressing barriers that dermatologists may face when talking to their patients about skin conditions and the genital area.
During their presentation they learned using the audience response system that most dermatologists believe their patients don’t want to talk about these topics.
“Interestingly, this directly is antithetical to what patients want,” says Dr. Mauskar. “They want their doctors to bring these topics up.”
As part of the session, the presenters conducted various mock patient-provider discussions to demonstrate how to bring specific topics up, including those that relate to sexual disorders, pain with sex, and intimate partner violence.
“These are all taboo topics that we know can happen and that go on in our patients lives,” says Dr. Mauskar. “[Our intention was to talk] about different words you can use and scripts that you can practice so these conversations won’t be so difficult.”
Several conditions, including AD, psoriasis, lichen sclerosis, and erosive lichen planus all warrant one or more of these conversations to be had with patients.
“You’d be amazed at how easy it is for patients once they know that you want to hear about this information. Then they tell you, so that you can help.”
Dr. Mauskar says it’s also important to be aware of pelvic floor dysfunction, which may develop in lichen sclerosis patients.
“Some patients come in with their chief complaint of, ‘it’s painful when I have sex.’ I think that pelvic floor dysfunction is something you need to have in the back of your mind, to evaluate for. Things that can cause that are like vaginismus, when patients are clamping down on the pelvic floor so that insertion is painful, and you can get them to pelvic floor physical therapy. That’s the best way to treat some of these conditions.”
