As a clinical sexologist I get to hear many complaints regarding vaginal pain ("Female trouble: 50 plus," March 30). My experience is that women don't talk to their health care providers about their sexual issues, since they haven't found one who is comfortable listening to their problems. Plus most doctors have not been trained to ask the appropriate questions pertinent to menopausal women's genital health.

I know this from the relief my clients (many in various stages of menopause) express at my comfort with their sexual issues. Sometimes the remedy is quite simple and I recommend specific suggestions based on their needs. Other times I advise medical intervention.


I know firsthand, as a patient of Dr. Susan Kellogg-Spadt, she is quite comfortable speaking about these issues and takes the time to understand her patient’s concerns. She is a rare find. As a sex therapist and educator, she had to participate in special training to become certified. The Sexual Attitude Reassessment (SAR) program is designed to ultimately get professionals to become comfortable discussing their client’s sexual needs.


Health-care providers can learn all the technical aspects of dysfunction and pain, but without participating in a SAR they are unlikely to put their patients at ease. When the clinician expresses judgment or discomfort with sexuality, it is a rare patient that will discuss topics regarding pain during penetration.

Susana Mayer, Ph.D.

Sexologist: consultant/educator

Philadelphia