Michael Reed, MD, MSCP, on how a sexual health framework legitimizes women's concerns

A structured clinical framework for women's sexual health can counteract the fragmentation that leaves patients without a clinical home and, in doing so, legitimize concerns that have the potential to be overlooked in routine care, according to Michael A. Reed, MD, MSCP, board-certified OB-GYN in Davis, California, and a NAMS-certified menopause practitioner. The discussion continues Reed's proposal of a “Fourth Pillar” of women's health, published in the International Journal of Sexual Health.^1,2

The cost of fragmentation

Reed described how the absence of a clear clinical pathway pushes patients between specialties without resolution.

“A patient comes with a concern to their family practice doctor, and that family practice doctor says, ‘No, go see OB. That is an OB issue.’ The OB says, ‘No, that is a sexual health issue.’ The sexual health doctor says, ‘No, go see a urogynecologist.’ And what happens is the patient realizes there is not a pathway for me,” he said. “It creates silence when you have concerns and there is no pathway for you to navigate. It is not women that need legitimacy. It is medicine that needs to recognize that these concerns are legitimate.”

“The other thing that we can do right now is just ask the question: Is intimacy a meaningful aspect of your life? You ask that, you will get so many answers. You will see where you need to improve. You can see how to improve the patient's life. You can make appropriate referrals,” Reed said.

Per the framework, this fragmentation persists despite available evidence-based approaches and contributes to delayed care, inconsistent clinical ownership, and patient self-silencing.¹ Reed characterized the framework as a guide rather than a mandate, “something to build on, a scaffolding.”

Reed traced the framework's origin to his own experience seeking care, which reshaped how he approached his patients.

“It was then that I realized that after 16 years, I have never asked my patients how they feel. What are they experiencing? Is intimacy a meaningful part of their life? And so that is what changed the way I thought, and that is what led me to get education,” he said.

References:

1. Reed M. Beyond Reproduction and Disease: Proposing a Fourth Pillar of Women’s Health as a Clinical Framework for Sexual Function, Intimacy, and Identity. International Journal of Sexual Health. Published online July 20, 2026. Accessed July 28, 2026. doi:10.1080/19317611.2026.2704787
2. Fitch J. Michael Reed, MD, MSCP, on proposing sexual health as a pillar of women's health. Contemporary OB/GYN. Published July 2026. Accessed July 28, 2026. https://www.contemporaryobgyn.net/view/michael-reed-md-mscp-on-proposing-sexual-health-as-a-pillar-of-womens-health