When was the last time you talked about your sex life with your doctor?
Sex, in other words, is part of our health. So discussing sex with our doctor is entirely relevant and should be routine.
“I think the evidence is strong that a person’s ability to function sexually is a basic part of their ability to function physically,” says Stacy Tessler Lindau, an associate professor of obstetrics and gynecology at the University of Chicago. “It ought to be assessed like any other [health issue].”
Two years ago, Lindau conducted a study of OB-GYNs nationwide showing that while about two-thirds routinely asked about patients’ sexual activity, 40 percent asked about sexual problems. Only 29 percent asked about sexual satisfaction, and 28 percent about sexual orientation.
Treating sex as a health issue
More often than not, discussions about sex only come up when there’s a problem, like sexual dysfunction as a side effect of medications patients are taking, Lindau continues. This is fine, but sex should also be addressed as a health measure such as regular exercise or nutritious eating.
OB-GYNs might naturally be at the forefront of specialists who delve into the subject of sex, but it’s also the domain of family doctors, primary care physicians, urologists and psychiatrists, she adds. “We want [patients] to be happy sexual beings as well as happy reproductive beings,” says Staci Pollack, an OB-GYN who specializes in infertility issues at Montefiore Medical Center in New York City.
For Pollack’s patients, “It’s very much an expectation that we’re going to have that conversation," she says. "There’s no pretense, no embarrassment. I ask questions about frequency, orgasm, time of the month, lubricants.”
But the same questions apply, even to patients who aren’t trying to conceive, she says. “Humans are sexual beings; it’s a huge part of our health. We need to ask.”
[Read: A Guide to Sex Toy Safety.]
Doctors should take the lead
Doctors, many experts feel, should be the ones to initiate that conversation.
“Patients repeatedly say they want their doctor to bring it [sex] up,” Lindau says. “Patients want to be good patients. They don’t want to aggravate their doctor or ask a stupid question.”
For their part, doctors may worry about offending a patient, or be uncomfortable with their own knowledge about certain sexual issues, but they have to push through that for the patient’s benefit. “By not asking, they run the risk of doing more harm than by asking,” Lindau says. That’s especially true if a sexual problem may tip doctors off to other significant health problems.
The best approach is a simple, nonjudgmental question, says Daniel Myers, who codirects the introduction to clinical medicine curriculum at the Albert Einstein College of Medicine. Myers teaches medical students how to engage in those conversations, bringing in actors to act as patients. The idea is to give students hands-on practice in breaching a subject that’s neglected in most medical school curricula. Typically, sexual issues comprise only five to 10 of the 3,000 hours in medical school. “It’s minuscule, and those hours tend to focus on the biology and physiology of sexuality,” Myers adds.
But that’s starting to change – in medical schools, as well as clinical practice, with the growing cultural emphasis on preventive medicine and wellness. “[Sex] is part of wellness,” Pollack says.
How to talk to your doctor about sex:
- Be in charge of your sexual health. Come prepared with questions or concerns, and don’t be afraid to bring them up if your doctor doesn’t initiate the conversation. “The doctor-patient relationship is more of a partnership than it was in the old days,” Myers says. “Patients often come in with a sophisticated knowledge of sexuality.”
- If you think sexual issues will take up a large portion of your doctor visit, let the nurse know in advance so the doctor can prepare for the conversation, too.
- Come with questions in your own words. “Don’t worry if they sound nonmedical,” Myers advises.
- Avoid the “doorknob effect” at the doctor, Myers says: “When patients get up to leave, they say the number one reason they came for in the first place but didn’t have the courage to say at the beginning.” Instead, at the start of your visit, state that you have some sexual concerns or questions.
- Both patients and doctors should show their appreciation for bringing up sex during the visit. “It works both ways. Doctors need positive reinforcement, too,” Myers says.
- Come out to your doctor if you are lesbian, gay, bisexual or transgender.
- Once the door is open, keep it open – with follow-up questions in later visits. For doctors, too, Myers emphasizes the importance of bringing up sexual health. “Even if a patient says nothing, it can pay dividends down the line.”
- If your doctor doesn’t know the answer to your question, ask for a referral for someone who will know the answer.
- Treat your doctor as a knowledgeable and trusted confidante. “Social media is altering boundaries,” Myers says. “Having your physician be able to hear you in confidence” can be important.
- Problems that seem big may have simple fixes – so ask! “Unless you ask questions you won’t know,” says Pollack. She’s treated patients for vaginal dryness who tell her, “You gave me a miracle treatment that’s changed my sex life.”