New Study: Docs Don’t Talk about Sex

When was the last time your doctor asked you how your sex life was going?

I thought so.

In a new study, a team from the University of Chicago surveyed over a thousand OB/GYNs about whether they talk with their patients about sex. The results may not surprise you, but they won’t reassure you, either.

• 63 percent routinely ask whether their patient is sexually active. (Good, but fairly superficial.)
• 40 percent routinely ask if the patient is having any problems regarding sex. (Which means that 60 percent don’t ask about sexual problems.)
• 28.5 percent ask about sexual satisfaction. (Which means that two out of three doctors don’t ask.)
• 28 percent ask about sexual orientation or identity. (Yikes! Two out of three don’t even know if their patient is gay or bisexual.)
• 13.8 percent ask about sexual pleasure. (Which means that 86 percent don’t ask whether the patient enjoys having sex.)

Even more distressing was that 25 percent of OB/GYNs reported expressing disapproval of a patient’s sexual practices. Foreign doctors, older doctors, and very religious doctors were more likely either not to address the issue of sex or to express disapproval. Female doctors and those whose practice focuses on gynecology rather than on delivering babies were more likely to do some sexual assessment, although it was often insufficient.

Dr. Stacy Tessler Lindau, a practicing OB/GYN and lead researcher in the study, points out that OB/GYNs are the most appropriate health care provider to be asking these questions, and if they aren’t, it’s unlikely that anyone else is. Which means, as we have found repeatedly, that women tend not to mention sexual problems, to assume that a doctor can’t help anyway, and to suffer with or adapt to sexual problems on their own.

Doctors should be talking about sex with their patients because

• Sex is an intimately linked to overall quality of life and the quality of one’s relationship.
• One-third of younger women and one-half of older women report having some sexual issues, from lack of desire to painful intercourse
• A change in sexual patterns can indicate an underlying health problem, such as depression or thyroid problems.
• Women with ongoing sexual issues are more likely to feel self-conscious, isolated, embarrassed, ashamed, or guilty.
• Assuming that a patient has a heterosexual orientation is alienating to patients who are lesbian or bisexual and can result in miscommunication and misdiagnosis.
• Common medications, such as those for depression and breast cancer, for example, can cause sexual problems, such as low libido. Women are often not told about sexual side effects of medications and are therefore unprepared to cope with them.

The researchers hypothesize that doctors don’t talk about sex because, like everyone else, they’re embarrassed or they may worry about embarrassing their patients. Talking about sex isn’t part of their medical training, and although they may treat a woman’s sexual organs, they aren’t equipped to assess and treat her sexual problems. So what’s a frustrated patient to do?

Take the initiative, counsels Dr. Lindau. If you trust your doctor, but he or she hasn’t asked about your sex life, you can, and should, begin the conversation.

• Formulate your questions ahead of time. What, exactly, do you want to ask your doctor about sex? Do you have specific issues, such as painful intercourse or low libido? Are you anxious about entering menopause and need information about what to expect? Write down your questions and be as specific as possible.
• Acknowledge your discomfort, advises Dr. Michelle Curtis. It clears the air. “I know this is a little embarrassing, but I have some questions about sex I’d like to discuss.” Don’t worry about embarrassing the doctor, says Dr. Curtis. It’s his or her job to answer your questions.
• Empower yourself. The medical profession will change as women take responsibility for their own sexual health and begin asking questions and expecting thoughtful answers. You can ground yourself in basic information with websites like this one or others backed by solid medical organizations, such as the Cleveland Clinic or Mayo Clinic. Then you can approach your doctor with good, informed questions.

And if your doctor doesn’t respond in kind, avoids your questions, or seems uninformed, you can consider finding another doctor. We’ll discuss that process in a future post.