Talking Sex with Your Health Care Provider

Dr. Sheryl Kingsberg is a MiddlesexMD advisor and a psychologist specializing in women’s sexual health. She talks to physicians a lot about why it’s important to at least ask about a patient’s sexual health and maybe take her sexual health history. So she’s very familiar with the view from the physician’s side of the desk when it comes to talking about sex with patients. Generally, she says, health care providers have little training in women’s sexual health, even though they deal with those organs all the time. So—“they’re not going to ask about a topic they don’t know much about because they feel like they’re walking into something blind,” Sheryl says. Plus, they’re probably embarrassed, and they’re afraid the discussion will take too much time. “All health care providers struggle with this issue,” she says. Patients are often embarrassed to bring up the S-word, too, even though they may have questions or problems. Or—they may think (studies prove this is true) that nothing can be done about the problem anyway. This is because, in general, women’s sexuality is complex and can be affected by everything from physical changes to cultural morés. There are treatments for women’s sexual problems, but they’re just not as simple as a pill, because, well, our sexuality isn’t that simple. As a result, sex is the elephant in the examination room. It’s the health care version of don’t ask, don’t tell. What Sheryl tells physicians is that not only is it important to give a woman permission to talk about sex and to be prepared either to treat her problem or to refer her to a specialist, it’s also their responsibility as a practitioner. Here’s how she puts it:

• Sexual issues are very common. About half of women will have some sexual difficulty at some point in their lives.
• Sexual health is a basic human right, according to the World Health Organization. It is the health care provider’s responsibility to be concerned about and to manage the patient’s sexual health.
• Sexuality is important to a woman’s overall health and quality of life.
• Patients are uncomfortable bringing up the topic. They don’t know if it’s appropriate, and they don’t think anything can be done to help them.
• Patients won’t be offended if the provider asks about their sex life.
• Asking about a woman’s sexual health doesn’t have to take a long time. At the very least, the health care provider should communicate that it’s okay to talk about sexual problems, and be prepared to refer the woman to a specialist.

That’s it. That’s the manifesto. It’s your right to have your sexual health questions and problems addressed, and if your physician can’t or won’t do that, Sheryl says: “Find a new provider.” The medical landscape is changing, she says. Rather than the old “doctor knows best” mentality whereby you, the patient, comply with the treatment regimen your doctor prescribes, now the approach is to work together with your provider to develop a regimen you can adhere to rather than passively comply with. Sexuality is important, and if your health care provider hasn’t asked you about this quality of life issue, bring it up. Then, if he or she doesn’t respond, well, there are lot of other providers in the pond.