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.
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
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.
Just when you thought you were home free—the kids are grown, and you’ve somehow gotten through multiple birds-and-bees talks. But now you find the shoe is on the other foot, and you’re the one needing information about sex. Maybe a health issue is affecting your sex life, or maybe your body is responding differently, or maybe you’re just not as responsive as you used to be. Where do you go for straight talk about these nitty-gritty topics?
According to a presentation I heard at the International Society for the Study of Women’s Sexual Health (ISSWSH) conference “physicians often do not talk to their patients about sex.” It occurred to me that the effect of this oversight is similar to neglecting the “talk” with our kids, i.e. you end up muddling along with misinformation, rumors, or half-truths.
Oddly, doctors cite similar reasons (excuses?) as the rest of us for avoiding the “talk” with their patients: They don’t have time; they don’t feel comfortable; they don’t know enough about this medical subspecialty to feel competent and helpful.
To be honest, doctors do operate under very tight time constraints in the course of a normal day. Also, sometimes, after talking about health and body parts for years, we forget how uncomfortable it might be for you to bring up what you consider an embarrassing problem. Rest assured, however, that we’ve probably discussed that problem before with someone.
None of this lets anyone off the hook. Sex is an important component to physical and mental health and well-being, and if you have questions or problems, who better to discuss them with than your doctor? If your doctor isn’t taking the initiative, here are some ways to help get the conversation started.
It sounds like you could benefit from a really good pelvic floor physical therapist. While many physical therapists have some training with the pelvic floor, there are only a few with that specialty. Find out who that person is in your community and ask for a referral to him or her.
Physical therapists will have tools that help them determine the strength of the muscles, which helps them make an informed plan for properly improving the tone; Kegel exercises are just one tool in that process. Sometimes after a trauma there is muscle spasm; part of the therapy may be training certain muscles to relax.
It's a good approach to see how far you can get with exercise and therapy before you consider reconstructive surgery. Good luck with your continued recovery from your accident!